Synthetic Augmented Suture Anchor Reconstruction for a Complete Traumatic Distal Triceps Tendon Rupture in a Male Professional Bodybuilder with Postoperative Biomechanical Assessment

Bodybuilding is a high-risk sport for distal triceps tendon ruptures. Management, especially in high-demanding athletes, is operative with suture anchor refixation technique being frequently used. However, the rate of rerupture is high due to underlying poor tendon quality. Thus, additional augmentation could be useful. This case report presents a reconstruction technique for a complete traumatic distal triceps tendon rupture in a bodybuilder with postoperative biomechanical assessment. A 28-year-old male professional bodybuilder was treated with a synthetic augmented suture anchor reconstruction for a complete triceps tendon rupture of his right dominant elbow. Postoperative biomechanical assessment included isokinetic elbow strength and endurance testing by using multiple angular velocities to simulate the “off-season” and “precompetition” phases of training. Eighteen months postoperatively and after full return to training, the biomechanical assessment indicated that the strength and endurance of the operated elbow joint was fully restored with even higher ratings compared to the contralateral healthy arm. The described reconstruction technique can be considered as an advisable option in high-performance athletes with underlying poor tendon quality due to high tensile strength and lack of donor site morbidity, thus enabling them to restore preinjury status and achieve safe return to sports. 1. Introduction Bodybuilders, along with weight-/powerlifters and football players, are among the most susceptible for distal triceps tendon ruptures [1–4]. Even though these injuries represent the 0.8% of all upper extremities tendon injuries in athletes [5], the risk of exhibiting a distal triceps tendon rupture in bodybuilding is particularly high [6–8]. Predisposing factors are anabolic steroid use [8–10], local steroid injection, and chronic tendinopathy [1, 11]. Anabolic steroid use has been shown to have a detrimental ultrastructural effect on the volume and quality of tendon collagen fibrils [9]. Recent studies report on the extensive damage to the musculotendinous unit after long-term steroid abuse [11] and intramuscular oil injections [12]. Furthermore, repetitive eccentric exercise, as the high volume resistance training employed in bodybuilding [13], is considered a predisposing factor due to an elevated risk of chronic tendinopathy. Management in top-level athletes is operative and well established with good mid- to long-term results and return to sports [3, 14]. Many techniques exist such as the currently favored anatomical suture anchor refixation