Comparison of the results of partial monopolar transfer of the pectoralis major for restoring active elbow flexion in children with arthrogryposis

Abstract

BACKGROUND: The absence of active forearm flexion in children with amyoplasia leads to severe functional disorders. Muscle transfer can potentially restore active elbow flexion and the patients daily living. AIM: This study compares the results of the transposition of the latissimus dorsi and pectoralis major to the biceps brachii and identifies the optimal donor area for restoring active elbow flexion in children with amyoplasia. MATERIALS AND METHODS: The retrospective study involved 61 patients with amyoplasia (30 (49%) girls and 31 (51%) boys) who were examined and treated from 2011 to 2020. Restoration of elbow flexion was performed in 90 cases. In 46 cases (51.1%), we used the pectoralis major, and in 44 (48.9%), the latissimus dorsi as donor muscles. In both groups, we performed monopolar muscle transfers. The clinical examination of the patients was conducted before and after the operation. Statistical data processing was performed using Statistica 10 and SAS JMP 11. RESULTS: The age of patients at the time of surgery was from 1.5 to 15.5 years (6.24 4.24 years), the follow-up period after surgery was from 6 to 99 months (41.25 30.19 months). After surgery, all patients had elbow flexion contractures. However, when the latissimus dorsi was used as a donor muscle, the degree of contracture was less than after pectoralis major transfer (15.19 13.04 and 23.24 15.37, respectively, p = 0.0483). In addition, after the latissimus dorsi transfer, the strength of the forearm flexors was on average 1 point greater than after the pectoralis major transfer (2.85 1.08 and 4.00 0.62 points, respectively, p 0.0001). After the latissimus dorsi transfer, the active elbow amplitude flexion was bigger than that of the pectoralis major transfer (75.37 17.86 and 55.88 24.60, respectively, p = 0.0022). CONCLUSIONS: The study demonstrated the effectiveness of using the latissimus dorsi and the pectoralis major to restore elbow flexion in children with amyoplasia. However, if it is possible to choose a donor muscle, it should be the latissimus dorsi.