Treatment for Complete Triceps Tendon Tear
Surgical repair is strongly recommended for complete triceps tendon tears, as these injuries require anatomic restoration of the extensor mechanism to restore elbow function and strength. 1
Surgical Intervention
Complete triceps tendon ruptures mandate surgical repair rather than conservative management. 1 Unlike partial tears which may respond to nonoperative treatment, complete ruptures result in significant functional impairment and require anatomic restoration of the tendon to bone. 1
Surgical Techniques
Multiple repair techniques are available, though no high-level comparative studies exist to definitively recommend one over another:
Transosseous bone tunnel repair remains a reliable option that provides solid fixation without requiring hardware removal. 2 This technique involves creating bone tunnels in the olecranon and securing the tendon with sutures passed through these tunnels. 3
Suture anchor repair using a "suture bridge" or "parachute" technique provides anatomic footprint restoration with potential advantages including increased load to failure, better footprint coverage, and allowance for early motion. 2, 4 The suture bridge technique specifically offers improved biomechanical strength. 4
Combined techniques that repair the deep and superficial triceps attachments as separate steps may optimize anatomic reconstruction of the footprint and maximize biomechanical strength. 5
Surgical Approach
The standard surgical approach involves:
- A midline posterior incision to access the ruptured tendon 2
- Identification and mobilization of the retracted triceps tendon 2
- Preparation of the tendon footprint on the olecranon 2
- Tendon repair with the elbow held in 40° of flexion 2
Postoperative Rehabilitation
A graduated five-phase rehabilitation program over 12 weeks is recommended following surgical repair:
- Weeks 0-6: Range of motion is gradually increased while protected in a brace, starting from 40° of flexion 2
- Progressive strengthening: Rehabilitation intensity gradually increases from isometric extension exercises to weight-resisted exercises 2
- Advanced phase: Plyometrics and throwing exercises are introduced in later stages to facilitate return to sport activities 2
This structured approach protects repair integrity while progressively restoring triceps strength and function. 2
Critical Timing Considerations
Acute repairs have superior outcomes compared to chronic repairs. 1 Surgical intervention should be pursued promptly once the diagnosis is confirmed, as delayed treatment may result in tendon retraction, muscle atrophy, and compromised surgical outcomes. 1
Common Pitfalls
- Missed diagnosis: Triceps tendon ruptures are frequently missed on initial emergency department presentation, so maintain high clinical suspicion with appropriate mechanism of injury and inability to extend the elbow against resistance. 2
- Inadequate footprint restoration: Failure to anatomically restore both deep and superficial triceps attachments may compromise biomechanical strength. 5
- Premature aggressive rehabilitation: Overly aggressive early motion can compromise repair integrity before adequate healing occurs. 2