scholarly journals Triceps tendon rupture: repair and rehabilitation

2017 ◽  
Vol 10 (1) ◽  
pp. 62-65 ◽  
Author(s):  
Cezary Kocialkowski ◽  
Rebecca Carter ◽  
Chris Peach
Keyword(s):  
Surgical Technique ◽  
Tendon Repair ◽  
Return To Sport ◽  
Rehabilitation Programme ◽  
Range Of Movement ◽  
Triceps Tendon Rupture ◽  
Sport Activities ◽  
Tendon Ruptures ◽  
Five Phases ◽  
Triceps Tendon

Triceps tendon ruptures are rare injuries and are frequently missed on initial presentation to the emergency department. In cases of complete rupture, surgical repair is recommended but no guidelines exist on the optimum reconstructive technique or rehabilitation. We present a surgical technique and rehabilitation programme for the management of these injuries. A midline posterior incision is performed, the ruptured triceps tendon is identified and mobilized, and the tendon footprint is prepared. The tendon is then repaired using bone suture anchors, with a parachute technique, and held in 40° of flexion. The rehabilitation programme is divided into five phases, over a period of 12 weeks. Range of movement is gradually increased in a brace for the first 6 weeks. Rehabilitation is gradually increase in intensity, progressing from isometric extension exercises to weight-resisted exercises, and finally plyometrics and throwing exercises. Our surgical technique provides a solid tendon repair without the need for further metalwork removal. The graduated rehabilitation programme also helps to protect the integrity of the repair at the same time as enabling patients to gradually increase the strength of the triceps tendon and ultimately return to sport activities.

scholarly journals Functional Outcomes and MRI Results Following Knotless Repair of Acute Achilles Tendon Ruptures

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0045
Author(s):  
Brian D. Steginsky ◽  
Mallory Suhling ◽  
Eric Giza ◽  
Christopher D. Kreulen ◽  
B. Dale Sharpe ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Achilles Tendon ◽  
Functional Outcomes ◽  
Tendon Repair ◽  
Surgical Techniques ◽  
Wound Complications ◽  
Distal Stump ◽  
Achilles Tendon Repair ◽  
Tendon Ruptures

Category: Ankle; Sports Introduction/Purpose: The surgical techniques for primary repair of acute Achilles tendon ruptures have evolved from large open incisions to mini-open and percutaneous techniques. Studies have demonstrated that lesser invasive surgical techniques may reduce the risk of post-operative wound complications. Knotless surgical repair of acute Achilles tendon ruptures can be performed through a mini-incision, but still permits a robust re-approximation of the tendon stumps and decreases suture burden through distal anchor fixation in the calcaneus. However, stress shielding and subsequent tendinosis of the distal tendon stump is a theoretical concern with this surgical technique. We hypothesize that our surgical technique allows for a durable repair through a minimally invasive approach, permitting a safe and accelerated rehabilitation protocol, excellent functional outcomes, and absence of distal stump tendinosis. Methods: A multicenter retrospective chart review was performed to identify all patients that underwent primary Achilles tendon repair using a knotless surgical technique with a minimum of one-year follow-up from three orthopedic foot and ankle surgeons’ practices. Exclusion criteria included: age <18, chronic Achilles tendon ruptures (>4 weeks), insertional Achilles tendon ruptures, revision Achilles surgery, peripheral neuropathy, and systemic inflammatory disease. All patients were contacted by phone and asked to return to the office for an MRI, clinical examination, and completion of functional outcome questionnaires. The primary outcome measure was the validated Achilles Tendon Total Rupture Score (ATRS). Secondary outcomes included the Visual Analog Score (VAS), postoperative complications, ankle range of motion, calf circumference, and single-heel rise. MRI was used to assess tendon continuity and healing, tendinosis, muscle atrophy, and bone marrow edema/stress fracture associated with anchor fixation in the calcaneus. MRI interpretation was performed by a single, blinded musculoskeletal radiologist. Results: Forty-three patients were identified with acute Achilles tendon ruptures. There were 36 patients (36/43, 84%) who underwent knotless Achilles tendon repair and agreed to participate in the study. The average time to clinical follow-up was 23.5 months (SD±16.3). The mean postoperative ATRS was 84.6 (SD±19.7). There was no significant difference in calf circumference (p=0.22), dorsiflexion (p=0.07), and plantarflexion (p=0.11) between the unaffected and surgical extremity at latest follow-up. One patient (1/36, 2.8%) experienced a re-rupture. There were no wound complications or neuritis. MRI was obtained in 26 patients (26/36, 72.2%) at an average of 17.5 months (SD±10.1). There were no MRI findings of distal stump tendinosis or calcaneal stress fractures. Thirty-two patients (32/36, 88.8%) returned to the same athletic activities one-year after surgery. Conclusion: There is paucity in the literature on functional outcomes following knotless Achilles tendon repair. In this multicenter study, we found that validated functional outcome scores and return to activity were similar to historical controls, with a low rate of surgical complications. MRI obtained in twenty-six patients (72.2%) at 17.5 months demonstrated an intact tendon without distal tendon stump stress shielding or calcaneal stress fracture. The knotless Achilles tendon repair is a unique surgical technique, minimizing suture burden and postoperative complications, while offering excellent functional outcomes and return to activity at two-year follow-up. The excellent clinical outcomes are corroborated by MRI.

