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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 may result in considerable loss of extension strength in patients with high functional demands. Typically, complete tears and tears larger than 50% in active patients are managed surgically. Initial techniques for primary transosseous suture repair were associated with re-tear rates as high as 13%, which led to the adoption of suture anchor technology. These contemporary techniques may require several anchors, which calls into question the cost effectiveness of such repair constructs. This video demonstrates an anatomic transosseous cruciate repair technique with the use of suture for the management of complete distal triceps rupture. Methods: Anatomic double-row repair is preferred over transosseous repair or single-row repair because it is associated with superior failure loads, minimal gapping, and improved footprint restoration. However, suture anchor malpositioning may lead to articular surface embarrassment. Anatomic transosseous cruciate suture repair affords secure initial fixation and stability during the healing phase and minimizes the risk of joint penetration. Results: The video demonstrates the technique for anatomic transosseous cruciate repair with the use of suture in a highly active patient with an acute, traumatic distal triceps rupture. The senior author has used this surgical technique in four patients, all of whom regained full elbow motion and strength and returned to work or sports activity by 6 months postoperatively. The salient aspects of the technique are highlighted, and the rationale behind the approach is reviewed. Discussion and Conclusion: With substantial advancements in suture anchor technology, several new techniques have been described for the surgical management of distal triceps rupture. Determining the clinical superiority of transosseous suture repair over single- or double-row suture anchor repair constructs is a challenge because most published reports are small case series with short-term follow-up. The technique described in this video involves the use of anatomic and transosseous repair principles, using suture alone to create a robust fixation construct that optimizes footprint restoration. This technique is a cost-conscious solution to suture anchor repair techniques for the management of complete distal triceps rupture.

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