Rehabilitation following distal triceps repair: A scoping review.

Abstract

Background: Distal triceps ruptures are relatively rare injuries where surgical repair is recommended for return to function and sport. There are various fixation techniques and different therapy protocols described in the literature.

Purpose: To scope and critically evaluate current knowledge of post-operative protocols and complications following repair and extrapolate tendon healing principles to clinical practice.

Study design: Scoping review.

Methods: The Joanna Briggs Institute framework for Scoping Reviews was followed, and specific inclusion/exclusion criteria were applied to identify high-quality, relevant evidence. Studies were included if they met the following criteria: written in English, focused on adults over 17 years of age with complete distal triceps tendon ruptures, and published as peer-reviewed articles, conference abstracts, university dissertations, or theses. Additionally, the studies had to use at least one validated outcome measure. Electronic and manual searches were completed of published and gray literature. Quantitative sources were included for complete triceps ruptures that measured outcomes using at least one validated outcome measure. Qualitative sources that were published within 10 years from a reputable journal were included for qualitative synthesis.

Results: Eighteen quantitative articles consisting of case series and systematic reviews, and 16 expert opinion and narrative reviews met the inclusion criteria. There was no standardized postoperative protocol with differences found in timing for ranging, strengthening, and return to function. The most reported complications were tendon rerupture, infection, pain, and ulnar nerve neuropathy.

Conclusions: What is known about triceps tendon repairs comes from low level evidence. Randomized controlled trials are required to evaluate the effect of surgical constructs and therapy on function. The protocols identified in this scoping review typically progressed through several stages, starting with complete immobilization and moving on to ranging, strengthening, and finally returning to sport and functional activities. Therapists can apply general tendon healing principles when rehabilitating these patients and should be aware of modifiers to healing timeframes when making decisions on strengthening and resuming activities that require high function.