Patient-Reported Outcomes in Children Undergoing the Modified Green Procedure for Treating Sprengel's Deformity: Results from a Multicentric Study.

Abstract

Background: Sprengel's Deformity (SD) is a rare condition of the shoulder girdle, appearing as the principal congenital anomaly of the shoulder in paediatric patients. The aim of this study is to document the combined experience of two paediatric orthopaedic departments in managing SD using the modified Green Procedure, with a specific emphasis on the clinical and functional outcomes reported by patients; Methods: from June 2010 to February 2023, 42 shoulders in 40 paediatric patients were surgically treated for SD at two paediatric orthopaedic departments. All patients were treated using the modified Green Procedure with or without clavicle osteotomy. To better evaluate the deformity, the Cavendish's classification for aesthetic appearance and the Rigault's classification for radiological aspect were used, while movements of abduction and flexion were quantified to assess shoulder mobility. Several dedicated questionnaires such as QuickDASH, the Shoulder Pain Index and the Shoulder Disability Index (SPADI) and finally the UCLA Shoulder Scale were submitted to assess the quality of life of the subjects and the ability to practice certain activities, including work and sports. Complications were evaluated according to the modified Clavien-Dindo-Sink classification; Results: The mean follow-up was 5 years (range, 1.0-13.6). Clavicular osteotomy, performed in 15 patients, improved post-operative abduction by a mean of 25° (95% CI: 11-39°; p = 0.001). Three patients had complications (7.1%), with two requiring re-operation. At follow-up, 67.5% of patients had a qDASH score < 7, highlighting excellent functional outcomes. Shoulder function showed moderate correlation with pre- and post-operative flexion. The SPADI and UCLASS scores indicated significant improvement, with 70.0% reporting high satisfaction. Factors like sex, associated anomalies, and surgical technique did not impact patient-reported outcomes or satisfaction; Conclusions: The modified Green's technique has proven to be a safe procedure with a low rate of complications and satisfactory clinical and functional patient-reported outcomes.