Dr. Garcia demonstrates his technique for triceps tendon repair

This video features Dr. Grant H. Garcia demonstrating his surgical technique for an open triceps tendon repair. The patient is an individual with a chronic triceps rupture (greater than 60% torn and over three months old) who was suffering from persistent muscle weakness.

Here is a summary of the procedure shown in the video:

• Exposure and Nerve Protection: The surgery begins with the release and isolation of the ulnar nerve to protect it throughout the procedure, which is particularly crucial because the medial side of the triceps tendon was severely retracted.
• Preparing the Footprint: The surgeon exposes the olecranon (the bony tip of the elbow) and thoroughly debrides the surface to create a fresh, healthy bone footprint that optimizes tendon-to-bone healing.
• Anchor Placement & Suture Passages: The surgeon uses innovative low-profile fiber tacks loaded with four suture tapes, which offer superior biomechanical strength and a very small footprint (less than 8mm) to avoid penetrating the joint space. Given the bulk of the patient's triceps, a Krakow stitch is placed through four separate limbs of the tendon. The surgeon ensures the needles exit at the superior surface of the tendon to allow for optimal tissue compression down to the bone.
• Mobilizing Retracted Tissue: Because the medial side was highly retracted compared to the lateral side, the surgeon performs a central split and elevates the medial triceps intra-articularly. Precise care is taken during mobilization to avoid extending too far proximally and damaging the radial nerve.
• Tension-Slide Fixation: With the patient's elbow held in full extension, a tension-slide technique is executed. The surgeon pulls sequentially on a marked post limb of each suture to glide the triceps tissue tightly back down to its native position on the olecranon. Alternating half-hitch knots are used to lock down the initial row.
• Double-Row Reinforcement: To establish a highly rigid, anatomical construct, the surgeon creates a double-row fixation. Two 3.9mm SwiveLock anchors—which have an expanded eyelet that can accommodate up to six to eight suture tapes—are inserted into the olecranon. The suture limbs are passed back up through the proximal tendon tissue, pulling it perfectly flat against the bone footprint to minimize potential implant irritation.
• Final Construct Assessment: The surgeon bends the elbow to nearly 90 degrees to confirm that the repair is structurally secure with excellent excursion and no gapping at the attachment site.

Post-operatively, the patient will be placed in a protective elbow brace set to 30 degrees, with passive range of motion exercises scheduled to begin at two weeks.