Boytchev Procedure Research Articles

Management of Recurrent Anterior Shoulder Dislocation by Modified Boytchev Procedure- Our Experience

Background: Recurrent anterior shoulder dislocation is not uncommon. Although the etiology for recurrent anterior shoulder dislocation is not very clear, there are 3 lesions usually responsible for its occurrence: Bankart lesion, Hill-Sachs lesion and laxity of subscapularis muscle. Several operations have been described for the treatment of recurrent anterior dislocation of shoulder but only a few of them have good result in terms of recurrence and loss of shoulder movement in follow-up period. Modified Boytchev procedure is an effective, technically simple procedure for the management of recurrent anterior dislocation of shoulder. Methods: Ten patients with recurrent anterior dislocation of the shoulder were treated from September 2017 to August 2019 by the modified Boytchev procedure. The age of the patients varied from 20 to 38 years (average 25.6 years). Outcome was evaluated using the Burkhead and Rockwood criteria, a score of 90 to 100 was considered excellent, 70 to 89 good, 40 to 69 fair and ?39 was considered poor. Results: The mean follow-up period was 15.4 (SD=3.2; range=6-29) months. Outcome was excellent in 7 patients, good in 2, and fair in 1. None had poor outcome. The shoulders were stable with increased ROM in all directions. Mean external rotation deficit at 0o and 90o of improved from 18o to 7o and 21o to 10o respectively (student's paired t-test). Conclusions: This is an effective, technically simple procedure with minimum restriction of movements around the shoulder joint and does not require expert skills.

Recurrent anterior shoulder dislocation with glenoid fracture managed by modified Boytchev procedure: a rare case report

<p class="abstract">Surgical procedures for recurrent anterior dislocation of the shoulder include using capsuloligamentous or bone blocks to create barriers and active interventions using muscle actions. Fracture of glenoid acts as a barrier for bone block procedures. Boytchev procedure, though outmoded, yet acts as simple and effective procedure in this condition. Here we report a 44 year old male with recurrent anterior dislocation with glenoid fracture treated by Boytchev procedure. The patient is on regular follow up since 3 years with no episode of shoulder dislocation till now with full range of movements. To conclude, Boytchev procedure is technically simple and effective method in patients with recurrent anterior shoulder dislocation with fracture of glenoid.</p>

Functional outcome of modified Boytchev procedure in recurrent shoulder dislocation

Objective: To evaluate functional outcome of recurrent anterior shoulder dislocation by modified Boytchev procedure. Materials and Method: This prospective study was done in 30 patients with recurrent dislocation of the shoulder, treated in the department of Orthopaedics Rajah Muthiah Medical Hospital and Sri Ramachandra Medical centre. The inclusion criteria were patients with recurrent anterior shoulder dislocation with minimum 5 to 8 episodes and age more than 18 years and less than 50 years. The exclusion criteria were fresh dislocation, dislocations with fracture of Coracoid process and patients with ligamentous laxity. The functional statuses of the patients were assessed using the Modified Rowe’s Scale. Results: out of thirty patients treated by modified Boytchev procedure 93% of patients had excellent/good outcome. Two patients, who had fair outcome in our study, were due to traumatic dislocation one year following the procedure, which leads to periarthritis of the affected shoulder and restricting abduction and external rotation movements. Conclusion: Modified Boytchev procedure is cost effective and has an easy learning curve. Therefore it is the ideal management in rural area.

Recurrent Anterior Shoulder Dislocation: Boytchev Treatment

Background: Utilized since 1951, the Boytchev procedure is an open anterior repair, performed for the treatment of anterior gleno-humeral instability, which involves rerouting the muscles that attach the coracoid process deep to the subscapularis muscle between this and the capsule. The tip of the coracoid with its muscles is reattached to its base in the anatomical position. Method: We conducted a prospective study of twenty patients with recurrent shoulder dislocations who were treated by the Boytchev procedure. All are men, with an average age of 29.2 years (age range from 17 to 42 years). 14 patients were affected on the right shoulder, 6 on the left. All had a clinical history of recurrent dislocation . We also performed a search of all published articles in the literature (16),17 studies including our series, with the aim of estimating, via a statistical analysis, to shed light on the post-operative results of recurrent anterior dislocations of the shoulder, for determining the reliability of this technique and possible specific risk factors that might lead to recurrence. Results: Evaluated using the Rowe score in our series, 19 patients had excellent and good results; one patient, who suffered a recurrence, had a poor result in terms of stability. Another patient developed osteoarthrosis. For the 17 studies, the number of patients is 477 with 485 dislocated shoulders. The rate of recurrence is 7.33% .In 12 studies, the rate is 2%, versus 21.08% in 5 studies with a significant difference (1-p=99.89%). Concerning the gradation of results, we have 441 excellent and good results and 44 fair and poor (91% versus 9% with p=>99.9% which is also very significant). Conclusion: The Boytchev procedure exhibits low recurrence rates in compiled studies and so can be considered a reliable surgical technique. Keywords: Shoulder recurrent dislocation, Boytchev treatment

Modified Boytchev procedure for recurrent anterior dislocation of shoulder.

