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

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

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 patient’s 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.

Full Text

Restricted Access

About the authors

Olga E. Agranovich

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: olga_agranovich@yahoo.com
ORCID iD: 0000-0002-6655-4108
SPIN-code: 4393-3694
Scopus Author ID: 56913386600
ResearcherId: B-3334-2019
http://www.rosturner.ru/kl10.htm

MD, PhD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

Ekaterina V. Petrova

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: pet_kitten@mail.ru
ORCID iD: 0000-0002-1596-3358
SPIN-code: 2492-1260
Scopus Author ID: 57194563255

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Sergey F. Batkin

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: sergey-batkin@mail.ru
ORCID iD: 0000-0001-9992-8906
SPIN-code: 5173-9340

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Vladimir M. Kenis

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: kenis@mail.ru
ORCID iD: 0000-0002-7651-8485
SPIN-code: 5597-8832
Scopus Author ID: 36191914200
ResearcherId: K-8112-2013

MD, PhD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg

Andrey V. Sapogovskiy

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: sapogovskiy@gmail.com
ORCID iD: 0000-0002-5762-4477
SPIN-code: 2068-2102
Scopus Author ID: 57193257532

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Evgeniy V. Melchenko

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: emelchenko@gmail.com
ORCID iD: 0000-0003-1139-5573
SPIN-code: 1552-8550
Scopus Author ID: 55022869800

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Evgeniy D. Blagoveschenskiy

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; National Research University “Higher School of Economics”

Email: eblagovechensky@hse.ru
ORCID iD: 0000-0002-0955-6633
SPIN-code: 2811-5723
Scopus Author ID: 6506349269
ResearcherId: B-5037-2014

PhD, Cand. Sci. (Biol.)

