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Gruber MS, Bischofreiter M, Rittenschober F, Schachermayr M, Ortmaier R, Ritsch M. Distal Triceps Tendon Repair in Strength Athletes Leads to Satisfactory Return to Sports: A Retrospective Analysis of 22 Cases. J Clin Med 2024; 13:4913. [PMID: 39201054 PMCID: PMC11355401 DOI: 10.3390/jcm13164913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/12/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Distal triceps brachii tendon rupture (DTTR) is a relatively rare injury that is common in bodybuilding and high-intensity contact sports and can lead to significant functional impairment of the elbow joint. This study was conducted to evaluate clinical outcomes and the rate of return to sports among competitive bodybuilders and high-demand strength athletes after surgical repair of DTTR. Methods: This retrospective case series was performed in an institutional setting in tertiary health care. Return to sports of 22 competing or high-demand strength athletes (meaning three or more exercises per week) were analyzed pre- and postoperatively after surgical repair of DTTR using a hybrid technique of transosseous sutures and anchor fixation. Descriptive statistics were used to analyze demographic variables, and independent and paired t-tests were used to assess clinical outcomes. Results: The follow-up showed that from pre- to postoperatively, there was no deterioration in the number of sports disciplines (2.4 and 2.5 sporting activities per person, respectively; p = 0.540) or in the frequency of weekly training (4.1 and 4.1 times per person, respectively; p = 0.329). The postoperative visual analog scale for pain (from 6.0 to 1.6, p < 0.001), level of fitness (from 5.1 to 2.6, p = 0.002), and ability to train (from 5.2 to 1.3, p < 0.001) improved significantly. The time of return to sports was 1.5-3 months and 4-6 months after the surgery for ten patients each. The overall rate of return to sports was 95%, whereas 86% returned to the preinjury level of sporting activity. Conclusions: Repair of DTTR leads to high rates of return to sports in competitive athletes.
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Affiliation(s)
- Michael Stephan Gruber
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenbergerstraße 69, 4040 Linz, Austria
| | - Martin Bischofreiter
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenbergerstraße 69, 4040 Linz, Austria
| | - Felix Rittenschober
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| | - Michael Schachermayr
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| | - Reinhold Ortmaier
- Department of Orthopedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
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Yoon JP, Lee HB, Jeon YJ, Kim DH, Jeong SM, Jeong JM. Reconstruction of Bilateral Chronic Triceps Brachii Tendon Disruption Using a Suture-Mediated Anatomic Footprint Repair in a Dog. Animals (Basel) 2024; 14:1687. [PMID: 38891734 PMCID: PMC11171138 DOI: 10.3390/ani14111687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
A 2-year-old, intact female Pomeranian presented with bilateral forelimb lameness, characterized by the olecranon making contact with the ground. The patient experienced two separate incidents of falling, occurring four and three weeks before admission, respectively. Following each episode, non-weight-bearing lameness was initially observed in the left forelimb, followed by the development of crouch gait. Based on the physical examination, radiographic, and ultrasonographic findings, bilateral triceps brachii tendon disruption was diagnosed. Intraoperatively, excessive granulation tissue at the distal end of the tendon was excised. The footprint region of each triceps brachii tendon was decorticated with a high-speed burr until bleeding was observed. The triceps brachii tendon was reattached to completely cover its footprint on the olecranon using the Krackow suture technique. This method involves anchoring the suture through bone tunnels in the ulna. Trans-articular external skeletal fixation was applied to both forelimbs to immobile and stabilize the elbow joints for nine weeks. Subsequently, the dog gradually increased its walking activities while on a leash over a six-week period. At the three-year follow-up, the patient exhibited improved forelimb function and maintained a normal gait without signs of lameness. Suture-mediated anatomic footprint repair proved useful in this single case and may be an effective surgical alternative for the management of chronic triceps brachii tendon disruption in dogs.
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Affiliation(s)
| | | | | | | | | | - Jae-Min Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99, Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (J.-P.Y.); (H.-B.L.); (Y.-J.J.); (D.-H.K.); (S.-M.J.)
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Haft M, MacKenzie JS, Shi BY, Ali I, Jenkins S, Nguyen D, van Riet R, Srikumaran U. Biomechanical strength of triceps tendon repairs: systematic review and meta-regression analysis of human cadaveric studies. Musculoskelet Surg 2024; 108:153-162. [PMID: 38713360 DOI: 10.1007/s12306-024-00817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/23/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE It is unclear which triceps tendon repair constructs and techniques produce the strongest biomechanical performance while minimizing the risk of gap formation and repair failure. We aimed to determine associations of construct and technique variables with the biomechanical strength of triceps tendon repairs. PubMed, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov were systematically searched for peer-reviewed studies on biomechanical strength of triceps tendon repairs in human cadavers. 6 articles met the search criteria. Meta-regression was performed on the pooled dataset (123 specimens). Outcomes of interest included gap formation, failure mode, and ultimate failure load. Covariates were fixation type; number of implants; and number of sutures. Stratification by covariates was performed. We found no association between fixation type and ultimate failure load; however, suture anchor fixation was associated with less gap formation compared with transosseous direct repair (β = - 1.1; 95% confidence interval [CI]:- 2.2, - 0.04). A greater number of implants was associated with smaller gap formation (β = - 0.77; 95% CI: - 1.3, - 0.28) while a greater number of sutures was associated with higher ultimate failure load ( β= 3; 95% CI: 21, 125). In human cadaveric models, the number of sutures used in triceps tendon repairs may be more important than the fixation type or number of implants for overall strength. If using a transosseous direct repair approach to repair triceps tendon tears, surgeons may choose to use more sutures in their repair in order to balance the risk of larger gap formation when compared to indirect repair techniques. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- M Haft
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA.
| | - J S MacKenzie
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - B Y Shi
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - I Ali
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - S Jenkins
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - D Nguyen
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - R van Riet
- Department of Orthopedic Surgery, University Hospital Antwerp, Edegem, Belgium
| | - U Srikumaran
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
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4
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Froom RJ, Wang Y, Martin B, Hackett TR. Traumatic Triceps and Medial Ulnar Collateral Ligament Rupture in an Adolescent Mogul Skier: A Case Report. Cureus 2024; 16:e61026. [PMID: 38915996 PMCID: PMC11194329 DOI: 10.7759/cureus.61026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
Triceps tendon ruptures are uncommon injuries that account for less than 1% of all upper extremity tendon injuries. Medial ulnar collateral ligament injury (mUCL), while common in overhead athletes as a result of valgus forces during the throwing mechanics, has scarcely been reported in non-overhead, throwing individuals. Traumatic assault to the elbow may result in the rupture of the triceps tendon with concomitant mUCL injury. As such an injury pattern typically presents in middle-aged males, weightlifters, or American football players from eccentric overloading of the elbow. We present an adolescent, elite-level, competitive skier with traumatic onset distal triceps rupture with concomitant medial ulnar collateral ligament rupture suffered via a fall on an outstretched hand (FOOSH) mechanism. Magnetic resonance imaging (MRI) showed acute full-thickness avulsion of the distal triceps tendon occurring at the olecranon enthesis. An open tendon repair was performed, and the patient was able to report significant symptom resolution over the course of six months postoperatively and successfully return to elite-level competition. This was a unique and rare case of triceps tendon rupture with concomitant mUCL injury in an adolescent via a non-contact, high-velocity injury mechanism. While a rare injury combination, this case nevertheless identifies an area of research not currently extensively covered-trampoline training and associated injuries in adolescents. This case, therefore, not only adds a novel dimension to the understanding of triceps and mUCL injuries in young athletes but also underscores the need for heightened awareness and specific safety protocols in sports training involving equipment like trampolines.
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Affiliation(s)
- Ryan J Froom
- Orthopedic Surgery, The Steadman Clinic, Vail, USA
| | - YuChia Wang
- Orthopedic Surgery, Steadman Philippon Research Institute, Vail, USA
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Shivdasani K, Scheidt M, Anderson J, Okafor L, Garbis N, Salazar D. Full-thickness triceps tears misdiagnosed as olecranon bursitis: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:319-323. [PMID: 38706666 PMCID: PMC11065744 DOI: 10.1016/j.xrrt.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Krishin Shivdasani
- Corresponding author: Krishin Shivdasani, BS, MPH, Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, 2160 South First Avenue, Maywood, IL 60153, USA.
| | - Michael Scheidt
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | | | - Lauren Okafor
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | - Nickolas Garbis
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | - Dane Salazar
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
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Ott N, Hackl M, Van Parys M, Leschinger T, Wegmann K, Müller LP. Distal Triceps Rupture with an Injury of the Medial Ulnar Collateral Ligament: a Result of a Fall Onto an Outstretched Arm - a Case Series. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:79-84. [PMID: 35926766 DOI: 10.1055/a-1865-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Traumatic triceps tendon ruptures are rare and known to result in substantial disability unless appropriate surgical treatment is performed. A traumatic rupture can occur due to a fall onto the outstretched hand. Tearing of the triceps tendon results in a valgus load onto the elbow, which can lead to injuries to the radial head/neck and/or the ulnar collateral ligament. Hence, attention must be paid to associated pathologies after diagnosis of rupture to the distal triceps tendon. Our surgical procedure in these cases includes diagnostic arthroscopy to detect concomitant injuries. In the following, we present three cases where we performed an open suture bridge repair of the triceps tendon followed by suture repair of the ulnar collateral ligament. All patients recovered well and reported no elbow pain or limited range of motion. The ASES and Mayo Elbow Performance scores were 100 at the 1-year follow-up.