PURPOSE. To evaluate results of the modified Boytchev procedure for recurrent anterior dislocation of the shoulder in 60 patients. METHODS. Medical records of 45 men and 15 women aged 20 to 44 years who underwent the modified Boytchev procedure for recurrent anterior dislocation of the right (n=44) and left (n=16) shoulders were reviewed. The mean number of dislocations was 14. Outcome was evaluated using the Burkhead and Rockwood criteria. RESULTS. The mean follow-up period was 56 months. Outcome was excellent in 32 patients, good in 21, and fair in 7. None had poor outcome. The mean external rotation deficit at 0º and 90º of abduction improved from 14º to 7º (p=0.04) and 18º to 7º (p=0.03), respectively. Two patients had fragmentation of the coracoid process, which was fixed with non-absorbable suture. Two patients had traction injury to the musculocutaneous nerve, which recovered after 6 months. One patient had recurrent dislocation that ruled out the chance of revision surgery. CONCLUSION. The modified Boytchev procedure is a viable and simple treatment for recurrent anterior shoulder dislocation.

The Results of the Boytchev Procedure for Treatment of Recurrent Dislocation of the Shoulder

The Results of the Boytchev Procedure for Treatment of Recurrent Dislocation of the Shoulder

A Modified Boytchev Procedure for the Treatment of Recurrent Anterior Shoulder Instability

A Modified Boytchev Procedure for the Treatment of Recurrent Anterior Shoulder Instability

Modified Boytchev procedure for treatment of recurrent anterior dislocation of shoulder

Background:More than 200 different operations have been described for the treatment of recurrent anterior dislocation of shoulder. The Modified Boytchev procedure employs rerouting of the detached tip of coracoid process with its attached conjoined tendon (short head of biceps and coracobrachialis) deep to subscapularis and reattaches to its anatomical location. We conducted a study on evaluation of long-term effect of modified Boytchev procedure and to compare our results with other studies published in literature.Materials and Methods:Since June 2002, modified Boytchev procedure was performed on 48 patients, who presented with recurrent anterior dislocation. 45 were men and 3 were women and were in the age group of 18-40 years (mean 27.83±4.95 years). Forty patients were affected on the dominant side and rest on the non-dominant side. The mean number of dislocations in these patients was 18.22±12.08. The mean followup period was 58.13±19.06 months (range 18-96 months). The patients were evaluated by visual analogue score, modified American Shoulder and Elbow Surgeon's Score (ASES), and Single Assessment Numeric Evaluation (SANE) score at the last followup.Results:All the patients regained almost preoperative range of forward flexion at the last followup. In the preoperative period the mean external rotation deficit at 0° and at 90° of abduction was 13.22°±5.16° and 18.06°±6.50°, respectively. At the last followup, the mean external rotation deficit at 0° and at 90° of abduction was 8.06°±2.47° and 8.95°±2.07°, respectively. This improvement in external rotation deficit was statistically significant (P<.05). Preoperative scores were compared with the most recent followup scores for all variables with use of a paired t test. All patients had significant improvement in visual analogue score, modified American Shoulder and Elbow Surgeon's Score (ASES), and Single Assessment Numeric Evaluation (SANE) score at the last followup. Four of the patients developed superficial infection which got resolved after treating with antibiotics, and two of the patients developed transient musculocutaneous nerve paresis. There was no radiological evidence of loosening and migration of coracoid screw or any glenohumeral arthritis on subsequent followup of skiagrams in any of our patients.Conclusion:Modified Boytchev procedure is an efficacious and technically simple procedure to treat recurrent anterior dislocation of shoulder.

Stabilizing effect of the transferred conjoined tendon on shoulder stability

The modified Boytchev procedure, i.e., rerouting of the coracoid process with its attached conjoined tendon (short head of biceps and coracobrachialis) deep to the subscapularis and reattachment to its anatomical location, has been advocated for recurrent anterior glenohumeral instability with controversial clinical outcomes. We aimed to investigate the dynamic contribution of the conjoined tendon in situ or transferred to the glenohumeral articulation in stable and unstable shoulders. Eight cadaveric shoulders were tested with the arm in 90 degrees abduction and 90 degrees external rotation. A constant 1.5 kg anterior translation force was applied to the proximal humerus, combined with 0, 1.5, 3.0 kg of load applied to the conjoined tendon sequentially. Anterior displacement of the humeral head relative to the scapula was recorded before and after an imitation Bankart lesion was created, and after treated with the modified Boytchev procedure for the Bankart lesion. Application of load to the conjoined tendon significantly reduced anterior displacement of the humeral head either with the capsule intact or with Bankart lesion simulated. The most significant decrease of the anterior displacement occurred when the conjoined tendon was transferred beneath the subscapularis. Our findings show that the conjoined tendon per se has a stabilizing effect on stable and unstable shoulders and therefore provide scientific support for the treatment of recurrent shoulder instability using the modified Boytchev procedure.

