Distal triceps knotless anatomic footprint repair is superior to transosseous cruciate repair: a biomechanical comparison

Arthroscopy. 2014 Oct;30(10):1254-60. doi: 10.1016/j.arthro.2014.07.005.


Purpose: The purpose of this study was to evaluate the biomechanical properties of a method of repair using bone tunnels with multiple high-strength nonabsorbable sutures and one knotless suture anchor compared with the standard transosseous technique for repair of the distal triceps.

Methods: The triceps tendon footprint was measured in 18 cadaveric elbows (9 matched pairs), and a distal tendon rupture was created. Eighteen elbows (9 matched pairs) were randomly assigned to one of 2 repair groups: transosseous cruciate repair group or knotless anatomic footprint repair group. Cyclic loading was performed for a total of 1,500 cycles and displacement was measured. Data for load at yield and peak load were obtained.

Results: The average bony footprint of the triceps tendon was 466 mm(2). Cyclic loading of tendons from the 2 repair types showed that the knotless anatomic footprint repair produced less displacement when compared with the transosseous cruciate repair (P < .05). Load at yield and peak load were also greater in the knotless anatomic footprint repair group (P < .05).

Conclusions: Distal triceps knotless anatomic footprint repair in a cadaveric model had a significantly higher load and cycle to failure when compared with the traditional transosseous cruciate repair and produced less repair site motion.

Clinical relevance: The increased biomechanical strength and resistance to displacement at the tendon-bone interface may lead to improved clinical outcomes with the knotless anatomic footprint repair technique and warrants further clinical study.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Arm Injuries / physiopathology
  • Arm Injuries / surgery*
  • Biomechanical Phenomena
  • Cadaver
  • Elbow / injuries
  • Humans
  • Suture Anchors
  • Suture Techniques
  • Tendon Injuries / physiopathology
  • Tendon Injuries / surgery*