{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:35:28Z","timestamp":1787754928444,"version":"build-2784847793"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JBJS Essential Surgical Techniques"],"abstract":"\n Background:<\/jats:title>\n Posterior elbow capsulotomy plus triceps lengthening facilitates passive elbow flexion in children with arthrogryposis multiplex congenita, allowing independent function for activities of daily living, such as feeding and self-care of the face and hair.<\/jats:p>\n <\/jats:sec>\n \n Description:<\/jats:title>\n The posterior aspect of the distal end of the humerus and the olecranon are identified by palpation and exposed via a curvilinear incision over the posterior aspect of the elbow. Identifying the osseous landmarks can be challenging in some patients. The ulnar nerve is identified and protected. The triceps tendon is isolated, and z-lengthening is performed. Next, the posterior elbow capsule is incised proximal to the tip of the olecranon to expose the joint surface, and the arthrotomy is continued incrementally along the medial and lateral capsule until elbow flexion increases by \u226540\u00b0, or past 90\u00b0 (maximum, 120\u00b0), with contact between the lengthened ends of the triceps tendon for repair. The triceps tendon is then repaired in the elongated position. After the wound is closed, the elbow is placed in flexion and immobilized in a cast.<\/jats:p>\n <\/jats:sec>\n \n Alternatives:<\/jats:title>\n Alternative treatments include passive stretching exercises to increase elbow flexion.<\/jats:p>\n <\/jats:sec>\n \n Rationale:<\/jats:title>\n Elbow extension contractures result in substantial limitations in the activities of daily living for children with arthrogryposis multiplex congenita. Those who fail to attain at least 90\u00b0 of elbow flexion with passive stretching in the first year of life benefit from posterior elbow release and triceps lengthening. In addition, children with <30\u00b0 of passive elbow flexion are at risk of developing valgus instability of the elbow from passive flexion exercises because the axis of rotation of the elbow is difficult to detect. Once passive elbow flexion is attained, such children may be candidates for tendon transfers allowing active elbow flexion.<\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.st.19.00030","type":"journal-article","created":{"date-parts":[[2020,2,14]],"date-time":"2020-02-14T08:06:50Z","timestamp":1581667610000},"page":"e0030","source":"Crossref","is-referenced-by-count":0,"title":["Posterior Elbow Capsulotomy and Triceps Lengthening for Elbow Extension Contracture in Children with Arthrogryposis Multiplex Congenita"],"prefix":"10.2106","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1529-7540","authenticated-orcid":false,"given":"Michelle A.","family":"James","sequence":"first","affiliation":[{"name":"Shriners Hospital for Children-Northern California, Sacramento, California"},{"name":"University of California Davis School of Medicine, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3559-9864","authenticated-orcid":false,"given":"Kelsey L.","family":"Millar","sequence":"additional","affiliation":[{"name":"University of California Davis School of Medicine, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3992-2806","authenticated-orcid":false,"given":"M. Claire","family":"Manske","sequence":"additional","affiliation":[{"name":"Shriners Hospital for Children-Northern California, Sacramento, California"},{"name":"University of California Davis School of Medicine, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8064-5508","authenticated-orcid":false,"given":"Ann E.","family":"Van Heest","sequence":"additional","affiliation":[{"name":"Shriners Hospital for Children-Twin Cities, Minneapolis, Minnesota"},{"name":"Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020]]},"reference":[{"issue":"7","key":"bib1-20230808","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.2106\/JBJS.F.01174","article-title":"Posterior elbow capsulotomy with triceps lengthening for treatment of elbow extension contracture in children with arthrogryposis","volume":"90","author":"Van Heest","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib2-20230808","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/BTH.0b013e3181d44583","article-title":"Index rotation flap for palmar thumb release in arthrogryposis","volume":"14","author":"Ezaki","year":"2010","journal-title":"Tech Hand Up Extrem Surg."},{"issue":"4","key":"bib3-20230808","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1097\/00130911-200412000-00005","article-title":"Carpal wedge osteotomy for the arthrogrypotic wrist","volume":"8","author":"Ezaki","year":"2004","journal-title":"Tech Hand Up Extrem Surg."},{"issue":"2","key":"bib4-20230808","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.jhsa.2012.10.034","article-title":"Dorsal carpal wedge osteotomy in the arthrogrypotic wrist","volume":"38","author":"Van Heest","year":"2013","journal-title":"J Hand Surg Am."},{"issue":"20","key":"bib5-20230808","doi-asserted-by":"crossref","first-page":"e150","DOI":"10.2106\/JBJS.L.01122","article-title":"Long-term outcome following carpal wedge osteotomy in the arthrogrypotic patient","volume":"95","author":"Foy","year":"2013","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib6-20230808","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1016\/j.jhsa.2012.02.032","article-title":"Posterior elbow release and humeral osteotomy for patients with arthrogryposis","volume":"37","author":"Zlotolow","year":"2012","journal-title":"J Hand Surg Am."},{"issue":"2","key":"bib7-20230808","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/BTH.0b013e3181da07aa","article-title":"Long head of the triceps muscle transfer for active elbow flexion in arthrogryposis","volume":"14","author":"Gogola","year":"2010","journal-title":"Tech Hand Up Extrem Surg."},{"issue":"3","key":"bib8-20230808","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.jhsa.2003.12.011","article-title":"The Steindler flexorplasty for the arthrogrypotic elbow","volume":"29","author":"Goldfarb","year":"2004","journal-title":"J Hand Surg Am."},{"issue":"11","key":"bib9-20230808","doi-asserted-by":"crossref","first-page":"2004","DOI":"10.1016\/j.jse.2017.04.002","article-title":"Is bipolar latissimus dorsi transfer a reliable option to restore elbow flexion in children with arthrogryposis? A review of 13 tendon transfers","volume":"26","author":"Zargarbashi","year":"2017","journal-title":"J Shoulder Elbow Surg."},{"issue":"6","key":"bib10-20230808","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1302\/0301-620X.87B6.15506","article-title":"Transfer of pectoralis major in arthrogryposis to restore elbow flexion: deteriorating results in the long term","volume":"87","author":"Lahoti","year":"2005","journal-title":"J Bone Joint Surg Br."}],"container-title":["JBJS Essential Surgical Techniques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.ST.19.00030","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:34:55Z","timestamp":1787751295000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.ST.19.00030"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.st.19.00030","relation":{},"ISSN":["2160-2204"],"issn-type":[{"value":"2160-2204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020]]}}}