2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Clinical and Cosmetic Results after Double Row Reconstruction of the Distal Triceps Tendon in (Semi-) Professional Athletes: A Retrospective Case Series of 70 Patients with a Mean Follow-up of 6 Years

Lorenz Fritsch, MD, Munich GERMANY
Lucca Lacheta, MD, München GERMANY
Maximilian Hinz, MD, Munich GERMANY
Marco-Christopher Rupp, MD, Munich, Bavaria GERMANY
Sebastian Siebenlist, MD, MHBA, Prof., Munich, Bavaria GERMANY
Pavel Kadanstev, MD, Munich, Bavaria GERMANY
Mathias Ritsch, MD, Vogtareuth GERMANY

Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany., Munich, Bavaria, GERMANY

FDA Status Cleared

Summary

Double row reconstruction of the distal triceps tendon leads to satisfying clinical results and high return to sports rate.

Abstract

Background

Clinical outcomes after surgical refixation of the distal triceps tendon are scarce and represented in small, heterogeneous case series. The aim of this study was to evaluate clinical and cosmetic outcomes after double-row refixation.

Methods

Between 2000 and 2021, all distal triceps tendon refixations were prospectively recorded in two centers and contacted for informed consent and follow-up examination. Patients were included who received distal triceps tendon refixation in double row fashion with a minimum follow-up of 24 months. The American Shoulder and Elbow Surgeon (ASES) score, the Mayo Elbow Performance Score (MEPS - without instability) and the Disabilities of the Arm, Shoulder and Hand (DASH) score were surveyed. In addition, customized sporting activities questionnaire including subjective strength perception (0-100%), time to return to sport, sports performance (bench presses, triceps presses), pain level (VAS), cosmetic results, complications, and failures (re-ruputure/ re-operation) were obtained.

Results

A total of 70 patients (all male) with an average age of 50.9 ± 8.7 years were included in this study. The average follow-up was 86.9 ± 51.4 months. The postoperative the ASES score 97.8 ± 4.8, the SANE score was 93.6 ± 10.9, the DASH score 2.2 ± 5.5 and the MEPS score 98.1 ± 6.4 points. Participation in sports competitions was reported in 40% of the patients preoperatively. Postoperatively, patients achieved a 95% return of full prior strength after a median of 7 months. In bench and triceps pressing, pre- to postoperative strength levels were 162.03 ± 53.1 kilogram to 134.7 ± 52.1 kilogram (p=0.001) and 70 kilogram (interquartile range 50-80) to 55 kilogram (50-60) (p=0.001), respectively. VAS decreased from 5.7 ± 2.7 preoperatively to 2.2 ± 5.5 (p= 0.001) postoperatively. 83.4% of patients were satisfied with the cosmetic result, 16.6% reported cosmetic concerns. There were 7 re-operations due to an infection and a re-rupture. Re-ruptures were observed in 6 patients (8.5%).

Conclusion

The distal double row reconstruction of triceps tendon ruptures achieved good clinical and cosmetic results with low complication profile in this high-demanding patient population consisting of (semi-) professional strength athletes. Full strength was regained after an average of 7 months, however, isolated triceps strength during triceps pull, bench and triceps press remains significantly reduced postoperatively.