Partial triceps tendon avulsion delayed reconstruction using Achilles tendon allograft, a case report

A case report of a 32-year-old bodybuilder with an incomplete triceps tendon avulsion on his right dominant upper extremity is presented. At initial presentation, an avulsion injury was suspected. Ultrasound diagnostics pointed toward partial distal triceps tendon rupture, and since the patient had retained active elbow extension, a trial of conservative treatment was initiated. The patient failed to regain forceful elbow extension. MRI revealed an avulsion fracture of the olecranon with large partial triceps tendon rupture with muscle retraction. A triceps tendon tenolysis and fixation with transosseous olecranon sutures was conducted in a secondary trauma center. However, we failed to recognize the true tendon in the extensive scar tissue formation, and the patient did not regain appropriate elbow extension strength. He was administered to a university medical center. An extensive triceps tenolysis was performed along with clear identification of retracted bony avulsion fragment and re-fixation of true triceps tendon on the olecranon using Achilles tendon allograft. During the postoperative period and physical rehabilitation therapy, the patient gradually developed normal elbow extension strength and was able to return to bodybuilding without limitations. Goniometric measurements and isokinetic testing were performed one year after the second surgery, showing only a minor reduction of right elbow extension strength compared to the uninjured elbow. Elbow function measured by the functional score questionnaire was comparable to the uninjured upper extremity.