The Surgical Management of Distal Triceps Tendon Ruptures: A Systematic Review.

BACKGROUND: Distal triceps tendon ruptures (DTTR) are highly uncommon injuries and can be treated with surgical repair. The purpose of this review is to compare the outcomes and complications of various surgical techniques used for primary repair of distal triceps tendon ruptures. METHODS: The electronic databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and PUBMED were searched from data inception to October 15, 2020. The Methodological Index for Non-Randomized Studies tool was used to assess study quality. Data is presented descriptively. RESULTS: Nineteen studies were identified, comprising 560 patients (565 triceps), of which 78.6% were male, with a mean age of 46.1 ± 8.4 years and a mean follow-up of 31.8 ± 21.0 months. The overall complication rate across all DTTR repair procedures was 14.9%. The distribution of complications for each technique was 29.2% for the direct repair technique (DR), 15.2% for the transosseous technique (TOS), and 7.7% for the suture anchors (SA) technique. Common complications include ulnar neuropathies, infections, and pain. The overall rerupture rate for TOS, SA, and DR was 4.3% (n = 12), 2.1% (n = 3), and 0% (n = 0) respectively. Patients undergoing DTTR repair have significant improvements postoperatively with regards to pain, strength, and range of motion. CONCLUSIONS: Patients undergoing DTTR experience improvements in postoperative outcomes, however there is a moderate reported risk of rerupture or complication. Due to the heterogeneity in rupture pattern, surgical procedures, and outcome measures, it is difficult to ascertain the superiority of one surgical technique over another. Future studies should use large prospective cohorts and long-term follow-up to determine more accurate complication rates and outcome scores.