Comparison of complication rates and outcomes for various surgical techniques for the repair of acute distal triceps ruptures.

BACKGROUND: Distal triceps ruptures are an injury caused by sudden forceful eccentric contraction at the elbow. Various techniques exist in the surgical treatment of distal triceps ruptures. This study sought to compare intraoperative and post-operative complication rates and functional outcomes of bone tunnels, suture anchors, and suture anchor-bone tunnel combination constructs for the surgical management of acute distal triceps ruptures. METHODS: This study was a retrospective review of distal triceps ruptures that occurred between the years 2014 and 2024 at a single institution. Chronic ruptures, revision procedures, reconstructions with allograft, direct end-to-end repairs, and atypical injury mechanisms (ie, lacerations) were excluded. Basic demographics and magnetic resonance imaging reports were collected from the electronic health record. Other variables collected were complications from the surgery (ie nerve damage, infection, etc.), pre-operative and post-operative elbow extension strength, surgical time, intraoperative blood loss, and return to the operating room (RTOR). Patients were then grouped into 3 groups based on operative technique (ie, bone tunnels, suture anchors, and suture anchor-bone tunnel combination constructs). Categorical variables were analyzed using chi-square tests and Fisher exact test for sparse data. One-way analysis of variance with Tukey honestly significantly difference post hoc testing was used for continuous variables. Multivariable logistic regression analysis was performed to adjust for tear type and tendon retraction length. P < .05 was set as the level of significance. RESULTS: Forty-seven total patients were included in the analysis, of which, 8 patients (17.0%) were treated with suture anchor constructs, 16 (34.0%) underwent fixation with trans-osseous bone tunnels, and 23 patients (48.9%) underwent combined fixation constructs with suture anchors and bone tunnels. No significant differences were observed for complication rate, RTOR rate, or triceps tendon re-rupture rate (all P > .05). Pre-operative extension strength (P = .090), post-operative extension strength (P = .190), and operative time (P = .313) also did not differ significantly by technique. Change in extension strength differed significantly by technique (P = .014), with greater functional strength improvement observed in the Combo group compared with the bone tunnels group. However, when adjusting for tear type and tendon retraction length, there were no statistical differences for changes in extension. DISCUSSION: There were no observed differences in re-rupture rate, complication rate, or RTOR between the 3 surgical techniques. However, there was an association with improved elbow extension strength for the combination group but this finding did not retain statistical significance when controlling for tear type and retraction length.