Russian Federation, Saint Petersburg; Moscow

References

  1. Sochol KM, Edwards G 3rd, Stevanovic M. Restoration of elbow flexion with a free functional gracilis muscle transfer in an arthrogrypotic patient using a motor nerve to pectoralis major. Hand (NY). 2020;15(5):739−743. doi: 10.1177/1558944720923412
  2. Atkins RM, Bell MJ, Sharrard WJ. Pectoralis major transfer for paralysis of elbow flexion in children. J Bone Joint Surg Br. 1985;67:640−644.
  3. Agranovich OE, Kochenova EA, Oreshkov AB, et al. Evaluation of unipolar transfer of the latissimus dorsi to flexor antebrachii in patients with arthrogryposis. Orthopaedic Genius. 2019;25(1):42−48. doi: 10.18019/1028-4427-2019-25-1-42-48
  4. Agranovich OE, Kochenova EA, Trofimova SI, et al. Restoration of elbow active flexion via latissimus dorsii transfer in patients with arthrogryposis. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2018;6(3):5−11. (In Russ.). doi: 10.17816/PTORS6273-75
  5. Carroll RE, Hill NA. Triceps transfer to restore elbow flexion. A study of fifteen patients with paralytic lesions and arthrogryposis. J Bone Joint Surg Am. 1970;52:239−244.
  6. Chomiak J, Dungl P, Včelák J. Reconstruction of elbow flexion in arthrogryposis multiplex congenita type I. J Pediatr Orthop. 2014;34(8):799–807. doi: 10.1097/bpo.0000000000000204
  7. Carroll RE, Kleinman WB. Pectoralis major transplantation to restore elbow flexion to the paralytic limb. J Hand Surg Am. 1979;4:501−507.
  8. Doyle JR, James PM, Larsen LJ, Ashley RK. Restoration of elbow flexion in arthrogryposis multiplex congenita. J Hand Surg. 1980;5A:149–152
  9. Gagnon E, Fogelson N, Seyfer AE. Use of the latissimus dorsi muscle to restore elbow flexion in arthrogryposis. Plast Reconstr Surg. 2000;106:1582−1585.
  10. Ezaki M. Treatment of the upper limb in the child with arthrogryposis. Hand Clinics. 2000;16(4):703–711. doi: 10.1016/s0749-0712(21)00228-6
  11. Goldfarb CA, Burke MS, Strecker WB, Manske PR. The Steindler flexorplasty for the arthrogrypotic elbow. J Hand Surg Am. 2004;29(3):462−469. doi: 10.1016/j.jhsa.2003.12.011
  12. Lahoti O, Bell MJ. Transfer of pectoralis major in arthrogryposis to restore elbow flexion. Deteriorating results in the long term. J Bone Joint Surg Br. 2005;87(6):858–860. doi: 10.1302/0301-620X.87B6.15506
  13. Zargarbashi R, Nabian MH, Werthel J-D, Valenti P. Is bipolar latissimus dorsi transfer a reliable option to restore elbow flexion in children with arthrogryposis? A review of 13 tendon transfers. J Shoulder Elbow Surg. 2017;26(11):2004–2009. doi: 10.1016/j.jse.2017.04.002
  14. Van Heest A, Waters PM, Simmons BP. Surgical treatment of arthrogryposis of the elbow. J Hand Surg Am. 1998;23:1063–1070. doi: 10.1016/S0363-5023(98)80017-8
  15. Oishi S, Agranovich O, Zlotolow D, et al. Treatment and outcomes of arthrogryposis in the upper extremity. Am J Med Genet C Semin Med Genet. 2019;181(3):363–371. doi: 10.1002/ajmg.c.31722
  16. Takagi T, Seki A, Kobayashi Y, et al. Isolated muscle transfer to restore elbow flexion in children with arthrogryposis. J Hand Surg Asian Pac Vol. 2016;21(1):44–48. doi: 10.1142/S2424835516500053
  17. Doi K, Arakawa Y, Hattori Y, Baliarsing AS. Restoration of elbow flexion with functioning free muscle transfer in arthrogryposis: a report of two cases. J Bone Joint Surg Am. 2011;93(18):e105. doi: 10.2106/JBJS.J.01846
  18. Kay S, Pinder R, Wiper J, et al. Microvascular free functioning gracilis transfer with nerve transfer to establish elbow flexion. J Plast Reconstr Aesthet Surg. 2010;63(7):1142–1149. doi: 10.1016/j.bjps.2009.05.021
  19. Bennett JB, Hansen PE, Granberry WM, Cain TE. Surgical management of arthrogryposis in the upper extremity. J Pediatr Orthop. 1985;5:281–286.
  20. Wall LB, Calhoun V, Roberts S, Goldfarb CA. Distal humerus external rotation osteotomy for hand position in arthrogryposis. J Hand Surg Am. 2017;42(6):473.e1–473.e7. doi: 10.1016/j.jhsa.2017.03.002

Supplementary files

Supplementary Files
Action
1. Fig. 1. Span diagrams for the indicator "amplitude of active movements, deg." after surgery in both groups. PGM - pectoralis major muscle; SHMS - latissimus dorsi muscle

Download (54KB)
2. Fig. 2. Span diagrams according to the indicator "extension deficit, deg." after surgery in both groups. PGM - pectoralis major muscle; SHMS - latissimus dorsi muscle

Download (47KB)
3. Fig. 3. Span diagrams in terms of "muscle strength, scores" after surgery in both groups. PGM - pectoralis major muscle; SHMS - latissimus dorsi muscle

Download (41KB)
4. Fig. 4. Change in the indicator "passive flexion, deg." after transposition of the pectoralis major muscle (BGM) and the latissimus dorsi muscle (BMS)

Download (57KB)
5. Fig. 5. Change in the indicator "active flexion, deg." in both groups of patients. PGM - pectoralis major muscle; SHMS - latissimus dorsi muscle

Download (64KB)
6. Fig. 6. Change in forearm flexor strength before and after surgery in both groups of patients. PGM - pectoralis major muscle; SHMS - latissimus dorsi muscle

Download (57KB)
7. Fig. 7. Change in the indicator "extension deficit, deg." in both groups of patients. PGM - pectoralis major muscle; SHMS - latissimus dorsi muscle

Download (59KB)
8. Fig. 8. Change in the strength of the forearm flexors at various times after surgery after transposition of the pectoralis major muscle. 1 — the first group (from 6 months to 1 year), 2 — the second group (1–3 years), 3 — the third group (more than 3 years)

