{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T05:27:34Z","timestamp":1762838854669,"version":"build-2065373602"},"reference-count":39,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Glenohumeral arthrodesis (GHA) and extraplexal tendon transfers (TT) have been described as options for secondary shoulder stabilization and reanimation following adult traumatic brachial plexus injury (BPI) with delayed presentation or failure of primary nerve reinnervation. This study aimed to evaluate the outcomes and complication profiles of these two approaches to shoulder reanimation to better understand the indications, anticipated outcomes, and complication risks of each for traumatic brachial plexus injury. Methods: A systematic search of six databases (PubMed, EMBASE, SCOPUS, CINAHL, SPORTDiscus, Cochrane Library) was conducted in March 2025 following PRISMA guidelines. Studies reporting clinical outcomes in adults undergoing GHA or TT for traumatic BPI were included. Pooled mean range of motion and proportional complication and reoperation rates were calculated using random- and fixed-effects models, as appropriate. Results: A total of 22 studies involving 269 TT procedures and 194 GHA procedures were analyzed. Mean shoulder abduction was 81\u00b0 (95% CI 54\u2013108\u00b0) in the TT group and 51\u00b0 (95% CI 37\u201365\u00b0) in the GHA group. Mean forward flexion was 88\u00b0 (95% CI 51\u2013124\u00b0) in the TT group and 56\u00b0 (95% CI 44\u201368\u00b0) in the GHA group. The pooled complication rate was 4.8% (95% CI 2.6\u20138.6%) after TT and 26.4% (95% CI 18.5\u201336.1%) after GHA. The pooled reoperation rate was 3.2% (95% CI 1.5\u20136.6%) after TT and 17% (95% CI 10.8\u201325.7%) after GHA. Notably, TT cohorts generally had shorter follow-up durations, which may underrepresent late complications or reoperations. Conclusions: TT results in significantly lower complication and reoperation rates and demonstrates similar range-of-motion outcomes compared to GHA, suggesting that TT can be considered a first-line salvage option for motion preservation, while GHA remains an option for persistent instability, pain, or inability to achieve functional positioning of the hand in patients with traumatic BPIs. Additional comparative studies with higher levels of evidence are warranted to validate these findings.<\/jats:p>","DOI":"10.3390\/jcm14227911","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T14:55:15Z","timestamp":1762527315000},"page":"7911","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Differentiating Outcomes and Complications Between Extraplexal Tendon Transfers and Arthrodesis for Shoulder Reanimation Following Traumatic Brachial Plexus Injury: A Systematic Review and Proportional Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6071-8944","authenticated-orcid":false,"given":"Bradley J.","family":"Lauck","sequence":"first","affiliation":[{"name":"University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jackson M.","family":"Cathey","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine, Durham, NC 27710, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5062-315X","authenticated-orcid":false,"given":"Julian","family":"Mobley","sequence":"additional","affiliation":[{"name":"University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2606-6027","authenticated-orcid":false,"given":"Joshua K.","family":"Kim","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine, Durham, NC 27710, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eoghan T.","family":"Hurley","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan S.","family":"Crook","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eliana B.","family":"Saltzman","sequence":"additional","affiliation":[{"name":"Division of Hand, Peripheral Nerve, and Microvascular Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neill Y.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA"},{"name":"Division of Hand, Peripheral Nerve, and Microvascular Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s10143-018-1009-2","article-title":"Epidemiology, etiology, and types of severe adult brachial plexus injuries requiring surgical repair: Systematic review and meta-analysis","volume":"43","author":"Kaiser","year":"2020","journal-title":"Neurosurg. Rev."