Meta-Analysis on Medical and Surgical Management of Arthrogryposis Multiplex Congenita and Associated Deformities

Abstract

Background: Arthrogryposis multiplex congenita (AMC) is a heterogeneous group of non-progressive congenital disorders characterized by multiple joint contractures present at birth and frequently associated with musculoskeletal deformities such as clubfoot, hip dislocation, and upper limb contractures. These deformities can significantly impair mobility, functional independence, and quality of life. Management strategies typically involve early rehabilitation, orthotic support, serial casting techniques, and selective orthopedic surgical interventions. However, variability in treatment protocols and outcome reporting across studies has limited the development of standardized evidence-based management guidelines. Objective: To systematically evaluate and synthesize available evidence on the effectiveness of medical and surgical management strategies for musculoskeletal deformities in children with arthrogryposis multiplex congenita. Methods: A systematic review and meta-analysis were conducted using literature retrieved from PubMed, Scopus, Web of Science, and Google Scholar for studies published between 1995 and 2025. Eligible studies included observational studies, systematic reviews, and clinical studies evaluating rehabilitation interventions, Ponseti-based clubfoot correction, and orthopedic surgical procedures in pediatric patients with AMC. Data on patient characteristics, intervention types, functional outcomes, recurrence rates, and complications were extracted and analyzed using random-effects meta-analysis models where appropriate. Results: Thirty-eight studies involving 2,184 pediatric patients were included in the analysis. The Ponseti method demonstrated a pooled initial correction rate of 79.6% for AMC-associated clubfoot, although recurrence occurred in 37.5% of cases. Early rehabilitation interventions significantly improved joint mobility and functional independence (p = 0.004). Surgical management of hip dislocation achieved joint stability in 72.3% of cases but was associated with complications including avascular necrosis and redislocation. Upper limb contracture release resulted in significant improvements in elbow range of motion and functional outcomes (p = 0.002). Conclusion: Early multidisciplinary rehabilitation combined with selective surgical intervention represents the most effective management strategy for children with arthrogryposis multiplex congenita. Conservative approaches remain the cornerstone of treatment, while surgery provides important functional benefits in carefully selected patients.