Olecranon Tendo-Osseous Allograft Reconstruction for Complex Extensor Mechanism and Bone Loss at the Elbow

• Published in: The Journal of hand surgery (American ed.) Vol. 49; no. 11; pp. 1141.e1 - 1141.e11
• Main Authors: Koso, Riikka, Gabig, Andrew M., Brady, Christina I., Dutta, Anil K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2024
• Subjects: Elbow; elbow arthroplasty; extensor reconstruction; tendo-osseous allograft; triceps reconstruction; Elbow; elbow arthroplasty; tendo-osseous allograft; extensor reconstruction; triceps reconstruction
• ISSN: 0363-5023; 1531-6564; 1531-6564
• DOI: 10.1016/j.jhsa.2023.02.006

The purpose of this study was to present the results of olecranon tendo-osseous allograft (OTOA) reconstruction for patients with an irreparable extensor mechanism from prior trauma or failed total elbow arthroplasty (TEA).
A retrospective review was performed of all patients with extensor mechanism loss after trauma or failed TEA who were treated with an OTOA to supplement fracture fixation or elbow arthroplasty, as indicated. Primary outcome measures were successful healing of the allograft, restoration of the extensor mechanism function, and Mayo Elbow Performance Scores (MEPS) at the most recent follow-up. Secondary outcomes included patients’ active range of motion and unplanned operative interventions.
Nine patients had extensor mechanism and proximal ulna loss as a result of prior TEA, acute trauma, or failed surgeries for prior trauma. All but one had undergone multiple prior surgeries. The mean follow-up was 27 months (6–60 months). At the final follow-up, patients reported MEPS of 92 (80–100). All patients regained active triceps extension (strength 3–5/5). Mean final range of motion was 16° (0° to 45°) extension, 124° (70° to 150°) flexion, 56° (45° to 80°) pronation, and 60° (40° to 80°) supination. Eight (89%) of the nine patients had a radiographically healed graft at the latest follow-up, of which four healed without notable complications or further surgical intervention. Complications included radial/ulnar nerve palsy, allograft olecranon stress fracture, deep infection, wound complications, instability, and complications related to the TEA prosthesis.
In the setting of elbow reconstruction in which there is inadequate triceps tendon and/or olecranon bone stock to perform internal fixation and/or revision arthroplasty, OTOA may supplement elbow reconstruction, albeit with high rates of complications. A triceps-olecranon allograft, combined with either internal fixation or TEA, is a potentially useful salvage procedure for managing bone loss and an irreparable extensor mechanism deficit at the elbow.
Therapeutic V.