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

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 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). 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.