# Clinical and Cosmetic Results After Double-Row Reconstruction of the Distal Triceps Tendon in an Athletic Population: A Retrospective Case Series of 70 Patients With a Mean Follow-up of 6 Years

## TL;DR

This study shows that double-row repair of the distal triceps tendon in athletes leads to good clinical and cosmetic outcomes with minimal complications.

## Contribution

The study provides long-term clinical and cosmetic outcomes of double-row distal triceps tendon repair in a large, high-demand athlete cohort.

## Key findings

- Patients achieved high satisfaction scores and good functional outcomes post-surgery.
- Strength returned to 94% of pre-injury levels, though weight loads in specific exercises decreased.
- Only 8.6% of patients experienced reruptures, and cosmetic satisfaction was high in 85.7% of cases.

## Abstract

Clinical outcomes after surgical repair of the distal triceps tendon are scarce and represented in small, heterogeneous case series.

To evaluate clinical and cosmetic outcomes after double-row repair in a high-demand athlete population.

Case series; Level of evidence, 4.

All patients who participated in regular weight lifting and underwent distal triceps tendon repairs between 2000 and 2021 in 2 centers were retrospectively contacted for informed consent and follow-up examination. Patients who received distal triceps tendon repair in double-row fashion with a minimum follow-up of 24 months were included. The American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Mayo Elbow Performance Score (MEPS; without instability), and Disabilities of the Arm, Shoulder and Hand (DASH) score were surveyed. General satisfaction on a scale from 0 (very unsatisfied) to 10 (very satisfied) was evaluated. In addition, a customized sporting activities questionnaire including subjective strength perception (0%-100%), time to return to sport, sports performance (bench and triceps press), visual analog scale (VAS) pain score, cosmetic results, complications, and failures (rerupture or reoperation) was administered.

A total of 70 patients (all male) with a mean age of 50.9 ± 8.7 years were included in this study. The mean follow-up was 86.9 ± 51.4 months. The postoperative outcome scores were as follows: 97.8 ± 4.8 for the ASES score, 93.6 ± 10.9 for the SANE score, 2.2 ± 5.5 for the DASH score, and 98.1 ± 6.4 points for the MEPS. The median satisfaction score was 10 (IQR, 10-10). Postoperatively, patients subjectively achieved a 94% return of prior strength after a median of 7 months. In bench and triceps press, pre- to postoperative weight loads were a mean of 162.03 ± 53.1 kg to 134.7 ± 52.1 kg (P = .001) and a median of 70 kg (IQR, 50-85 kg) to 60 kg (IQR, 50-60 kg) (P = .001), respectively. The preoperative VAS score was 5.7 ± 2.7 versus 0.2 ± 0.6 postoperatively (P = .001). Overall, 85.7% of patients were satisfied with the cosmetic result. In total, 6 reruptures (8.6%) and 1 infection (1.4%) were observed. All 7 patients underwent surgical revision.

Double-row reconstruction of distal triceps tendon ruptures achieved good clinical and cosmetic results with a low complication rate in this high-demand patient population. Subjectively, maximum strength was regained after a median of 7 months; however, selective triceps strength during bench and triceps press resulted in significantly reduced weight loads postoperatively.