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Posterior Elbow Capsulotomy with Triceps Lengthening for Treatment of Elbow Extension Contracture in Children with Arthrogryposis

¹ Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue, Suite 200, Minneapolis, MN 55454
² Department of Orthopedic Surgery, Shriners Hospital for Children, 2425 Stockton Boulevard, Sacramento, CA 95817-2215
³ Department of Orthopaedic Surgery, University of California at Davis Medical Center, 2315 Stockton Boulevard, Room 6103, Sacramento, CA 95817
Investigation performed at the Shriners Hospital for Children-Twin Cities, Minneapolis, Minnesota, and Shriners Hospital for Children-Northern California, Sacramento, California

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Methods: The medical records of all children with arthrogryposis who had been followed for a minimum of two years after treatment with elbow capsulotomy and triceps lengthening were retrospectively reviewed. The postoperative range of motion and ability to reach the mouth were compared with the preoperative status.

Results: Posterior capsulotomy with triceps lengthening was performed in twenty-nine elbows of twenty-three children with an average age of thirty-five months (range, seven months to thirteen years). The average duration of follow-up was 5.4 years. The arc of motion of all twenty-nine elbows improved from an average of 32° (range, 0° to 75°) preoperatively to an average of 66° (range, 10° to 125°) at the time of final follow-up. All children were able to reach the mouth using passive assistance (e.g., table-push, trunk-sway, and cross-arm techniques), and twenty-two children were able to feed themselves independently. No child underwent subsequent tendon transfer surgery.

Conclusions: Elbow capsulotomy with triceps lengthening successfully increases passive elbow flexion and the arc of elbow motion of children with arthrogryposis, enabling hand-to-mouth activities. In contrast to studies in which tendon transfer surgery was used to increase elbow flexion, none of the children in this series underwent subsequent tendon transfer surgery.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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