Surgical timing and management patterns across joints in arthrogryposis: a systematic review

This study systematically reviewed the literature on surgical management of arthrogryposis multiplex congenita (AMC) to identify trends in timing and outcomes of interventions across joints. A secondary objective was to provide practical recommendations and a clear research agenda to inform a forthcoming consensus process on timing and synchronization of care in AMC. A systematic review was conducted using MEDLINE, Embase, Web of Science, and Scopus databases from inception to June 2025. Studies reporting surgical management of AMC with data on age at intervention, recurrence, or functional outcomes were included. Forty-two studies encompassing 729 patients and 1088 joints were analyzed descriptively. The mean age at intervention ranged from infancy for foot and hip procedures to late childhood and adolescence for upper-extremity surgeries and spinal reconstructions. Soft-tissue releases and tendon procedures predominated in early life, while bony reconstructions were more common in older patients. Recurrence rates were highest after isolated soft-tissue procedures of the foot and knee (30-100%), and lowest after osteotomies, muscle transfers, and definitive fusions in the wrist, shoulder, and spine (<20%). Functional outcomes were generally favorable, with most studies reporting improved alignment, mobility, and quality of life, though long-term recurrence remains a persistent challenge across joints. This review highlights trends linking procedure type and patient age to recurrence and function but also reveals substantial heterogeneity and a lack of standardized protocols. The findings underscore the need for a multidisciplinary consensus study to define optimal timing, sequencing, and staged correction of joint deformities in AMC.