All-Suture Anatomic Footprint Repair of the Distal Triceps Tendon

Abstract

Distal triceps ruptures are an uncommon injury, and currently, there is a lack of consensus on the optimal surgical technique for repair. The traditional transosseous cruciate repair has been shown to be nonanatomic and to have a higher failure rate and be biomechanically inferior to suture anchor repairs. The use of anchors significantly increases procedure cost and theoretically increases the risk of complications related to drill and anchor placement. The technique described in this article allows anatomic restoration of the triceps tendon while avoiding the increased cost and risk that may be associated with suture anchor placement.

Reconstruction of Bilateral Chronic Triceps Brachii Tendon Disruption Using a Suture-Mediated Anatomic Footprint Repair in a Dog

“…In human medicine, triceps brachii tendon disruptions typically occur at the osseo-tendinous junction, where several repair strategies are employed, including trans-osseous, suture anchor, and hybrid approaches [ 10 , 22 ]. However, traditional trans-osseous repairs, which have a notable failure rate of approximately 21%, often fail to adequately cover the triceps brachii footprint, leading to higher failure rates compared with those using suture anchors [ 9 , 11 ]. These anchors, however, present limitations in small dogs because of the risk of bone fracture [ 9 ].…”

“…Given that tendon disruptions rarely heal with conservative therapy, surgical intervention is the standard treatment [ 2 , 9 ]. These disruptions can be categorized into three patterns as follows: myotendinous junction, central part of the tendon, and osseo-tendinous junction [ 1 ].…”

“…Disruption at the central part requires a tendon–tendon suture, while osseo-tendinous disruption necessitates a tendon–bone suture through bone tunnels [ 1 , 10 ]. Techniques for tendon–bone sutures include trans-osseous, suture anchor, and hybrid trans-osseous–suture anchor approaches [ 9 , 11 ]. The restoration of the anatomical footprint and the prevention of postoperative gap formation are crucial for tendon healing, as they significantly impact the biomechanical strength and speed of recovery [ 11 , 12 , 13 ].…”

“…This limited contact reduces mechanical strength and delays healing. Consequently, techniques employing suture anchors are preferred for their strong holding strength and ease in reconstructing the footprint, which leads to successful outcomes [ 9 , 11 ].…”

“…The application of anchors in small dogs can be challenging because of the limited bone availability at the olecranon [ 9 ]. Moreover, in chronic cases, excessive scar tissue, tendon retraction, and muscle atrophy can occur following tendon degeneration, resulting in a large gap [ 3 , 14 , 15 , 16 , 17 ].…”