Treatment of a Complex Distal Triceps Tendon Rupture With a New Technique: A Case Report

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.

Distal triceps injuries (including snapping triceps): A systematic review of the literature

“…For chronic ruptures with significant tendon retraction, reconstruction with a graft may be required. Grafts include achilles allograft[ 11 , 13 ] or ipsilateral semi-tendinous tendon[ 10 , 15 ], aconeus[ 10 , 11 ], Latisimus Dorsi[ 10 ], plantaris[ 10 ] and palmaris longus[ 10 ]. Aconeus[ 26 ] and palmaris longus have also been used in augmentation of primary repairs[ 20 ].…”

Elbow sarcoma resection and triceps reconstruction with Achilles allograft: an overview, case report, and technique guide

“… 20 In the setting of chronic triceps insufficiency, Aunon-Martin et al employed a technique combining Achilles tendon allograft in combination with a BicepsButton (Arthrex Inc., Naples, FL, USA) Aand interferon screw distally to secure the allograft at the olecranon and incorporated it proximally into the allograft with a suture tendon allograft band and a pulvertaft-type technique. 1 Pilih and Kozic reported a case in which an Achilles tendon allograft, without a calcaneal bone fragment, was utilized in triceps reconstruction. It resulted in successful tendon integration, improved functional outcome, strength recovery, pain reduction, and ROM measured with goniometric measurements and isokinetic testing.…”

“… 11 , 18 Several case studies have demonstrated that a wide range of Achilles allograft reconstruction methods produce good to excellent patient outcomes, but no method has been established to guide treatment. 1 , 18 , 19 Our decision to utilize an Achilles allograft was a combination of defect size, decreased donor site morbidity and enhanced biomechanical properties, affording our patient the greatest chance for functional recovery of her dominant limb. Surgical reconstruction of the triceps poses a considerable technical challenge.…”

Tríade terrível do cotovelo associada a avulsão do tendão do tríceps braquial e da massa flexo-pronadora: relato de caso

“…Nesse mesmo contexto, a realização da incisão posterior universal do cotovelo foi imprescindível na identificação dessas lesões associadas, uma vez que permitiu a exposição praticamente todas as estruturas do cotovelo sem ter sido necessárias incisões extras. Outros pontos positivos que estão relacionados a essa incisão são a diminuição das complicações de cicatrização, menor período de imobilização e menores taxas de lesões iatrogênicas do nervo interósseo posterior [17,18].…”