},{"key":"ref_2","first-page":"e24626","article-title":"Traumatic Bilateral Brachial Plexus Injury","volume":"14","author":"Kokkalis","year":"2022","journal-title":"Cureus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1177\/1753193414540074","article-title":"Timing of surgical reconstruction for closed traumatic injury to the supraclavicular brachial plexus","volume":"40","author":"Hems","year":"2015","journal-title":"J. Hand Surg. Eur. Vol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.2106\/JBJS.J.01913","article-title":"Tendon transfer options about the shoulder in patients with brachial plexus injury","volume":"94","author":"Elhassan","year":"2012","journal-title":"J. Bone Jt. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4445498","DOI":"10.1155\/2021\/4445498","article-title":"Shoulder Arthrodesis versus Upper Trapezius Tran.sfer for Traumatic Brachial Plexus Injury: A Proportional Meta-Analysis","volume":"2021","author":"Zhang","year":"2021","journal-title":"Adv. Orthop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"918e","DOI":"10.1097\/PRS.0000000000011270","article-title":"Injury and Biological Factors Impact Shoulder Function following Autogenous Grafting of Spinal Nerves for Pan-Brachial Plexus Reconstruction","volume":"154","author":"Li","year":"2024","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_7","first-page":"e12914","article-title":"Systematic Review With Meta-Analysis: Are Muscle Transfers a Satisfactory Treatment Option to Restore Shoulder Abduction in Delayed Adult Brachial Plexus Injuries?","volume":"13","author":"Hermena","year":"2021","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"705","DOI":"10.5435\/JAAOS-D-18-00433","article-title":"Adult Traumatic Brachial Plexus Injuries","volume":"27","author":"Noland","year":"2019","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1016\/j.jse.2023.10.025","article-title":"Glenohumeral arthrodesis outcomes and complications: A systematic review","volume":"33","author":"Cabell","year":"2024","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Sobhi, S., Bochat, K., Booth, G., Mattin, A., and Moniz, S. (2024). Clinical and Surgical Outcomes of Shoulder Arthrodesis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13164701"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"598","DOI":"10.2106\/JBJS.17.00428","article-title":"Long-Term Outcomes of Glenohumeral Arthrodesis","volume":"100","author":"Wagner","year":"2018","journal-title":"J. Bone Jt. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1055\/s-0040-1721865","article-title":"Functional Evaluation of Levator Scapulae Tendon to Supraspinatus in Adult Brachial Plexus Injuries","volume":"54","author":"Rayidi","year":"2021","journal-title":"Indian J. Plast. Surg."},{"key":"ref_13","first-page":"ED000142","article-title":"Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions","volume":"10","author":"Cumpston","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Wan, X., Wang, W., Liu, J., and Tong, T. (2014). Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-135"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"346","DOI":"10.4103\/2347-9264.169503","article-title":"Transfer of upper trapezius with clavicular segment for restoration of shoulder movements following injury to the brachial plexus","volume":"2","author":"Agrawal","year":"2015","journal-title":"Plast. Aesthetic Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/j.jhsa.2012.01.012","article-title":"Functional outcome of glenohumeral fusion in brachial plexus palsy: A report of 54 cases","volume":"37","author":"Atlan","year":"2012","journal-title":"J. Hand Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1302\/0301-620X.72B4.2380231","article-title":"Transfer of the trapezius for flail shoulder after brachial plexus injury","volume":"72","author":"Aziz","year":"1990","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1002\/micr.20838","article-title":"Upper and lower trapezius muscle transfer to restore shoulder abduction and external rotation in longstanding upper type palsies of the brachial plexus in adults","volume":"31","author":"Bertelli","year":"2011","journal-title":"Microsurgery"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1302\/0301-620X.86B5.13549","article-title":"Glenohumeral arthrodesis in upper and total brachial plexus palsy. A comparison of functional results","volume":"86","author":"Chammas","year":"2004","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"6s","DOI":"10.1177\/1558944721998008","article-title":"Shoulder Arthrodesis for Traumatic Brachial Plexus Injuries: Functional Outcomes and Complications","volume":"18","author":"Cho","year":"2023","journal-title":"Hand"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1177\/1558944717735944","article-title":"Lower Trapezius Transfer