Clinical Outcomes of Low-Cost, Anchorless Repair of the Triceps Tendon Using a Proximal Knot Technique

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 tunnelebased 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 AE 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 AE 3.1; the mean Mayo Elbow Performance Score was 99.3 AE 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.

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

“…Although the TBT group showed a slightly better MEPS and DASH scores than the SA group, neither difference reached a level of clinical significance. Our meta-analysis showed a significantly higher MEPS for transosseous repairs 13 , 15 , 17 , 23 than for SA repairs 4 , 11 , 14 , 15 , 23 (95 vs. 93, P = .04). However, both groups fell in the “excellent” range of outcomes, and this difference does not reach a level of clinical significance.…”

“…The mean Disabilities of Arm, Shoulder, and Hand (DASH) score was 4 (TBT vs. SA, 3 vs. 6), the mean QuickDASH 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 = .04). 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% (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 = .008). Of those complications, TBT repairs had a significantly higher rate of retears than SA repairs (7% vs. 2%, P = .03).…”

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