Management of Lower-Extremity Deformity in Arthrogryposis Multiplex Congentia: A Narrative Review

Arthrogryposis multiplex congenita (AMC) is a highly heterogeneous constellation of disorders defined by non-progressive congenital multiple joint contractures, typically manifesting across multiple limbs. The pathology results in significant functional impairment, including restricted range of motion, chronic arthralgia, and secondary musculoskeletal deformities like scoliosis. Given that AMC is an umbrella designation encompassing over 300 distinct etiologies, the profound clinical variability poses substantial diagnostic and therapeutic challenges. The relative rarity of AMC and the absence of consensus-based, longitudinal treatment protocols create a critical void in standardized clinical management across the lifespan of patients. This comprehensive narrative review synthesizes the contemporary literature and clinical evidence to establish a structured, life-course management paradigm, extending from neonatal screening through to adult care. We advocate for an evidence-based approach that recalibrates therapeutic goals to emphasize maximal functional capacity and societal participation rather than strict anatomical normalization. Key aspects addressed include early-life neuroplasticity, the principles of staged and minimally- invasive surgical correction, and the need for seamless, lifelong, multidisciplinary care coordination. Furthermore, the review critically examines persistent clinical dilemmas concerning hip and knee contracture management, and proposes algorithmic pathways for addressing recurrent foot deformities. By integrating the latest advancements in molecular genetics, surgical innovations, and rehabilitative science, this work serves as an authoritative resource, offering clinically applicable strategies to optimize long-term outcomes for individuals living with AMC.