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Affiliation(s)
- Nadine Ott
- Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany
| | - Michael Hackl
- Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany
| | | | - Tim Leschinger
- Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany
| | - Kilian Wegmann
- Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany
- -, Orthopädische Chirurgie München (OCM), München, Germany
| | - Lars Peter Müller
- Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany
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Lee E, Stillson QA, Seidel HD, Bhattacharjee S, Koh JL, Strelzow JA, Shi LL. Surgical Outcomes, Trends, and Risk Factors of Distal Triceps Repairs. Hand (N Y) 2023; 18:1300-1306. [PMID: 35658641 PMCID: PMC10617476 DOI: 10.1177/15589447221095114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Distal triceps ruptures are rare, and complete ruptures are commonly treated with surgery. Studies of patients in small cohorts with distal triceps tear have reported outcomes and risk factors; however, large-scale data are scant. This study seeks to determine current trends, outcomes, and risk factors of distal triceps tears. METHODS Within a large insurance claims database, distal triceps repair patients were identified through Current Procedural Terminology coding with concomitant distal triceps International Classification of Diseases, 9th Revision/10th Revision diagnosis codes and 1-year active status before and after surgery. Demographics, total costs, 90-day complications, and revision rates within 1 year of index surgery were analyzed. Logistic regression was performed for revision and complication rates using sex, age, and comorbidities (anabolic steroid use, diabetes, ischemic heart disease, tobacco use, rheumatoid arthritis, and chronic kidney disease). RESULTS A total of 8143 patients were included in the cohort. Male patients and patients aged 40 to 59 years comprised most of the study population. The postoperative complication rate was 5.8%, and the 1-year revision rate was 2.6%. Male sex, age >60 years, ischemic heart disease, rheumatoid arthritis, and chronic kidney disease were statistically significant risk factors for higher 90-day complication rates. Anabolic steroid use significantly increased the risk of surgical revision. CONCLUSIONS Distal triceps repairs in this large cohort study occur most frequently in men aged 40 to 59 years. Complications are generally low, with age >60 years, male sex, ischemic heart disease, rheumatoid arthritis, and chronic kidney disease as risk factors for 90-day complications and prior anabolic steroid use as a risk factor for 1-year revision surgery. This information can help to improve education and expectations of this procedure.
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Affiliation(s)
| | - Quinn A. Stillson
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Henry D. Seidel
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Jason L. Koh
- NorthShore University HealthSystem, Evanston, IL, USA
| | - Jason A. Strelzow
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL, USA
| | - Lewis L. Shi
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL, USA
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Geyer S, Kadantsev P, Bohnet D, Marx C, Vieider RP, Braun S, Siebenlist S, Lappen S. Partial ruptures of the distal triceps tendons show only slightly lower ultimate load to failure: a biomechanical study. BMC Musculoskelet Disord 2023; 24:590. [PMID: 37468862 PMCID: PMC10357868 DOI: 10.1186/s12891-023-06720-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023] Open
Abstract
OBJECTIVE Partial ruptures of the distal triceps tendon are usually treated surgically from a size of > 50% tendon involvement. The aim of this study was to compare the ultimate load to failure of intact triceps tendons with partially ruptured tendons and describe the rupture mechanism. METHODS Eighteen human fresh-frozen cadaveric elbow specimens were randomly assigned to two groups with either an intact distal triceps tendon or with a simulated partial rupture of 50% of the tendon. A continuous traction on the distal triceps tendon was applied to provoke a complete tendon rupture. The maximum required ultimate load to failure of the tendon in N was measured. In addition, video recordings of the ruptures of the intact tendons were performed and analysed by two independent investigators. RESULTS A median ultimate load to failure of 1,390 N (range Q0.25-Q0.75, 954 - 2,360) was measured in intact distal triceps tendons. The median ultimate load to failure of the partially ruptured tendons was 1,330 N (range Q0.25-Q0.75, 1,130 - 1.470 N). The differences were not significant. All recorded ruptures began in the superficial tendon portion, and seven out of nine tendons in the lateral tendon portion. DISCUSSION Partial ruptures of the distal triceps tendon demonstrate a not statistically significant lower ultimate load to failure than intact tendons and typically occur in the superficial, lateral portion of the tendon. This finding can be helpful when deciding between surgical and conservative therapy for partial ruptures of the distal triceps tendon.
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Affiliation(s)
- Stephanie Geyer
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
- St. Vinzenz Kliniken Pfronten Im Allgäu, Pfronten, Germany
| | - Pavel Kadantsev
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
| | - Daniel Bohnet
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
| | - Christian Marx
- UMIT - Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik, Private University Hall, Hall/Tirol, Austria
| | - Romed P Vieider
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
| | - Sepp Braun
- UMIT - Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik, Private University Hall, Hall/Tirol, Austria
- Gelenkpunkt - Sports and Joint Surgery Innsbruck, Innsbruck, Austria
| | - Sebastian Siebenlist
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany.
| | - Sebastian Lappen
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
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Alkhalfan YH, Jha G, Verma B, Coatwala A, Mishra A, Rasheed Ali Khan TM, Sinha A, Bollineni RL, Subbiah P. The Elbow's Achilles Heel: A Systematic Review and Meta-Analysis of Triceps Tendon Rupture and Repair Techniques. Cureus 2023; 15:e41584. [PMID: 37559858 PMCID: PMC10407265 DOI: 10.7759/cureus.41584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 08/11/2023] Open
Abstract
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.
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Affiliation(s)
- Yousif H Alkhalfan
- Trauma and Orthopaedics, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, GBR
| | - Gaurav Jha
- Trauma and Orthopaedics, Leicester Royal Infirmary, Leicester, GBR
| | - Bhawika Verma
- Medicine, Maharashtra University of Health Sciences, Mumbai, IND
| | - Aadila Coatwala
- Surgery, Mahatma Gandhi Mission Institute of Health Sciences, Mumbai, IND
| | - Aarushi Mishra
- Medicine, Danylo Halytsky Lviv National Medical University, Lviv, UKR
| | | | - Akatya Sinha
- Medicine, Mahatma Gandhi Mission Medical College, Mumbai, IND
| | | | - Praveen Subbiah
- Intensive Care Unit, Broomfield Hospital, Mid and South Essex National Health Service (NHS) Foundation Trust, Chelmsford, GBR
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Bartlett LE, Klein BJ, Daley A, Goodwillie A, Cohn RM. Functional Considerations in Bilateral, Simultaneous Tendon Injuries of the Upper Extremity: A Narrative Review of Current Literature. JBJS Rev 2023; 11:01874474-202306000-00008. [PMID: 37307343 DOI: 10.2106/jbjs.rvw.23.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
» Bilateral, simultaneous same-tendon injuries of the upper extremity are rarely encountered, yet their unique complexity poses a substantial challenge for treating orthopaedic surgeons.» In general, extremities with more tendon retraction should be repaired acutely while contralateral injuries can be treated in a staged or simultaneous manner depending on injury morphology, location, and anticipated functional impairment.» Combinations of accelerated and conventional rehabilitation protocols can be used for individual extremities to minimize the length of functional impairment.
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Affiliation(s)
- Lucas E Bartlett
- Department of Orthopedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington Hospital, Huntinton, New York
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11
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Trizepssehnenrupturen. ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-022-00572-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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12
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Ritsch M, Regauer M, Schoch C. [Surgical treatment of distal triceps tendon ruptures]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2022; 34:438-446. [PMID: 36094541 DOI: 10.1007/s00064-022-00781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/21/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Restoration of the anatomy and the original length of the muscle-tendon unit in triceps tendon ruptures. INDICATIONS Acute and chronic triceps tendon ruptures with persisting symptoms and significant strength deficits. CONTRAINDICATIONS Infections and tumors in the surgical area. SURGICAL TECHNIQUE Prone position. Skin incision over the distal triceps in a lateral direction around the olecranon. Mobilization of the tendon and débridement of the olecranon. Drilling of 2 × 2.9 mm suture anchor holes medial and lateral into the footprint of the olecranon. In addition, drilling through the olecranon 12 mm distal to the tip of the olecranon and transosseous introduction of 4 sutures. Then the suture anchors (all-suture or titanium anchors) are inserted into the drill holes. Refix the deep and superficial tendons with the anchor threads. Refix the upper tendon portions with the transosseous sutures. In the case of chronic lesions, a graft interposition is necessary. POSTOPERATIVE MANAGEMENT Dorsal 10 ° splint, then change to an orthosis fixed in 20 ° extension and passive mobility 0-30 ° flexion for 6 weeks. From the 7th week onwards, load-free, physiotherapeutically controlled increasing mobilization. Starting weight-loading from the 13th week on. Full load after 6 months. RESULTS In all, 34 male strength athletes with acute triceps tendon rupture underwent surgery using the hybrid technique described and were prospectively recorded. The MEPS‑G score averaged 94.7 points, there were no permanent limitations in mobility, and the postoperative strength ability averaged 94% of the original strength performance ability. The return to sport achieved 100%. The complication rate was 20.6%. Reconstruction of the distal triceps tendon using hybrid technology leads to very good functional results. Half of all patients complained of symptoms even before the rupture, which suggests previous damage to the distal triceps tendon caused by degeneration.