scholarly journals Distal Triceps Tendon Injury

2022 ◽  
Vol 2 (1) ◽  
pp. 263502542110445
Author(s):  
John R. Matthews ◽  
Ryan W. Paul ◽  
Kevin B. Freedman
Keyword(s):  
Tendon Repair ◽  
Eccentric Contraction ◽  
Tendon Injury ◽  
Acute Onset ◽  
Gap Formation ◽  
Double Row ◽  
Highly Active ◽  
Left Posterior ◽  
Tendon Ruptures ◽  
Triceps Tendon

Background: Triceps tendon ruptures typically result from a forceful elbow eccentric contraction. The goal of a distal triceps tendon repair is to reattach the torn tendon back to the olecranon. Surgery is indicated for patients with complete rupture of the triceps tendon or symptomatic partial tears with failed conservative management. The complication rate occurs in 22% of patients postoperatively; however, only 0% to 4% of patients suffer a re-rupture of the tendon. Indications: We present a case of a highly active 38-year-old right-hand dominant man with acute onset of left posterior elbow pain following 1-handed pushup resulting in a complete distal triceps avulsion with 1.5 cm retraction. Technique: The distal triceps avulsion was repaired in a double row fashion using 2 double-loaded all-suture anchors in the medial row and anchor in the lateral row through a posterior approach. Results: Full anatomic footprint coverage was able to be achieved intraoperatively, and gentle range of motion from 0 to 90 degrees of flexion did not result in gap formation. Discussion/Conclusion: Successful outcomes with full anatomic footprint coverage of the distal triceps tendon can be achieved through a double row repair configuration.

scholarly journals Repair of a Chronic Triceps Tendon Rupture in a Dog Using an Autogenous Thoracolumbar Fascia Onlay Graft

VCOT Open ◽  
2021 ◽  
Vol 04 (01) ◽  
pp. e32-e36
Author(s):  
Christopher J. Wood ◽  
Ricky G. Cashmore
Keyword(s):  
Weight Bearing ◽  
Tendon Repair ◽  
Sinus Tract ◽  
Triceps Brachii ◽  
German Shepherd ◽  
Thoracolumbar Fascia ◽  
Onlay Graft ◽  
Thoracic Limb ◽  
Triceps Tendon Rupture ◽  
Triceps Tendon

AbstractA 5-year-old 38 kg entire male German Shepherd dog was referred for persistent non-weight bearing left thoracic limb lameness 5 weeks following failed triceps tendon repair. Physical exam revealed complete incompetence of the triceps mechanism with a large palpable defect proximal to the olecranon and when the shoulder was fixed in extension, the elbow could be fully flexed. A purulent draining tract was present on the caudolateral aspect of the distal brachium. Staged tendon repair was delayed until resolution of infection to allow for improved healing. Culture following surgical exploration of the traumatized area with resection of sinus tract and interposed fibro-granulomatous tissue yielded no growth. Definitive triceps brachii tendon repair was augmented with an autogenous thoracolumbar fascia onlay graft. Postoperatively, the repair was protected with a spica splint and the left thoracic limb immobilized with the elbow maintained in an extended position for 6 weeks. Re-evaluation 7 months later revealed the patient to be free of lameness. Disruption of the triceps brachii tendon is a rarely reported tendon injury with chronic disruption of triceps tendon associated with a guarded prognosis. To the authors knowledge, successful surgical repair of tendinous injury incorporating the use of an autogenous thoracolumbar fascia onlay graft has not previously been described.

scholarly journals Treatment of a Neglected Patellar Tendon Rupture with a Modified Surgical Technique: Ipsilateral Semitendinosus Autograft Reconstruction with Suture Tape Augmentation

