Partial triceps tendon avulsion delayed reconstruction using Achilles tendon allograft, a case report – ScienceOpen
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      Partial triceps tendon avulsion delayed reconstruction using Achilles tendon allograft, a case report

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          Abstract

          A case report of a 32-year-old bodybuilder with an incomplete triceps tendon avulsion on his right dominant upper extremity is presented. At initial presentation, an avulsion injury was suspected. Ultrasound diagnostics pointed toward partial distal triceps tendon rupture, and since the patient had retained active elbow extension, a trial of conservative treatment was initiated. The patient failed to regain forceful elbow extension. MRI revealed an avulsion fracture of the olecranon with large partial triceps tendon rupture with muscle retraction. A triceps tendon tenolysis and fixation with transosseous olecranon sutures was conducted in a secondary trauma center. However, we failed to recognize the true tendon in the extensive scar tissue formation, and the patient did not regain appropriate elbow extension strength. He was administered to a university medical center. An extensive triceps tenolysis was performed along with clear identification of retracted bony avulsion fragment and re-fixation of true triceps tendon on the olecranon using Achilles tendon allograft. During the postoperative period and physical rehabilitation therapy, the patient gradually developed normal elbow extension strength and was able to return to bodybuilding without limitations. Goniometric measurements and isokinetic testing were performed one year after the second surgery, showing only a minor reduction of right elbow extension strength compared to the uninjured elbow. Elbow function measured by the functional score questionnaire was comparable to the uninjured upper extremity.

          Highlights

          • During an initial operative procedure, a vast scar tissue formation was observed.

          • Tendon tenolysis was performed with clear identification of the bony avulsion.

          • Achilles tendon allograft without a calcaneal bone fragment was used to bridge.

          • Control MRI was performed, showing reconstructed triceps tendon continuity.

          • The patient feels he can live his life unaffected by the injury.

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          Most cited references10

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          Disruption of muscles and tendons; an analysis of 1, 014 cases.

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            Triceps tendon ruptures in professional football players.

            Distal rupture of the triceps tendon is a rare injury, and treatment guidelines are not well established. Football players with triceps tendon ruptures will be able to return to their sport with minimal functional deficits. Uncontrolled retrospective review. Twenty-one partial and complete ruptures of the triceps tendon were identified in 19 National Football League players over a period of 6 years. Team physicians retrospectively reviewed training room, clinical, and operative notes for each of these players. Most of the injured players were linemen. The most common mechanism of injury was an eccentric load to a contracting triceps. Seven players had prodromal symptoms prior to injury, and 5 had received a cortisone injection. Eleven elbows with complete tears underwent surgical repair. Of 10 players with partial tears, 6 healed without surgery. One player suffered a subsequent complete tear requiring surgery, and 3 with residual pain and weakness underwent surgical repair following the season. Two surgical complications occurred, both requiring a second operation. All of the players but 1 returned to play at least one season of professional football after their injury. Partial triceps tendon ruptures can heal without functional deficit. Surgical repair for complete ruptures generally produces good functional results and allows return to play.
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              Triceps Tendon Ruptures: A Systematic Review

              Triceps tendon ruptures (TTR) are an uncommon injury. The aim of this systematic review was to classify diagnostic signs, report outcomes and rerupture rates, and identify potential predisposing risk factors in all reported cases of surgical treated TTR.
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                Author and article information

                Contributors
                Journal
                Trauma Case Rep
                Trauma Case Rep
                Trauma Case Reports
                Elsevier
                2352-6440
                04 October 2022
                December 2022
                04 October 2022
                : 42
                : 100701
                Affiliations
                [a ]Department of Traumatology and Orthopedics, General Hospital Slovenj Gradec, Gosposvetska cesta 1, 2380 Slovenj Gradec, Slovenia
                [b ]Department of Traumatology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
                Author notes
                [* ]Corresponding author at: General Hospital Slovenj Gradec, Gosposvetska cesta 1, 2380 Slovenj Gradec, Slovenia. klemen.pilih@ 123456sb-sg.si
                Article
                S2352-6440(22)00097-8 100701
                10.1016/j.tcr.2022.100701
                9561914
                36247880
                6ff89625-a503-4dca-993c-74b7c5f9e854
                © 2022 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 2 October 2022
                Categories
                Case Report

                triceps tendon avulsion,surgical treatment,delayed reconstruction,achilles tendon allograft,isokinetic strength measurement

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