|
1
|
Abate B, Coppola M, Bardellini G, Martinelli F, Celli A, Celli L. ARTT Approach to Total Elbow Arthroplasty Devised for Post-Trauma Patients: Preliminary Results. J Clin Med 2025; 14:2901. [PMID: 40363933 PMCID: PMC12072726 DOI: 10.3390/jcm14092901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2025] [Revised: 04/18/2025] [Accepted: 04/20/2025] [Indexed: 05/15/2025] Open
Abstract
Background: An increasing number of total elbow arthroplasty (TEA) procedures are performed in trauma patients every year through a variety of approaches. We have devised the Anconeus-reflected Triceps tongue (ARTT) approach for TEA, which optimizes soft tissue management and implant placement, particularly in post-trauma patients, where extensive scar tissue and/or marked bone deformity hamper joint exposure and carry a risk of component malposition. We describe the ARTT surgical technique, discuss its advantages, and report its preliminary results. Methods: Six consecutive patients with malunion of the articular elbow surfaces with severe soft tissue retraction and multiple previous surgeries underwent TEA using the ARTT approach, which spares the triceps tendon insertion on the olecranon and reflects the anconeus and triceps muscles as one. Results: At a mean follow-up of 29 months, the Mayo Elbow Performance Score had increased from 39 to 95 points, whereas the visual analog score for pain had fallen from 7.5 to 1. None of the patients had insufficiency or secondary detachment of the triceps tendon and all achieved grade 4 or 5 on the Medical Research Council scale. Discussion: The ARTT approach provides enhanced joint exposure, resulting in the preservation of the triceps tendon insertion on the olecranon and enabling earlier active rehabilitation. Our preliminary results indicate that it is a viable alternative to traditional techniques, particularly in post-trauma patients with severe elbow dysfunction, who often suffer from extensive scarring, soft tissue damage, and bone deformity.
Collapse
Affiliation(s)
| | | | | | | | - Andrea Celli
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Via Arqua 80, 41125 Modena, Italy; (B.A.); (M.C.); (G.B.); (F.M.); (L.C.)
| | | |
Collapse
|
|
2
|
Habis AA, Nguyen K, Chan J, Anam E, Bicknell RT, Ploeg HL, Daneshvar P. Triceps insertion violation from commonly applied olecranon plating system: a comparison. JSES Int 2025; 9:326-331. [PMID: 39898230 PMCID: PMC11784505 DOI: 10.1016/j.jseint.2024.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2025] Open
Abstract
Background Surgeons generally avoid compromising tendon insertions during fracture fixation; however, it is a common practice to violate the triceps tendon insertion during olecranon plate fixation. The assumption in these procedures is that minimal triceps insertion is disrupted. The purpose of this study was to quantify the degree of triceps insertion that is violated, intentionally peeled off, by commonly utilized olecranon plating systems. The secondary objectives are to measure the surface area of the triceps insertion and olecranon using a 3-dimensional (3D) technique and compare them to 2 similar papers that were done using 2-dimensional (2D) measurements. Evaluating the amount of olecranon plates' violation to the triceps insertion was not one of the objectives of those papers. It was hypothesized that olecranon plate fixation violates a larger portion of the triceps footprint than previously thought. Methods Six olecranon plate designs and 12 cadaveric upper-extremity specimens were used. Olecranon plates, triceps insertion footprints, and olecranon surface areas were digitized as 3D surface models with a laser scanner (SG100; ShapeGrabber Inc., Ottawa, Canada). The violated triceps insertion footprint area, required to accommodate the plate surface on the olecranon, was calculated using 3D modeling software (MeshLab; ISTI - CNR Research Center, Pisa, Italy). Results were compared with both 2D and 3D measurements and the 2D surface area measurements of 2 previous studies. Results The median triceps insertion footprint violation for 6 common olecranon plates was 46% (range, 40%-62%) using 3D analysis, and 47% (range, 41%-64%) using 2D analysis. The greatest footprint violations were observed with Synthes - Wide VA at 62% and Smith-Nephew Peri-LOC (Smith & Nephew, Andover, MA, USA) plates at 58%, while the least violation was seen with Wright Medical EPS (Wright Medical, Memphis, TN, USA) and Synthes - Extended (DePuy Synthes, Raynham, MA, USA) plates at 40%. The median triceps insertion surface area was 254 mm2 (range, 193-348 mm2) and 260 mm2 (range, 171-364 mm2) using 2D and 3D methods, respectively. Median olecranon surface area was 645 mm2 (range, 478-775 mm2) and 573 mm2 (range, 411-722 mm2) by 2D and 3D methods, respectively. Conclusions Many commonly used olecranon plating systems violate a large portion of the triceps insertion footprint which is up to 62% in this study. A better understanding of the triceps insertion footprint, olecranon anatomy, and clinical implications of triceps footprint disruption may lead to improvements in olecranon plate design and postoperative outcomes. Future studies should assess the possibility of any clinical implications of triceps insertion disruption.
Collapse
Affiliation(s)
- Ahmed A. Habis
- Faculty of Medicine, Department of Orthopaedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Surgery, Queen’s University, Kingston, ON, Canada
| | - Kevin Nguyen
- Centre for Health Innovation, Queen’s University, Kingston, ON, Canada
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada
| | - Julie Chan
- Department of Surgery, Queen’s University, Kingston, ON, Canada
| | - Emad Anam
- Faculty of Medicine, Department of Orthopaedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Surgery, Queen’s University, Kingston, ON, Canada
| | - Ryan T. Bicknell
- Department of Surgery, Queen’s University, Kingston, ON, Canada
- Centre for Health Innovation, Queen’s University, Kingston, ON, Canada
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada
| | - Heidi-Lynn Ploeg
- Centre for Health Innovation, Queen’s University, Kingston, ON, Canada
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada
| | - Parham Daneshvar
- Department of Surgery, Queen’s University, Kingston, ON, Canada
- Centre for Health Innovation, Queen’s University, Kingston, ON, Canada
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada
| |
Collapse
|
|
3
|
Haft M, MacKenzie JS, Shi BY, Ali I, Jenkins S, Nguyen D, van Riet R, Srikumaran U. Biomechanical strength of triceps tendon repairs: systematic review and meta-regression analysis of human cadaveric studies. Musculoskelet Surg 2024; 108:153-162. [PMID: 38713360 DOI: 10.1007/s12306-024-00817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/23/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE It is unclear which triceps tendon repair constructs and techniques produce the strongest biomechanical performance while minimizing the risk of gap formation and repair failure. We aimed to determine associations of construct and technique variables with the biomechanical strength of triceps tendon repairs. PubMed, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov were systematically searched for peer-reviewed studies on biomechanical strength of triceps tendon repairs in human cadavers. 6 articles met the search criteria. Meta-regression was performed on the pooled dataset (123 specimens). Outcomes of interest included gap formation, failure mode, and ultimate failure load. Covariates were fixation type; number of implants; and number of sutures. Stratification by covariates was performed. We found no association between fixation type and ultimate failure load; however, suture anchor fixation was associated with less gap formation compared with transosseous direct repair (β = - 1.1; 95% confidence interval [CI]:- 2.2, - 0.04). A greater number of implants was associated with smaller gap formation (β = - 0.77; 95% CI: - 1.3, - 0.28) while a greater number of sutures was associated with higher ultimate failure load ( β= 3; 95% CI: 21, 125). In human cadaveric models, the number of sutures used in triceps tendon repairs may be more important than the fixation type or number of implants for overall strength. If using a transosseous direct repair approach to repair triceps tendon tears, surgeons may choose to use more sutures in their repair in order to balance the risk of larger gap formation when compared to indirect repair techniques. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- M Haft
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA.
| | - J S MacKenzie
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - B Y Shi
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - I Ali
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - S Jenkins
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - D Nguyen
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - R van Riet
- Department of Orthopedic Surgery, University Hospital Antwerp, Edegem, Belgium
| | - U Srikumaran
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| |
Collapse
|
|
4
|
Chapleau J, Joly-Chevrier M, Tohmé P, El-Kayem E, Petit Y, Rouleau DM. A novel fragment specific classification of complex olecranon fractures: 3-dimensional model design, radiological validation, and proposed surgical algorithm. J Shoulder Elbow Surg 2024; 33:1084-1091. [PMID: 38365170 DOI: 10.1016/j.jse.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/04/2023] [Accepted: 12/25/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Current classifications for proximal ulna fracture patterns rely on qualitative data and cannot inform surgical planning. We propose a new classification system based on a biological and anatomical stress analysis. Our hypothesis is that fragment types in complex fractures can be predicted by the tendon and ligament attachments on the proximal ulna. METHODS First, we completed a literature review to identify quantitative data on proximal ulna soft tissue attachments. On this basis, we created a 3-dimensional model of ulnar anatomy with SliceOMatic and Catia V5R20 software and determined likely locations for fragments and fracture lines. The second part of the study was a retrospective radiological study. A level-1 trauma radiological database was used to identify computed tomography scans of multifragmentary olecranon fractures from 2009 to 2021. These were reviewed and classified according to the "fragment specific" classification and compared to the Mayo and the Schatzker classifications. RESULTS Twelve articles (134 elbows) met the inclusion criteria and 7 potential fracture fragments were identified. The radiological study included 67 preoperative computed tomography scans (mean 55 years). The fragments identified were the following: posterior (40%), intermediate (42%), tricipital (100%), supinator crest (25%), coronoid (18%), sublime tubercle (12%), and anteromedial facet (18%). Eighteen cases (27%) were classified as Schatzker D (comminutive) and 21 (31%) Mayo 2B (stable comminutive). Inter-rater correlation coefficient was 0.71 among 3 observers. CONCLUSION This proposed classification system is anatomically based and considers the deforming forces from ligaments and tendons. Having a more comprehensive understanding of complex proximal ulna fractures would lead to more accurate fracture evaluation and surgical planning.
Collapse
Affiliation(s)
- Julien Chapleau
- Department of Orthopedic Surgery, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Patrick Tohmé
- Department of Orthopedic Surgery, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Elie El-Kayem
- Department of Orthopedic Surgery, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Yvan Petit
- Research Center, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Dominique M Rouleau
- Department of Orthopedic Surgery, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
| |
Collapse
|
|
5
|
Trizepssehnenrupturen. ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-022-00572-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
|
|
6
|
Ritsch M, Regauer M, Schoch C. [Surgical treatment of distal triceps tendon ruptures]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2022; 34:438-446. [PMID: 36094541 DOI: 10.1007/s00064-022-00781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/21/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Restoration of the anatomy and the original length of the muscle-tendon unit in triceps tendon ruptures. INDICATIONS Acute and chronic triceps tendon ruptures with persisting symptoms and significant strength deficits. CONTRAINDICATIONS Infections and tumors in the surgical area. SURGICAL TECHNIQUE Prone position. Skin incision over the distal triceps in a lateral direction around the olecranon. Mobilization of the tendon and débridement of the olecranon. Drilling of 2 × 2.9 mm suture anchor holes medial and lateral into the footprint of the olecranon. In addition, drilling through the olecranon 12 mm distal to the tip of the olecranon and transosseous introduction of 4 sutures. Then the suture anchors (all-suture or titanium anchors) are inserted into the drill holes. Refix the deep and superficial tendons with the anchor threads. Refix the upper tendon portions with the transosseous sutures. In the case of chronic lesions, a graft interposition is necessary. POSTOPERATIVE MANAGEMENT Dorsal 10 ° splint, then change to an orthosis fixed in 20 ° extension and passive mobility 0-30 ° flexion for 6 weeks. From the 7th week onwards, load-free, physiotherapeutically controlled increasing mobilization. Starting weight-loading from the 13th week on. Full load after 6 months. RESULTS In all, 34 male strength athletes with acute triceps tendon rupture underwent surgery using the hybrid technique described and were prospectively recorded. The MEPS‑G score averaged 94.7 points, there were no permanent limitations in mobility, and the postoperative strength ability averaged 94% of the original strength performance ability. The return to sport achieved 100%. The complication rate was 20.6%. Reconstruction of the distal triceps tendon using hybrid technology leads to very good functional results. Half of all patients complained of symptoms even before the rupture, which suggests previous damage to the distal triceps tendon caused by degeneration.
Collapse
Affiliation(s)
- Mathias Ritsch
- sportortho-ro, Schön-Klinik Vogtareuth, Luitpoldstr. 4, 83022, Rosenheim, Deutschland.
| | - Markus Regauer
- sportortho-ro, Schön-Klinik Vogtareuth, Luitpoldstr. 4, 83022, Rosenheim, Deutschland
| | | |
Collapse
|
|
7
|
Kholinne E, Kwak JM, Heo Y, Hwang SJ. The anatomic - magnetic resonance imaging study of distal triceps brachii tendon. J Orthop Surg (Hong Kong) 2022; 30:10225536221122262. [PMID: 36165331 DOI: 10.1177/10225536221122262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The study aimed to describe the distal triceps brachii insertion on the olecranon and to correlate the findings with those seen in normal MR (Magnetic Resonance) anatomy of the triceps brachii insertion. MATERIALS AND METHODS 14 un-paired fresh frozen elbows were included according to the institution guidelines and dissected. Histologic examination was performed to the distal triceps brachii insertion. The dimension of the distal triceps brachii tendon insertion was measured and defined based on its layer. The measurement of distal triceps brachii insertion was performed with image processing program (Image J, National Institute of Health, Bethesda, Maryland). T1-weighted elbow MR images (3.0 T) of a 102 patients were acquired and analyzed according to its sagittal plane. RESULTS All specimens shows that distal triceps brachii tendon is with three distinct insertional areas in the olecranon which are: (1) capsular, (2) deep muscular, (3) superficial tendinous insertion with the areas of 80.7 mm2, 56.4 mm2, and 175.2 mm2, respectively. The superficial tendinous insertion was observed with a thickened portion, the "central cord" with 0.5 occupation ratio. MR analysis showed that 30% (31/102) of the distal biceps brachii insertion was with a cleft between the bipartite insertion of the superficial tendinous and the deep muscular insertion on olecranon which designated as the "lacuna" which was also found in 35% (5/14) of the specimens. CONCLUSIONS The distal triceps brachii has three distinct insertion on the olecranon. The superficial tendinous layer was separated with the deep muscular layer by a cleft in one third of the cases. Knowledge of this anatomy will help surgeon to understand the partial triceps injury and to avoid iatrogenic injury to the distal triceps tendon during surgery.
Collapse
Affiliation(s)
- Erica Kholinne
- Faculty of Medicine, 64752Universitas Trisakti, Department of Orthopedic Surgery, St Carolus Hospital, Jakarta, Indonesia
| | - Jae-Man Kwak
- Department of Orthopaedic Surgery, Uijeongbu Eulji Medical Center, College of Medicine, 587171Eulji University, Uijeongbu, South Korea
| | - Yijin Heo
- Department of Anatomy, 37994University of Ulsan, Seoul, Korea
| | - Seung-Jun Hwang
- Department of Anatomy, 37994University of Ulsan, Seoul, Korea
| |
Collapse
|
|
8
|
Distal Triceps Tendon Tears: Magnetic Resonance Imaging Patterns Using a Systematic Classification. J Comput Assist Tomogr 2022; 46:224-230. [PMID: 35081601 DOI: 10.1097/rct.0000000000001265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate distal triceps tendon tear patterns using a systematic classification based on the tendon's layered structure. METHODS We retrospectively identified Magnetic resonance imaging (MRI) examinations with triceps tendon tears that underwent reconstructive surgery. Magnetic resonance images were reviewed independently by 2 musculoskeletal radiologists to determine tendon layer involvement and ancillary findings, including tear size, involvement of triceps lateral expansion, and presence of olecranon bursal fluid. Surgical reports were scrutinized for level of anatomic detail and correlation with imaging findings. RESULTS We identified 69 triceps tendon tears in 68 subjects (61 men, 7 women; mean age, 45 ± 12 years) who underwent surgical reconstruction. On MRI, the superficial layer was always involved with either a partial or full-thickness tear. The most common tear pattern was a combination of superficial layer full-thickness tear with deep layer partial tear (25 of 69 [36%]). Mean tear length was 24 ± 12 mm. We found no cases of isolated deep layer tears. Involvement of triceps lateral expansion and presence of bursal fluid correlated positively with tear severity of superficial and deep layers (P < 0.001). Detailed surgical correlation was limited, with only 9 of 69 (13%) of surgical reports containing information specifically addressing individual tendon layers. CONCLUSIONS Triceps tendon tears show tear patterns following its layered structure and can be assessed by MRI. Radiologists and surgeons are encouraged to describe tear patterns considering both superficial and deep tendon layers.
