Boven, E.T.W. (2017) Latissimus Dorsi to Biceps Transfer in Children with Arthrogryposis:Influence of Preoperative Volume on Outcome and Comparison to Reference Values. thesis, Medicine.
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Abstract
Background: Arthrogryposis Multiplex Congenita (AMC) is a term used to describe the presence of multiple congenital joint contractures. In the subtype amyoplasia the biceps muscle is often abnormally developed or absent. Latissimus Dorsi (LD) to biceps transfers can restore active flexion but the LD can be atrophic in this patient category, which gives poor results. Therefore in this study the influence of preoperative volume of the LD on the postoperative outcome after LD to biceps transfer is explored. Methods: In this retrospective case series, 6 patients that received an LD transfer were studied with a total of 8 transfers. Preoperative values were range of motion (ROM), volume of the LD and quality of the LD assessed by the surgeon. Postoperative outcome measures were performed with a mean follow-up time of 4.5 years (range 1.6-8.3) and consisted of active and passive ROM, strength of elbow flexion and functional outcome graded by performing several activities of daily living (ADL). To establish reference values for normal LD volumes, 44 MRIs of children without neuromuscular disease were measured. Results: Reliability analysis of the LD measurements gave an excellent inter-observer and intra-observer agreement. The LD volumes comparable to normal control patients gave an adequate strength but had a tendency of developing an extension deficit. The relatively small LD volumes resulted in insufficient strength and received a poor perioperative quality but gave a good ROM without extension deficit. In two cases there was a poor functional outcome, not related to the LD volume. Conclusion: The results of this study suggest that preoperative volume measurements of the LD are reliable and could give an indication of certain outcomes after transfer in AMC patients. In the case of a small LD volume compared to our reference values, the transfer will probably lack strength. If the LD volume is normal compared to the reference values, there is a possibility of an extension deficit.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Lei Prof. Dr. B. van der (UMCG) |
| Supervisor name: | Second supervisor: and Nieuwenhoven, Dr. C.A. van and Institution: Erasmus Medical Centre and Department: Plastic and Reconstructive Surgery |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:50 |
| Last Modified: | 25 Jun 2020 10:50 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1132 |
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