Reconstruction of Elbow Flexion in Arthrogryposis Multiplex Congenita Type I: Results of Transfer of Pectoralis Major Muscle With Follow-up at Skeletal Maturity
Abstract
Background: The purpose of this study was to analyze the results of a pectoralis major transfer to restore active elbow flexion in patients with extension elbow contracture in arthrogryposis. The hypotheses were: (1) this transfer ensures permanent useful elbow flexion; and (2) flexion elbow deformity will not progress during growth and after its cessation.
Methods: Unipolar transfer of the 3 distal parts of the pectoralis major muscle was used in 9 extremities of 5 patients (age range, 5 to 9 y; average age, 6.3 y) and the results were prospectively followed in the period of 13 to 16 years. Posterior elbow release was necessary in 5 extremities to achieve passive flexion of 90 degrees before the transfer.
The subjective evaluation of daily living activities and data on the physical examination of the range of movement of the elbow, muscle strength, and electrical activity of the transferred muscle were assessed. Two specimens from transferred muscles were histologically examined.
Conclusions: The hypotheses of the study were not confirmed, because this muscle transfer restores useful elbow flexion without flexion deformity if the passive flexion at children's age exceeds 90 degrees without a necessity of posterior release. In these cases, bilateral pectoralis to biceps transfer is recommended.