Collapse
|
|
9
|
Ritsch M. Bizeps- und Trizepssehnenrupturen im Kraftsport. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00486-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
|
10
|
Zacharia B, Roy A. A clinicoradiological classification and a treatment algorithm for traumatic triceps tendon avulsion in adults. Chin J Traumatol 2021; 24:266-272. [PMID: 33941433 PMCID: PMC8563844 DOI: 10.1016/j.cjtee.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/08/2021] [Accepted: 02/09/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Triceps tendon avulsion (TTA) is an uncommon injury, and there are no classifications or treatment guidelines available. This study aims to describe a clinicoradiological classification and treatment algorithm for traumatic TTA in adults. The functional outcome of surgical repair has been evaluated too. METHODS A retrospective analysis of adult patients with traumatic TTA treated in our institution between January 2012 and December 2017 was done. We only included complete TTA injuries. Children below 15 years, with open injuries, associated fractures, or partial TTA were excluded. The data were obtained from hospital records. The intraoperative findings were correlated with the clinicoradiological presentation for classifying TTA. The functional outcome was analyzed using the Mayo Elbow Performance index and Hospital for Special Surgery elbow score. ANOVA test was used to assess the statistical significance. RESULTS There were 15 patients included, 11 males and 4 females. The mean age was (31.5 ± 9.15) years, and the mean follow-up was (22.4 ± 8.4) months. Fall on outstretched hand was the mode of injury. In 6 patients, diagnosis was missed on the initial visit. TTA were classified as Type I: palpable soft-tissue defect without bony mass; Type II: palpable soft-tissue defect with a wafer-thin/comminuted bony fragment on X-ray; Type III: palpable soft-tissue defect with a bony mass and a large bony fragment on X-ray without extension to the articular surface; and Type IV: an olecranon fracture with less than 25% of the articular surface. An algorithm for treatment was recommended, i.e. transosseous suture repair/suture anchor for Type I, transosseous suture repair for Type II, and tension band wiring or steel wire sutures for Types III and IV. All the patients achieved good to excellent outcome: the mean Mayo Elbow Performance index was 100 and Hospital for Special Surgery score was 98.26 ± 2.60 on final follow-up. CONCLUSION Our clinicoradiological classification and treatment algorithm for TTAs is simple. Surgical treatment results in excellent functions of the elbow. Since it is a single-center study involving a very small number of cases, a multicenter study with a larger number of patients is required for external validation of our classification and treatment recommendations.
Collapse
Affiliation(s)
- Balaji Zacharia
- Department of Orthopedics, Govt. Medical College, Kozhikkode, 673008, Kerala, India,Department of Arthroscopy, Ganga Hospital, Coimbatore, 641043, Tamilnadu, India,Corresponding author. Department of Orthopedics, Govt. Medical College, Kozhikkode, 673008, Kerala, India.
| | - Antony Roy
- Department of Orthopedics, Govt. Medical College, Kozhikkode, 673008, Kerala, India,Department of Arthroscopy, Ganga Hospital, Coimbatore, 641043, Tamilnadu, India
| |
Collapse
|
|
11
|
Kheiran A, Pandey A, Pandey R. Common tendinopathies around the elbow; what does current evidence say? J Clin Orthop Trauma 2021; 19:216-223. [PMID: 34150494 PMCID: PMC8190485 DOI: 10.1016/j.jcot.2021.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 01/21/2023] Open
Abstract
Tendinopathies are common causes of pain around the elbow resulting in significant functional impairment in athletes or the working-age population. Patients complain of a gradual onset pain with or without any specific trauma. Tissue histology shows chronic fibroblast and vascular proliferation, with a disorganized collagen pattern and absence of inflammatory mediators. Currently, numerous treatment options are described, but many of these are only supported by a heterogenous evidence base. Thus, management guidelines are difficult to define. Surgery is mostly indicated in selected cases that have failed non-operative management. This article reviews the pathophysiology and natural history of lateral and medial elbow tendinopathies, as well as distal biceps and triceps tendinopathies, and their current treatment options.
Collapse
Affiliation(s)
- Amin Kheiran
- Shoulder & Elbow Unit, University Hospitals of Leicester, Leicester, UK
| | - Aditi Pandey
- University College of London Hospital, London, UK
| | - Radhakant Pandey
- Shoulder & Elbow Unit, University Hospitals of Leicester, Leicester, UK,Corresponding author. University Hospitals of Leicester Leicester, LE5 4PW, UK
| |
Collapse
|
|
12
|
Akamatsu FE, Negrão JR, Rodrigues MB, Itezerote AM, Saleh SO, Hojaij F, Andrade M, Jacomo AL. Is there something new regarding triceps brachii muscle insertion? Acta Cir Bras 2020; 35:e202001007. [PMID: 33237178 PMCID: PMC7709896 DOI: 10.1590/s0102-865020200100000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/19/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Previous studies have questioned whether the triceps brachii muscle tendon (TBMT) has a double or single insertion on the ulna. Aiming to provide an answer, we describe the anatomy of the TBMT and review a magnetic resonance imaging (MRI) series of the elbow. METHODS Forty-one elbows were dissected to assess the details of the triceps brachii insertion. Elbow plastination slices were analyzed to determine whether there was a space on the TBMT. Magnetic resonance imaging from the records of the authors were also obtained to demonstrate the appearance of the pre-tricipital space on MRI. RESULTS A virtual space on the medial aspect near the TBTM insertion site in the olecranon was consistently found on anatomic dissections. It was a distal pre-tricipital space. Magnetic resonance imaging demonstrated the appearance of the pre-tricipital space on MRI, and its extension was measured longitudinally either in elbow flexion or extension. There was no statistically significant difference between the measurements of this space in the right and left elbows or between flexion and extension (p > 0.05). The coefficient of variation was <10% for all measurements. CONCLUSION Knowledge of this structure may be essential to avoid incorrect diagnosis and unnecessary therapeutic interventions.
Collapse
|
|
13
|
Abstract
Distal triceps ruptures are uncommon, usually caused by a fall on an outstretched hand or a direct blow. Factors linked to injury include eccentric loading of a contracting triceps, anabolic steroid use, weightlifting, and traumatic laceration. Risk factors include local steroid injection, hyperparathyroidism, and olecranon bursitis. Initial diagnosis can be complicated by pain and swelling, and a palpable defect is not always present. Plain radiographs can be helpful. MRI confirms the diagnosis and directs treatment. Incomplete tears can be treated nonsurgically; complete tears are best managed surgically. Good to excellent restoration of function has been shown with surgical repair.
Collapse
|
|
14
|
Distal insertional anatomy of the triceps brachii muscle: MRI assessment in cadaveric specimens employing histologic correlation and Play-doh ® models of the anatomic findings. Skeletal Radiol 2020; 49:1057-1067. [PMID: 31993688 DOI: 10.1007/s00256-020-03382-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Assess the insertional anatomy of the distal aspect of the triceps brachii muscle using magnetic resonance imaging (MRI) in cadavers with histologic correlation and Play-doh® models of the anatomic findings. MATERIALS Elbows were obtained from twelve cadaveric arm specimens by transverse sectioning through the proximal portion of the humerus and the midportion of the radius and ulna. MRI was performed in all elbows. Two of the elbow specimens were then dissected while ten were studied histologically. Subsequently, Play-doh® models of the anatomic findings of the distal attachment sites of the triceps brachii muscle were prepared. RESULTS MRI showed a dual partitioned appearance of the distal attachment sites into the olecranon in all specimens. In the deeper tissue planes, the medial head muscle insertion was clearly identified while superficially, the terminal portion of the long and lateral heads appeared as a conjoined tendon. Histologic analysis, however, showed continuous tissue rather than separate structures attaching to the olecranon. CONCLUSION Although MRI appeared to reveal separate and distinct attachments of the triceps brachii muscle into the olecranon, histologic analysis delineated complex but continuous tissue related to the attachments of the three heads of this muscle. The Play-doh® models were helpful for the comprehension of this complex anatomy and might serve as a valuable educational tool when applied to the analysis of other musculoskeletal regions.
Collapse
|
|
15
|
Abstract
CLINICAL/METHODICAL ISSUE Muscular injuries represent the most common musculoskeletal lesions. Especially in professional athletes an imaging clarification is essential in order to define the exact location of the lesion, the affected muscles, the extent and degree of the injury as well as to define possible concomitant complications. The best possible therapy can be initiated and a necessary rest period for a low risk resumption of sporting activity can be individually specified. STANDARD RADIOLOGICAL METHODS/METHODICAL INNOVATIONS Due to technical improvements, for example mobile devices and thus increased rapid availability as well as relative cost-effectiveness compared to other modalities, the imaging evaluation of muscle injury would nowadays be unthinkable without ultrasound. PERFORMANCE The article discusses general prerequisites for the performance of muscle ultrasound as well as a standardized examination algorithm of muscle injuries beginning with general and leading to special tips and tricks. ACHIEVEMENTS/PRACTICAL RECOMMENDATIONS Despite the known investigator dependence, ultrasound enables a reliable and unerring imaging clarification of muscle injuries. For this reason, ultrasound should be considered as the first-line diagnostic imaging modality when dealing with muscle trauma.
