Overview
The triceps extends the elbow — essential for pushing, throwing, and overhead work. Rupture of the distal triceps is uncommon but almost always requires surgical repair when complete, because the muscle cannot overcome gravity against extension without its attachment.
How the Procedure Works
We expose the olecranon tip through a posterior incision, retrieve the retracted tendon, and prepare its end with heavy non-absorbable sutures in a locking configuration. The olecranon footprint — a broad, rough area at the tip — is freshened to bleeding bone. We anchor the tendon either through transosseous tunnels drilled side-to-side through the olecranon or with suture anchors, depending on bone quality; tunnels generally provide stronger fixation in good bone. The critical intraoperative check is elbow flexion with the repair under load: the tendon should sit flat on bone at 30–40° of flexion without gapping, which is the position we protect in the early postoperative brace.
When to Consider Distal Triceps Repair
Distal triceps repair is generally offered when symptoms, imaging, and a trial of non-operative care together point to surgery as the next step. The typical picture includes:
Acute distal triceps rupture
Complete tear with loss of active elbow extension against gravity.
Partial tear with persistent weakness
A partial tear that has not improved with conservative care and continues to limit activity.
Conditions This Treats
Physicians Who Perform Distal Triceps Repair
Providers Who Surgically Assist with Distal Triceps Repair
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes loss of active elbow extension against gravity and a weak arm for pushing, pressing, and anything overhead. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with patients before distal triceps repair include:
- bleeding and infection
- anesthesia risk
- stiffness
- re-rupture
- suture-anchor irritation
- ulnar nerve irritation (the nerve runs close to the exposure)
The indication to proceed is an acute distal triceps rupture with a palpable defect and loss of extension strength. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: