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

Author(s): Van Heest A, James MA, Lewica A, Anderson KA

Source: J Bone and Joint Surg 90-A (7) 1517-1523, 2008.

Summary:

This retrospective review was performed on twenty-nine elbows of twenty-three children with arthrogryposis that underwent a posterior elbow capsulotomy and triceps lengthening at an average of thirty-five months (range, seven months to thirteen years).  The average duration of follow-up was 5 years (range, two to eleven years).  The average arc of passive motion increased from 32° to sixty-six degrees (average lack of extension of 34° to an average of 100° of flexion).  The average increase in the arc of motion was 33° and the increases in flexion, extension and arc of motion between preoperative and postoperative visits were significant. 

Preoperatively, only two elbows had Grade -3/5 biceps strength.  At the time of final follow up, however, biceps strength was graded as 0/5 in twenty-two elbows, 1/5 in two, 2/5 in 3, 3/5 in 1 and 4/5 in 1.  Twenty-two of the twenty-three children were able to feed themselves with the hand on the operatively treated side although many adapted with passive assistance from either their other arm or the table.  No child underwent subsequent tendon transfer surgery.

This study confirms the ability to improve passive elbow flexion in children with arthrogryposis with an elbow capsulotomy and triceps lengthening.  Most previous authors have recommended an active tendon transfer to restore biceps flexion after restoration of passive elbow flexion.  However, these authors felt that the risk associated with tendon transfer after posterior elbow capsular release outweighed the benefits.  Future studies may be of benefit to elucidate the potential benefit of an active tendon transfer after regaining passive motion.