Collapse
|
|
16
|
Vannabouathong C, Ayeni OR, Bhandari M. A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544118809050. [PMID: 30450008 PMCID: PMC6236480 DOI: 10.1177/1179544118809050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/16/2018] [Indexed: 11/15/2022]
Abstract
Avulsion fractures compromise function and movement at the affected joint. If
left untreated, it can lead to deformity, nonunion, malunion, pain, and
disability. The purpose of this review was to identify and describe the
epidemiology and available treatment options for common avulsion fractures of
the upper and lower extremities. Current evidence suggests that optimal
treatment is dependent on the severity of the fracture. Conservative efforts
generally include casting or splinting with a period of immobilization. Surgery
is typically indicated for more severe cases or if nonoperative treatments fail;
patient demographics or preferences and surgeon experience may also play a role
in decision making. Some avulsion fractures can be surgically managed with any
one of various techniques, each with their own pros and cons, and often there is
no clear consensus on choosing one technique over another; however, there is
some research suggesting that screw fixation, when possible, may offer the best
stability and compression at the fracture site and earlier mobilization and
return to function. Physicians should be mindful of the potential complications
associated with each intervention.
Collapse
Affiliation(s)
| | - Olufemi R Ayeni
- Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
|
17
|
Carpenter SR, Stroh DA, Melvani R, Parks BG, Camire LM, Murthi AM. Distal triceps transosseous cruciate versus suture anchor repair using equal constructs: a biomechanical comparison. J Shoulder Elbow Surg 2018; 27:2052-2056. [PMID: 30093233 DOI: 10.1016/j.jse.2018.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/09/2018] [Accepted: 05/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND/HYPOTHESIS Suture anchor-based repair has been advocated for repair of distal triceps avulsion, but previous models have used an unequal number of sutures across the repair site. We hypothesized that there would be no difference in triceps tendon displacement between gold standard repair with transosseous cruciate bone tunnels and suture anchor repair with an equal number of sutures in the constructs. METHODS The triceps tendon footprint was measured in 20 cadaveric elbows (10 matched pairs), and a distal triceps tendon rupture was created. The specimens in each pair were randomly assigned to transosseous cruciate repair or knotless, double-row, anatomic footprint, suture anchor repair. Specimens underwent cyclic loading to 1500 cycles and then load to failure. Footprint uncoverage was measured at 1500 cycles. Data for medial and lateral triceps tendon displacement, footprint uncoverage, and failure load were obtained. RESULTS Triceps displacement did not differ significantly between the transosseous cruciate and the suture anchor repair group at 1500 cycles on the medial (3.6 ± 0.9 mm vs. 4.3 ± 1.6 mm [mean ± standard deviation], respectively; P = .27) and lateral side (3.1 ± 1.2 mm vs. 2.0 ± 1.2 mm, respectively; P = .06). No other differences were found between the constructs. DISCUSSION/CONCLUSION Transosseous cruciate distal triceps repair and knotless double-row suture anchor repair using constructs with an equal number of sutures showed no significant difference in tendon displacement at 1500 loading cycles. These findings suggest that the biomechanical strength of an all-suture construct is not different from that of suture anchors for repair of distal triceps avulsions.
Collapse
Affiliation(s)
- Shannon R Carpenter
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - D Alex Stroh
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Roshan Melvani
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Brent G Parks
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Lyn M Camire
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA.
| | - Anand M Murthi
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| |
Collapse
|
|
18
|
Scheiderer B, Imhoff FB, Morikawa D, Lacheta L, Obopilwe E, Cote MP, Imhoff AB, Mazzocca AD, Siebenlist S. The V-Shaped Distal Triceps Tendon Repair: A Comparative Biomechanical Analysis. Am J Sports Med 2018; 46:1952-1958. [PMID: 29763339 DOI: 10.1177/0363546518771359] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Restoring footprint anatomy, minimizing gap formation, and maximizing the strength of distal triceps tendon repairs are essential factors for a successful healing process and return to sport. HYPOTHESIS The novel V-shaped distal triceps tendon repair technique with unicortical button fixation closely restores footprint anatomy, provides minimal gap formation and high ultimate failure load, and minimizes iatrogenic fracture risk in acute/subacute distal triceps tendon tears. STUDY DESIGN Controlled laboratory study. METHODS Twenty-four cadaveric elbows (mean ± SD age, 66 ± 5 years) were randomly assigned to 1 of 3 repair groups: the transosseous cruciate repair technique (gold standard), the knotless suture-bridge repair technique, and the V-shaped distal triceps tendon repair technique. Anatomic measurements of the central triceps tendon footprint were obtained in all specimens with a 3-dimensional digitizer before and after the repair. Cyclic loading was performed for a total of 1500 cycles at a rate of 0.25 Hz, pulling in the direction of the triceps. Displacements were measured on the medial and lateral tendon sites with 2 differential variable reluctance transducers. Load to failure and construct failure mode were recorded. RESULTS The mean triceps bony insertion area was 399.05 ± 81.23 mm2. The transosseous cruciate repair technique restored 36.6% ± 16.8% of the native tendon insertion area, which was significantly different when compared with the knotless suture-bridge repair technique (85.2% ± 14.8%, P = .001) and the V-shaped distal triceps tendon repair technique (88.9% ± 14.8%, P = .002). Mean displacement showed no significant difference between the V-shaped distal triceps tendon repair technique (medial side, 0.75 ± 0.56 mm; lateral side, 0.99 ± 0.59 mm) and the knotless suture-bridge repair technique (1.61 ± 0.97 mm and 1.29 ± 0.8 mm) but significance between the V-shaped distal triceps tendon repair technique and the transosseous cruciate repair technique (4.91 ± 1.12 mm and 5.78 ± 0.9 mm, P < .001). Mean peak failure load of the V-shaped distal triceps tendon repair technique (732.1 ± 156.0 N) was significantly higher than that of the knotless suture-bridge repair technique (505.4 ± 173.9 N, P = .011) and the transosseous cruciate repair technique (281.1 ± 74.8 N, P < .001). Mechanism of failure differed among the 3 repairs, with the only olecranon fracture occurring in the knotless suture-bridge repair technique at the level of the lateral row suture anchors. CONCLUSION At time zero, the V-shaped distal triceps tendon repair technique and the knotless suture-bridge repair technique both provided anatomic footprint coverage. Ultimate load to failure was highest for the V-shaped distal triceps tendon repair technique, while gap formation was different only in comparison with the transosseous cruciate repair technique. CLINICAL RELEVANCE The V-shaped distal triceps tendon repair technique provides an alternative procedure to other established repairs for acute/subacute distal triceps tendon ruptures. The reduced repair site motion of the V-shaped distal triceps tendon repair technique and the knotless suture-bridge repair technique at the time of surgery may allow a more aggressive rehabilitation program in the early postoperative period.
Collapse
Affiliation(s)
- Bastian Scheiderer
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Florian B Imhoff
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Daichi Morikawa
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA.,Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
| | - Lucca Lacheta
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| |
Collapse
|
|
19
|
|
|
20
|
Barco R, Sánchez P, Morrey ME, Morrey BF, Sánchez-Sotelo J. The distal triceps tendon insertional anatomy-implications for surgery. JSES OPEN ACCESS 2017; 1:98-103. [PMID: 30675548 PMCID: PMC6340860 DOI: 10.1016/j.jses.2017.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Improved knowledge of the distal triceps insertion is needed as a result of an increase in procedures involving this area, including distal triceps repair, posterior capsulectomy, and olecranon tip osteotomy for coronoid reconstruction. Materials and methods Five pair-matched upper limbs were dissected to study the morphology and dimension of the distal triceps tendon, triceps tendon insertion, capsular insertion on the olecranon, and triceps lateral retinaculum. Muscle origins of the triceps insertions were identified proximally. Results Three distinct insertional areas were found in the olecranon corresponding to the posterior capsular insertion, the deep muscular portion, and the superficial tendinous portion of the triceps with areas of 1.5, 1.2, and 2.8 cm2, respectively. The deep muscular head corresponded to the medial head of the triceps and the tendinous portion corresponded to the long and lateral heads and correlated with the height of the specimen. The triceps width at insertion was 2.6 ± 0.5 cm (standard deviation), and the triceps lateral retinaculum extended the tendon laterally for 2.5 ± 0.7 cm. The tendinous portion of the triceps tendon extended proximally 15.3 ± 1.4 cm. The triceps inserted at a mean of 1.1 cm from the tip of the olecranon. Conclusions The distinct insertional heads of the triceps provides additional knowledge that can aid in diagnosing and treating partial triceps tears. In addition, a safe zone for capsulectomy and olecranon tip osteotomy is described that can be used to increase the safety of these procedures.
