Triceps Rupture: A Case Series, Anatomical Study of the Triceps Footprint and Description of Surgical Technique

Abstract

Background Distal triceps tendon ruptures are rare accounting for less than 1% of all tendinous injuries in the upper extremity. Such injuries should be suspected in patients who have pain about the elbow following an eccentric contraction to the upper extremity. Complete ruptures should be treated with early surgical repair with reattachment of the tendon to the olecranon. Most reports to date have used suture fixation through olecranon drill holes. This study was performed to asses the anatomy of the triceps insertion and it's implications on the adequate fixation of the triceps tendon using a novel technique.Methods Ten cadaveric adult upper extremities with no signs of prior trauma or surgery were used in this study. The specimens were stripped of all skin and subcutaneous tissue through a direct posterior approach, to identify the triceps insertion. The insertion of the triceps tendon was then mapped and the area of the medial, long and lateral heads measured. Three cases of distal triceps rupture using this new open repair technique are also described using two distal drill holes and sutures augmented with a proximal anchor. Two of the three patients also needed LARS ligament augmentation at the time of surgery due to tissue loss. ResultsIn all cadaveric sections separate insertions were found consisting of the medial head and the conjoint tendons of the long and lateral heads. The mean surface areas for the medial and long/lateral insertions were 100.4 mm 2 and 307.9 mm 2 respectively. The mean total area for the triceps insertion was found to be 408.3 mm 2 . At follow up all cases were assessed using the Oxford Elbow Score, Mayo Elbow Performance Scores and Disabilities of the Arm, Shoulder and Hand Scores. ConclusionsWe have shown that the insertion of the triceps tendon is a ''footprint'' made from the tendon of the medial head and a conjoint tendon of the long and lateral heads. For cases of distal triceps rupture we have described an open procedure using a ''double row footprint reconstruction'' technique which we believe anatomically reconstructs the triceps insertion.

Triceps tendon rupture: repair and rehabilitation

“…Kirschner wires reinforced with circlage wire can also be used if a significant olecranon fragment is present. 2,[4][5][6][7] Tendon repairs can also be augmented, using artificial ligament or tendon graft, if the quality of the tissue is poor as a result of systemic disease, or in the case of chronic rupture. 3,8 We prefer to use suture bone anchors because we consider that this provides a solid repair and does not require further surgery for removal of metalwork, which can be the case if Kirschner wires are used.…”

“…1,3 In cases of complete rupture of the triceps tendon, surgical repair is usually recommended; however, no clear guidelines exist for the treatment of these injuries or the postoperative rehabilitation. 4,5 Delayed repair is technically demanding and results are inferior to acute repair; therefore, prompt recognition and repair leads to superior outcomes. We report our technique for surgical repair, as well as a regime for postoperative rehabilitation of these injuries.…”

Surgical repair of distal triceps rupture: a systematic review of outcomes and complications

“…The mean Disabilities of Arm, Shoulder, and Hand (DASH) score was 4 (TBT vs. SA, 3 vs. 6), the mean Quick-DASH score was 8 (TBT vs. SA, 11 vs. 4), and the mean Mayo Elbow Performance Score (MEPS) was 92. Subanalysis showed a slightly higher MEPS for transosseous repairs 13,15,17 than for SA repairs 4,11,14,15,23 (95 vs. 93, P ¼ .04). The mean American Shoulder and Elbow SurgeonseElbow 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% (TBT vs. SA, 82% vs. 95%) (Table III).…”

“…Complications occurred in 15% of cases, of which retears accounted for 5%. Subanalysis of cases with reported repair types revealed a significantly higher complication rate in TBT repairs 13,15,17,19,20,23 than in SA repairs 4,10,11,[14][15][16]19,23 (18% vs. 8 %, P ¼ .008). Of those complications, TBT repairs had a significantly higher rate of retears than SA repairs (7% vs. 2%, P ¼ .03).…”

Surgical Outcomes, Trends, and Risk Factors of Distal Triceps Repairs

“…5 Initial misdiagnosis is common, and recent literature has highlighted the importance of early and accurate diagnosis for successful treatment. 5,[10][11][12][13] Surgical management versus nonsurgical management of triceps ruptures are guided by the severity of the injury and the patient's functional status. 5 For example, a tear >50% could be treated nonsurgically in an older or less active person, whereas surgical management may be more appropriate in a highly functioning athlete.…”