Background: Over the past decade, the indications for total elbow
arthroplasty have increased. One complication that is well recognized but is
poorly described in the literature is insufficiency of the extensor mechanism
involving complete or partial rupture, or avulsion, of the triceps tendon. We
therefore reviewed the records of patients who had undergone surgery for the
treatment of triceps insufficiency following total elbow arthroplasty to
determine the management options and outcomes of intervention for this
Methods: The records on 887 total elbow arthroplasties performed
between 1982 and 2001 were assessed to identify patients who had undergone a
subsequent procedure on the triceps. Patients in whom triceps insufficiency
developed after débridement for infection were excluded, leaving
sixteen elbows in fourteen patients. A Mayo Elbow Performance Score was
calculated and elbow extension strength against gravity was measured at the
time of final follow-up.
Results: There were seven male and seven female patients. The mean
age was fifty-four years. The mean duration of follow-up after the triceps
reconstruction was sixty-seven months. Three basic techniques were used to
repair or reconstruct the extensor mechanism; these included direct suture in
seven elbows, anconeus rotation in four, and use of an Achilles tendon
allograft in four. The capacity to extend against gravity was restored to
fifteen of the sixteen elbows. According to the Mayo Elbow Performance Score,
eleven elbows had an excellent outcome, three had a good outcome, and two were
considered a clinical failure.
Conclusions: In most patients with triceps insufficiency following
total elbow arthroplasty, it is possible to reconstruct the triceps mechanism
with a procedure appropriately selected on the basis of tissue quality, tendon
retraction, and the status of the olecranon.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.