Collapse
Affiliation(s)
- Raul Barco
- Shoulder & Elbow Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bernard F Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
|
21
|
Shuttlewood K, Beazley J, Smith CD. Distal triceps injuries (including snapping triceps): A systematic review of the literature. World J Orthop 2017; 8:507-513. [PMID: 28660143 PMCID: PMC5478494 DOI: 10.5312/wjo.v8.i6.507] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/13/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To review current literature on types of distal triceps injury and determine diagnosis and appropriate management.
METHODS We performed a systematic review in PubMed, Cochrane and EMBASE using the terms distal triceps tears and snapping triceps on the 10th January 2017. We excluded all animal, review, foreign language and repeat papers. We reviewed all papers for relevance and of the papers left we were able to establish the types of distal triceps injury, how these injuries are diagnosed and investigated and the types of management of these injuries including surgical. The results are then presented in a review paper format.
RESULTS Three hundred and seventy-nine papers were identified of which 65 were relevant to distal triceps injuries. After exclusion we had 47 appropriate papers. The papers highlighted 2 main distal triceps injuries: Distal triceps tears and snapping triceps. Triceps tear are more common in males than females occurring in the 4th-5th decade of life and often due to a direct trauma but are also strongly associated with weightlifting and American football. The tears are diagnosed by history and clinically with a palpable gap. Diagnosis can be confirmed with the use of ultrasound (US) and magnetic resonance imaging. Treatment depends on type of tear. Partial tears can be treated conservatively with bracing and physio whereas acute tears need repair either open or arthroscopic using suture anchor or bone tunnel techniques with similar success. Chronic tears often need augmenting with tendon allograft or autograft. Snapping triceps are also seen more in men than women but at a mean age of 32 years. They are characterized by a snapping sensation mostly medially and can be associated with ulna nerve subluxation and ulna nerve symptoms. US is the diagnostic modality of choice due to its dynamic nature and to differentiate between snapping triceps tendon or ulna nerve. Treatment is conservative initially with activity avoidance and if that fails surgical management includes resection of triceps edge or transposition of the tendon plus or minus ulna nerve transposition.
CONCLUSION Distal triceps injuries are uncommon. This systematic review examines the evidence base behind diagnosis, imaging and treatment options of distal triceps injuries including tears and snapping triceps.
Collapse
|
|
22
|
Celli A, Bonucci P. The anconeus-triceps lateral flap approach for total elbow arthroplasty in rheumatoid arthritis. Musculoskelet Surg 2016; 100:73-83. [PMID: 27900699 DOI: 10.1007/s12306-016-0417-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/29/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND The posterior approaches to the elbow are considered as to allow an excellent joint exposure for total elbow arthroplasty. One complication that is well recognized is the insufficiency of the extensor mechanism in particular with the patients with poor tendon quality as in the rheumatoid diseases. The purpose of this paper is to present a new triceps-splitting exposure for total elbow arthroplasty used in rheumatoid patients with their preliminary results. METHODS Fifteen consecutive patients with rheumatoid disease at grades III to V of the Larsen grading scale underwent total elbow replacement using the new triceps-splitting exposure called anconeus-triceps lateral flap and it preserves the integrity of the medial proper triceps tendon. The assessments were performed with a minimum follow-up of 2 years. RESULTS The mean Mayo Elbow Performance Score increased from 24 points to 95 points at a mean follow-up of 38 months. The pain was calculated using the visual analogue score, it had a mean pre-operative value of 8.9 points and it became 0.5 points. Although elbow motion in flexion-extension and pronosupination was allowed from the day after surgery, we did not observe any insufficiency or secondary detachments of the triceps tendon reporting grade 4 to 5 according to the Medical Research Council scale. CONCLUSIONS These preliminary outcomes suggest that the decision to preserve the medial proper triceps tendon insertion allows to start an earlier active unrestricted rehabilitation programme. This new triceps management improves the surgical exposure of the olecranon surface. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- A Celli
- Department of Orthopaedic Surgery, Hesperia Hospital, Via Emilia Est 380\1, 41124, Modena, Italy.
| | - P Bonucci
- Department of Orthopaedic Surgery, Hesperia Hospital, Via Emilia Est 380\1, 41124, Modena, Italy
| |
Collapse
|
|
23
|
Abstract
Elbow pain is a frequent presenting symptom in athletes, particularly athletes who throw. The elbow can be injured as a result of acute trauma, such as a direct blow or a fall onto an outstretched hand or from chronic microtrauma. In particular, valgus extension overload during the throwing motion can precipitate a cascade of chronic injuries that can be debilitating for both casual and high-performance athletes. Prompt imaging evaluation facilitates accurate diagnosis and appropriate targeted interventions.
Collapse
Affiliation(s)
- Matthew D Bucknor
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA 94158
| | - Kathryn J Stevens
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA 94158
| | - Lynne S Steinbach
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA 94158
| |
Collapse
|
|
24
|
Ng T, Rush LN, Savoie FH. Arthroscopic Distal Triceps Repair. Arthrosc Tech 2016; 5:e941-e945. [PMID: 27709062 PMCID: PMC5040600 DOI: 10.1016/j.eats.2016.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/20/2016] [Indexed: 02/03/2023] Open
Abstract
In this note, we describe an arthroscopic repair of a degenerative tear of the triceps using a suture weave and an anatomic footprint anchor. We are able to assess, debride, and anatomically repair the distal triceps to its insertion. Compared with open procedures, this arthroscopic repair offers lower morbidity, faster recovery, and improved cosmesis. Our goal was to improve the function and strength of the elbow through this arthroscopic surgical fixation.
Collapse
Affiliation(s)
- Tracy Ng
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.,Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A
| | - Lane N. Rush
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.,Address correspondence to Lane N. Rush, M.D., Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, SL-32, New Orleans, LA 70112, U.S.A.Department of Orthopaedic SurgeryTulane University School of Medicine1430 Tulane AvenueSL-32New OrleansLA70112U.S.A.
| | - Felix H. Savoie
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| |
Collapse
|
|
25
|
Celli A. A new posterior triceps approach for total elbow arthroplasty in patients with osteoarthritis secondary to fracture: preliminary clinical experience. J Shoulder Elbow Surg 2016; 25:e223-31. [PMID: 27422461 DOI: 10.1016/j.jse.2016.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 03/23/2016] [Accepted: 04/05/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND During the past decade, total elbow arthroplasty (TEA) procedures have increased because of an increase in the number of trauma patients. Even though most current posterior approaches to the elbow provide excellent joint exposure, they involve the risk of extensor mechanism injury and of eventual insufficiency, particularly in patients with osteoarthritis (OA) secondary to fracture. I describe a new triceps exposure approach for TEA, the anconeus-triceps lateral flap, which has proved valuable in patients with distal humeral and olecranon fracture malunion, and its preliminary results at a minimum follow-up of 24 months. METHODS Twenty consecutive patients with OA due to distal humeral and olecranon fracture malunion underwent TEA by the anconeus-triceps lateral flap approach, which preserves the olecranon insertion of the medial portion of the triceps proper tendon. RESULTS At a mean follow-up of 33 months, the mean Mayo Elbow Performance Score rose from 41.3 to 94.3. The mean pain score on the visual analog scale fell from 7.1 to 1.1. There were no patients with insufficiency, secondary detachment of the triceps tendon, or grade 4 to 5 of the Medical Research Council scale. DISCUSSION These preliminary data suggest that preservation of the insertion of the medial portion of the triceps proper tendon enables earlier active rehabilitation. Moreover, the new approach provides optimum exposure of the olecranon also in patients with OA secondary to intra-articular fracture of the distal humerus and olecranon, where scarring and bone deformity usually hamper joint exposure.
Collapse
Affiliation(s)
- Andrea Celli
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Modena, Italy.
| |
Collapse
|
|
26
|
Lubberts B, Janssen S, Mellema J, Ring D. Quantitative 3-dimensional computed tomography analysis of olecranon fractures. J Shoulder Elbow Surg 2016; 25:831-6. [PMID: 26711473 DOI: 10.1016/j.jse.2015.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/05/2015] [Accepted: 10/18/2015] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS/BACKGROUND Olecranon fractures have variable size of the proximal fragment, patterns of fragmentation, and subluxation of the ulnohumeral joint that might be better understood and categorized on the basis of quantitative 3-dimensional computed tomography analysis. Mayo type I fractures are undisplaced, Mayo type II are displaced and stable, and Mayo type III are displaced and unstable. The last is categorized into anterior and posterior dislocations. The purpose of this study was to further clarify fracture morphology between Mayo type I, II, and III fractures. METHODS Three-dimensional models were created for a consecutive series of 78 patients with olecranon fractures that were evaluated with computed tomography. We determined the total number of fracture fragments, the volume and articular surface area of each fracture fragment, and the degree of displacement of the most proximal olecranon fracture fragment. RESULTS Displaced olecranon fractures were more comminuted than nondisplaced fractures (P = .02). Displaced fractures without ulnohumeral subluxation were smallest in terms of both volume (P < .001) and articular surface involvement (P < .001) of the most proximal olecranon fracture fragment. There was no difference in average displacement of the proximal fragment between displaced fractures with and without ulnohumeral subluxation (P = .74). Anterior olecranon fracture-dislocations created more displaced (P = .04) and smaller proximal fragments than posterior fracture-dislocations (P = .005), with comparable fragmentation on average (P = .60). DISCUSSION/CONCLUSION The ability to quantify volume, articular surface area, displacement, and fragmentation using quantitative 3-dimensional computed tomography should be considered when increased knowledge of fracture morphology and fracture patterns might be useful.
Collapse
Affiliation(s)
- Bart Lubberts
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA
| | - Stein Janssen
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA
| | - Jos Mellema
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA; Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, TX, USA.
| |
Collapse
|
|
27
|
Neumann H, Schulz AP, Breer S, Faschingbauer M, Kienast B. Traumatic Rupture of the Distal Triceps Tendon (A Series of 7 Cases). Open Orthop J 2015; 9:536-41. [PMID: 26664499 PMCID: PMC4671227 DOI: 10.2174/1874325001509010536] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/01/2015] [Accepted: 09/11/2015] [Indexed: 12/12/2022] Open
Abstract
Even non-traumatic ruptures of the triceps tendon are rare, surgical therapy should be recommended in all
cases, because of poor results after non-operative treatment. A golden standard for the surgical procedure is not
established. A small series of traumatic distal tendon ruptures was treated surgical in our hospital and was followed up
after 12 months concerning their function. Very good and good results could be found with a strong reintegration of the
tendon by using transosseus sutures with non resorbable suture material. The refixation with suture anchors showed
disappointing results with early pull-outs of the anchor. Revision with screw augmentation with a washer had to be
performed. Concerning the biomechanical forces, which show up on the olecranon (up to 40 NM), the refixation of the
triceps tendon has proved to be extremely resistant against pull out forces. The good results by using non absorbable
transosseus sutures led to a standardized procedure in our trauma center, even the rupture is not traumatic.
Collapse
Affiliation(s)
- H Neumann
- Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Center Hamburg, Germany
| | - A-P Schulz
- Department of Traumatology & Orthopaedics, University of Schleswig-Holstein, Campus Lübeck, Germany
| | - S Breer
- Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Center Hamburg, Germany
| | - M Faschingbauer
- Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Center Hamburg, Germany
| | - B Kienast
- Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Center Hamburg, Germany ; Department of Traumatology & Orthopaedics, University of Schleswig-Holstein, Campus Lübeck, Germany
| |
Collapse
|
|
28
|
Abstract
Triceps tendon tear is one of the least commonly recognized major tendon tears. Bilateral triceps tendon tears are especially rare. We present a case of simultaneous complete tears of bilateral triceps tendons secondary to a fall. The anatomy, etiology, image findings, and current literature are discussed.
Collapse
|
|
29
|
Abstract
Acute triceps ruptures are an uncommon entity, occurring mainly in athletes, weight lifters (especially those taking anabolic steroids), and following elbow trauma. Accurate diagnosis is made clinically, although MRI may aid in confirmation and surgical planning. Acute ruptures are classified on an anatomic basis based on tear location and the degree of tendon involvement. Most complete tears are treated surgically in medically fit patients. Partial-thickness tears are managed according to the tear severity, functional demands, and response to conservative treatment. We favor an anatomic footprint repair of the triceps to provide optimal tendon to bone healing and, ultimately, functional outcome.
Collapse
Affiliation(s)
- Jay D Keener
- Department of Orthopaedic Surgery, Washington University, CB# 8233, 660 South Euclid Avenue, St Louis, MO 63110, USA.
| | - Paul M Sethi
- The ONS Sports and Shoulder Service, 6 Greenwich Office Park, Greenwich, CT 06831, USA
| |
Collapse
|
|
30
|
Celli A. Triceps tendon rupture: the knowledge acquired from the anatomy to the surgical repair. Musculoskelet Surg 2015; 99 Suppl 1:S57-S66. [PMID: 25957546 DOI: 10.1007/s12306-015-0359-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 02/02/2015] [Indexed: 06/04/2023]
Abstract
Triceps injuries are relatively uncommon in most traumatic events, and the distal triceps tendon ruptures are rare. Recently, the knowledge of this tendon lesion has increased, and it seems to be related to more precise diagnostic and clinical assessments. The most common mechanism of injury remains a forceful eccentric contraction of the muscle, while several other risk factors have been studied as chronic renal failure, endocrine disorders, metabolic bone diseases as well as steroid use. Olecranon bursitis and local corticosteroid injections may also play a role. The commonest site of rupture is at the tendon's insertion into the olecranon and rarely at the myotendinous junction or intramuscularly. The surgical intervention is recommended in acute complete ruptures, and non-operative treatment is reserved for patients with major comorbidities, as well as for partial ruptures with little functional disability and in low demanding patients. Various techniques and approaches as the direct repair to bone, the tendon augmentation, the anconeus rotation flap and the Achilles tendon allograft have been proposed for the management of these challenging injuries. The goal of surgical management should be an anatomical repair of the injured tendon by selection of a procedure with a low complication rate and one that allows early mobilization. This manuscript focuses the triceps tendon ruptures starting from the anatomy to the diagnosis and entity of the triceps tendon injuries, as well as the indications and guidelines for the management.
Collapse
Affiliation(s)
- A Celli
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Via Emilia Est 380\1, 41124, Modena, Italy.
| |
Collapse
|
|
31
|
Kose O, Kilicaslan OF, Guler F, Acar B, Yuksel HY. Functional outcomes and complications after surgical repair of triceps tendon rupture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:1131-9. [PMID: 26164405 DOI: 10.1007/s00590-015-1669-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/03/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The purpose of this study was to present the functional outcomes and complications after primary repair of triceps tendon ruptures (TTR). PATIENTS AND METHODS A retrospective review was performed on eight patients (six males, two females) who underwent transosseous suture repair for TTR. Mayo elbow score, range of motion, muscle strength and patient satisfaction were evaluated after at least 1-year follow-up. RESULTS The mean age of the patients was 25.1 years (range 16-42). The mechanism of injury was a sports injury in three patients, simple fall (fall on outstretched hand) in four and motorcycle accident in one patient. Two patients had associated radial head fracture, and one had a radial head fracture and trochlear fracture, and one patient had a medial epicondyle fracture. In two patients the diagnosis was missed at the initial admission to ED (delay, 20 and 75 days). Only one patient, who was a bodybuilder, had a history of anabolic steroid use, and the rest had no underlying disease or a predisposing factor for TTR. One of the patients with radial head fracture (displaced three parts) underwent simultaneous fixation using two headless screws. Patients were followed up for a mean of 18.8 months (range 12-26). At the final follow-up, all patients were satisfied with the treatment and the Mayo elbow score was excellent in six patients and good in two patients. There was 5° extension loss in two patients. Triceps muscle strength was 5/5 in all patients. Ulnar nerve entrapment occurred in one patient, so ulnar nerve release and anterior transposition were performed 3 months after surgery. Posterior interosseous nerve palsy occurred in one patient who underwent simultaneous radial head fracture fixation, but eventually returned back to normal 3 months postoperatively. All patients returned to their previous level of activity and occupation. CONCLUSION Transosseous suture technique is a safe and effective treatment method for acute TTR with a low rate of complications and excellent functional outcomes. LEVEL OF EVIDENCE Retrospective case series, Level IV.
