Distal Triceps Speed Bridge Repair

Abstract

Distal triceps ruptures are uncommon injuries resulting in loss of elbow extension strength and necessitating surgical repair to ensure optimal functional outcome. Traditional fixation techniques using running, locking sutures through the tendon secured through bone tunnels have been shown to poorly restore the anatomic footprint and are mechanically inferior to anatomic repairs. We endorse restoring the anatomic footprint of the distal triceps, similar to the well-researched rotator cuff repair model.

Fig 1

Posterior view of the flexed left elbow with the patient in the supine position demonstrates a lateral curvilinear posterior approach to expose the torn triceps tendon.

Fig 2

Posterior view of the flexed left elbow demonstrates a posterior approach exposing the torn triceps tendon retracted proximally and the olecranon distally.

Fig 3

Posterior view of the flexed left elbow with the patient in the supine position demonstrates a posterior approach exposing the delaminated torn triceps tendon retracted proximally. An Allis clamp is used to mobilize the superficial layer.

Fig 4

(A) Posterior view of the flexed left elbow demonstrates a drill used to create pilot holes for the proximal anchors within the triceps footprint on the olecranon process. (B) Lateral view of the flexed left elbow demonstrates the proper angle to drill to avoid penetration of the joint surface.

Fig 5

Posterior view of the flexed left elbow demonstrates insertion of the 2 proximal double-loaded anchors with an additional FiberTape in each anchor within the triceps footprint on the olecranon process.

Fig 6

Posterior view of the flexed left elbow demonstrates FiberWire being passed distally through the torn triceps tendon in a horizontal mattress configuration using a free needle in preparation for repair.

Fig 7

Posterior view of the flexed left elbow demonstrates FiberWire passed distally in a horizontal mattress configuration and FiberTape passed proximally through the torn triceps tendon in preparation for repair.

Fig 8

Posterior view of the flexed left elbow with the patient in the supine position demonstrates FiberWire passed distally in a horizontal mattress configuration and FiberTape passed proximally through the torn triceps tendon in preparation for repair.

Fig 9

Posterior view of the flexed left elbow demonstrates FiberWire tied distally in a horizontal mattress configuration and FiberTape passed proximally through the torn triceps tendon in preparation for repair.

Fig 10

(A) Posterior view of the flexed left elbow demonstrates FiberWire tied distally in a horizontal mattress configuration and FiberTape passed proximally through the torn triceps tendon in preparation for repair. A drill is used to create pilot holes for the distal anchors within the triceps footprint on the olecranon process. (B) Lateral view of the flexed left elbow demonstrates the proper angle to drill.

Fig 11

Posterior view of the flexed left elbow demonstrates insertion of the distal row of anchors incorporating the proximal FiberWire and FiberTape in a criss-cross pattern for distal triceps repair.

Fig 12

(A) Posterior view of the flexed left elbow demonstrates the final distal triceps repair construct using a speed bridge technique. (B) Lateral view of the flexed left elbow demonstrates the final repair.

Fig 13

Posterior view of the flexed left elbow with the patient in the supine position demonstrates the final distal triceps repair construct using a speed bridge technique.