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Affiliation(s)
- Mathias Ritsch
- sportortho-ro, Schön-Klinik Vogtareuth, Luitpoldstr. 4, 83022, Rosenheim, Deutschland.
| | - Markus Regauer
- sportortho-ro, Schön-Klinik Vogtareuth, Luitpoldstr. 4, 83022, Rosenheim, Deutschland
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Macknet DM, Ford SE, Mak RA, Loeffler BJ, Connor PM, Gaston RG. Complications after traumatic distal triceps tears: an analysis of 107 cases. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:520-525. [PMID: 37588465 PMCID: PMC10426459 DOI: 10.1016/j.xrrt.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background The major complication and reoperation rates after distal triceps repair are poorly defined. The purpose of this large retrospective cohort study of distal triceps repairs performed by multiple surgeons within a large orthopedic group was to more clearly define the rates and risk factors of clinically impactful major complications and reoperations. Methods All distal triceps tendon repairs for traumatic injuries performed from January 2006 to April 2017 with a minimum 2-month follow-up were identified using the Current Procedural Terminology code 24342. A total of 107 patients were included in this study. The primary outcome measure was total major complication rate. Reoperations, minor complications, and risk factors were also tracked. Results Repairs were performed via bone tunnels (63.5%), suture anchors (13%), or a combination of the two (17.8%). A 14% complication rate and 13.1% reoperation rate were observed. Indication for reoperation included 9 reruptures, 3 infections, and 2 others. The time between injury and surgery was not found to be a risk factor for tendon rerupture. Smoking status, gender, utilization of a splint or controlled motion brace, and time to first active mobilization were not shown to influence rates or rerupture. Conclusion Distal triceps repair for traumatic injuries is associated with 14% complication and 13.1% reoperation rates. Patient, rehabilitation, and surgeon-specific factors did not influence the complication rate.
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Affiliation(s)
- David M. Macknet
- Department of Orthopaedic Surgery, Carolina Medical Center, Charlotte, NC, USA
| | - Samuel E. Ford
- Department of Orthopaedic Surgery, Carolina Medical Center, Charlotte, NC, USA
| | - Ryan A. Mak
- Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA
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A biomechanical comparison between transosseous cruciate sutures and suture anchors for triceps tendon repair: a systematic review and meta-analysis. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Tran DV, Yetter TR, Somerson JS. Surgical repair of distal triceps rupture: a systematic review of outcomes and complications. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:332-339. [PMID: 37588859 PMCID: PMC10426566 DOI: 10.1016/j.xrrt.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Triceps tendon injury is rare and accounts for only 2% of all tendinous injuries. It typically occurs after trauma or physical strain with eccentric loading. Treatment involves surgical repair, commonly with either transosseous bone tunnels or suture anchors. Nonsurgical management is typically reserved for low-demand or high-risk patients, as this is associated with deficits in strength and functional disability. Despite several recent high-quality observational studies that have added to our understanding of outcomes after surgical repair, we are not aware of a systematic review that includes literature published after 2015. In addition, prior reviews did not compare outcomes between different surgical repair methods, particularly transosseous bone tunnel and suture anchor techniques. Methods This systematic review examines published literature between January 1970 and May 2021 in PubMed, Scopus, and Cochrane databases to further examine reported functional outcomes and compare those outcomes between the two surgical repair methods. Results Our literature search yielded 309 results, of which only 16 met inclusion criteria. At the latest follow-up, the mean Disabilities of Arm, Shoulder, and Hand score was 4, the mean Quick Disabilities of Arm, Shoulder, and Hand score was 8, the mean Mayo Elbow Performance Score was 92, the mean American Shoulder and Elbow Surgeons-Elbow score was 99, the mean modified American Shoulder and Elbow Surgeons score was 94, the mean Oxford Elbow Score was 43, and the mean isokinetic muscle strength testing was 87%. A very high percentage (95%) of patients reported being satisfied with the repair. Preinjury levels of function were achieved in 92% of patients, and 100% regained at least a score of 4 of 5 for gross muscle strength. Complications occurred in 15% of cases, of which retears accounted for 5%. Subanalysis of cases with reported repair types revealed a significantly higher overall complication rate with transosseous repairs than with suture anchor repairs (18% vs. 8%, P = .008) as well as a higher retear rate in the transosseous repair group (7% vs. 2%, P = .03). Conclusion Patient-reported outcome measures were favorable for both suture anchor and transosseous tunnel repair methods. Suture anchor repair showed significantly better results with regard to isokinetic strength testing, complication rates, and retear rates. Further study is needed to establish superiority of either technique and cost-efficacy. In light of the evidence supporting greater biomechanical strength and lower clinical rates of failure, surgeons may consider use of a suture anchor technique for repair of distal triceps ruptures.
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Affiliation(s)
- Danny V. Tran
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Thomas R. Yetter
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jeremy S. Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
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16
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Whitaker JJ, Hartke J, Hawayek BJ, Howard CS, Ablove RH. Histologic Evaluation of the Triceps Brachii Tendon Insertion: Implications for Triceps-Sparing Surgery. J Hand Surg Am 2022; 47:386.e1-386.e8. [PMID: 34147316 DOI: 10.1016/j.jhsa.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 03/04/2021] [Accepted: 05/03/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Triceps detachment and olecranon osteotomy are 2 techniques used to enhance exposure in elbow surgery. Both the techniques can potentially add considerable morbidity and lengthen the recovery after surgery. Triceps-sparing surgery can potentially mitigate those issues. The purpose of this study was to evaluate the triceps tendon insertion at a histologic level to help improve triceps-sparing surgical techniques used in elbow trauma and arthroplasty. METHODS Seventeen fresh-frozen cadaveric elbow specimens were collected. The olecranon and its soft tissue attachments were isolated. We performed gross measurements and sectioned the specimens for histologic evaluation in the saggital or coronal planes. The proximal-to-distal and medial-to-lateral dimensions of the tendon and the distance from the proximal tip of the olecranon to the proximal tendon insertion were measured microscopically on stained embedded sections. RESULTS The proximal-to-distal dimension of the triceps tendon insertion was less than previously reported, whereas the medial-to-lateral dimension was similar. The true distance from the tip of the olecranon to the proximal tendon insertion was greater than the previously reported distance obtained via gross measurement. CONCLUSIONS Gross measurement of the triceps tendon insertion overestimates and inaccurately represents the true insertional footprint. Gross measurement has been shown to demonstrate consistent disparity compared with histologic measurement. Histologic investigation provides a more accurate description. CLINICAL RELEVANCE The finding that the distance from the articular tip of the olecranon to the proximal tendon insertion is greater than previously reported may have clinical implications. A triceps split approach may allow more visualization and exposure of the posterior joint and, therefore, lessen the need for triceps detachment or olecranon osteotomy.
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Affiliation(s)
- John Jack Whitaker
- Department of Orthopaedics, University at Buffalo, Cheektowaga, NY; Tri-County Orthopedic & Sports Medicine, Hugh Chatham Memorial Hospital, Elkin, NC
| | - Joelle Hartke
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Barrow Neurological Institute, Phoenix, AZ
| | - Bradley J Hawayek
- Department of Orthopaedics, University at Buffalo, Cheektowaga, NY; University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.
| | - Craig S Howard
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Robert H Ablove
- Department of Orthopaedics, University at Buffalo, Cheektowaga, NY
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17
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Wegmann S, Rausch V, Hackl M, Leschinger T, Scaal M, Müller LP, Wegmann K. Anatomic evaluation of the triceps tendon insertion at the proximal olecranon regarding placement of fracture fixation devices. Surg Radiol Anat 2022; 44:627-634. [PMID: 35301578 PMCID: PMC8960582 DOI: 10.1007/s00276-022-02921-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Olecranon fractures, especially with a small proximal fragment, remain a surgical challenge. Soft tissue irritation and affection of the triceps muscle bear a risk of complications. In order to find an area for a soft-tissue sparing placement of implants in the treatment of olecranon fractures, we aimed to define and measure the segments of the proximal olecranon and evaluate them regarding possible plate placement. METHODS We investigated 82 elbow joints. Ethical approval was obtained from the local ethics committee, After positioning in an arm holder and a posterior approach we described the morphology of the triceps footprint, evaluated and measured the surface area of the triceps and posterior capsule and correlated the results to easily measurable anatomical landmarks. RESULTS We found a bipartite insertional footprint with a superficial tendinous triceps insertion of 218.2 mm2 (± 41.2, range 124.7-343.2), a capsular insertion of 159.3 mm2 (± 30.2, range 99.0-232.1) and a deep, muscular triceps insertion area of 138.1 mm2 (± 30.2, range 79.9-227.5). Olecranon height was 26.7 mm (± 2.3, range 20.5-32.2), and olecranon width was 25.3 mm (± 2.4, range 20.9-30.4). Average correlation between the size of the deep insertion and ulnar (r = 0.314) and radial length (r = 0.298) was obtained. CONCLUSIONS We demonstrated the bipartite morphology of the distal triceps footprint and that the deep muscular triceps insertion area by its measured size could be a possible site for the placement of fracture fixations devices. The size correlates with ulnar and radial length.
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Affiliation(s)
- Sebastian Wegmann
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.