Collapse
Affiliation(s)
- Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Uncalı mahallesi Toroslar caddesi, Samut Comfort Palace E Blok No: 2, Konyaaltı, Antalya, Turkey.
| | - Omer Faruk Kilicaslan
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Uncalı mahallesi Toroslar caddesi, Samut Comfort Palace E Blok No: 2, Konyaaltı, Antalya, Turkey
| | - Ferhat Guler
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Uncalı mahallesi Toroslar caddesi, Samut Comfort Palace E Blok No: 2, Konyaaltı, Antalya, Turkey
| | - Baver Acar
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Uncalı mahallesi Toroslar caddesi, Samut Comfort Palace E Blok No: 2, Konyaaltı, Antalya, Turkey
| | - Halil Yalçın Yuksel
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Uncalı mahallesi Toroslar caddesi, Samut Comfort Palace E Blok No: 2, Konyaaltı, Antalya, Turkey
| |
Collapse
|
|
32
|
|
|
33
|
|
|
34
|
Abstract
Triceps ruptures are less common injuries presenting to the orthopaedic or emergency department setting compared with other musculoskeletal injuries. This to some extent reduces the level of index of suspicion or chances of considering the triceps rupture as one of the differential diagnosis while examining a patient following upper limb injury. The literature search shows that a significant proportion of patient diagnosis has been missed during initial presentation, leading to a delay in diagnosis and in providing definitive treatment, ranging from 6 to 18 months. The triceps are the primary extensor of the elbow and are supplied with the radial nerve. Any injury to the triceps can adversely affect the functioning of the limb and influence the ability to work and return to employment. We share our experience of treating a patient with a triceps rupture, in whom the diagnosis was made 6 months after injury; the patient was able to return to manual work 3 months after surgical repair.
Collapse
Affiliation(s)
| | - Naveen Keerthi
- Department of Orthopaedics, University College of London, London, UK
| |
Collapse
|
|
35
|
Heikenfeld R, Listringhaus R, Godolias G. Endoscopic repair of tears of the superficial layer of the distal triceps tendon. Arthroscopy 2014; 30:785-9. [PMID: 24794569 DOI: 10.1016/j.arthro.2014.03.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 03/03/2014] [Accepted: 03/06/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the results after endoscopic repair of partial superficial layer triceps tendon tears. METHODS Fourteen patients treated surgically between July 2005 and December 2012 were studied prospectively for 12 months. Indication for surgery was a partial detachment of the triceps tendon from the olecranon that was proved by magnetic resonance imaging (MRI) in all cases. Ten of these patients had chronic olecranon bursitis. All patients were treated with endoscopic surgery including bursectomy and repair of the distal triceps tendon with double-loaded suture anchors. Clinical examination of the patients as well as functional and subjective scores (Mayo Elbow Performance Index [MEPI], Disabilities of the Arm, Shoulder and Hand Score [Quick DASH]) were obtained preoperatively and postoperatively at 6 and 12 months. An isokinetic strength measurement and MRI were performed preoperatively and 12 months after surgery. RESULTS All 14 patients were completely evaluated. The MEPI and Quick DASH Score improved significantly after the repair at all postoperative examinations. The MEPI gained 29 points, up to 96 points at last follow-up (P < .05), and the Quick DASH Score went down 15.6 points after 12 months to 4.5 points (P < .05). Maximum extension power improved 55.8%, up to 94.7% at last follow-up compared with the contralateral side. Using MRI, we found one reruptured partial tear of the triceps tendon that did not require revision surgery. DISCUSSION Although triceps tendon ruptures are generally uncommon, partial superficial tears might be more common than previously described. Once the diagnosis is made, endoscopic repair is a method leading to good clinical results with improved function of the affected elbow. CONCLUSIONS Endoscopic repair of superficial tears of the triceps tendon is able to restore function and strength and leads to excellent clinical results after 1 year. Strength recovers to nearly that of the contralateral side, and serious complications appear to be infrequent. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
Affiliation(s)
| | - Rico Listringhaus
- Center for Orthopedics and Traumatology, St. Anna Hospital Herne, Germany
| | - Georgios Godolias
- Center for Orthopedics and Traumatology, St. Anna Hospital Herne, Germany
| |
Collapse
|
|
36
|
Abstract
OBJECTIVE To elucidate mechanism of injury, nonoperative protocols, surgical techniques, rehabilitation schedules, and return to sports guidelines for partial and complete triceps tendon injuries. DATA SOURCES The PubMed and OVID databases were searched in 2010 and peer-reviewed English language articles in 2011. MAIN RESULTS After a fall on an outstretched hand, direct trauma on the elbow, or lifting against resistance, patients often present with pain and weakness of extension. Examination may reveal a palpable tendon gap, and radiographs may reveal a Flake sign. Acute partial injuries have positive outcomes with immobilization in 30-degree flexion for 4 to 6 weeks. Primary repair for complete rupture can restore normal extensor function after 3 to 4 months. Reconstruction returns normal extensor function up to 4 years. Most authors support postoperative immobilization for 2 to 3 weeks at 30- to 40-degree flexion, flexion block bracing for an additional 3 weeks, and unrestricted activity at 6 months. Athletes may be able to return to sports after 4 to 5 weeks of recovery from a partial injury, but return may be delayed if operative tendon repair is performed. CONCLUSIONS Acute partial triceps tendon injuries may be managed conservatively at first and should be repaired primarily if this fails or if presentation is delayed. Reconstruction should first use the anconeus rotation technique. If the anconeus is devitalized, the Achilles tendon may be the allograft of choice.
Collapse
|
|
37
|
Donaldson O, Vannet N, Gosens T, Kulkarni R. Tendinopathies Around the Elbow Part 2: Medial Elbow, Distal Biceps and Triceps Tendinopathies. Shoulder Elbow 2014; 6:47-56. [PMID: 27582910 PMCID: PMC4986646 DOI: 10.1111/sae.12022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/19/2013] [Indexed: 01/17/2023]
Abstract
In the second part of this review article the management of medial elbow tendinopathy, distal biceps and distal triceps tendinopathy will be discussed. There is a scarcity of publications concerning any of these tendinopathies. This review will summarise the current best available evidence in their management. Medial elbow tendinopathy, also known as Golfer's elbow, is up to 6 times less common than lateral elbow tendinopathy. The tendinopathy occurs in the insertion of pronator teres and flexor carpi radialis. Diagnosis is usually apparent through a detailed history and examination but care must be made to exclude other conditions affecting the ulnar nerve or less commonly the ulnar collateral ligament complex. If doubt exists then MRI/US and electrophysiology can be used. Treatment follows a similar pattern to that of lateral elbow tendinopathy. Acute management is with activity modification and topical NSAIDs. Injection therapy and surgical excision are utilised for recalcitrant cases. Distal biceps and triceps tendinopathies are very rare and there is limited evidence published. Sequelae of tendinopathy include tendon rupture and so it is vital to manage these tendinopathies appropriately in order to minimise this significant complication. Their management and that of partial tears will be considered.
