Neurophysiological signals for estimation of the result of latissimus dorsii muscle transfer to biceps brachii in patients with arthrogryposis

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

Background. One of the leading causes of restriction in daily-living activities in patients with arthrogryposis is severe hypoplasia (or aplasia) of the biceps brachii. Latissimus dorsii muscle transfer to the biceps brachii is one of the most used methods for the reconstruction of active elbow flexion in patients with arthrogryposis. Aim. The aim of the study is to identify neurophysiological correlates for evaluating the result of the transposition of the latissimus dorsii muscle to the biceps in patients with multiple congenital arthrogryposis. Materials and methods. From 2011 to 2018, we performed monopolar latissimus dorsii muscle transfer to the biceps for the restoration of active elbow flexion in 30 patients with arthrogryposis (44 upper extremities). The follow-up results were studied in 14 cases. For this purpose, we used clinical examination, surface electromyography (sEMG), and statistical analysis. The patients were examined before and from 1 month to 96 months (7 months; 2–24.5 months) after the surgery. The age of patients was from 1 to 10 years at the time of surgery (4.89 ± 2.42 years). Results. Our study showed that the age of the child at the time of surgery does not significantly change the index of activation of the latissimus dorsii muscle. A decrease of coactivation of the latissimus dorsii muscle in the long term after surgery correlates with an increase in the strength of the displaced latissimus dorsii muscle, and an improvement in active flexion in the elbow. If the value of the index of coactivation of the latissimus dorsii muscle is less 42%, the muscle strength after surgery reaches 4 points. It was found that the index of coactivation of the latissimus dorsii muscle does not depend on the level of segmental damage to the spinal cord. However, the strength of the muscle depends on the level of spinal cord damage. Conclusion. The determination of the index coactivation of the latissimus dorsii muscle after surgery can be used to evaluate the results of the latissimus dorsii muscle transfer to the biceps in patients with arthrogryposis. The index of activation of the latissimus dorsii muscle must be less than 42% for effective elbow active flexion.

Full Text

Restricted Access

About the authors

Olga E. Agranovich

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: olga_agranovich@yahoo.com
MD, PhD, D.Sc., Supervisor of the Department of Arthrogryposis 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Margarita V. Savina

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: drevma@yandex.ru
MD, PhD, Head of the Laboratory of Physiological and Biomechanical Research 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Dmitry A. Ivanov

Kazan State Medical University

Email: i.dmitry1988@gmail.com
MD, assistant of the Department of Public Health and Health Organization 49, Butlerov street, Kazan, 420012

Alexey E. Boyko

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: ex.trol@mail.ru
MD, resident 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Yevgeny D. Blagoveshchenskiy

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery; Higher School of Economics

Email: eblagovechensky@hse.ru
research associate at the Laboratory of Physiological and Biomechanical Research; PhD, senior research associate 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603; 20, Myasnitskaya str., Moscow, 101000

Yuriy Alekseevich Lapkin

Email: lapkin1950@mail.ru

Elena Yur'evna Skripchenko

Email: wwave@yandex.ru

Elizaveta Leonidovna Kononova

Email: Yelisaveta@yandex.ru

References

  1. Kroksmark AK, Kimber E, Jerre R, et al. Muscle involvement and motor function in amyoplasia. Am J Med Genet A. 2006;140(16):1757-1767. https://doi.org/10.1002/ajmg.a.31387.
  2. Basheer H, Zelic V, Rabia F. Functional scoring system for obstetric brachial plexus palsy. J Hand Surg Br. 2000;25(1):41-45. https://doi.org/10.1054/jhsb.1999.0281.
  3. Van Heest A, Waters PM, Simmons BP. Surgical treatment of arthrogryposis of the elbow. J Hand Surg Am. 1998;23(6):1063-1070. https://doi.org/10.1016/S0363-5023(98)80017-8.
  4. Ezaki M. Treatment of the upper limb in the child with arthrogryposis. Hand Clin. 2000;16(4):703-711.
  5. Zargarbashi R, Nabian MH, Werthel JD, Valenti P. Is bipolar latissimus dorsi transfer a reliable option to restore elbow flexion in children with arthrogryposis? A review of 13 tendon transfers. J Shoulder Elbow Surg. 2017;26(11):2004-2009. https://doi.org/10.1016/ j.jse.2017.04.002.
  6. Boven ETW. Latissimus dorsi to biceps transfer in children with arthrogryposis: influence of preoperative volume on outcome and comparison to reference values.
  7. Агранович О.Е., Коченова Е.А., Трофимова С.И., и др. Использование широчайшей мышцы спины для восстановления активного сгибания в локтевом суставе у больных с артрогрипозом // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2018. – Т. 6. – № 3. – C. 5–11. [Agranovich OE, Kochenova EA, Trofimova SI, et al. Restoration of elbow active flexion via latissimus dorsii transfer in patients with arthrogryposis. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2018;6(3):5-11. (In Russ.)]. https://doi.org/10.17816/PTORS6273-75.
  8. Агранович О.Е., Лахина О.Л. Клинические варианты деформаций верхних конечностей у больных с артрогрипозом // Травматология и ортопедия России. – 2013. – № 3. – С. 125–129. [Agranovich OE, Lakhina OL. Clinical variants of upper limbs deformities in children with arthrogryposis multiplex congenita. Traumatology and Orthopedics of Russia. 2013;(3):125-129. (In Russ.)]. https://doi.org/10.21823/2311-2905-2013--3-125-129.
  9. Aoki M, Okamura K, Fukushima S, et al. Transfer of the latissimus dorsi for irreparable rotator-cuff tears. J Bone Joint Surg Br. 1996;78(5):761-766.
  10. Gerber C. Latissimus dorsi transfer for the treatment of irreparable tears of the rotator cuff. Clin Orthop Rel Res. 1992;(275):152-160.
  11. Gerber C, Vinh TS, Hertel H, Hess CW. Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff. A preliminary report. Clin Orthop Rel Res. 1988;(232):51-61.
  12. Ianotti JP, Hennigan S, Herzog R, et al. Latissimus dorsi tendon transfer for irreparable posteriosuperior rotator cuff tears. J Bone Joint Surg Am. 2006;88(2):342-348. https://doi.org/10.2106/JBJS.D.02996.
  13. Irlenbusch U, Bernsdorf M, Born S, et al. Electromyographic analysis of muscle function after latissimus dorsi tendon transfer. J Shoulder Elbow Surg. 2008;17(3):492-499. https://doi.org/10.1016/ j.jse.2007.11.012.
  14. Plath JE, Seiberl W, Beitzel K, et al. Electromyographic activity after latissimus dorsi transfer: testing of coactivation as a simple tool to assess latissimus dorsi motor learning. J Shoulder Elbow Surg. 2014;23(8):1162-1170. https://doi.org/10.1016/j.jse.2013.11.005.

Copyright (c) 2020 Agranovich O.E., Savina M.V., Ivanov D.A., Boyko A.E., Blagoveshchenskiy Y.D., Lapkin Y.A., Skripchenko E.Y., Kononova E.L.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies