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Welborn B, White CC, Bruce JR. Augmentation of triceps tendon repair with a bio-inductive collagen scaffold. BMJ Case Rep 2023; 16:e255469. [PMID: 37793840 PMCID: PMC10551870 DOI: 10.1136/bcr-2023-255469] [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] [Indexed: 10/06/2023] Open
Abstract
Two active, adult male patients, one with prior triceps rupture and direct repair, presented with traumatic rupture of the distal triceps tendon. MRI confirmed not only complete rupture with retraction in both, but also signal changes within the tendon, raising concern for healing potential and re-rupture. Surgical repair was performed using heavy, non-absorbable suture and suture anchors in the standard fashion, followed by augmentation with a bovine, bio-inductive collagen scaffold in order to increase tendon thickness and aid with healing capability. This technique is well described for rotator cuff repair augmentation but is a novel technique to the literature in the setting of triceps tendons repair. Both patients returned to full, preinjury activity without complication with sustained results at 3 and 3.5 years postoperatively.
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Affiliation(s)
- Benjamin Welborn
- Department of Orthopaedic Surgery, The University of Tennessee Health Science Center, College of Medicine, Chattanooga, Tennessee, USA
| | - Charles Cody White
- Department of Orthopaedic Surgery, The University of Tennessee Health Science Center, College of Medicine, Chattanooga, Tennessee, USA
| | - Jeremy R Bruce
- Department of Orthopaedic Surgery, The University of Tennessee Health Science Center, College of Medicine, Chattanooga, Tennessee, USA
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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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Venkatapathy S, Bhargavan R. Clinical Assessment of Existence of Palmaris Longus Muscle among South Indian Population. J Hand Surg Asian Pac Vol 2020; 25:137-142. [PMID: 32312195 DOI: 10.1142/s2424835520500149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Palmaris longus tendon is often used as a donor tendon by surgeons in tendon grafts. It is one of the flexor muscles of the forearm and documented well for its variations in both morphology and number of tendons. Prevalence of absence of this muscle varies among the individuals of same population and individuals of various ethnic groups. The aim of this study was to assess the existence of Palmaris longus muscle within a group of students and its association with side of the limb and gender of the individual. Methods: Three hundred medical students of 150 males and 150 females with age group of 18-21 years were clinically assessed. The standard Schaffer's test was used for the assessment of PL tendon. If the tendon was not found in this test, the confirmation was done by other four tests. Results: Results of this study shows that an overall absence of palmaris longus muscle in both sexes was found to be 32%, out of which 21% absence was found in males and 43% absence found in females. Among the males, the unilateral agenesis was seen in 16% and bilateral agenesis in 4% and in females the unilateral agenesis was seen in 29% and bilateral agenesis seen in 14%. Conclusions: To conclude; in the present study, prevalence of Palmaris longus muscle agenesis was found to be more in female subjects on their left side. Surgeons who plan for tendon reconstructive procedures should know variations of Palmaris longus muscle and its clinical assessment.
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Affiliation(s)
- Santhi Venkatapathy
- Department of Anatomy, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry Affiliated to Bharath Institute of Higher Education and Research (Deemed-to-be University), Chennai, India
| | - Rajesh Bhargavan
- Department of Anatomy, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry Affiliated to Bharath Institute of Higher Education and Research (Deemed-to-be University), Chennai, India
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Clancy R, Lim Z, Ravinsky RA, OʼNeill A, Ferguson P, Wunder J. Use of a Fascia Lata Autograft to Reconstruct a Large Triceps Tendon Defect After En-Bloc Resection of a Soft-Tissue Sarcoma: A Case Report. JBJS Case Connect 2020; 10:e0390. [PMID: 32224670 DOI: 10.2106/jbjs.cc.19.00390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE In this report, we present the case of a patient undergoing en-bloc resection of a large triceps soft-tissue sarcoma, requiring reconstruction of the triceps tendon including its distal insertion. We describe a surgical technique using fascia lata (FL) autograft to reconstruct the patient's extensor mechanism with long-term follow-up and functional results. CONCLUSIONS FL autograft is a viable option for reconstruction of large tendinous defects. It is simple and straightforward to harvest, inexpensive when compared with alternatives, with many potential applications.
