title: Subscapularis Z-lengthening in children with brachial plexus birth palsy loses efficiency at mid-term follow-up: a retrospective cohort study.
abstract: OBJECTIVE
  The aim of this study was to evaluate early and mid-term clinical outcomes after isolated subscapularis Z-lengthening in children with shoulder internal rotation contractures resulting from brachial plexus birth palsy.
  
  
  METHODS
  Children with brachial plexus birth palsy treated with subscapularis tendon Z-lengthening from 2001 to 2011 were retrospectively reviewed. Over this period, 31 patients were identified. Primary outcome was improvement in Mallet score after surgery, and secondary outcome measures were active range of motion and Mallet sub-scores. Clinical outcomes were collected at three time intervals: pre-operatively, one-year post-operative and at latest follow-up.
  
  
  RESULTS
  After exclusion, 21 patients remained for further analysis. Mean age at surgery was 3.7 years (range, 1.2-8.7), and mean follow-up length was 6.5 years (2.9-9.7). Moderate improvements were found for mean Mallet score, active external rotation, active abduction and hand-to-mouth movement at one year and latest follow-up. However, improvements in active external rotation and Mallet score were not fully maintained at final follow up.
  
  
  CONCLUSIONS
  Isolated subscapularis Z-lengthening is effective at early follow-up, but results are not maintained at mid-term follow-up.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK. askruit@live.nl.|, Wijde Begijnestraat 5, 3512 AW, Utrecht, The Netherlands. askruit@live.nl.
authors.forename: Anne Sophie
authors.identifier: http://orcid.org/0000-0001-6368-9974
authors.initials: AS
authors.lastname: Kruit
authors.affiliation: Department of Plastic and Reconstructive Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
authors.forename: Fouzia
authors.initials: F
authors.lastname: Choukairi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
authors.forename: Anuj
authors.initials: A
authors.lastname: Mishra
authors.affiliation: Department of Orthopaedic Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Gaffey
authors.affiliation: Department of Plastic and Reconstructive Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
authors.forename: Andrea
authors.initials: A
authors.lastname: Jester
mesh_terms: D001917:Brachial Plexus / Q000293:injuries / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003286:Contracture / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery; D058971:Tenotomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Brachial plexus birth palsy; Muscle contracture; Shoulder; Subscapularis lengthening