Surgical Repair of Distal Triceps Tendon Injuries: Short-Term Clinical Outcomes and Re-Rupture Rate

Abstract

Objectives:The purpose of this study is to describe the clinical, functional, and patient-reported outcomes of distal triceps tendon repairs, as well as to describe perioperative risk profile and re-rupture rates among those with or without pre-existing enthesopathy.Methods:Patients who underwent surgical repair of traumatic triceps tendon injuries between 2008 and 2016 were identified from the surgical database at a single institution. The electronic medical records were queried to determine demographic information, time from injury, mechanism of injury, extent of tear, pre-existing enthesopathy, and postoperative complications. Patients with arthritis, concomitant ligament surgery, and/or secondary rupture following previous elbow surgery were excluded. Follow-up outcome measures included the Mayo Elbow, Disabilities of the Arm, Hand, and Shoulder (QuickDASH), Veterans RAND (VR/SF-12), and Kerlan-Jobe Orthopaedic Clinic (KJOC) scores with a minimum of 1-year follow up.Results:A total of 88 patients (83 males, 5 females) with mean age of 47 years (range, 14-74) were identified with distal triceps tendon repairs at an average of 49 days (range, 1 to 3650 days) after injury. Sixty-nine patients (76.1%) returned for follow-up at average 3.99 years post-operatively (SD, 2.51). The most common mechanisms of injury were direct elbow trauma (45.4%), extension/lifting exercises (18.1%), overuse (13.6%), and hyperflexion or hyperextension (14.8%). Twenty patients were identified with pre-existing, symptomatic enthesophytes, and 68 tears were caused by acute injury; A total of 42 and 46 partial tendon tears were identified (Table 1). Bone tunnels were most commonly used (n=42, 47.7%), while direct sutures (n=31, 35.2%) and suture anchors (n=12, 13.6%) were also used. Postoperative complications occurred in 23.9% of patients, but no patients experienced re-rupture at time of final follow-up. Final postoperative patient-reported outcome measures are noted in Table 1. No statistically significant correlation was found between patient age (p=0.750), degree of tear (p=0.870), or surgical technique (p=0.740) and presence of perioperative complications.Conclusion:Despite heightened risk of perioperative complications after primary repair of distal triceps tendon injuries, the current series identifies favorable functional outcomes and no cases of re- rupture at short- to mid-term follow-up. Furthermore, age, surgical technique, and extent of tear were not associated with adverse patient outcomes in this investigation.Table 1:Outcomes by Presence of EnthesophytesOutcomesTotalEnthesophytesAcute TearP value Number 882068 Complete Tears 42240 <0.001 Complications (n) 21 (23.9%)9 (42.9%)12(17.9%) 0.019 Persistent pain/numbness/swelling1156.0101 Significant strength loss2020.159 Tendon calcification2200.163 Triceps thickening2110.471 Triceps adhesions1010.320 Olecranon cyst2110.471 Dehiscence1010.320 Sane ± SD 89.4 ± 18.181.2± 18.191.3 ± 17.10.191 VAS ± SD 0.881 ± 1.742.06 ± 2.920.550 ± 0.9430.062 KJOC±SD 84.5 ± 20.085.6 ± 17.584.2 ± 20.90.875 VR/SF-12±SD 0.793 ± 0.1190.768 ± 0.1650.802 ± 0.1030.590