# Understanding the long-term clinical effectiveness of L’Episcopo procedure in restoring external rotation & abduction in patients suffering from brachial plexus birth injury: a systematic review & meta-analysis

## TL;DR

This study reviews the long-term effectiveness of the L’Episcopo procedure in improving shoulder movement for patients with brachial plexus birth injury.

## Contribution

The paper provides a systematic review and meta-analysis of the L’Episcopo procedure's clinical effectiveness in BPBI patients.

## Key findings

- The L’Episcopo procedure showed a very large effect size (Hedge’s g = 1.66) in improving shoulder range of motion.
- Improvements were associated with increased functionality and external rotation/abduction in BPBI patients.
- Results were statistically significant with a p-value of < 0.0001.

## Abstract

Brachial Plexus Birth Injury (BPBI) affects 1 in 1,000 births in the U.S., drawing significant attention from orthopedic and plastic surgeons. While risk factors include shoulder dystocia, instrumental delivery, and fetal macrosomia, many cases lack clear causes. Tendon transfers, especially L’Episcopo, are commonly performed to restore shoulder external rotation and abduction using latissimus dorsi (LD) and teres major (TM) transfers.

The goal is to understand the clinical effectiveness of L’Episcopo in improving shoulder ROM and complications in BPBI patients.

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’Episcopo 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.

Four studies were included in the meta-analysis. Mallet scores were assessed at an average follow-up of 44 months. L’Episcopo procedure demonstrated both clinical and statistical effectiveness, with a Hedge’s g value of 1.66 indicating a very large effect size, and a p-value of < 0.0001. An improvement in Mallet scores is associated with increased range of motion and functionality of the shoulder.

L’Episcopo 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).