Triceps Reconstruction with an Achilles Tendon Allograft

Abstract

In some patients, a primary repair of the ruptured triceps tendon may not be possible. A tendon augmentation will be necessary. This can be done in multiple ways. We prefer to use an Achilles tendon allograft technique to reconstruct the distal triceps tendon and to obtain a firm fixation to the proximal ulna. It is imperative to debride scar tissue from the triceps tendon stump up to healthy tendon. The native tendon is released to mobilize it as far as possible toward the proximal ulna, with the elbow extended. The proximal part of the Achilles tendon is draped over at least 10 cm of the triceps tendon stump. It is fixed with multiple rows of suture to obtain a strong fixation and to decrease the risk of a seroma between the native and allograft tendons. The distal part of the allograft Achilles tendon is fixed to the bone with bone tunnels and a bone anchor. The calcaneum can be used to achieve a bone-to-bone fixation, but as it is bulky, we prefer not to use this if the bone stock of the patient is sufficient. Postoperatively, the elbow is protected with a dynamic brace that allows for progressive flexion over a period of 6 weeks.