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Affiliation(s)
- Rachel Clancy
- Division of Plastic and Reconstructive Surgery, University Health Network, Toronto, Ontario, Canada
| | - Zachary Lim
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Ravinsky
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
- The CORE Institute, Phoenix, Arizona
| | - Anne OʼNeill
- Division of Plastic and Reconstructive Surgery, University Health Network, Toronto, Ontario, Canada
| | - Peter Ferguson
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jay Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
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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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Gupta RK, Soni A, Malhotra A, Masih GD. Triceps tendon reconstruction using autologous semitendinosis graft in professional kabaddi player-A rare case report. J Clin Orthop Trauma 2017; 8:S38-S40. [PMID: 28878538 PMCID: PMC5574866 DOI: 10.1016/j.jcot.2017.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/17/2017] [Accepted: 05/25/2017] [Indexed: 11/19/2022] Open
Abstract
Triceps tendon rupture is a rare injury occurs due to sudden forceful contraction of triceps against flexed elbow. Though there are case reports describing various treatment options for this injury, including primary repair as well as reconstruction using different technique, no standardised technique has been defined. We present, for the first time, a case of five month old neglected triceps tendon rupture in a professional kabaddi player. Ruptured tendon was reconstructed using free autologous semitendinous graft with good functional outcome.
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Shuttlewood K, Beazley J, Smith CD. Distal triceps injuries (including snapping triceps): A systematic review of the literature. World J Orthop 2017; 8:507-513. [PMID: 28660143 PMCID: PMC5478494 DOI: 10.5312/wjo.v8.i6.507] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/13/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To review current literature on types of distal triceps injury and determine diagnosis and appropriate management.
METHODS We performed a systematic review in PubMed, Cochrane and EMBASE using the terms distal triceps tears and snapping triceps on the 10th January 2017. We excluded all animal, review, foreign language and repeat papers. We reviewed all papers for relevance and of the papers left we were able to establish the types of distal triceps injury, how these injuries are diagnosed and investigated and the types of management of these injuries including surgical. The results are then presented in a review paper format.
RESULTS Three hundred and seventy-nine papers were identified of which 65 were relevant to distal triceps injuries. After exclusion we had 47 appropriate papers. The papers highlighted 2 main distal triceps injuries: Distal triceps tears and snapping triceps. Triceps tear are more common in males than females occurring in the 4th-5th decade of life and often due to a direct trauma but are also strongly associated with weightlifting and American football. The tears are diagnosed by history and clinically with a palpable gap. Diagnosis can be confirmed with the use of ultrasound (US) and magnetic resonance imaging. Treatment depends on type of tear. Partial tears can be treated conservatively with bracing and physio whereas acute tears need repair either open or arthroscopic using suture anchor or bone tunnel techniques with similar success. Chronic tears often need augmenting with tendon allograft or autograft. Snapping triceps are also seen more in men than women but at a mean age of 32 years. They are characterized by a snapping sensation mostly medially and can be associated with ulna nerve subluxation and ulna nerve symptoms. US is the diagnostic modality of choice due to its dynamic nature and to differentiate between snapping triceps tendon or ulna nerve. Treatment is conservative initially with activity avoidance and if that fails surgical management includes resection of triceps edge or transposition of the tendon plus or minus ulna nerve transposition.
CONCLUSION Distal triceps injuries are uncommon. This systematic review examines the evidence base behind diagnosis, imaging and treatment options of distal triceps injuries including tears and snapping triceps.
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Choo J, Wilhelmi BJ, Kasdan ML. Iatrogenic Injury to the Median Nerve During Palmaris Longus Harvest: An Overview of Safe Harvesting Techniques. Hand (N Y) 2017; 12:NP6-NP9. [PMID: 28082854 PMCID: PMC5207290 DOI: 10.1177/1558944716648313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: A rare and disastrous complication of harvesting a tendon graft is the misidentification of the median nerve for the palmaris longus. Methods: The authors report a referred case in which the median nerve was harvested as a free tendon graft. Results: Few reports of this complication are found in the literature despite the frequency of palmaris longus tendon grafting and the proximity of the palmaris tendon to the median nerve. Given the obvious medicolegal implications, the true incidence of this complication is difficult to assess. Discussion: Safe harvesting of the palmaris longus mandates a thorough understanding of the relevant anatomy, in particular the proper differentiation between nerve and tendon and recognition of when the palmaris longus tendon is absent. Techniques to facilitate proper identification of the palmaris longus are outlined.