Collapse
Affiliation(s)
| | - Nicola Vannet
- Department of Orthopaedics, Royal Gwent Hospital, Newport, UK
| | - Taco Gosens
- Department of Orthopaedics and Traumatology, St Elisabeth Hospital, Tilburg, Netherlands
| | - Rohit Kulkarni
- Department of Orthopaedics, Royal Gwent Hospital, Newport, UK
| |
Collapse
|
|
38
|
Studer A, Athwal GS, MacDermid JC, Faber KJ, King GJW. The lateral para-olecranon approach for total elbow arthroplasty. J Hand Surg Am 2013; 38:2219-2226.e3. [PMID: 24206987 DOI: 10.1016/j.jhsa.2013.07.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 07/22/2013] [Accepted: 07/24/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe and evaluate the lateral para-olecranon approach for total elbow arthroplasty and to compare it with the paratricipital and triceps splitting approaches. METHODS A total of 34 patients who underwent total elbow arthroplasty were evaluated: 25 with rheumatoid arthritis (28 elbows) and 9 with fractures. The average duration of follow-up was 54 months (range, 12-105 mo). Of the 28 elbows with rheumatoid arthritis, 17 underwent a triceps splitting approach, 6 a lateral para-olecranon, and 5 a paratricipital approach. Of the 9 fracture cases, 5 patients underwent a lateral para-olecranon and 4 a paratricipital approach. Extension strength, range of motion, elbow function (Mayo Elbow Performance Index), and complications related to triceps insufficiency were compared for all 3 approaches. In addition, we compared triceps strength after lateral para-olecranon and paratricipital approaches with the contralateral healthy elbow in the 9 fracture cases. RESULTS Patients with rheumatoid arthritis had better extension torque when the prosthesis was implanted through the lateral para-olecranon approach (20 ± 8 N-m) compared with the triceps splitting (13 ± 4 N-m) or paratricipital approaches (12 ± 6 N-m). In the fracture group, the extension strength of the replaced elbow was similar to the contralateral normal elbow in both the paratricipital and lateral para-olecranon groups. CONCLUSIONS The lateral para-olecranon approach avoids triceps tendon detachment from and repair to the olecranon, thereby reducing the risk of triceps insufficiency while maintaining better extension strength relative to a triceps splitting approach. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
Collapse
Affiliation(s)
- Alexis Studer
- Hand and Upper Limb Centre, St. Joseph's Healthcare London, 268 Grosvenor Street, London, Ontario N6A 4L6, Canada.
| | | | | | | | | |
Collapse
|
|
39
|
Elbow arthroscopy in acute injuries. Knee Surg Sports Traumatol Arthrosc 2012; 20:2542-8. [PMID: 22278657 DOI: 10.1007/s00167-012-1904-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 01/12/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE Arthroscopy of the elbow has become a standard treatment option for many indications. The purpose of this article is to review literature concerning the use of arthroscopy for acute elbow injuries. METHODS The main medical literature databases were searched for articles on the use of elbow arthroscopy in acute injuries. A total of 13 publications relevant to the topic were included. The Coleman methodology score was used to assess the methods of each article. RESULTS All published articles have been case reports or retrospective case series. In fracture treatment, arthroscopy has been used in the treatment of displaced radial head, coronoid and capitellum fractures in adults and displaced radial neck and lateral humeral condyle fractures in children with good results. Endoscopic techniques have been used in distal biceps rupture and medial avulsion of the triceps. And also new techniques have been developed for the treatment of intra-articular soft-tissue lesions like rupture of the radial ulnohumeral ligament complex. One of the 13 studies analyzed was considered of good quality, 5 of moderate quality and all others of poor quality with inconsistent methodology and outcomes. CONCLUSION The range of treatments using elbow arthroscopy in acute injuries is expanding and brings new controversies and challenges. Single reports of arthroscopically treated bony and soft-tissue injuries of the elbow showed satisfactory results. However, further randomized prospective studies are needed to evaluate their safety and efficacy compared with open 'gold standard' techniques. LEVEL OF EVIDENCE IV.
Collapse
|
|
40
|
Clinical outcome after suture anchor repair for complete traumatic rupture of the distal triceps tendon. Arthroscopy 2012; 28:1058-63. [PMID: 22405915 DOI: 10.1016/j.arthro.2011.12.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 12/08/2011] [Accepted: 12/15/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical results of surgical repair of complete distal triceps tendon rupture using suture anchors and high-strength sutures by use of validated outcome measures. METHODS A consecutive series of traumatic distal triceps tendon ruptures at a single institution were studied. All cases were surgically repaired by use of suture anchors double loaded with ultrahigh-molecular-weight polyethylene-containing sutures. All patients were evaluated with a physical examination, radiographs, and questionnaires. The following postoperative validated outcome measures were used: the Disabilities of the Arm, Shoulder and Hand (DASH) score; the Oxford Elbow Score; the American Shoulder and Elbow Surgeons elbow assessment form; and the Mayo Elbow Performance Index. RESULTS Five male patients with a mean follow-up of 32 months underwent suture anchor repair for traumatic rupture of the distal triceps tendon. Of the repairs, 3 were in the dominant arm and 2 in the nondominant arm. The mean patient age was 47 years (range, 35 to 54 years). Postoperatively, the mean DASH score was 1.4, the mean American Shoulder and Elbow Surgeons elbow score was 99.2, the mean Mayo Elbow Performance Index was 95.8, the mean Oxford Elbow Score for pain was 98.8, the mean Oxford Elbow Score for function was 100, and the mean Oxford Elbow Score for the social domain was 96.2. A lower score for the DASH indicates less disability and better function. CONCLUSIONS This retrospective case series of suture anchor repair of distal triceps tendon ruptures showed excellent elbow function based on validated clinical outcome measures. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
|
|
41
|
Tagliafico A, Gandolfo N, Michaud J, Perez MM, Palmieri F, Martinoli C. Ultrasound demonstration of distal triceps tendon tears. Eur J Radiol 2012; 81:1207-1210. [PMID: 21420815 DOI: 10.1016/j.ejrad.2011.03.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 03/02/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE Rupture of the distal triceps tendon is an uncommon injury that may be unrecognized on clinical examination. The purpose of the study is to describe the role of US in distal triceps tendon tears evaluation. MATERIALS AND METHODS IRB approval was obtained and patients gave written informed consent. Of 77 consecutive US examinations of the elbow obtained over a five-year period, eight patients with correlative MR and surgery available were identified having partial or complete distal triceps tendon tear. RESULTS N = 4 complete tears of the triceps tendon and n = 4 partial tears of the distal triceps involving the lateral/superficial head were identified. Patients with partial tear had a history of a single traumatic event that determined a sudden eccentric contraction of the triceps muscle against resistance. US demonstrated on axial and longitudinal planes a partial tear of the triceps brachii tendon that resulted in a fusiform swelling and retraction of the lateral/superficial head in four patients. It was possible to identify the normal insertion of the medial head of the triceps moving the transducer medially. MR and surgical findings were concordant with US findings in every patient. CONCLUSION Ultrasound is able to differentiate complete from partial triceps tendon tears. US has the potential to identify isolated lesions of the lateral/superficial head of the triceps with an intact medial head.
Collapse
Affiliation(s)
- Alberto Tagliafico
- Department of Radiology, National Institute for Cancer Research, Genoa, Italy.
| | | | | | | | | | | |
Collapse
|
|
42
|
Downey R, Jacobson JA, Fessell DP, Tran N, Morag Y, Kim SM. Sonography of partial-thickness tears of the distal triceps brachii tendon. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1351-1356. [PMID: 21968485 DOI: 10.7863/jum.2011.30.10.1351] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to retrospectively characterize the sonographic appearance of partial-thickness distal triceps brachii tendon tears. METHODS After Institutional Review Board approval, sonographic records were searched for patients who had an unequivocal partial-thickness triceps tendon tear at surgery or magnetic resonance imaging. Sonograms were retrospectively characterized for tendon discontinuity of the superficial or deep layers, tendon retraction, osseous fracture fragments, and joint effusion. Imaging findings were then compared with clinical, imaging, and surgical results. RESULTS Five patients had a partial-thickness distal triceps brachii tendon tear at surgery (n = 4) or magnetic resonance imaging (n = 1). All cases only involved the superficial tendon layer (combined long and lateral heads) with retraction of a fractured olecranon enthesophyte fragment. The deep tendon layer (medial head) was intact in all cases with no joint effusion. CONCLUSIONS Partial-thickness distal triceps brachii tendon tears have a characteristic appearance with selective superficial tendon retraction and olecranon enthesophyte avulsion fracture.
Collapse
Affiliation(s)
- Ryan Downey
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | | | | | | | | | | |
Collapse
|
|
43
|
Sampaio ML, Schweitzer ME. Elbow magnetic resonance imaging variants and pitfalls. Magn Reson Imaging Clin N Am 2010; 18:633-42. [PMID: 21111970 DOI: 10.1016/j.mric.2010.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Imaging variants of the elbow and pitfalls can be disconcerting and can lead to diagnostic mistakes. Inhomogeneities in the magnetic field and coil position can result in signal changes that may simulate abnormality. Bone signal and morphology variants, such as the islands of red marrow and the pseudodefect of the capitellum and intraarticular inclusions such as plicae, may be mistaken for abnormal findings. Variations of the distal biceps and triceps tendons and different aspects of the ligaments and their insertions, as well as nonpathologic signal and width changes in the ulnar nerve, are other examples of common pitfalls in magnetic resonance imaging of the elbow.
Collapse
Affiliation(s)
- Marcos Loreto Sampaio
- Musculoskeletal Radiology Department, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Module S, Ottawa, ON K1H 8L6, Canada.
| | | |
Collapse
|