V-shaped double-row distal triceps tendon repair: a novel technique using unicortical button fixation

Abstract

Background: This report was designed to present a novel technique combining suture anchor and unicortical button fixation for distal triceps tendon repair.

Technical description: For anatomical reinsertion of an acute distal triceps tendon rupture, two suture anchors and one unicortical button forming a V-shaped configuration were used. The operative approach is described in detail.

Results: Excellent clinical and functional results were achieved in the early postoperative phase. The patient reached full elbow range of motion and extension muscle strength (5/5) compared to the uninjured arm 12 weeks after surgery. Complications did not occur.

Conclusion: This is the first report using unicortical button fixation in distal triceps tendon repair with promising preliminary results.

Level of evidence: Technical description, case report, Level V.

Keywords: Distal triceps; Double row; Tendon repair; unicortical button.

Fig. 1

Intraoperative situs of the V-shaped technique: the unicortical fixation using a BicepsButton™ provides a planar contact pressure of the triceps tendon

Fig. 2

Cadavaric demonstration of the double-row V-shaped triceps repair. a Following debridement, pilot holes for two 5.5-mm suture anchors are created at the proximal border of the footprint. b Krakow whipstich sutures placed along the medial, lateral and central part of the triceps tendon. c 4 cm distal to the footprint line, a monocortical 3.2-mm drill-hole is placed in an angle of 45° in proximal direction to the ulnar shaft. d Result following knot tying creating a proximal row repair, subsequently one end of each suture is cut. e Loaded BicepsButton™. Before it is passed through the posterior cortex, the cancellous bone within the intramedullary canal should be compressed using a small clamp

Fig. 3

Full active ROM 12 weeks postoperatively

Fig. 4

Postoperative radiograph showing the intramedullary cortical button