This retrospective review from the Mayo Clinic examines triceps (extensor mechanism) insufficiency after total elbow arthroplasty. It asks how often the complication requires reoperation and which reconstruction techniques restore function. Sixteen elbows treated with direct suture, anconeus flap, or Achilles allograft were analyzed over 19 years.
When a total elbow arthroplasty patient loses active extension and can no longer reach overhead or push open a door, suspect triceps insufficiency even without a traumatic event. The key decision driver is not the diagnosis but three anatomic variables: tendon quality, degree of retraction, and status of the olecranon.
Use the Mayo algorithm. Good tendon without retraction gets direct crisscross bone suture. Retracted or poor tissue with a healthy anconeus gets an anconeus rotational flap. A devitalized anconeus or large defect gets an Achilles tendon allograft.
The most testable pitfall is olecranon resorption. It eliminates the triceps lever arm and caused every direct-repair failure in this series, so a deficient olecranon must be augmented with calcaneal or rib bone graft for reconstruction to hold. Remember also that the triceps-splitting GSB approach carries higher insufficiency rates than the triceps-sparing Bryan-Morrey exposure.
This retrospective review from the Mayo Clinic examines triceps (extensor mechanism) insufficiency after total elbow arthroplasty. It asks how often the complication requires reoperation and which reconstruction techniques restore function. Sixteen elbows treated with direct suture, anconeus flap, or Achilles allograft were analyzed over 19 years.
When a total elbow arthroplasty patient loses active extension and can no longer reach overhead or push open a door, suspect triceps insufficiency even without a traumatic event. The key decision driver is not the diagnosis but three anatomic variables: tendon quality, degree of retraction, and status of the olecranon.
Use the Mayo algorithm. Good tendon without retraction gets direct crisscross bone suture. Retracted or poor tissue with a healthy anconeus gets an anconeus rotational flap. A devitalized anconeus or large defect gets an Achilles tendon allograft.
The most testable pitfall is olecranon resorption. It eliminates the triceps lever arm and caused every direct-repair failure in this series, so a deficient olecranon must be augmented with calcaneal or rib bone graft for reconstruction to hold. Remember also that the triceps-splitting GSB approach carries higher insufficiency rates than the triceps-sparing Bryan-Morrey exposure.