Functional outcomes of tendon transfer for brachial plexus birth palsy using the Hoffer technique

Abstract

Aims To describe and analyze the mid-term functional outcomes of a large series of patients who underwent the Hoffer procedure for brachial plexus birth palsy (BPBP). Methods All patients who underwent the Hoffer procedure with minimum two-year follow-up were retrospectively reviewed. Active shoulder range of movement (ROM), aggregate modified Mallet classification scores, Hospital for Sick Children Active Movement Scale (AMS) scores, and/or Toronto Test Scores were used to assess functional outcomes. Subgroup analysis based on age and level of injury was performed. Risk factors for subsequent humeral derotational osteotomy and other complications were also assessed. A total of 107 patients, average age 3.9 years (1.6 to 13) and 59% female, were included in the study with mean 68 months (24 to 194) follow-up. Results All patients demonstrated statistically significant improvement in all functional outcomes and active shoulder abduction and external rotation ROM (p < 0.001). Patients < 2.5 years of age had higher postoperative AMS, abduction ROM and strength scores, and aggregate postoperative Toronto scores (p ≤ 0.035) compared to patients ≥ 2.5 years old. There were 17 patients (16%) who required a subsequent humeral derotational osteotomy; lower preoperative AMS external rotation scores and external rotation ROM were predictive risk factors (p ≤ 0.016). Conclusion Patients with BPBP who underwent the Hoffer procedure demonstrated significant improvement in postoperative ROM, strength, and functional outcome scores at mid-term follow-up. Patients younger than 2.5 years at the time of surgery generally had better functional outcomes. Limited preoperative external rotation strength and ROM were significantly associated with requirement for subsequent humeral derotational osteotomy. In our chort significant improvements in shoulder function were obtained after the Hoffer procedure for BPBP. Cite this article: Bone Joint J 2020;102-B(2):246–253.

Long-term functional outcome of secondary shoulder surgery in brachial plexus birth palsy patients

“…30,33,35,39,40 in contrast, one study described a statistically significant better mean abduction (6.1 vs 5.2 points, p < 0.001) in the active movement scale, better active abduction ROM (141° vs 118°, p = 0.001), and better Toronto scores (8.8 vs 7.7, p = 0.035) in patients operated at an age younger than 2.5 years, compared to patients operated at an age older than 2.5 years. 28 There was no difference in external rotation between the groups in this study. Finally, the question of whether the indication for secondary surgery should be set in at an early age cannot be answered based on the available literature.…”

“…20,31,37,40,42 The mean external rotation improvement ranged between 12° to 72° in the soft-tissue release group, 20,27,31,32,37,42 and between 29° and 128° in the soft-tissue lengthening group. 28,30,33,35,39,43 Since the surgical techniques are different, the groups cannot be compared. One study found preferable results after subscapularis release combined with a latissimus dorsi transfer compared to subscapularis release only.…”

“…20,31,37,40,42 the mean external rotation improvement ranged between 12° to 72° in the soft-tissue release group, 20,27,31,32,37,42 and between 29° and 128° in the soft-tissue lengthening group. 28,30,33,35,39,43 In all cases except one, the posterior dislocation was corrected.…”

“…19 To evaluate the correlation of age at surgery and radiological and functional outcome, eight studies performed a subgroup analysis. 28,30,33,35,36,38-40 Jönsson et al 36 described an improvement of glenoid version in all age subgroups (0 to 2, 2 to 5, and > 5 years) without significant differences between the groups after a subscapularis lengthening at ten-year follow-up. Additionally, five other studies described no differences in functional outcome regarding external rotation and abduction between different age subgroups.…”

“…20,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] the literature search and selection process are shown in the flowchart in Figure1. study characteristics.…”