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Long-term Outcomes of Long Head of the Triceps Transfer in Patients with Amyoplasia
Meera Reghunathan, MD
1; Andreas Weber, MD
2; Courtney Schneidau, PA
3; Terri Beckwith, MPH, CCRP
3; Oishi Scott, FACS
41UC San Diego, San Diego, CA; 2Texas Scottish Rite Hospital for Children, Dallas, CA; 3Texas Scottish Rite Hospital for Children, Dallas, TX; 4Hand Surgery/Orthopedics, Texas Scottish Rite Hospital, Dallas, TX
Purpose The purpose of this study was to investigate long-term outcomes of the long head triceps transfer procedure to achieve active elbow flexion in patients with amyoplasia.
MethodsA retrospective review of medical records was performed for all patients with amyoplasia who underwent a long head triceps transfer between January 1, 2008, and December 31, 2019. Patients with follow-up of less than two years were excluded. Pre and post operative range of motion, and functional patient reported outcome measures of the Visual Analog Scale (VAS), Pediatric Outcomes Data Collection Instrument (PODCI), and Pediatric Evaluation of Disability Inventory (PEDI-CAT) were recorded. Pre and post operative motion were compared via paired t-tests.
ResultsA total of 23 upper extremities were included for a total of 19 patients. The mean age of surgery was 6.2 years with an average age at follow-up of 12.65 years. Patients had minimum 18 months follow up. Postoperatively, patients obtained an average against-gravity passive elbow flexion of 112° (std 13.6°), active elbow flexion of 75°(std 21.9°) and with gravity eliminated 89°(std 16.0°) . Patients with active elevation of the shoulder greater than or equal to 90° showed an active elbow flexion with gravity eliminated of 92°. Eight out of 23 (34%) developed a flexion contracture of over 30 degrees, and for 3 patients this was greater than 60 degrees. Mean VAS scores for improvement of function was 8.2 (Rang: 4-10; parent-guardian score) and 9.0 (Range: 8-10; patient reported score for patients older than 10 years). The mean overall satisfaction VAS score was 8.1 (Range: 6-10) for parents and 8.4 (Range: 7-10) for patients respectively. Average PODCI scores were measured for: upper extremity was 59.3, for transfer and basic mobility 86.8, for sports participation 68.9, pain and comfort 92.6, happiness 89.4, and global function 76.5.
ConclusionsThe long head of the triceps transfer is an effective treatment modality for appropriate patients with amyoplasia that present with absent active elbow flexion but a good passive range of motion and a well-formed triceps muscle. Patients gained active range of elbow motion with low risk for significant functional elbow contracture and improved quality of life.
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