Techniques“Triple Window” Surgical Approach to the Elbow: A Hybrid ExposureKamineni, Srinath MD, MBBCh, BSc(Hons), FRCS (Orth)*; Abbenhaus, Eric MD*; Snowden, Ryan MD†Author Information *Department of Orthopaedic Surgery and Sports Medicine, Elbow Shoulder Research Center, University of Kentucky, Lexington, KY †Tennessee Orthopaedic Alliance The authors declare no conflict of interest. Reprints: Srinath Kamineni, MD, MBBCh, BSc(Hons), FRCS (Orth), Department of Orthopaedic Surgery, Elbow Shoulder Research Centre, University of Kentucky, 740 South Limestone Street, K-412 Kentucky Clinic, Lexington, KY 40536-0284 (e-mail: [email protected]). Techniques in Shoulder & Elbow Surgery: December 2020 - Volume 21 - Issue 4 - p 116-123 doi: 10.1097/BTE.0000000000000207 Buy Metrics Abstract Triceps-off approaches of the elbow detach not only the central tendinous insertion but also the medial and lateral peripheral muscular extensions, which are often replaced by scar tissue instead of functioning contractile muscular tissue when re-attached firmly with suture. These muscular extensions have been shown to be important for terminal elbow extension and may explain why triceps-off approaches have a higher rate of triceps insufficiency in terminal, antigravity elbow extension. Triceps-on approaches of the elbow lead to difficulty accessing the ulna for preparation and insertion of the ulna component of elbow replacements, with malpositioning of the ulna component a common concern. We present an elbow “triple window” surgical approach that preserves the contractile medial and lateral footprints of the triceps, while affording a better in-line access than a pure “triceps-on” approach. This approach only violates 50% of the central tendinous insertion, with the remainder of the central tendon and the medial and lateral muscular extensions preserved. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.