W e read with great interest the article entitled "Shoulder Release and Tendon Transfer following Neonatal Brachial Plexus Palsy: Gains, Losses, and Midline Function," by Adidharma et al. in Plastic and Reconstructive Surgery. 1 The authors presented their experience with shoulder reconstruction for persistent deficits from neonatal brachial plexus palsy, in attempts to rebalance internal and external rotators. The authors elected to release the coracohumeral ligament, fractionally lengthen the pectoralis major, and transfer the latissimus dorsi and teres major into the rotator cuff. However, the mean follow-up was only 25 months, despite many authors' having demonstrated that outcomes continue to change past this period. [2][3][4][5] This study had a minimum 2-year follow-up period, but studies with similar criteria still had drastically