Download (44KB)
9. Fig. 9. Changes in the strength of the forearm flexors at various times after surgery after transposition of the latissimus dorsi muscle. 1 — the first group (from 6 months to 1 year), 2 — the second group (1–3 years), 3 — the third group (more than 3 years)

Download (46KB)
10. Fig. 10. Change in the indicator "active flexion, deg." at various times after surgery after transposition of the pectoralis major muscle. 1 — the first group (from 6 months to 1 year), 2 — the second group (1–3 years), 3 — the third group (more than 3 years)

Download (49KB)
11. Fig. 11. Change in the indicator "active flexion, deg." at various times after surgery after transposition of the latissimus dorsi muscle. 1 — the first group (from 6 months to 1 year), 2 — the second group (1–3 years), 3 — the third group (more than 3 years)

Download (48KB)
12. Fig. 12. Change in the indicator "deficiency of extension, deg." at various times after surgery after transposition of the pectoralis major muscle. 1 — the first group (from 6 months to 1 year), 2 — the second group (1–3 years), 3 — the third group (more than 3 years)

Download (53KB)
13. Fig. 13. Change in the indicator "extension deficiency, deg." at various times after surgery after transposition of the latissimus dorsi muscle. 1 — the first group (from 6 months to 1 year), 2 — the second group (1–3 years), 3 — the third group (more than 3 years)

Download (53KB)
14. Fig. 1. Box plots for the postoperative ‘amplitude of active movements, deg.’ in both groups. PMM, pectoralis major muscle; LDM, latissimus dorsi muscle

Download (49KB)
15. Fig. 2. Box plots for the postoperative ‘extension deficit, deg.’ in both groups. PMM, pectoralis major muscle; LDM, latissimus dorsi muscle

Download (43KB)
16. Fig. 3. Box plots for the postoperative ‘muscle strength, points’ in both groups. PMM, pectoralis major muscle; LDM, latissimus dorsi muscle

Download (40KB)
17. Fig. 4. Change in ‘passive flexion, deg.’ after transposition of the pectoralis major muscle (PMM) and latissimus dorsi muscle (LDM)

Download (54KB)
18. Fig. 5. Change in ‘active flexion, deg.’ in both groups. PMM, pectoralis major muscle; LDM, latissimus dorsi muscle

Download (60KB)
19. Fig. 6. Change in forearm flexor strength before and after surgery in both groups. PMM, pectoralis major muscle; LDM, latissimus dorsi muscle

Download (57KB)
20. Fig. 7. Change in ‘extension deficit, deg.’ in both groups. PMM, pectoralis major muscle; LDM, latissimus dorsi muscle

Download (56KB)
21. Fig. 8. Change in the strength of the forearm flexors at various times after pectoralis major muscle transposition. 1, group 1 (6 months to 1 year); 2, group 2 (1–3 years); 3, group 3 (>3 years)

Download (46KB)
22. Fig. 9. Change in the strength of the forearm flexors at various times after latissimus dorsi muscle transposition. 1, group 1 (6 months to 1 year); 2, group 2 (1–3 years); 3, group 3 (>3 years)

Download (48KB)
23. Fig. 10. Change in ‘active flexion, deg.’ at various times after pectoralis major muscle transposition. 1, group 1 (6 months to 1 year); 2, group 2 (1–3 years); 3, group 3 (>3 years)

Download (47KB)
24. Fig. 11. Change in ‘active flexion, deg.’ at various times after latissimus dorsi muscle transposition. 1, group 1 (6 months to 1 year); 2, group 2 (1–3 years); 3, group 3 (>3 years)

Download (47KB)
25. Fig. 12. Change in ‘extension deficit, deg.’ at various times after pectoralis major muscle transposition. 1, group 1 (6 months to 1 year); 2, group 2 (1–3 years); 3, group 3 (>3 years)

Download (48KB)
26. Fig. 13. Change in ‘extension deficit, deg.’ at various times after latissimus dorsi muscle transposition. 1, group 1 (6 months to 1 year); 2, group 2 (1–3 years); 3, group 3 (>3 years).

Download (48KB)

Copyright (c) 2022 Agranovich O.E., Petrova E.V., Batkin S.F., Kenis V.M., Sapogovskiy A.V., Melchenko E.V., Blagoveschenskiy E.D.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies