SURGICAL-TREATMENT OF ARYTHROGRYPOSIS OF THE ELBOW

The purpose of this study was to analyze our results of surgical treat ment of arthrogryposis of the elbow and to compare our tendon transfer results using range of motion (ROM) criteria versus functional use cr iteria. Eighteen tendon transfers for elbow flexion in 14 children wit h arthrogryposis with an average follow-up period of 4 years (range, 1 -14 years) and 6 elbow capsulotomies with triceps lengthening in 6 chi ldren with arthrogryposis with an average follow-up period of 5 years (range, 2-9 years) were evaluated. Each child was assessed by a questi onnaire regarding functional use of the upper extremity, physical exam ination of ROM and strength, and a videotaped activities of daily livi ng evaluation. Tendon transfer results were classified and compared us ing 2 methods of evaluation: postoperative strength and ROM and effect ive functional use of the tendon transfer to perform activities of dai ly living. The 6 elbow capsulotomies improved from an average preopera tive are of 17 degrees of motion (average extension, -2 degrees; avera ge flexion, 19 degrees) to an average final follow-up arc of 67 degree s (average extension, -25 degrees; average flexion, 92 degrees). The 1 8 tendon transfers evaluated by strength and ROM criteria showed 9 tri ceps to biceps transfers in 9 arms (7 good, 1 fair, and 1 poor), 5 pec toralis to biceps transfers in 4 arms (1 good, 3 fair, and 1 poor), an d 4 latissimus dorsi to biceps transfers in 3 arms (2 good and 2 fair) . Evaluation by functional use criteria gave the same result in 13 tra nsfers and downgraded the result in 5; the downgraded results were due to resultant flexion contracture or limited functional use because th e transfer was in the nondominant arm. Based on this review, optimal s urgical candidates for tendon transfer are children older than 4 years , who have full passive ROM of the elbow in the dominant arm, and at l east grade 4 strength of the muscle to be transferred. (J Hand Surg 19 98;23A:1063-1070. Copyright (C) 1998 by the American Society for Surge ry of the Hand.).