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While risk factors include shoulder dystocia, instrumental delivery, and fetal macrosomia, many cases lack clear causes. Tendon transfers, especially L\u2019Episcopo, are commonly performed to restore shoulder external rotation and abduction using latissimus dorsi (LD) and teres major (TM) transfers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The goal is to understand the clinical effectiveness of L\u2019Episcopo in improving shoulder ROM and complications in BPBI patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive search was conducted using PRISMA 2020 guidelines, yielding 612 studies. After the initial inclusion and exclusion, 10 studies were reviewed in full text using Rayyan.ai. Studies for patients undergoing the L\u2019Episcopo procedure for BPBI, with Mallet scores assessing shoulder range of motion, were included as inclusion criteria. Statistical analysis was performed for a random-effects meta-analysis using SPSS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four studies were included in the meta-analysis. Mallet scores were assessed at an average follow-up of 44 months. L\u2019Episcopo procedure demonstrated both clinical and statistical effectiveness, with a Hedge\u2019s g value of 1.66 indicating a very large effect size, and a p-value of &lt;\u20090.0001. An improvement in Mallet scores is associated with increased range of motion and functionality of the shoulder.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>L\u2019Episcopo with the use of Latissimus Dorsi and Teres major shows supportive evidence in improving external rotation and abduction in patients suffering from brachial plexus birth injury (BPBI).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00402-026-06191-w","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T04:44:25Z","timestamp":1770007465000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding the long-term clinical effectiveness of L\u2019Episcopo procedure in restoring external rotation &amp; abduction in patients suffering from brachial plexus birth injury: a systematic review &amp; meta-analysis"],"prefix":"10.1007","volume":"146","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5159-7996","authenticated-orcid":false,"given":"Kunal","family":"P Shah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7130-5804","authenticated-orcid":false,"given":"Jonathan","family":"Elias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2297-0808","authenticated-orcid":false,"given":"Ryan","family":"St. John","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7267-5054","authenticated-orcid":false,"given":"Mario","family":"Salah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5053-6500","authenticated-orcid":false,"given":"Kunal","family":"Damaraju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4428-0414","authenticated-orcid":false,"given":"Sean","family":"McMillan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"issue":"1","key":"6191_CR1","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1186\/s12884-023-05696-1","volume":"23","author":"S Jaufuraully","year":"2023","unstructured":"Jaufuraully S, Lakshmi Narasimhan A, Stott D, Attilakos G, Siassakos D (2023) A systematic review of brachial plexus injuries after caesarean birth: challenging delivery? 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