title: Isolated Muscle Transfer to Restore Elbow Flexion in Children with Arthrogryposis.
abstract: Arthrogryposis is the general term given to conditions characterized by multiple joint contractures resulting in substantial disability most frequently involving a child. Early muscle transfer reconstructive surgery reliably restores elbow flexion. In the present study, we aimed to determine which preoperative condition is best able to restore elbow flexion in patients with arthrogryposis.
  
  
  
  We retrospectively reviewed five children (seven cases) who underwent elbow flexor reconstruction (Steindler flexorplasty, four cases; latissimus dorsi transfer, two cases; pectoralis major transfer, one case). Upper-extremity function was assessed on the basis of range of elbow extension and flexion and elbow flexor muscle power pre- and postoperatively.
  
  
  
  The mean postoperative active flexion and extension range of motion was 82.1° (60° to 100°) and -15.0° (-40° to 0°) respectively. Mean postoperative elbow flexor muscle power was graded as a 3.4 (2 to 4) as measured with the Medical Research Council (MRC) scale. The preoperative passive elbow flexion angle was found to correlate with postoperative muscle power (MRC) (r = 0.830, p = 0.042) and postoperative active elbow flexion angle (r = 0.902, p = 0.027). Age at operation was not found to correlate with postoperative muscle power (MRC) (r = -0.063, p = 0.878) or active elbow flexion angle (r = -0.134, p = 0.743).
  
  
  
  We found a positive correlation between preoperative passive elbow flexion/range of elbow motion and postoperative results including active range of motion and transferred muscle power. Diminished preoperative elbow flexion appeared to correlate with having a poor outcome. The present results suggest that choosing another muscle, such as the gracilis, may be beneficial for muscle transfer in more severe cases of arthrogryposis.
authors.affiliation: 1 Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan.|† Department of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Takagi
authors.affiliation: † Department of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Atsuhito
authors.initials: A
authors.lastname: Seki
authors.affiliation: 1 Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: 1 Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Mochida
authors.affiliation: † Department of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Takayama
mesh_terms: D001176:Arthrogryposis / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint; D005260:Female; D006801:Humans; D008297:Male; D010369:Pectoralis Muscles / Q000503:physiopathology / Q000637:transplantation*; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D064171:Superficial Back Muscles / Q000503:physiopathology / Q000637:transplantation*; D016896:Treatment Outcome
keywords: Arthrogryposis; Elbow flexion; Latissimus dorsi muscle; Muscle transfer; Pectoralis major muscle transfer; Steindler flexorplasty