for Patients With Brachial Plexus Injury","volume":"14","author":"Crepaldi","year":"2019","journal-title":"Hand"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1016\/j.otsr.2019.08.018","article-title":"Comparison of spinal accessory nerve transfer to supra-scapular nerve vs. shoulder arthrodesis in adults with brachial plexus injury","volume":"105","author":"Degeorge","year":"2019","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1016\/j.jhsa.2015.12.026","article-title":"Contralateral Trapezius Transfer to Restore Shoulder External Rotation Following Adult Brachial Plexus Injury","volume":"41","author":"Elhassan","year":"2016","journal-title":"J. Hand Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/00003086-199707000-00013","article-title":"Shoulder fusion for paralyzed upper limb","volume":"340","author":"Emmelot","year":"1997","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"412","DOI":"10.3944\/AOTT.2011.2487","article-title":"Shoulder arthrodesis with plate fixation","volume":"45","author":"Esenyel","year":"2011","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1142\/S2424835520500150","article-title":"Trapezius Transfer to Restore Shoulder Function in Traumatic Brachial Plexus Injury: Revisited and Modified","volume":"25","author":"Karki","year":"2020","journal-title":"J. Hand Surg. Asian-Pac. Vol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e115","DOI":"10.1016\/j.jse.2016.09.040","article-title":"Arthroscopic arthrodesis of the shoulder in brachial plexus palsy","volume":"26","author":"Lenoir","year":"2017","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3109\/17453679809002360","article-title":"Trapezius transfer for shoulder paralysis. 6 patients with brachial plexus injuries followed for 1 year","volume":"69","author":"Hinarejos","year":"1998","journal-title":"Acta Orthop. Scand."},{"key":"ref_31","first-page":"2","article-title":"Trapezius transfer to treat flail shoulder after brachial plexus palsy","volume":"2","author":"Monreal","year":"2007","journal-title":"J. Brachial Plex. Peripher. Nerve Inj."},{"key":"ref_32","first-page":"184","article-title":"Trapezius transfer in brachial plexus palsy","volume":"87","author":"Schmolke","year":"2005","journal-title":"J. Bone Jt. Surg. Ser. B"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"39","DOI":"10.4103\/0970-0358.32662","article-title":"Modified trapezius transfer technique for restoration of shoulder abduction in brachial plexus injury","volume":"40","author":"Singh","year":"2007","journal-title":"Indian J. Plast. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1177\/1753193411405742","article-title":"Shoulder arthrodesis in adult brachial plexus injury: What is the optimal position?","volume":"36","author":"Sousa","year":"2011","journal-title":"J. Hand Surg. Eur. Vol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1177\/1758573217693807","article-title":"Glenohumeral arthrodesis for late reconstruction of flail shoulder in patients with traumatic supraclavicular brachial plexus palsy","volume":"9","author":"Thangarajah","year":"2017","journal-title":"Shoulder Elb."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1007\/s00590-018-2152-8","article-title":"Satisfied patients after shoulder arthrodesis for brachial plexus lesions even after 20 years of follow-up","volume":"28","author":"Schotanus","year":"2018","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/j.jhsa.2010.05.001","article-title":"Shoulder tendon transfer options for adult patients with brachial plexus injury","volume":"35","author":"Elhassan","year":"2010","journal-title":"J. Hand Surg."},{"key":"ref_38","first-page":"1","article-title":"Lower trapezius tendon transfer for irreparable rotator cuff injuries: A scoping review","volume":"3","author":"Desai","year":"2023","journal-title":"JSES Rev. Rep. Tech."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"70","DOI":"10.2106\/JBJS.G.00203","article-title":"Glenohumeral arthrodesis after failed prosthetic shoulder arthroplasty","volume":"90","author":"Scalise","year":"2008","journal-title":"J. Bone Jt. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/7911\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T05:22:39Z","timestamp":1762838559000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/7911"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,7]]},"references-count":39,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14227911"],"URL":"https:\/\/doi.org\/10.3390\/jcm14227911","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,11,7]]}}}