- Department for Orthopedic and Trauma Surgery, University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Köln, Germany.
| | - V Rausch
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - M Hackl
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - T Leschinger
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - M Scaal
- Faculty of Medicine, Department of Anatomy II, University of Cologne, Cologne, Germany
| | - L P Müller
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - K Wegmann
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
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OZTURK T, ERPALA F. A rare injury "goalkeeper's elbow:" a triceps tendon rupture. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.20.05246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Distal Triceps Tendon Tears: Magnetic Resonance Imaging Patterns Using a Systematic Classification. J Comput Assist Tomogr 2022; 46:224-230. [PMID: 35081601 DOI: 10.1097/rct.0000000000001265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate distal triceps tendon tear patterns using a systematic classification based on the tendon's layered structure. METHODS We retrospectively identified Magnetic resonance imaging (MRI) examinations with triceps tendon tears that underwent reconstructive surgery. Magnetic resonance images were reviewed independently by 2 musculoskeletal radiologists to determine tendon layer involvement and ancillary findings, including tear size, involvement of triceps lateral expansion, and presence of olecranon bursal fluid. Surgical reports were scrutinized for level of anatomic detail and correlation with imaging findings. RESULTS We identified 69 triceps tendon tears in 68 subjects (61 men, 7 women; mean age, 45 ± 12 years) who underwent surgical reconstruction. On MRI, the superficial layer was always involved with either a partial or full-thickness tear. The most common tear pattern was a combination of superficial layer full-thickness tear with deep layer partial tear (25 of 69 [36%]). Mean tear length was 24 ± 12 mm. We found no cases of isolated deep layer tears. Involvement of triceps lateral expansion and presence of bursal fluid correlated positively with tear severity of superficial and deep layers (P < 0.001). Detailed surgical correlation was limited, with only 9 of 69 (13%) of surgical reports containing information specifically addressing individual tendon layers. CONCLUSIONS Triceps tendon tears show tear patterns following its layered structure and can be assessed by MRI. Radiologists and surgeons are encouraged to describe tear patterns considering both superficial and deep tendon layers.
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20
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Agarwalla A, Gowd AK, Liu JN, Garcia GH, Jan K, Naami E, Wysocki RW, Fernandez JJ, Cohen MS, Verma NN. Return to Sport Following Distal Triceps Repair. J Hand Surg Am 2022; 48:507.e1-507.e8. [PMID: 35074247 DOI: 10.1016/j.jhsa.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/18/2021] [Accepted: 11/10/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this investigation was to examine the timeline of return-to-sport following distal triceps repair; evaluate the degree of participation and function upon returning to sport; and identify risk factors for failure to return to sport. METHODS Patients who underwent distal triceps repair with a minimum of 1 year of follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire and were scored on a visual analog scale for pain; the Mayo Elbow Performance Index; the Quick Disabilities of the Arm, Shoulder, and Hand; and the Single Assessment Numerical Evaluation. RESULTS Out of 113 eligible patients who had a distal triceps repair, 81 patients (71.7%) were contacted. Sixty-eight patients (84.0%) who participated in sports prior to surgery were included at 6.0 ± 4.0 years after surgery, and the average age was 46.6 ± 11.5 years. Sixty-one patients (89.7%) resumed playing at least 1 sport by 5.9 ± 4.4 months following distal triceps repair. However, 18 patients (29.5%) returned to a lower level of activity intensity. The average postoperative Quick Disabilities of the Arm, Shoulder, and Hand; Mayo Elbow Performance; visual analog scale for pain; and Single Assessment Numerical Evaluation scores were 8.2 ± 14.0, 89.5 ± 13.4, 2.0 ± 1.7, and 82.2 ± 24.3, respectively. No patients underwent revision surgery at the time of final follow-up. CONCLUSIONS Distal triceps repair enables 89.7% of patients to return to sport by 5.9 ± 4.4 months following surgery. However, 29.5% of patients were unable to return to their preinjury level of activity. It is imperative that patients are appropriately educated to manage postoperative expectations regarding sport participation following distal triceps repair. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC
| | - Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, CA
| | | | - Kyleen Jan
- School of Medicine, University of Illinois, Chicago, IL
| | - Edmund Naami
- School of Medicine, University of Illinois, Chicago, IL
| | - Robert W Wysocki
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - John J Fernandez
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - Mark S Cohen
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - Nikhil N Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL.
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21
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Alnaji O, Erdogan S, Shanmugaraj A, AlQahtani S, Prada C, Leroux T, Khan M. The surgical management of distal triceps tendon ruptures: a systematic review. J Shoulder Elbow Surg 2022; 31:217-224. [PMID: 34343662 DOI: 10.1016/j.jse.2021.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/14/2021] [Accepted: 06/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal triceps tendon ruptures (DTTRs) are highly uncommon injuries and can be treated with surgical repair. The purpose of this review was to compare the outcomes and complications of various surgical techniques used for primary repair of DTTRs. METHODS The electronic databases MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed were searched from data inception to October 15, 2020. The Methodological Index for Non-randomized Studies tool was used to assess study quality. Data are presented descriptively. RESULTS A total of 19 studies were identified, comprising 560 patients (565 triceps tendons), of whom 78.6% were male patients. The mean age was 46.1 ± 8.4 years, and the mean follow-up period was 31.8 ± 21.0 months. The overall complication rate across all DTTR repair procedures was 14.9%. The distribution of complications for each technique was 29.2% for the direct repair technique, 15.2% for the transosseous technique (transosseous suture), and 7.7% for the suture anchor technique. Common complications include ulnar neuropathies, infections, and pain. The overall rerupture rate for transosseous suture, suture anchor, and direct repair was 4.3% (n = 12), 2.1% (n = 3), and 0% (n = 0), respectively. Patients undergoing DTTR repair experience significant improvements postoperatively regarding pain, strength, and range of motion. CONCLUSIONS Patients undergoing DTTR experience improvements in postoperative outcomes; however, there is a moderate reported risk of rerupture or complication. Owing to the heterogeneity in rupture patterns, surgical procedures, and outcome measures, it is difficult to ascertain the superiority of one surgical technique over another. Future studies should use large prospective cohorts and long-term follow-up to determine more accurate complication rates and outcome scores.
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Affiliation(s)
- Omar Alnaji
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Safiya Erdogan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Saad AlQahtani
- Orthopedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Carlos Prada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Timothy Leroux
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
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22
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Kirchhoff K, Beirer M, Völk C, Buchholz A, Biberthaler P, Kirchhoff C. [Lesions of the triceps tendon : Diagnostics, management, treatment]. Unfallchirurg 2021; 125:73-82. [PMID: 34910226 DOI: 10.1007/s00113-021-01103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
The triceps brachii muscle is the main extender of the elbow joint. Triceps tendon rupture or tearing presents a rare injury pattern in general. Distal tendon ruptures occur most commonly in the area of the insertion of the olecranon. Fractures of the radial head are reported as the most common concomitant injury. In many cases, pre-existing degenerative damage predisposes for tendon injury. These include local steroid injections, anabolic steroid abuse, renal insufficiency requiring dialysis, hyperparathyroidism, lupus erythematosus and Marfan's syndrome. However, the most frequent trauma mechanism is a direct fall onto the extended forearm or a blow to the elbow. Beside clinical examination and sonography, magnetic resonance imaging is the diagnostic gold standard. The treatment of triceps tendon injuries includes conservative as well as operative approaches, whereby the indications for surgical treatment must be generously considered depending on the patient's age, functional demands of the patient, involvement of the dominant extremity as well as on the extent of the tendon rupture.
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Affiliation(s)
- K Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - M Beirer
- Klinik für Unfallchirurgie und Orthopädie, Schwarzwald-Baar Klinikum, Klinikstr. 11, 78052, Villingen-Schwenningen, Deutschland
| | - C Völk
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - A Buchholz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - P Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - C Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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Triceps Rupture and Repair in a Healthy, Young Woman following Rock Climbing. Case Rep Orthop 2021; 2021:3340479. [PMID: 34840839 PMCID: PMC8616681 DOI: 10.1155/2021/3340479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 12/03/2022] Open
Abstract
Triceps tendon rupture in females is rare. In this case report, we present a young adult female patient with a distal triceps tendon rupture from bouldering treated with open surgical repair technique using a modified bone tunnel and suture anchor fixation technique. The diagnosis and technique for repair and postoperative rehabilitation are described. A review of the current literature of biomechanical and clinical outcomes of various repair techniques is also presented.
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24
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Constantino DC, Varela E, Quintas I, Campos V, Carpinteiro E, Barros A. Acute and chronic triceps tendon rupture treated with knotless double-row anchor repair: two case reports. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:457-463. [PMID: 37588701 PMCID: PMC10426664 DOI: 10.1016/j.xrrt.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
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Ritsch M. Bizeps- und Trizepssehnenrupturen im Kraftsport. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00486-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Stratchko L, Rosas H. Imaging of Elbow Injuries. Clin Sports Med 2021; 40:601-623. [PMID: 34509201 DOI: 10.1016/j.csm.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Familiarity with throwing mechanics during elbow range of motion allows accurate diagnosis of sports-related elbow injuries, which occur in predictable patterns. In addition, repetitive stress-related injuries are often clinically apparent; however, imaging plays an important role in determining severity as well as associated injuries that may affect clinical management. A detailed understanding of elbow imaging regarding anatomy and mechanism of injury results in prompt and precise treatment.
