Distal triceps tendon rupture repair results in high return to sport rates for amateur and professional athletes: a systematic review.

Background: Distal triceps tendon ruptures (DTTRs) typically occur in active patients engaged in sports and exercises involving resisted elbow extension. Surgical repair is generally recommended to restore arm function and strength. There is currently limited evidence to guide expectations for return-to-sport (RTS) among active patients. The purpose of this investigation is to systematically review the literature to better understand outcomes after repair of DTTR, particularly in amateur and professional athletes, with a focus on RTS rate and timing, along with the incidence of post-operative complications. Methods: Studies included in PubMed, EMBASE, and Cochrane Library databases from inception to September 2025 reporting on patients identified as athletes undergoing DTTR repair were identified. Inclusion criteria included studies reporting injury mechanism, tear characteristics (extent and location), competition level, RTS rate and timing, and post-operative outcomes, including complications and/or reoperations, and patient-reported outcomes. Results: A total of 31 studies, consisting of 277 athletes (n = 283 elbows) undergoing DTTR repair, with a weighted mean follow-up of 23.4 (range, 12-108) months, were identified. The weighted mean patient age was 36.2 years (range, 12-62 years), with 96.4% of patients being male. Sports-related injuries were the most frequently reported etiology (59.0%; n = 131/222), with the dominant arm being affected in 55.6% (n = 50/90) of cases. Weightlifting (40.7%, n = 87/214) and American football (26.6%, n = 57/214) were the most commonly reported athletic activities. The weighted mean time interval from injury to repair was 2.3 months (range, 0.1-12). Repair techniques included open repair using transosseous bone tunnel (45.3%, n = 97/214) and primary suture (40.2%, n = 86/214) repair. Rerupture was the most frequently reported complication (4.4%; n = 9/206), with 7.8% (n = 16/206) undergoing reoperations, including revision repair in 2.4% (n = 5/206). A total of 93.0% (n = 252/271) of athletes reported successful RTS at a weighted mean of 5.2 (range, 1.6-10.6) months, with 63.6% (n = 42/66) returning to their prior or higher level of competition. The weighted mean post-operative visual analog scale score was 1.7 (n = 97), with Disabilities of the Arm, Shoulder, and Hand score of 4.1 (n = 24), Quick Disabilities of the Arm, Shoulder, and Hand score of 8.1 (n = 71), and Mayo Elbow Performance Score of 89.1 (n = 119). Conclusion: The vast majority of patients undergoing DTTR repair are male, most commonly engaged in weightlifting or American football. Successful RTS was reported in 93% of patients at a mean of 5.2 months following repair, while tendon rerupture was reported in 4.4% and reoperations in 7.8%.