Distal Triceps Knotless Anatomic Footprint Repair Is Superior to Transosseous Cruciate Repair: A Biomechanical Comparison

PurposeThe 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.MethodsThe 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.ResultsThe average bony footprint of the triceps tendon was 466 mm2. 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).ConclusionsDistal 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 RelevanceThe 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.