Repair of a Chronic Triceps Tendon Rupture in a Dog Using an Autogenous Thoracolumbar Fascia Onlay Graft

Abstract

A 5-year-old 38 kg entire male German Shepherd dog was referred for persistent non-weight bearing left thoracic limb lameness 5 weeks following failed triceps tendon repair. Physical exam revealed complete incompetence of the triceps mechanism with a large palpable defect proximal to the olecranon and when the shoulder was fixed in extension, the elbow could be fully flexed. A purulent draining tract was present on the caudolateral aspect of the distal brachium. Staged tendon repair was delayed until resolution of infection to allow for improved healing. Culture following surgical exploration of the traumatized area with resection of sinus tract and interposed fibro-granulomatous tissue yielded no growth. Definitive triceps brachii tendon repair was augmented with an autogenous thoracolumbar fascia onlay graft. Postoperatively, the repair was protected with a spica splint and the left thoracic limb immobilized with the elbow maintained in an extended position for 6 weeks. Re-evaluation 7 months later revealed the patient to be free of lameness. Disruption of the triceps brachii tendon is a rarely reported tendon injury with chronic disruption of triceps tendon associated with a guarded prognosis. To the authors knowledge, successful surgical repair of tendinous injury incorporating the use of an autogenous thoracolumbar fascia onlay graft has not previously been described.

Keywords

tendon repair - tendon injury - lameness - dogs

Authors' Contributions

R.G.C. performed the surgery and revised the current manuscript. C.J.W. wrote the manuscript and submitted to the journal.

Publikationsverlauf

Eingereicht: 21. Oktober 2020

Angenommen: 16. Januar 2021

Artikel online veröffentlicht:
24. Juni 2021

• References

• 1 Earley NF, Ellse G, Wallace AM. et al. Complications and outcomes associated with 13 cases of triceps tendon disruption in dogs and cats (2003-2014). Vet Rec 2018; 182 (04) 108
• 2 Echigo R, Fujita A, Nishimura R, Mochizuki M. Triceps brachii tendon injury in four Pomeranians. J Vet Med Sci 2018; 80 (05) 772-777
• 3 Yoon H-Y, Jeong SW. Traumatic triceps tendon avulsion in a dog: magnetic resonance imaging and surgical management evaluation. J Vet Med Sci 2013; 75 (10) 1375-1377
• 4 Ambrosius L, Arnoldy C, Waller III KR, Little JP, Bleedorn JA. Reconstruction of chronic triceps tendon avulsion using synthetic mesh graft in a dog. Vet Comp Orthop Traumatol 2015; 28 (03) 220-224
• 5 Clarke SP, Jermyn K, Carmichael S. Avulsion of the triceps tendon insertion in a cat. Vet Comp Orthop Traumatol 2007; 20 (03) 245-247
• 6 Liehmann L, Lorinson D. Traumatic triceps tendon avulsion in a cat. J Small Anim Pract 2006; 47 (02) 94-97
• 7 Anson LW, Betts CW. Triceps tendon avulsion in a dog: surgical management and zeroradiographic evaluation. J Am Anim Hosp Assoc 1989; 25: 655-658
• 8 Davies JV, Clayton Jones DG. Triceps tendon rupture in the dog following corticosteroid injection. J Small Anim Pract 1982; 23: 779-787
• 9 Gilmore DR. Triceps tendon avulsion in the dog and cat. J Am Anim Hosp Assoc 1984; 20: 239-242
• 10 García-Fernández P, Quero Martín P, Mayenco A, Gardoqui M, Calvo I. Surgical management and follow-up of triceps tendon avulsion after repeated local infiltration of steroids: two cases. Vet Comp Orthop Traumatol 2014; 27 (05) 405-410
• 11 Henderson ER, Friend EJ, Toscano MJ, Parsons KJ, Tarlton JF. Biomechanical comparison of canine fascia lata and thoracolumbar fascia: an in vitro evaluation of replacement tissues for body wall reconstruction. Vet Surg 2015; 44 (01) 126-134
• 12 Bojrab MJ, Monnet E. Mechanisms of Disease in Small Animal Surgery. 3rd edition.. Jackson, WY: Teton NewMedia; 2010
• 13 Boyer MI, Gelberman RH, Burns ME, Dinopoulos H, Hofem R, Silva MJ. Intrasynovial flexor tendon repair. An experimental study comparing low and high levels of in vivo force during rehabilitation in canines. J Bone Joint Surg Am 2001; 83 (06) 891-899
• 14 Gelberman RH, Boyer MI, Brodt MD, Winters SC, Silva MJ. The effect of gap formation at the repair site on the strength and excursion of intrasynovial flexor tendons. An experimental study on the early stages of tendon-healing in dogs. J Bone Joint Surg Am 1999; 81 (07) 975-982
• 15 Ibrahim SA. Surgical treatment of chronic Achilles tendon rupture. J Foot Ankle Surg 2009; 48 (03) 340-346
• 16 Us AK, Bilgin SS, Aydin T, Mergen E. Repair of neglected Achilles tendon ruptures: procedures and functional results. Arch Orthop Trauma Surg 1997; 116 (6-7): 408-411
• 17 Shani J, Shahar R. Repair of chronic complete traumatic rupture of the common calcaneal tendon in a dog, using a fascia lata graft. Vet Comp Orthop Traumatol 2000; 13: 104-108
• 18 Houlton JEF, Dyce J. The use of polypropylene mesh for revision of failed repair of superficial digital flexor tendon luxation in three dogs. Vet Comp Orthop Traumatol 1993; 6: 129
• 19 Schlegel TF, Hawkins RJ, Lewis CW, Motta T, Turner AS. The effects of augmentation with Swine small intestine submucosa on tendon healing under tension: histologic and mechanical evaluations in sheep. Am J Sports Med 2006; 34 (02) 275-280
• 20 Shea KP, Obopilwe E, Sperling JW, Iannotti JP. A biomechanical analysis of gap formation and failure mechanics of a xenograft-reinforced rotator cuff repair in a cadaveric model. J Shoulder Elbow Surg 2012; 21 (08) 1072-1079
• 21 Nicholson GP, Breur GJ, Van Sickle D, Yao JQ, Kim J, Blanchard CR. Evaluation of a cross-linked acellular porcine dermal patch for rotator cuff repair augmentation in an ovine model. J Shoulder Elbow Surg 2007; 16 (5, Suppl): S184-S190
• 22 MacGillivray JD, Fealy S, Terry MA, Koh JL, Nixon AJ, Warren RF. Biomechanical evaluation of a rotator cuff defect model augmented with a bioresorbable scaffold in goats. J Shoulder Elbow Surg 2006; 15 (05) 639-644
• 23 van der Meijden OA, Wijdicks CA, Gaskill TR, Jansson KS, Millett PJ. Biomechanical analysis of two-tendon posterosuperior rotator cuff tear repairs: extended linked repairs and augmented repairs. Arthroscopy 2013; 29 (01) 37-45
• 24 Burkhart SS, Diaz Pagàn JL, Wirth MA, Athanasiou KA. Cyclic loading of anchor-based rotator cuff repairs: confirmation of the tension overload phenomenon and comparison of suture anchor fixation with transosseous fixation. Arthroscopy 1997; 13 (06) 720-724
• 25 Dueland R, Quenin J. Triceps tenotomy: biomechanical assessment of healing strength. J Am Anim Hosp Assoc 1980; 16: 507
• 26 Thomopoulos S, Parks WC, Rifkin DB, Derwin KA. Mechanisms of tendon injury and repair. J Orthop Res 2015; 33 (06) 832-839
• 27 Lichtnekert J, Kawakami T, Parks WC, Duffield JS. Changes in macrophage phenotype as the immune response evolves. Curr Opin Pharmacol 2013; 13 (04) 555-564
• 28 Sugg KB, Lubardic J, Gumucio JP, Mendias CL. Changes in macrophage phenotype and induction of epithelial-to-mesenchymal transition genes following acute Achilles tenotomy and repair. J Orthop Res 2014; 32 (07) 944-951
• 29 Nielsen C, Pluhar GE. Outcome following surgical repair of Achilles tendon rupture and comparison between postoperative tibiotarsal immobilization methods in dogs: 28 cases (1997-2004). Vet Comp Orthop Traumatol 2006; 19 (04) 246-249
• 30 Corr SA, Draffan D, Kulendra E, Carmichael S, Brodbelt D. Retrospective study of Achilles mechanism disruption in 45 dogs. Vet Rec 2010; 167 (11) 407-411