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Sanjum P. Samagh ◽  
Fernando A. Huyke ◽  
Lucas Buchler ◽  
Michael A. Terry ◽  
Vehniah K. Tjong
Keyword(s):  
Surgical Technique ◽  
Patellar Tendon ◽  
Primary Repair ◽  
Tendon Repair ◽  
Acute Injury ◽  
Tendon Ruptures ◽  
Neglected Patellar Tendon Rupture ◽  
Straight Leg Raise ◽  
Tendon Autograft ◽  
Suture Tape

Patellar tendon ruptures are rare, but debilitating injuries are typically seen in young active males in the third and fourth decades of life. They can occur as a single acute injury or from repetitive microtrauma weakening the tendon. Patients typically present complaining of knee pain, swelling, and an inability to perform a straight leg raise. Most conventionally, these injuries are classified as acute (less than two weeks) or chronic (greater than two weeks) based upon the timing of presentation. In patients with patellar tendon ruptures and inability to perform a straight leg raise, patellar tendon repair is most often recommended. A subset of patients with chronic patellar tendon ruptures, however, presents several months after their initial injuries. These neglected patella tendon ruptures present a particularly challenging clinical scenario in which primary repair is often difficult or not possible. This case report describes a modification to an existing surgical technique for reconstructing the patellar tendon using an ipsilateral semitendinosus tendon autograft with suture tape augmentation.

scholarly journals A Novel “Shark-Fin” Pyramidal Achilles Bone-Tendon Allograft Surgical Technique for Delayed Reconstruction of Triceps Tendon Rupture and Review of the Literature

2021 ◽  
Vol 11 (6) ◽  
Author(s):  
Natalie Holmes ◽  
Mina Al-Janabi ◽  
Siddharth Virani ◽  
Jaikumar Relwani
Keyword(s):  
Surgical Technique ◽  
Literature Review ◽  
Reconstructive Surgical Procedures ◽  
Osteotomy Site ◽  
Full Thickness ◽  
Triceps Brachii ◽  
Tendon Allograft ◽  
Triceps Tendon Rupture ◽  
Triceps Tendon ◽  
Delayed Reconstruction

Introduction: Triceps tendon injuries are rare and often caused by direct trauma to the arm. There are no clear guidelines on the management of these and typically partial tears are treated conservatively whilst full thickness tears are treated with primary surgical repair. We aim to review the literature on the methods for triceps repair and propose a novel surgical technique. Methods: A “Medline” and “Embase” literature search of titles and abstracts combining “triceps brachii muscle,” “reconstruct/ed” or “reconstruction” alongside “reconstructive surgical procedures,” and further cross referenced with “repair/s/ed.” Excluded those related to brachial plexus injuries or general elbow trauma and removing duplicate results. 32 English results within 10 years were relevant and reviewed. Results: A 50-year-old gentleman with a 4-month-old full thickness triceps tear was repaired with a novel surgical technique of using an Achilles bone-tendon allograft fashioned into a “shark-fin” pyramidal shape and secured to the proximal ulnar in a lock and key type construct. The tendon was secured to the triceps remnant using a Krackow stitch. Complete radiological and clinical recovery was made by 18 months postoperatively with return to full physical activity. The literature review concluded no consensus in the method of treatment for delayed triceps reconstruction. Conclusion: The use of the bone-tendon allograft specifically shaped to fit congruently into an olecranon osteotomy site allows for direct bone-to-bone healing has not previously been mentioned in the literature. Results have been encouraging and the technique described is easily reproducible. Keywords: Triceps rupture, delayed, reconstruction, achilles allograft, surgical technique, literature review.

scholarly journals Triceps Ruptures After Fluoroquinolone Antibiotics: A Report of 2 Cases

2017 ◽  
Vol 9 (5) ◽  
pp. 474-476 ◽  
Author(s):  
Theodore B. Shybut ◽  
Ernest R. Puckett
Keyword(s):  
Sports Medicine ◽  
Tendon Rupture ◽  
Surgical Repair ◽  
Triceps Brachii ◽  
Fluoroquinolone Antibiotics ◽  
Triceps Tendon Rupture ◽  
Tendon Ruptures ◽  
Tendon Pathology ◽  
Triceps Tendon ◽  
Medicine Team

Rupture of the triceps brachii tendon is exceedingly rare, and surgical repair is generally indicated. Fluoroquinolone antibiotics have been implicated in tendon pathology, including tendon ruptures. Triceps rupture has not been previously reported in the setting of fluoroquinolone antibiotic therapy. We present 2 cases of triceps tendon rupture after treatment with fluoroquinolones. In both cases, triceps repair was performed with good outcomes. These cases highlight a risk of fluoroquinolone-induced tendinopathy to athletes. The sports medicine team should be aware of this risk and consider it when choosing antibiotics to treat athletes.

