Triceps Rupture: A Case Series, Anatomical Study of the Triceps Footprint and Description of Surgical Technique

Abstract

BackgroundDistal triceps tendon ruptures are rare accounting for less than 1% of all tendinous injuries in the upper extremity. Such injuries should be suspected in patients who have pain about the elbow following an eccentric contraction to the upper extremity. Complete ruptures should be treated with early surgical repair with reattachment of the tendon to the olecranon. Most reports to date have used suture fixation through olecranon drill holes. This study was performed to asses the anatomy of the triceps insertion and it's implications on the adequate fixation of the triceps tendon using a novel technique.MethodsTen cadaveric adult upper extremities with no signs of prior trauma or surgery were used in this study. The specimens were stripped of all skin and subcutaneous tissue through a direct posterior approach, to identify the triceps insertion. The insertion of the triceps tendon was then mapped and the area of the medial, long and lateral heads measured. Three cases of distal triceps rupture using this new open repair technique are also described using two distal drill holes and sutures augmented with a proximal anchor. Two of the three patients also needed LARS ligament augmentation at the time of surgery due to tissue loss.ResultsIn all cadaveric sections separate insertions were found consisting of the medial head and the conjoint tendons of the long and lateral heads. The mean surface areas for the medial and long/lateral insertions were 100.4 mm2and 307.9 mm2respectively. The mean total area for the triceps insertion was found to be 408.3 mm2. At follow up all cases were assessed using the Oxford Elbow Score, Mayo Elbow Performance Scores and Disabilities of the Arm, Shoulder and Hand Scores.ConclusionsWe have shown that the insertion of the triceps tendon is a “footprint” made from the tendon of the medial head and a conjoint tendon of the long and lateral heads. For cases of distal triceps rupture we have described an open procedure using a “double row footprint reconstruction” technique which we believe anatomically reconstructs the triceps insertion.