Original Article With Video Illustration| Volume 30, ISSUE 7, P785-789, July 2014

Download started.


Endoscopic Repair of Tears of the Superficial Layer of the Distal Triceps Tendon


      The purpose of this study was to evaluate the results after endoscopic repair of partial superficial layer triceps tendon tears.


      Fourteen patients treated surgically between July 2005 and December 2012 were studied prospectively for 12 months. Indication for surgery was a partial detachment of the triceps tendon from the olecranon that was proved by magnetic resonance imaging (MRI) in all cases. Ten of these patients had chronic olecranon bursitis. All patients were treated with endoscopic surgery including bursectomy and repair of the distal triceps tendon with double-loaded suture anchors. Clinical examination of the patients as well as functional and subjective scores (Mayo Elbow Performance Index [MEPI], Disabilities of the Arm, Shoulder and Hand Score [Quick DASH]) were obtained preoperatively and postoperatively at 6 and 12 months. An isokinetic strength measurement and MRI were performed preoperatively and 12 months after surgery.


      All 14 patients were completely evaluated. The MEPI and Quick DASH Score improved significantly after the repair at all postoperative examinations. The MEPI gained 29 points, up to 96 points at last follow-up (P < .05), and the Quick DASH Score went down 15.6 points after 12 months to 4.5 points (P < .05). Maximum extension power improved 55.8%, up to 94.7% at last follow-up compared with the contralateral side. Using MRI, we found one reruptured partial tear of the triceps tendon that did not require revision surgery.


      Although triceps tendon ruptures are generally uncommon, partial superficial tears might be more common than previously described. Once the diagnosis is made, endoscopic repair is a method leading to good clinical results with improved function of the affected elbow.


      Endoscopic repair of superficial tears of the triceps tendon is able to restore function and strength and leads to excellent clinical results after 1 year. Strength recovers to nearly that of the contralateral side, and serious complications appear to be infrequent.

      Level of Evidence

      Level IV, therapeutic case series.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Anzel S.H.
        • Covey K.W.
        • Weiner A.D.
        • Lipscomb P.R.
        Disruption of muscles and tendons. An analysis of 1,014 cases.
        Surgery. 1959; 45: 406-414
        • Bach Jr., B.R.
        • Warren R.F.
        • Wickiewicz T.L.
        Triceps rupture: A case report and literature review.
        Am J Sports Med. 1987; 15: 285-289
        • Aso K.
        • Torisu T.
        Muscle belly tear of the triceps.
        Am J Sports Med. 1984; 12: 485-487
        • Murphy B.J.
        MR imaging of the elbow.
        Radiology. 1992; 184: 525-529
        • Madsen M.
        • Marx R.G.
        • Millett P.J.
        • Rodeo S.A.
        • Sperling J.W.
        • Warren R.F.
        Surgical anatomy of the triceps branchii tendon: Anatomical study and clinical correlation.
        Am J Sports Med. 2006; 34: 1839-1843
        • Keener J.D.
        • Chafik D.
        • Kim H.M.
        • Galatz L.M.
        • Yamaguchi K.
        Insertional anatomy of the triceps brachii tendon.
        J Shoulder Elbow Surg. 2010; 19: 399-405
        • Athwal G.S.
        • McGrill R.J.
        • Rispoli D.M.
        Isolated avulsion of the medial head of the triceps tendon: An anatomic study and arthroscopic repair in 2 cases.
        Arthroscopy. 2009; 25: 983-988
        • Khiami F.
        • Tavassoli S.
        • De Ridder Baeur L.
        • Catonné Y.
        • Sariali E.
        Distal partial ruptures of triceps brachii tendon in an athlete.
        Orthop Traumatol Surg Res. 2012; 98: 242-246
        • Van Riet R.P.
        • Morrey B.F.
        • Ho E.
        • O'Driscoll S.W.
        Surgical treatment of distal triceps ruptures.
        J Bone Joint Surg Am. 2003; 85: 1961-1967
        • Bava E.D.
        • Barber F.A.
        • Lund E.R.
        Clinical outcome after suture anchor repair for complete traumatic rupture of the distal triceps tendon.
        Arthroscopy. 2012; 28: 1058-1063
        • Yeh P.C.
        • Stephens K.T.
        • Solovyova O.
        • et al.
        The distal triceps tendon footprint and a biomechanical analysis of 3 repair techniques.
        Am J Sports Med. 2010; 38: 1025-1033
        • Morrey B.F.
        • An K.N.
        • Chao E.Y.S.
        Functional evaluation of the elbow.
        in: Morrey B.F. The elbow and its disorders. Ed 2. WB Saunders, Philadelphia1993: 86-89
        • Sharma S.C.
        • Singh R.
        • Goel T.
        • Singh H.
        Missed diagnosis of triceps tendon rupture: a case report and review of literature.
        J Orthop Surg. 2005; 13: 307-309
        • Sollender J.L.
        • Rayan G.M.
        • Barden G.A.
        Triceps tendon rupture in weight lifters.
        J Shoulder Elbow Surg. 1998; 7: 151-153
        • O'Driscoll S.W.
        Intramuscular triceps rupture.
        Can J Surg. 1992; 35: 203-207
        • Wagner J.R.
        • Cooney W.P.
        Rupture of the triceps muscle at the musculotendinous junction: A case report.
        J Hand Surg Am. 1997; 22: 341-343

      Linked Article

      • Health Care Cost Consciousness: Testing Triceps Strength Instead of Routinely Ordering Imaging Procedures
        ArthroscopyVol. 31Issue 2
        • Preview
          In an era of cost consciousness, diagnostic tests might best be ordered only when there is a clear indication. Instead of “always” ordering ultrasound or MRI of the triceps tendon in patients with olecranon bursitis as Heikenfeld et al.1 suggest in their recent article, these tests could be limited to those patients with pain and/or weakness on resisted extension of the elbow. As olecranon bursitis is common and accompanying triceps tears are rare, brief physical examination with triceps strength testing simplifies the care and decreases the cost of care for most patients with olecranon bursitis.
        • Full-Text
        • PDF