# Single versus double tendon transfer for improving shoulder function in brachial plexus birth palsy: a meta-analysis of comparative studies

## TL;DR

This study compares single and double tendon transfer surgeries for shoulder function in brachial plexus birth palsy, finding similar outcomes but potential differences in complications.

## Contribution

The first meta-analysis comparing functional outcomes and complications of single versus double tendon transfer in brachial plexus birth palsy.

## Key findings

- Single and double tendon transfers showed comparable shoulder function outcomes in OBPP.
- LD single transfers had significantly higher odds of LOM compared to TM single transfers.
- No significant differences were found in total modified Mallet scores between the two techniques.

## Abstract

Obstetric brachial plexus palsy (OBPP) may result in lifelong shoulder dysfunction despite nerve repair surgery. Tendon transfer has emerged as a surgical option to restore external rotation and abduction in OBPP sequelae. Single and double tendon transfer techniques have been developed, but the optimal approach remains debated. This meta-analysis is the first to compare the range of motion outcomes and complications, particularly loss of midline function (LOM), between the two techniques in managing OBPP sequelae.

On January 2025, systematic literature search was performed in five databases (PubMed, Cochrane Library, Embase, Scopus and Web of Science), to identify studies comparing single and double tendon transfer in children with OBPP. Eligible studies underwent quality assessment via MINORS criteria and a meta-analysis using RevMan was conducted to compare the functional outcomes and complications.

Five retrospective studies encompassing 189 patients were analyzed. The pooled mean difference (MD) in the total modified Mallet score between groups was statistically insignificant (MD = 0.09; 95% CI= -0.68 to 0.85;p > 0.05). Analyses for the sub-scores revealed no differences across all sub-scores. However, for Latissimus Dorsi (LD) single transfers, Abdel-Ghani et al. reported 7.7-fold greater odds of LOM (OR = 0.13; 95% CI = 0.04–0.42;p < 0.05), whereas the pooled LOM of Teres Major (TM) single transfers were not significantly different (OR = 0.40; 95% CI = 0.11–1.47;p > 0.05).

In conclusion, our meta-analysis suggests that both single and double tendon transfers achieve comparable functional outcomes. However, the data suggests that LD single tendon transfer potentially lowers rate of LOM, though further research is needed to confirm this finding.

Not applicable.

The online version contains supplementary material available at 10.1186/s12891-025-08803-9.