Restoration of elbow active flexion in children with amyoplasia: What is the better age to do the operation?

BACKGROUND: The absence of active elbow flexion is the most common problem in children with amyoplasia, leading to daily living difficulties. Many variants of muscle transfer are used for the restoration of active elbow flexion. The pectoralis major and latissimus dorsi muscles are the most used muscles for this purpose; however, the optimal age for these operations is not reported in the literature.

AIM: This study aimed to determine the optimal age of children with amyoplasia for the restoration of active elbow flexion.

MATERIALS AND METHODS: The retrospective study involved 61 patients (90 upper limbs) with amyoplasia (30 [49%] girls and 31 [51%] boys) who were examined and treated between 2011 and 2020. In 46 (51.1%) cases, we used major muscles, and in 44 (48.9%) cases, the latissimus dorsi muscle was used as a donor muscle. All patients were divided into four groups: group 1 included children aged 1–3 years (n = 17, 27.9%); group 2, 3–7 years (n = 30, 49.2%); group 3, 7–11 years (n = 8, 13.1%), and group 4, 12–18 years (n = 6, 9.8%). The clinical examination of the patients was conducted before and after the operation (≥6 months). Statistical data processing was performed using Statistica 10 and SAS JMP 11. To describe the numerical scales, the average value and standard deviation (M ± SD) were used.

RESULTS: The age of the patients at the time of surgery was 5.16 ± 3.72 years, and the postoperative follow-up period was 41.93 ± 30.13 months. Elbow flexion contractures were observed mainly in groups 1–3 (p < 0.05). The greatest changes in indicators such as the strength of forearm flexor muscles, active elbow flexion, and function of the elbow were noted in group 1 (p < 0.05). The same postoperative indicators were worse in group 4 than in younger patients (p < 0.05). Groups 3 and 4 had less strength of the donor muscles than groups 1 and 2 (p < 0.05).

CONCLUSIONS: The retrospective analysis of the results of the restoration of active elbow flexion in children with amyoplasia allowed us to recommend these operations in children aged 1–3 years. The prevention of elbow flexion contractures and the formation of a new stereotype of movement help improve the self-ability of these patients and the treatment results.