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Affiliation(s)
- Lindsay Stratchko
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
| | - Humberto Rosas
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
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Zacharia B, Roy A. A clinicoradiological classification and a treatment algorithm for traumatic triceps tendon avulsion in adults. Chin J Traumatol 2021; 24:266-272. [PMID: 33941433 PMCID: PMC8563844 DOI: 10.1016/j.cjtee.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/08/2021] [Accepted: 02/09/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Triceps tendon avulsion (TTA) is an uncommon injury, and there are no classifications or treatment guidelines available. This study aims to describe a clinicoradiological classification and treatment algorithm for traumatic TTA in adults. The functional outcome of surgical repair has been evaluated too. METHODS A retrospective analysis of adult patients with traumatic TTA treated in our institution between January 2012 and December 2017 was done. We only included complete TTA injuries. Children below 15 years, with open injuries, associated fractures, or partial TTA were excluded. The data were obtained from hospital records. The intraoperative findings were correlated with the clinicoradiological presentation for classifying TTA. The functional outcome was analyzed using the Mayo Elbow Performance index and Hospital for Special Surgery elbow score. ANOVA test was used to assess the statistical significance. RESULTS There were 15 patients included, 11 males and 4 females. The mean age was (31.5 ± 9.15) years, and the mean follow-up was (22.4 ± 8.4) months. Fall on outstretched hand was the mode of injury. In 6 patients, diagnosis was missed on the initial visit. TTA were classified as Type I: palpable soft-tissue defect without bony mass; Type II: palpable soft-tissue defect with a wafer-thin/comminuted bony fragment on X-ray; Type III: palpable soft-tissue defect with a bony mass and a large bony fragment on X-ray without extension to the articular surface; and Type IV: an olecranon fracture with less than 25% of the articular surface. An algorithm for treatment was recommended, i.e. transosseous suture repair/suture anchor for Type I, transosseous suture repair for Type II, and tension band wiring or steel wire sutures for Types III and IV. All the patients achieved good to excellent outcome: the mean Mayo Elbow Performance index was 100 and Hospital for Special Surgery score was 98.26 ± 2.60 on final follow-up. CONCLUSION Our clinicoradiological classification and treatment algorithm for TTAs is simple. Surgical treatment results in excellent functions of the elbow. Since it is a single-center study involving a very small number of cases, a multicenter study with a larger number of patients is required for external validation of our classification and treatment recommendations.
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Affiliation(s)
- Balaji Zacharia
- Department of Orthopedics, Govt. Medical College, Kozhikkode, 673008, Kerala, India,Department of Arthroscopy, Ganga Hospital, Coimbatore, 641043, Tamilnadu, India,Corresponding author. Department of Orthopedics, Govt. Medical College, Kozhikkode, 673008, Kerala, India.
| | - Antony Roy
- Department of Orthopedics, Govt. Medical College, Kozhikkode, 673008, Kerala, India,Department of Arthroscopy, Ganga Hospital, Coimbatore, 641043, Tamilnadu, India
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28
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Acute Distal Triceps Tendon Rupture Repair: Case Presentation and Surgical Technique. J Orthop Trauma 2021; 35:S18-S19. [PMID: 34227595 DOI: 10.1097/bot.0000000000002164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 02/02/2023]
Abstract
This case presentation and surgical technique demonstrates a complete distal triceps tendon rupture repair with single-row suture anchor fixation through a posterior midline approach to the elbow in a 17-year-old male rugby player. Key procedure points include complete triceps mobilization for adequate excursion to facilitate repair, identification of the ulnar nerve, isolation and sharp debridement of torn tissue to healthy tendon, thorough debridement of the olecranon reattachment site, suture construct, and order of fixation to optimize tendon-bone apposition.
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29
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Verstuyft L, Caekebeke P, van Riet R. Postoperative rehabilitation in elbow surgery. J Clin Orthop Trauma 2021; 20:101479. [PMID: 34262846 PMCID: PMC8254033 DOI: 10.1016/j.jcot.2021.101479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022] Open
Abstract
Postoperative rehabilitation plays a crucial role in the treatment of elbow pathology. Depending on the type of surgery, the elbow may need to be protected. As a general rule, the elbow should not be immobilized for a prolonged period after surgery. A removable splint can be used to protect the soft-tissues immediately postoperative and the patient is encouraged to remove the splint several times daily to mobilize the elbow. Dynamic articulated braces can be used to encourage movement while ligament or tendon repairs are being protected. Literature on postoperative elbow rehab is scarce. In this paper we provide practical guidelines for specific surgical procedures.
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Affiliation(s)
| | - Pieter Caekebeke
- Ziekenhuis Oost-Limburg, Department of Orthopaedics Surgery and Traumatology, Schiepse Bos 6, 3600, Genk, Belgium
| | - Roger van Riet
- AZ Monica, Orthoca, Stevenslei 20, 2100, Antwerp, Belgium,University Hospital Antwerp, Drie Eikenstraat 655, 2650, Edegem, Belgium,Orthopaedic Specialists, Harley Street Specialist Hospital, 18-22 Queen Anne St, London, W1G 8HU, United Kingdom,Corresponding author.
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Morrey B. Why the elbow? My experience and perspective. J Clin Orthop Trauma 2021; 20:101474. [PMID: 34194971 PMCID: PMC8220003 DOI: 10.1016/j.jcot.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Najefi AA, Domos P. A unique case of bilateral triceps avulsion fracture in a patient with pseudohypoparathyroidism. Shoulder Elbow 2021; 13:334-338. [PMID: 34659475 PMCID: PMC8512989 DOI: 10.1177/1758573219876553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 11/17/2022]
Abstract
Triceps tendon ruptures and avulsions are rare injuries and are often associated with systemic diseases. This paper illustrates the unique case of a 20-year-old female patient with pseudohypoparathyroidism, who sustained bilateral triceps avulsion fractures after a fall. She underwent suture anchor fixation, augmented with tension band suture as double row repair with excellent post-operative results. We describe the pathophysiology of this injury and the unique method of fixation, which can be an alternative effective method to repair these injuries.
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Affiliation(s)
- Ali-Asgar Najefi
- Ali-Asgar Najefi, Trauma & Orthopaedic
Department, Royal Free Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet EN5
3DJ, UK.
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[Transosseous reconstruction of triceps tendon rupture : Surgical technique]. Unfallchirurg 2021; 124:1024-1031. [PMID: 34023923 PMCID: PMC8632856 DOI: 10.1007/s00113-021-01007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/24/2022]
Abstract
Operationsziel Transossäre Rekonstruktion der Trizepssehne. Indikation Sämtliche Trizepssehnenrupturen, die eine spannungsfreie Rekonstruktion erlauben. Kontraindikation Retrahierte Trizepssehnenrupturen, die nach Mobilisation keine spannungsfreie Rekonstruktion erlauben. Operationstechnik Durch 2 sich kreuzende transossäre Kanäle erfolgt das Durchfädeln eines nichtresorbierbaren Fadens. Direkt im Footprint erfolgt zudem das Setzen eines Fadenankers. Durch den primären Faden erfolgt nach transossärem Shutteln am Footprint beginnend das Durchflechten der Sehne in Krackow-Nahttechnik und, erneut am Footprint angekommen, das erneute transossäre Shutteln sowie das körperferne Verknoten. Mit dem ersten Fadenpaar des Ankers erfolgen in ähnlicher Weise das Armieren der Sehne und anschließend das intratendinöse Verknoten. Durch ein Verknoten des zweiten Fadenpaares des Ankers auf den primären körperfernen Knoten kann der Anpressdruck auf das Avulsionsfragment erhöht werden. Alternativ kann mit den Fäden des Fadenankers eine Mason-Allen Naht-durchgeführt werden. Weiterbehandlung Die ersten 6 Wochen erfolgt die Nachbehandlung in einer „ROM brace“ mit einem stufenweisen Freigeben der Flexion. Nach 6 Wochen freie Flexion. Beginn mit Kräftigungsübungen nach 12 Wochen. Ergebnisse Autoren beschreiben gute Ergebnisse nach operativer Versorgung von Trizepssehnenrupturen. Im vorliegenden Fall wird 6 Monate postoperativ, ungeachtet von einem in der Literatur beschriebenen möglichen Extensionsdefizit, ein exzellentes Outcome mit freiem Bewegungsausmaß erreicht.
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Kheiran A, Pandey A, Pandey R. Common tendinopathies around the elbow; what does current evidence say? J Clin Orthop Trauma 2021; 19:216-223. [PMID: 34150494 PMCID: PMC8190485 DOI: 10.1016/j.jcot.2021.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 01/21/2023] Open
Abstract
Tendinopathies are common causes of pain around the elbow resulting in significant functional impairment in athletes or the working-age population. Patients complain of a gradual onset pain with or without any specific trauma. Tissue histology shows chronic fibroblast and vascular proliferation, with a disorganized collagen pattern and absence of inflammatory mediators. Currently, numerous treatment options are described, but many of these are only supported by a heterogenous evidence base. Thus, management guidelines are difficult to define. Surgery is mostly indicated in selected cases that have failed non-operative management. This article reviews the pathophysiology and natural history of lateral and medial elbow tendinopathies, as well as distal biceps and triceps tendinopathies, and their current treatment options.
