Long-term Outcomes of Long Head of the Triceps Transfer in Patients With Amyoplasia

Background: Achieving active elbow flexion in children with amyoplasia can greatly improve independence in activities of daily living. This study investigated long-term outcomes of the long head triceps transfer procedure performed for that purpose. Methods: A 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 2 years were excluded. Pre- and postoperative range of motion were recorded, and patient-reported outcome measures included a visual analog scale (VAS) for function (scale 0 to 10), a VAS for overall satisfaction (scale 0 to 10), and the Pediatric Outcomes Data Collection Instrument (PODCI). Pre- and postoperative motion were compared via paired t tests. Results: Seventeen patients (25 extremities) were included. Postoperatively, average active elbow flexion was 78 degrees against gravity and 90 degrees with gravity eliminated. Patients with active elevation of the shoulder ≥90 degrees showed average active elbow flexion with gravity eliminated of 85 degrees. The mean VAS score for improvement of function was 8.3 (range, 4 to 10) from parents and 9.0 (range, 8 to 10) from patients older than 10 years. The mean VAS scores for overall satisfaction were 8.0 (range, 5 to 10) and 8.1 (range, 6 to 10), respectively. Mean PODCI scores ranged from 63 to 73 for upper extremity, 83 to 76 for transfer and basic mobility, 64 to 73 for sports participation, 83 to 95 for pain and comfort, 90 to 97 for happiness, and 74 to 79 for global function. Conclusions: The long head of the triceps transfer is an effective treatment modality for patients with amyoplasia who present with absent active elbow flexion, good passive elbow flexion, and well-defined long head and lateral heads of the triceps muscle. Overall, patients gained an active range of elbow motion with no significant functional elbow contracture and improved quality of life. However, patients with a history of elbow release surgery are at higher risk of flexion contracture and should be screened especially carefully. Level of evidence: Level IV-case series.