Aditya K S Gowda, Vivek Singh, Rahul Mishra, Cury Sharma, Vikas Maheshwari, Anil Regmi
{"title":"出生臂丛损伤的关节镜下肩胛下复合体释放和联合肌腱转移：一个基于证据的病例系列。","authors":"Aditya K S Gowda, Vivek Singh, Rahul Mishra, Cury Sharma, Vikas Maheshwari, Anil Regmi","doi":"10.1007/s00264-025-06630-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Shoulder deformities and impaired function in individuals with birth brachial plexus injury (BBPI) are often caused by internal rotator (IR) contractures and abductor weakness, which may progress to glenohumeral dysplasia. Although subscapularis-complex release and tendon transfer is a time-tested procedure, there are controversies regarding the appropriate management of shoulder contractures, especially in preschool children. Therefore, this study examines the efficiency of arthroscopically done progressive controlled release of IR contracture combined with tendon transfer.</p><p><strong>Methods: </strong>This study included 12 children who presented with shoulder soft tissue contractures and functional impairments, specifically, loss of shoulder abduction and external rotation, but with good deltoid function. They underwent a surgical intervention involving arthroscopy-assisted subscapularis-complex release and conjoint muscle transfer onto the infraspinatus footprint on the humeral head. The evaluation of shoulder function was conducted using the Mallet score system, and the range of motion was measured at preoperative and six month postoperative intervals. Statistical analyses were performed to determine the significance of the outcomes.</p><p><strong>Results: </strong>The average age of participants was 4.83 ± 2.1 years. Preoperatively, the mean Mallet score was 14.08 ± 1.4, which improved to 23.83 ± 1.2 postoperatively. The average gain in shoulder abduction was 66.4 ± 5.6°, and external rotation improved by 85.4 ± 16.6° at 18 months final follow-up. All patients exhibited improvements in shoulder function, with a significant correlation (p value = 0.037) between Naraka grading, and clinical outcomes.</p><p><strong>Conclusion: </strong>The combined surgical approach of arthroscopic subscapularis-complex release with conjoint tendon transfer effectively enhances the shoulder function in the studied cohort. Further research and extended follow-up are needed to evaluate the long-term benefits.</p><p><strong>Level of evidence: </strong>Level IV (Therapeutic case series).</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"2529-2537"},"PeriodicalIF":2.6000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Arthroscopic subscapularis-complex release and conjoint tendon transfer in birth brachial plexus injuries: a case series with evidence-based insights.\",\"authors\":\"Aditya K S Gowda, Vivek Singh, Rahul Mishra, Cury Sharma, Vikas Maheshwari, Anil Regmi\",\"doi\":\"10.1007/s00264-025-06630-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Shoulder deformities and impaired function in individuals with birth brachial plexus injury (BBPI) are often caused by internal rotator (IR) contractures and abductor weakness, which may progress to glenohumeral dysplasia. Although subscapularis-complex release and tendon transfer is a time-tested procedure, there are controversies regarding the appropriate management of shoulder contractures, especially in preschool children. Therefore, this study examines the efficiency of arthroscopically done progressive controlled release of IR contracture combined with tendon transfer.</p><p><strong>Methods: </strong>This study included 12 children who presented with shoulder soft tissue contractures and functional impairments, specifically, loss of shoulder abduction and external rotation, but with good deltoid function. They underwent a surgical intervention involving arthroscopy-assisted subscapularis-complex release and conjoint muscle transfer onto the infraspinatus footprint on the humeral head. The evaluation of shoulder function was conducted using the Mallet score system, and the range of motion was measured at preoperative and six month postoperative intervals. Statistical analyses were performed to determine the significance of the outcomes.</p><p><strong>Results: </strong>The average age of participants was 4.83 ± 2.1 years. Preoperatively, the mean Mallet score was 14.08 ± 1.4, which improved to 23.83 ± 1.2 postoperatively. The average gain in shoulder abduction was 66.4 ± 5.6°, and external rotation improved by 85.4 ± 16.6° at 18 months final follow-up. All patients exhibited improvements in shoulder function, with a significant correlation (p value = 0.037) between Naraka grading, and clinical outcomes.</p><p><strong>Conclusion: </strong>The combined surgical approach of arthroscopic subscapularis-complex release with conjoint tendon transfer effectively enhances the shoulder function in the studied cohort. Further research and extended follow-up are needed to evaluate the long-term benefits.</p><p><strong>Level of evidence: </strong>Level IV (Therapeutic case series).</p>\",\"PeriodicalId\":14450,\"journal\":{\"name\":\"International Orthopaedics\",\"volume\":\" \",\"pages\":\"2529-2537\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Orthopaedics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00264-025-06630-0\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/8/7 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Orthopaedics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00264-025-06630-0","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/7 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Arthroscopic subscapularis-complex release and conjoint tendon transfer in birth brachial plexus injuries: a case series with evidence-based insights.
Purpose: Shoulder deformities and impaired function in individuals with birth brachial plexus injury (BBPI) are often caused by internal rotator (IR) contractures and abductor weakness, which may progress to glenohumeral dysplasia. Although subscapularis-complex release and tendon transfer is a time-tested procedure, there are controversies regarding the appropriate management of shoulder contractures, especially in preschool children. Therefore, this study examines the efficiency of arthroscopically done progressive controlled release of IR contracture combined with tendon transfer.
Methods: This study included 12 children who presented with shoulder soft tissue contractures and functional impairments, specifically, loss of shoulder abduction and external rotation, but with good deltoid function. They underwent a surgical intervention involving arthroscopy-assisted subscapularis-complex release and conjoint muscle transfer onto the infraspinatus footprint on the humeral head. The evaluation of shoulder function was conducted using the Mallet score system, and the range of motion was measured at preoperative and six month postoperative intervals. Statistical analyses were performed to determine the significance of the outcomes.
Results: The average age of participants was 4.83 ± 2.1 years. Preoperatively, the mean Mallet score was 14.08 ± 1.4, which improved to 23.83 ± 1.2 postoperatively. The average gain in shoulder abduction was 66.4 ± 5.6°, and external rotation improved by 85.4 ± 16.6° at 18 months final follow-up. All patients exhibited improvements in shoulder function, with a significant correlation (p value = 0.037) between Naraka grading, and clinical outcomes.
Conclusion: The combined surgical approach of arthroscopic subscapularis-complex release with conjoint tendon transfer effectively enhances the shoulder function in the studied cohort. Further research and extended follow-up are needed to evaluate the long-term benefits.
Level of evidence: Level IV (Therapeutic case series).
期刊介绍：
International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters.
Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable.
The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.
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