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Affiliation(s)
- Amin Kheiran
- Shoulder & Elbow Unit, University Hospitals of Leicester, Leicester, UK
| | - Aditi Pandey
- University College of London Hospital, London, UK
| | - Radhakant Pandey
- Shoulder & Elbow Unit, University Hospitals of Leicester, Leicester, UK,Corresponding author. University Hospitals of Leicester Leicester, LE5 4PW, UK
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Surgical Repair Using Suture Bridge Technique for Triceps Tendon Avulsion. Case Rep Orthop 2021; 2021:5572126. [PMID: 33968456 PMCID: PMC8081627 DOI: 10.1155/2021/5572126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Triceps tendon avulsion is a rarely occurring tendinous injury. Various surgical procedures, such as repair using sutures through the transosseous tunnel or suture anchors, have been reported for treating triceps tendon avulsion. However, standard surgical treatment has not yet been established. Here, we present a case of triceps tendon avulsion treated using the suture bridge technique. A 58-year-old man who fell on his left elbow from standing height presented to our hospital. Plain radiography revealed an avulsion fracture of the left olecranon process, suggesting triceps tendon avulsion. We performed surgical repair of the avulsed bone fragments and ruptured triceps tendon. We inserted suture anchors into the ulna, proximal to the fracture site, and passed the sutures through the full thickness of the triceps. Subsequently, fracture fragments were reduced and fixed by pulling them together with the triceps. We inserted knotless anchors into the ulna distal to the fracture site and fixed the avulsed bone fragments and triceps tendon using the suture bridge technique. The patient recovered well in five months and reported no elbow pain or limited range of motion. This suture bridge technique is advantageous as it prevents iatrogenic fracture and knot irritation, and it would be indicated in cases with poor bone quality or thin skin soft tissue of the olecranon.
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Agarwalla A, Gowd AK, Jan K, Liu JN, Garcia GH, Naami E, Wysocki RW, Fernandez JJ, Cohen MS, Verma NN. Return to work following distal triceps repair. J Shoulder Elbow Surg 2021; 30:906-912. [PMID: 32771606 DOI: 10.1016/j.jse.2020.07.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the rate and duration of return to work in patients undergoing distal triceps repair (DTR). METHODS Consecutive patients undergoing DTR from 2009 to 2017 at our institution were retrospectively reviewed at a minimum of 1 year postoperatively. Patients completed a standardized and validated work questionnaire; a visual analog scale for pain; the Mayo Elbow Performance Score; the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire; and a satisfaction survey. RESULTS Of 113 eligible patients who underwent DTR, 81 (71.7%) were contacted. Of these patients, 74 (91.4%) were employed within 3 years prior to surgery (mean age, 46.0 ± 10.7 years; mean follow-up, 5.9 ± 3.9 years). Sixty-nine patients (93.2%) returned to work by 2.2 ± 3.2 months postoperatively. Sixty-six patients (89.2%) were able to return to the same level of occupational intensity. Patients who held sedentary-, light-, medium-, and high-intensity occupations were able to return to work at a rate of 100.0%, 100.0%, 80.0%, and 76.9%, respectively, by 0.3 ± 0.5 months, 1.8 ± 1.5 months, 2.5 ± 3.6 months, and 4.8 ± 3.9 months, respectively, postoperatively. Of the workers' compensation patients, 15 (75%) returned to work by 6.5 ± 4.3 months postoperatively, whereas 100% of non-workers' compensation patients returned to work by 1.1 ± 1.6 months (P < .001). Seventy-one patients (95.9%) were at least somewhat satisfied, with 50 patients (67.6%) reporting excellent satisfaction. Seventy-two patients (97.3%) would undergo the operation again if presented the opportunity. A single patient (1.4%) required revision DTR. CONCLUSIONS Approximately 93% of patients who underwent DTR returned to work by 2.2 ± 3.2 months postoperatively. Patients with higher-intensity occupations had an equivalent rate of return to work but took longer to return to their preoperative level of occupational intensity. Information regarding return to work is imperative in preoperative patient consultation to manage expectations.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Kyleen Jan
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, CA, USA
| | | | - Edmund Naami
- School of Medicine, University of Illinois, Chicago, IL, USA
| | - Robert W Wysocki
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - John J Fernandez
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Mark S Cohen
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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Lee JH, Ahn KB, Kwon KR, Kim KC, Rhyou IH. Differences in Rupture Patterns and Associated Lesions Related to Traumatic Distal Triceps Tendon Rupture Between Outstretched Hand and Direct Injuries. Clin Orthop Relat Res 2021; 479:781-789. [PMID: 33181575 PMCID: PMC8083823 DOI: 10.1097/corr.0000000000001550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/07/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Traumatic distal triceps tendon rupture results in substantial disability in the absence of an appropriate diagnosis and treatment. To the best of our knowledge, differences in the degree of injury according to the injury mechanisms and associated lesions are not well known. QUESTIONS/PURPOSES In this study, we asked: (1) What differences are seen in triceps tear patterns between indirect injuries (fall on an outstretched hand) and direct injuries? (2) What are the associated elbow and soft tissue injuries seen in indirect and direct triceps ruptures? METHODS Between 2006 and 2017, one center treated 73 elbows of 72 patients for distal triceps tendon rupture. Of those, 70% (51 of 73 elbows) was excluded from this study; 8% (6 of 73) were related to systemic diseases, 59% (43 of 73) sustained open injuries, and 3% (2 of 73) were related to local steroid injections. We retrospectively collected data on traumatic distal triceps tendon rupture in 30% (22 of 73) of elbows at a single trauma center during a 10-year period. A fall on an outstretched hand was the cause of injury in 15 patients and direct blow by object or contusion were the cause in seven. MRI and surgery were performed in all patients. Traumatic distal triceps tendon rupture was classified by the Giannicola method, which is classified according to the depth and degree of the lesion based on MRI and surgical findings. Associated fractures and bone contusions on MRI were characterized. Ligament injuries on MRI was divided into partial and complete rupture. Agreement between the MRI and intraoperative findings for the presence of a traumatic distal triceps tendon rupture was perfect, and the Giannicola classification of traumatic distal triceps tendon rupture was good (kappa = 0.713). RESULTS In the indirect injury group (fall on an outstretched hand), 15 of 15 patients had injuries that involved only the tendinous portion of the distal triceps, but these injuries were not full-thickness tears, whereas in the direct injury group, three of seven patients had a full-thickness rupture (odds ratio [OR] 1.75 [95% CI 0.92 to 3.32]; p = 0.02). The direct injury group had no associated ligamentous injuries while 14 of 15 patients with indirect injuries had ligamentous injuries (OR 0.13 [95% CI 0.02 to 0.78]; p < 0.001; associated injuries in the indirect group: anterior medial collateral ligament [14 of 15], posterior medial collateral ligament [7 of 15], and lateral collateral ligament complex [2 of 15]). Similarly, one of seven patients in the direct injury group had a bone injury (capitellar contusion), whereas 15 of 15 patients with indirect ruptures had associated fractures or bone contusions (OR 16.0 [95% CI 2.4 to 106.7]; p < 0.001). CONCLUSION A fall on an outstretched hand may result in an injury mostly to the lateral and long head of distal triceps tendon and an intact medial head tendon; however, direct injuries can involve full-thickness ruptures. Although a traumatic distal triceps tendon rupture occurs after a fall on an outstretched hand, radial neck, capitellar, and medial collateral ligament injury can occur because of valgus load and remnant extensor mechanisms. Based on our finding, the clinician encountering a distal triceps tendon rupture due to a fall on an outstretched hand should be aware of the possibility of remaining elbow extensor mechanism by intact medial head tendon portion, and associated injuries, which may induce latent complications. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Ji Ho Lee
- J. H. Lee, K. B. Ahn, K. C. Kim, I. H. Rhyou, Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, SM Christianity Hospital, Pohang, South Korea
- K. R. Kwon, Department of Radiology Semyeong Christianity Hospital, Pohang, South Korea
| | - Kee Baek Ahn
- J. H. Lee, K. B. Ahn, K. C. Kim, I. H. Rhyou, Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, SM Christianity Hospital, Pohang, South Korea
- K. R. Kwon, Department of Radiology Semyeong Christianity Hospital, Pohang, South Korea
| | - Kwi Ryun Kwon
- J. H. Lee, K. B. Ahn, K. C. Kim, I. H. Rhyou, Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, SM Christianity Hospital, Pohang, South Korea
- K. R. Kwon, Department of Radiology Semyeong Christianity Hospital, Pohang, South Korea
| | - Kyung Chul Kim
- J. H. Lee, K. B. Ahn, K. C. Kim, I. H. Rhyou, Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, SM Christianity Hospital, Pohang, South Korea
- K. R. Kwon, Department of Radiology Semyeong Christianity Hospital, Pohang, South Korea
| | - In Hyeok Rhyou
- J. H. Lee, K. B. Ahn, K. C. Kim, I. H. Rhyou, Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, SM Christianity Hospital, Pohang, South Korea
- K. R. Kwon, Department of Radiology Semyeong Christianity Hospital, Pohang, South Korea
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Alberta FG. CORR Insights®: Differences In Rupture Patterns and Associated Lesions Related to Traumatic Distal Triceps Tendon Rupture Between Outstretched Hand and Direct Injuries. Clin Orthop Relat Res 2021; 479:790-791. [PMID: 33497063 PMCID: PMC8083935 DOI: 10.1097/corr.0000000000001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
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Hall RR, Sarokhan AK, Leung NL. Clinical Outcomes of Low-Cost, Anchorless Repair of the Triceps Tendon Using a Proximal Knot Technique. Arthrosc Sports Med Rehabil 2021; 3:e535-e541. [PMID: 34027466 PMCID: PMC8129437 DOI: 10.1016/j.asmr.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/09/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To use validated outcome measures to evaluate the clinical results of surgical repair of distal triceps tendon ruptures using transosseous tunnels and high-strength sutures with proximally based knots. Methods A consecutive series of traumatic distal triceps tendon ruptures at a single institution was studied. All cases were surgically repaired by 1 surgeon using high-strength suture with a bone tunnel-based repair technique. Repair knots were oriented proximally instead of in the traditional distal position. All patients were evaluated at long-term follow-up with a physical examination performed by the orthopaedic surgeon and the following validated outcome measures: Disabilities of the Arm, Shoulder and Hand score; Mayo Elbow Performance Score; and visual analog scale score. Results Seven male patients with a mean age of 38 years (range, 19-50 years) and mean follow-up period of 4.1 ± 1.2 years underwent distal triceps tendon repair with bone tunnels and high-strength sutures with proximally positioned knots. Of the repairs, 4 involved the dominant arm. At final follow-up, the mean Disabilities of the Arm, Shoulder and Hand score was 1.3 ± 3.1; the mean Mayo Elbow Performance Score was 99.3 ± 1.9; and the mean visual analog scale score was 0. One additional patient who declined participation in the study had wound dehiscence and infection with an associated partial rerupture. Conclusions This case series of triceps tendon repairs using transosseous tunnels and proximally based knots showed favorable postoperative elbow function based on validated outcome measures. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Robert R. Hall
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
- Address correspondence to Robert R. Hall III, B.S., Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, U.S.A.
| | - Alison K. Sarokhan
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Nicky L. Leung
- Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts, U.S.A
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Akamatsu FE, Negrão JR, Rodrigues MB, Itezerote AM, Saleh SO, Hojaij F, Andrade M, Jacomo AL. Is there something new regarding triceps brachii muscle insertion? Acta Cir Bras 2020; 35:e202001007. [PMID: 33237178 PMCID: PMC7709896 DOI: 10.1590/s0102-865020200100000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/19/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Previous studies have questioned whether the triceps brachii muscle tendon (TBMT) has a double or single insertion on the ulna. Aiming to provide an answer, we describe the anatomy of the TBMT and review a magnetic resonance imaging (MRI) series of the elbow. METHODS Forty-one elbows were dissected to assess the details of the triceps brachii insertion. Elbow plastination slices were analyzed to determine whether there was a space on the TBMT. Magnetic resonance imaging from the records of the authors were also obtained to demonstrate the appearance of the pre-tricipital space on MRI. RESULTS A virtual space on the medial aspect near the TBTM insertion site in the olecranon was consistently found on anatomic dissections. It was a distal pre-tricipital space. Magnetic resonance imaging demonstrated the appearance of the pre-tricipital space on MRI, and its extension was measured longitudinally either in elbow flexion or extension. There was no statistically significant difference between the measurements of this space in the right and left elbows or between flexion and extension (p > 0.05). The coefficient of variation was <10% for all measurements. CONCLUSION Knowledge of this structure may be essential to avoid incorrect diagnosis and unnecessary therapeutic interventions.
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Homen D, Domingo-Johnson EL, Helm JM, Schalow M, Zumwalt M. Triceps Tendon Rupture - A Novel Repair of an Uncommon Injury. J Orthop Case Rep 2020; 10:35-39. [PMID: 32953652 PMCID: PMC7476698 DOI: 10.13107/jocr.2020.v10.i02.1686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Triceps tendon rupture is a rare injury accounting for <1% of all tendon injuries with varying repair techniques described. We present this novel repair to supplement available literature and help optimize the clinical outcomes for affected patients. We report this technique because it is unique in that we augmented our surgical fixation with a subtle variation in the described technique by repairing the deep portion of the triceps tendon as a separate step, maximizing the recreation of the anatomic footprint of the triceps. Case Report The patient is a 70-year-old Caucasian male presenting with pain, swelling, and ecchymosis around the elbow after the episode of injury. He also complained of a painful popping sensation whenever he ranged the elbow and an inability to extend, with pain and weakness any time he attempted elbow extension. Radiographs reviewed at his initial visit revealed a small osseous fragment approximately 5 cm proximal to the olecranon tip. Subsequent MR imaging confirmed our suspicion, showing a complete tear of the triceps tendon with hematoma at its insertion site and tendon retraction approximately 3 cm proximally. With the diagnosis of triceps tendon rupture conformed, we took the patient for primary tendon repair using suture with bone bridge and suture anchor, using elements from described techniques. Our technique was unique in that we performed repair of the deep and superficial triceps attachments as separate steps, in an endeavor to improve the anatomic reconstruction of the footprint and biomechanical strength. Conclusions We combined findings from our review of the available literature with novel surgical techniques and suture design to maximize the patient outcome and minimize complications. The patient went on to have a very satisfactory functional recovery. We hope that this case report will complement the evidence-based care of these patients by orthopedic surgeons and lead to the best results possible.
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Affiliation(s)
- Dylan Homen
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center (TTUHSC), 3601 4th St. Stop 9436, Lubbock, Texas 79430-9436, United States
| | - E L Domingo-Johnson
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center (TTUHSC), 3601 4th St. Stop 9436, Lubbock, Texas 79430-9436, United States
| | - J Matthew Helm
- Department of Medicine, Texas Tech University Health Sciences Center School of Medicine, 3601 4th St. Stop 9436, Lubbock, Texas 79430-9436, United States
| | - Melinda Schalow
- Department of Orthopaedic Surgery, Medical Office Bldg. 4102 24th St. Suite 407, Lubbock, Texas 79410, United States
| | - Mimi Zumwalt
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center (TTUHSC), 3601 4th St. Stop 9436, Lubbock, Texas 79430-9436, United States
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Freislederer F, Papillo D, Glanzmann M, Scheibel M. Distale Bizepssehnen- und Trizepssehnenrupturen. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 158:663-682. [DOI: 10.1055/a-0999-8250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ZusammenfassungRupturen der distalen Bizeps- und Trizepssehne sind selten, treten jedoch gehäuft bei männlichen, sportlichen und körperlich schwer arbeitenden Patienten auf. Dieser Übersichtsartikel beschreibt Ätiologie und Pathogenese sowie Diagnostik, Behandlungsmöglichkeiten, das zu erwartende Outcome dieser Verletzungen und gibt Einblicke in das eigene Vorgehen.
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Abstract
Distal triceps ruptures are uncommon, usually caused by a fall on an outstretched hand or a direct blow. Factors linked to injury include eccentric loading of a contracting triceps, anabolic steroid use, weightlifting, and traumatic laceration. Risk factors include local steroid injection, hyperparathyroidism, and olecranon bursitis. Initial diagnosis can be complicated by pain and swelling, and a palpable defect is not always present. Plain radiographs can be helpful. MRI confirms the diagnosis and directs treatment. Incomplete tears can be treated nonsurgically; complete tears are best managed surgically. Good to excellent restoration of function has been shown with surgical repair.
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Gaviria M, Ren B, Brown SM, McCluskey LC, Savoie FH, Mulcahey MK. Triceps Tendon Ruptures: Risk Factors, Treatment, and Rehabilitation. JBJS Rev 2020; 8:e0172. [PMID: 32539261 DOI: 10.2106/jbjs.rvw.19.00172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Triceps tendon ruptures (TTRs) are rare and often occur as a result of falling on an outstretched hand, forceful eccentric contraction, direct trauma to the elbow, or lifting against resistance. TTRs are most commonly seen in middle-aged men, football players, and weightlifters. Radiography, ultrasonography, and magnetic resonance imaging may be utilized for diagnosis and to guide treatment. Acute partial TTRs may have good outcomes with nonoperative management. Surgery should be considered if nonoperative treatment is unsuccessful or if substantial musculotendinous retraction is present. Surgical repair is strongly recommended for complete TTRs.
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Affiliation(s)
- Manuela Gaviria
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
| | - Beth Ren
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
| | - Symone M Brown
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
| | - Leland C McCluskey
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
| | - Felix H Savoie
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
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Figueiredo EA, Lara PHS, Patriota G, Roncetti Júnior R, Belangero PS, Ejnisman B. Partial Rupture of the Distal Triceps in an Athlete: Case Report and Description of Surgical Technique. Rev Bras Ortop 2019; 54:601-604. [PMID: 31686716 PMCID: PMC6819156 DOI: 10.1016/j.rbo.2017.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/09/2017] [Indexed: 11/27/2022] Open
Abstract
Brachial triceps tendon ruptures account for less than 1% of all upper limbs tendinous ruptures. Partial ruptures are underdiagnosed, and a partial rupture may become a total lesion. Complete ruptures usually require surgical treatment; however, there is no well-defined conduct for partial ruptures. This article presents the case of a 42-year-old male jiu-jitsu athlete with partial rupture of the brachial triceps who underwent surgical treatment due to persistent loss of elbow extension strength, even after conservative treatment. The repair was performed with grafting of the long palmar muscle tendon, using a technique developed by the authors. No complications were observed, and the patient presented a satisfactory result, evidenced by the improvement in the parameters of isokinetic studies, which were performed before surgery and at 5 months postoperatively. This technique has proven to be an option for cases of partial rupture of the brachial triceps in patients with high physical demand who do not show improvement with the conservative treatment.
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Affiliation(s)
- Eduardo Antônio Figueiredo
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Paulo Henrique Schmidt Lara
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Gyoguevara Patriota
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Ronaldo Roncetti Júnior
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Paulo Santoro Belangero
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Benno Ejnisman
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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45
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Prkić A, Viveen J, The B, van Bergen CJ, Koenraadt KL, Eygendaal D. Comparison of isometric triceps brachii force measurement in different elbow positions. J Orthop Surg (Hong Kong) 2019; 26:2309499018783907. [PMID: 29954252 DOI: 10.1177/2309499018783907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Objective and reliable force measurement is necessary to monitor the rehabilitation after triceps brachii pathology, injuries, and posterior approach-based surgery. It is unclear at which amount of extension the triceps is best tested and if comparison to the uninjured sided is reliable. This study aims to identify the most reliable elbow position at which elbow extension force is measured using a dynamometer. Furthermore, it aims to compare the extension strength of the dominant arm with that of the nondominant arm. METHODS Isometric elbow extension force of the dominant and nondominant arms of healthy subjects was measured. The measurements were taken in three sequences per arm in 0, 30, 60, 90, and 120 degrees of flexion. A subgroup repeated the measurements to analyze test-retest reliability using intraclass correlation. RESULTS We included a total of 176 volunteers. The repeated measures analysis of variance for within-subject effect showed the lowest variation coefficient at 30 degrees of flexion. Extension forces showed a mean difference of 3.2-6.9 N in advantage of the dominant arm, resulting in ratios from 1.05 to 1.09. Learning curve analysis showed that during the first session in dominant and nondominant arms, less forces were exerted. CONCLUSION The most reliable isometric triceps brachii muscle strength measurement was at 30 degrees of flexion of the elbow. Considering the learning curve, a first tryout session for both arms is indicated. Then, a second measurement suffices as no further learning curve is observed.
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Affiliation(s)
- Ante Prkić
- 1 Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Jetske Viveen
- 1 Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Bertram The
- 1 Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | | | - Koen Lm Koenraadt
- 1 Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Denise Eygendaal
- 1 Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands.,2 Department of Orthopedic Surgery, University of Amsterdam, Amsterdam, The Netherlands
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Kholinne E, Al-Ramadhan H, Bahkley AM, Alalwan MQ, Jeon IH. MRI overestimates the full-thickness tear of distal triceps tendon rupture. J Orthop Surg (Hong Kong) 2019; 26:2309499018778364. [PMID: 29871547 DOI: 10.1177/2309499018778364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Injury to the distal triceps brachii tendon is rare. Imaging radiographs are used to confirm the findings of physical examination, classify the extent of injury, and guide treatment. Magnetic resonance imaging (MRI) is considered the gold standard of diagnostic imaging. However, no previous study has reported on the accuracy of differentiation between partial- and full-thickness triceps tendon tears. Our study's aim was to define the accuracy of MRI in differentiating partial- from full-thickness tear of the distal triceps tendon. We hypothesized that MRI has low accuracy in differentiating partial- from full-thickness tears. METHODS A total of eight patients with nine triceps tendon tears underwent surgical repair from 2011 to 2015. MRI of the elbows were retrospectively reviewed for the presence and type of tear, tendon involvement, and location of the tear, and later correlated with surgical findings. RESULTS Of the three surgically confirmed complete tears, MRI correctly reported a complete tear in all patients. Of the six partial tears confirmed at surgery, MRI correctly identified four tears. In two cases, MRI described a complete tear, but only a partial tear was noted at surgery. CONCLUSION False-positive MRI assessment of distal triceps injury is not rare. Surgeons should rely on clinical examination in assessing distal triceps tendon injury, with imaging studies providing an adjunctive role in the diagnosis and decision-making.
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Affiliation(s)
- Erica Kholinne
- 1 Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.,2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Hassan Al-Ramadhan
- 2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | | | - Malak Q Alalwan
- 3 College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - In-Ho Jeon
- 2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
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47
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Sarokhan AK, Leung NL. Acute Triceps Tendon Repair: A Technique Utilizing 3 Curved Tunnels and Proximal Knots. Arthrosc Tech 2019; 8:e705-e712. [PMID: 31485396 PMCID: PMC6713898 DOI: 10.1016/j.eats.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/03/2019] [Indexed: 02/03/2023] Open
Abstract
Although triceps tendon tears are less common than other tendon tears, complete ruptures require surgical repair to restore the strength of the extensor mechanism of the elbow. There are several described techniques for repair using both transosseous tunnels and suture anchors. Current techniques often result in large suture knots over the dorsal ulna under thin subcutaneous tissue, which can be irritating for patients. Knotless techniques require costly suture anchors. In this technical note, we describe a novel transosseous 3-tunnel technique with proximal suture knots to lessen the potential for postoperative pain.
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Affiliation(s)
- Alison K. Sarokhan
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A.,Address correspondence to: Alison K. Sarokhan, M.D., Department of Orthopaedic Surgery, Tufts Medical Center, 800 Washington Street, TMC Box #306, Boston, Massachusetts 02111, U.S.A.
| | - Nicky L. Leung
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A.,Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts, U.S.A
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Waterman BR, Dean RS, Veera S, Cole BJ, Romeo AA, Wysocki RW, Cohen MS, Fernandez JJ, Verma NN. Surgical Repair of Distal Triceps Tendon Injuries: Short-term to Midterm Clinical Outcomes and Risk Factors for Perioperative Complications. Orthop J Sports Med 2019; 7:2325967119839998. [PMID: 31069242 PMCID: PMC6492365 DOI: 10.1177/2325967119839998] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Brian R Waterman
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Robert S Dean
- University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Shreya Veera
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Robert W Wysocki
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Mark S Cohen
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - John J Fernandez
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Yammine K, Saghie S, Assi C. A Meta-Analysis of the Surgical Availability and Morphology of the Plantaris Tendon. J Hand Surg Asian Pac Vol 2019; 24:208-218. [DOI: 10.1142/s2424835519500280] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The tendon of the plantaris muscle (PM) is highly relevant in surgical practice. It is used as a graft for tendon/ligament repair or reconstruction in hand surgery whenever palmaris longus (PL) is lacking. Its occurrence in humans is reported to be high. Methods: A meta-analysis based on cadaveric studies was conducted to quantitatively assess PM frequency and size. Results: Data from 41 studies including 10062 leg specimens yielded the following: overall true prevalence ≈ 93%, overall crude prevalence = 90.6%, bilateral prevalence ≈ 92%, significantly more frequent on the right side, no gender significance, and no significant differences between ethnicities except that of Brazilian populations. The pooled mean length (± SD) of the PM tendon (PT) was 30.63 ± 5.87 cm and that of its width was 3.68 ± 1.37 mm. Pooled frequencies of the types of PT insertion are reported. Conclusions: This meta-analysis demonstrated a higher prevalence of PM when compared to clinical PL frequency in the literature with a tendon length double than that of PL along with an acceptable width. The surgical availability of the PM tendon was found stable across human populations; a clinical advantage when compared to the high variability of PL ethnicity-based frequency. Our results indicate that the PT is of high clinical relevance as a reliable and suitable resource for tendon grafting and reconstruction.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Lebanon
- Center for Evidence-Based Anatomy, Sports & Orthopedic Research, Jdeideh, Lebanon
| | - Said Saghie
- Department of Orthopedic Surgery, American University of Beirut, Beirut, Lebanon
| | - Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Lebanon
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Dunn JC, Kusnezov N, Fares A, Kilcoyne K, Garcia E, Orr JD, Waterman BR. Outcomes of Triceps Rupture in the US Military: Minimum 2-Year Follow-up. Hand (N Y) 2019; 14:197-202. [PMID: 29199471 PMCID: PMC6436132 DOI: 10.1177/1558944717745499] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The objective of this study was to examine the subjective and objective midterm functional clinical outcomes of surgically repaired triceps injuries in a moderate- to high-demand population. METHODS The US Military Health System was queried to identify all surgically treated triceps tendon ruptures between 2008 and 2013. Primary endpoints included rates of rerupture, perioperative complications, or significant persistent elbow dysfunction; Disability of the Arm, Shoulder and Hand (DASH) score, Mayo Elbow score, and ability to do push-ups were also extracted. RESULTS Thirty-seven patients underwent triceps tendon repair with a mean follow-up of 49.8 ± 17.3 months (range: 26.8-80.2). The most common mechanisms of injury were military duties (27%), sporting activity (24%), or fall-related (21.6%), with most injuries occurring during an eccentric movement (54%). While 45% experienced occasional elbow pain postoperatively, only 1 patient (2.7%) had a rerupture. Despite this, at 2 years, 31 patients (84%) were able to return to full military duty. While 6 patients were discharged from military service, only 1 underwent medical separation while 5 retired for reasons unrelated to their triceps tendon rupture. Patient-reported outcomes were available for 14 patients at final follow-up. The average DASH and Mayo Elbow scores were 4.7 (SD ± 4.7, range: 0-15.9) and 85.4 (SD ± 11.7, range: 60-100), respectively. The cohort could perform mean 54.2 (range: 9-90) push-ups. In additional, 12 of 14 (85.7%) were satisfied with their elbow function. CONCLUSIONS The active duty cohort experienced excellent postoperative results with a high rate of return to military duty, despite nearly half of the patients recognizing some degree of activity-related, elbow pain.
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Affiliation(s)
- John C. Dunn
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | | | - Austin Fares
- Creighton University, Omaha, NE, USA,Austin Fares, School of Medicine, Creighton University, 3561 Howard Street, Omaha, NE 68105, USA.
| | - Kelly Kilcoyne
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | | | - Justin D. Orr
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
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