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Affiliation(s)
- Joshua Choo
- University of Louisville, KY, USA,Joshua Choo, Department of Surgery, University of Louisville, 550 S. Jackson Street, Louisville, KY 40202, USA.
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Aunon-Martin I, Prada-Canizares A, Jimenez-Diaz V, Vidal-Bujanda C, Leon-Baltasar JL. Treatment of a Complex Distal Triceps Tendon Rupture With a New Technique: A Case Report. ARCHIVES OF TRAUMA RESEARCH 2016; 5:e32221. [PMID: 27148500 PMCID: PMC4853493 DOI: 10.5812/atr.32221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 09/03/2015] [Indexed: 12/11/2022]
Abstract
Introduction: The distal triceps tendon rupture is an uncommon injury. The acute treatment is well-defined, but when a delayed diagnosis is made or when a tendon retraction is present the alternatives or reconstruction are limited and sometimes complex. Case Presentation: In this case, we report on a 28-year-old man who presented with a chronic disruption of the distal triceps tendon with a gap of approximately 15 cm. The patient was diagnosed in another center with an inveterate breakage of the distal triceps tendon and was initially treated with an Achilles allograft that was complicated by a wound infection and required more than ten surgeries. Nearly 22 months after the initial trauma, and 12 months after the first surgery, we performed a reconstruction with an Achilles tendon allograft using the new technique of distal attachment. At the 12-month follow-up the patient presented a joint balance from -5º to 110º and presented with no pain. Conclusions: The use of an Achilles tendon allograft provides excellent results in complex distal triceps tendon ruptures. We report the use of a new technique to anchor a distal Achilles allograft.
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Affiliation(s)
- Ismael Aunon-Martin
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
- Corresponding author: Ismael Aunon-Martin, Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain. Tel: +35-913908227, E-mail:
| | - Alfonso Prada-Canizares
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
| | - Veronica Jimenez-Diaz
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
| | - Carlos Vidal-Bujanda
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
| | - Jose Luis Leon-Baltasar
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
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Reconstrução de ruptura crônica do tríceps distal sob a configuração de dupla fileira: nota técnica. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2015.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Paniago AF, Storti TM, Faria RSS, Morais DCAD, Souza MPD. Reconstruction of chronic tearing of the distal triceps using the double-row configuration: technical note. Rev Bras Ortop 2015; 50:596-600. [PMID: 26535208 PMCID: PMC4610994 DOI: 10.1016/j.rboe.2015.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/06/2014] [Indexed: 12/14/2022] Open
Abstract
Tearing of the distal triceps is uncommon and may be difficult to diagnose, especially in situations of partial tearing. Imaging methods such as ultrasonography and magnetic resonance imaging should be used to confirm the diagnosis and define the extent of the injury. The preferred treatment for complete tearing of the triceps is surgical, unlike in cases of partial tearing, in which the treatment depends on factors such as pain, functional deficit and the patient's expectations. Here, we describe the case of a patient with partial tearing of the distal triceps after falling to the ground, which was not diagnosed at the time of first attendance and evolved with pain and great functional loss. The surgical procedure was performed nine months after the injury, with reconstruction of the triceps by means of reinforcement using the tendon of the ipsilateral semitendinosus and fixation in the olecranon using the double-row configuration. The patient remained immobilized using a sling for one week and then gains in passive range of motion (ROM) were introduced. Three weeks later, the patient was released for gains in active ROM. Muscle strengthening was started after 12 weeks. Six weeks after the surgical procedure, the patient was free from pain and presented complete ROM, grade V elbow extension force and hypertrophy of the triceps. The technique described here was shown to be useful for treating tears of the tendon of the distal triceps.
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Bibliography—Editors’ selection of current world literature. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e31829d7cd1] [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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