Chronic Tendonopathy as a Unique Cause of Non Traumatic Triceps Tendon Rupture in a (Risk Factors Free) Bodybuilder: A Case Report

The Elbow's Achilles Heel: A Systematic Review and Meta-Analysis of Triceps Tendon Rupture and Repair Techniques

Triceps tendon avulsion is a rare but debilitating condition and the least frequent of all tendon injuries, but it is receiving increasing attention in the literature. The most common mechanism of injury is resisted extension, which is typically seen in a fall onto an extended hand. Such injuries are easily overlooked and should be considered a differential diagnosis in all patients who describe pain and swelling at the posterior aspect of the elbow following a traumatic event. Non-operative management is the general principle for partial rupture as opposed to a variety of surgical treatments for a complete avulsion. The goal of this meta-analysis is to analyse the current literature on triceps avulsion and provide a detailed overview of the occurrence, diagnosis, treatment options and outcomes, comparison of various repair techniques, and consequences of this injury.

Surgical Repair of Distal Triceps Tendon Injuries: Short-term to Midterm Clinical Outcomes and Risk Factors for Perioperative Complications

Background

Few large-scale series have described functional outcomes after distal triceps tendon repair. Predictors for operative success and a comparative analysis of surgical techniques are limited in the reported literature.

Purpose

To evaluate short-term to midterm functional outcomes after distal triceps tendon repair in a broad patient population and to comparatively evaluate patient-reported outcomes in patients with and without pre-existing olecranon enthesopathy while also assessing for modifiable risk factors associated with adverse patient outcomes and/or revision surgery.

Study Design

Case series; Level of evidence, 4.

Methods

This study was a retrospective analysis of 69 consecutive patients who underwent surgical repair of distal triceps tendon injuries at a single institution. Demographic information, time from injury to surgery, mechanism of injury, extent of the tear, pre-existing enthesopathy, perioperative complications, and validated patient-reported outcome scores were included in the analysis. Patients with a minimum of 1-year follow-up were included.

Results

The most common mechanisms of injury were direct elbow trauma (44.9%), extension/lifting exercises (20.3%), overuse (17.4%), and hyperflexion or hyperextension (17.4%). Eighteen patients were identified with pre-existing symptomatic enthesopathy, and 51 tears were caused by an acute injury. A total of 36 complete and 33 partial tendon tears were identified. Bone tunnels were most commonly used (n = 30; 43.5%), while direct sutures (n = 23; 33.3%) and suture anchors (n = 13; 18.8%) were also used. Perioperative complications occurred in 21.7% of patients, but no patients experienced a rerupture at the time of final follow-up. No statistically significant relationship was found between patient age (P = .750), degree of the tear (P = .613), or surgical technique employed (P = .608) and the presence of perioperative complications.

Conclusion

Despite the heightened risk of perioperative complications after primary repair of distal triceps tendon injuries, the current series found favorable functional outcomes and no cases of reruptures at short-term to midterm follow-up. Furthermore, age, surgical technique, extent of the tear, and mechanism of injury were not associated with adverse patient outcomes in this investigation. Pre-existing triceps enthesopathy was shown to be associated with increased complication rates.