scholarly journals A Comparative Biomechanical Analysis of 2 Double-Row, Distal Triceps Tendon Repairs

2017 ◽  
Vol 5 (5) ◽  
pp. 232596711770830 ◽  
Author(s):  
Matthew A. Dorweiler ◽  
Rufus O. Van Dyke ◽  
Robert C. Siska ◽  
Michael A. Boin ◽  
Mathew J. DiPaola
Keyword(s):  
Tendon Repair ◽  
Biomechanical Properties ◽  
Double Row ◽  
Repair Technique ◽  
Significant Difference ◽  
Load To Failure ◽  
Tendon Ruptures ◽  
The Mean ◽  
Triceps Tendon ◽  
Double Row Repair

Background: Triceps tendon ruptures are rare orthopaedic injuries that almost always require surgical repair. This study tests the biomechanical properties of an original anchorless double-row triceps repair against a previously reported knotless double-row repair. Hypothesis: The anchorless double-row triceps repair technique will yield similar biomechanical properties when compared with the knotless double-row repair technique. Study Design: Controlled laboratory study. Methods: Eighteen cadaver arms were randomized into 2 groups. One group received the anchorless repair and the other received the knotless anchor repair. A materials testing system (MTS) machine was used to cycle the repaired arms from 0° to 90° with a 2.5-pound weight for 1500 cycles at 0.25 Hz. Real-time displacement of the tendon was measured during cycling using a probe. Load to failure was performed after completion of cyclic loading. Results: The mean displacement with the anchorless technique was 0.77 mm (SD, 0.25 mm) at 0° (full elbow extension) and 0.76 mm (SD, 0.38 mm) at 90° (elbow flexion). The mean displacement with the anchored technique was 0.83 mm (SD, 0.57 mm) at 0° and 1.01 mm (SD, 0.62 mm) at 90°. There was no statistically significant difference for tendon displacement at 0º ( P = .75) or 90º ( P = .31). The mean load to failure with the anchorless technique was 618.9 N (SD, 185.6 N), while it was 560.5 N (SD, 154.1 N) with the anchored technique, again with no statistically significant difference ( P = .28). Conclusion: Our anchorless double-row triceps repair technique yields comparable biomechanical properties to previously described double-row triceps tendon repair techniques, with the added benefit of avoiding the cost of suture anchors. Clinical Relevance: This anchorless double-row triceps tendon repair can be considered as an acceptable alternative to a knotless anchor repair for triceps tendon ruptures.

Return to Sport and Weightlifting Analysis Following Distal Biceps Tendon Repair

2021 ◽  
Author(s):  
Anirudh K. Gowd ◽  
Joseph N. Liu ◽  
Bhargavi Maheshwer ◽  
Grant H. Garcia ◽  
Edward C. Beck ◽  
...  
Keyword(s):  
Biceps Tendon ◽  
Tendon Repair ◽  
Return To Sport ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Biceps Tendon Repair

Bone suture anchor repair and functional outcome of a triceps tendon rupture, a rare clinical entity

2021 ◽  
Vol 14 (7) ◽  
pp. e241773
Author(s):  
Pieter Willem Johannes Lozekoot ◽  
Juul Jeanne Wilhelmus Tegels ◽  
Raoul van Vugt ◽  
Erik Robert de Loos
Keyword(s):  
Tendon Rupture ◽  
Suture Repair ◽  
Bone Anchor ◽  
Rare Injury ◽  
Accident And Emergency ◽  
Active Range Of Motion ◽  
Triceps Tendon Rupture ◽  
Elbow Function ◽  
Triceps Tendon ◽  
Anchor Suture

Triceps tendon rupture is rare and easily missed on presentation. A 58-year-old man was seen in our accident and emergency department with an inability to extend his right elbow against gravity after he fell. Ultrasound and MRI confirmed the suspected diagnosis of a traumatic triceps tendon rupture and excluded additional injuries. Surgical repair was carried out by a bone anchor suture reinsertion of the tendon to the olecranon. After 2 weeks of cast immobilisation, an early active range of motion (ROM) rehabilitation schedule was followed, resulting in excellent elbow function at 12 weeks postoperatively.In conclusion, it is important to suspect this rare injury and use additional studies to confirm the diagnosis of triceps tendon rupture. Also, good clinical outcome with regards to function can be achieved using bone anchor suture repair and an early active ROM rehabilitation schedule.

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