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Suture Repair of Distal Triceps Rupture with an Anatomic Transosseous Cruciate Construct

February 19, 2016

Contributors: Dylan Lowe, MD; Christopher S Ahmad, MD, FAAOS; David Kovacevic, MD; David Kovacevic, MD

INTRODUCTION: Distal triceps tendon injuries occur infrequently, but can leave the functionally high demand patient with significant loss of extension strength. Typically, complete tears and those larger than 50% are managed surgically in active patients. Initial techniques utilizing primary transosseous suture repair have reported re-tear rates up to 13%, which subsequently led to the adoption of suture anchor technology. These contemporary techniques can require several anchors, calling into question the cost effectiveness of such repair constructs. This video presents an anatomic transosseous cruciate repair technique using suture for the treatment of complete distal triceps rupture.

METHODS: Performing an anatomic double-row repair due to superior failure loads, minimal gapping, and improved footprint restoration compared to transosseous repair or single-row repair constructs is desirable. However, suture anchor malposition can lead to articular surface embarrassment. The anatomic transosseous cruciate suture repair provides secure initial fixation and stability during the healing phase, while minimizing risk of joint penetration.

RESULTS: We demonstrate the technique for anatomic transosseous cruciate repair with suture in a case of acute, traumatic distal triceps rupture in a highly active patient. The senior author has utilized this surgical technique in four patients, with all regaining full elbow motion, strength, and return to work or sport by six months. The salient aspects of the technique are highlighted and the rationale behind the approach is reviewed.

DISCUSSION AND CONCLUSION: With significant advancements in suture anchor technology, several new techniques have been described for the surgical management of distal triceps rupture. Determining clinical superiority with transosseous suture repair over single- or double-row suture anchor repair constructs is challenging as most published reports are small case series with short-term follow up. The technique described in this video makes full use of both anatomic and transosseous repair principles using suture only to create a robust fixation construct that optimizes footprint restoration, while providing a cost-conscious solution to suture anchor repair techniques for complete distal triceps rupture.

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