A Comparative Study between Modified Boytchev Procedure and Arthroscopic Bankart Repair

A Comparative Study between Modified Boytchev Procedure and Arthroscopic Bankart Repair

Pressure between the humeral head and the subscapularis tendon after the modified Boytchev procedure

The pressure between the humeral head and the subscapularis tendon was determined in 32 patients who had recurrent anterior shoulder dislocations. These patients' pressures were measured during a modified Boytchev procedure both before and after transposition of the conjoined tendon, and they were remeasured at the time of screw removal, performed at a mean of 13 months after the initial surgery. The mean clinical follow-up period was 31 months. A micro-tip catheter transducer was inserted into the glenohumeral joint between the humeral head and the subscapularis tendon. Pressures were measured at particular degrees of motion for two positions: passive external rotation of the arm at the side at 0°, 15°, 30°, 45°, and 60° and passive external rotation at the 90° abducted position at 0°, 30°, 60°, and 90°. The pressures were statistically significantly higher after the conjoined tendon transfer at all measured degrees of motion in the two positions. The pressures at the time of screw removal were not statistically significantly different from those seen after the tendon transfer during external rotation at 90° of abduction. The modified Boytchev procedure increases the pressure between the humeral head and the subscapularis tendon. We suspect that this increased pressure increases proprioceptive stimuli in the subscapularis tendon and thus accelerates the protective reflex needed to prevent shoulder dislocation.

Modified Boytchev procedure for the treatment of recurrent anterior dislocation of the shoulder.

From January 1990 to December 1998, 48 patients with 50 recurrent anterior dislocations of the shoulder were treated using a modified Boytchev procedure. The age of the patients varied from 18 to 35 years (average 24.7 years). The follow-up period was in average 88 (26-132) months. Six patients were lost in follow-up. Forty-two shoulders showed excellent results. There was one traction injury of the musculocutaneous nerve and one patient with immediate recurrence of the dislocation. Superficial wound infection occurred in five cases, all of which were controlled by antibiotics.

Stabilizing Mechanism of Modified Boytchev Procedure

Stabilizing Mechanism of Modified Boytchev Procedure

Results of Boytchev's Procedure for Recurrent Dislocation of the Shoulder

Results of Boytchev's Procedure for Recurrent Dislocation of the Shoulder

70 Preoperative arthroscopic findings in recurrent cases of modified Boytchev procedure for recurrent dislocation and subluxation of the shoulder

70 Preoperative arthroscopic findings in recurrent cases of modified Boytchev procedure for recurrent dislocation and subluxation of the shoulder

Capsulolabral Reconstruction for a Recurrent Dislocation of the Shoulder after a Boytchev Procedure

Capsulolabral Reconstruction for a Recurrent Dislocation of the Shoulder after a Boytchev Procedure

Preoperative Arthroscopic Findings in Recurrent Cases of Modified Boytchev procedure for Recurrent Dislocation and Subluxations of the Shoulder

Preoperative Arthroscopic Findings in Recurrent Cases of Modified Boytchev procedure for Recurrent Dislocation and Subluxations of the Shoulder

The Results of Our Modification of Boytchev's Procedure and Modified Bristow's Procedure Accompained by an Anterior Capsular Shift

The Results of Our Modification of Boytchev's Procedure and Modified Bristow's Procedure Accompained by an Anterior Capsular Shift

The results of our modification of Boytchev's procedure and modified bristows procedure accompanied with anterior capsular shift

The results of our modification of Boytchev's procedure and modified bristows procedure accompanied with anterior capsular shift

烏口突起センタリングジグの改良

We developed a drilling instrument (Type 1) for the coracoid process two years ago, and have been performing a modified Boytchev's procedure for patients with recurrent shoulder disloction using this instrument.When we inserted a screw into the coracoid process using the Type 1 instrument, the axis of the screw was directed caudally toward the coracoid process. We have now developed a new drilling instrument for the coracoid process (Type 2) that is able to insert the screw correctly into the center of the coracoid process. We performed a comparative study concerned with direction of the screw for three groups. Group 1: 13 cases had a screw inserted without intstrumentation. Group 2: 14 cases had their screw inserted using the Type 1 instrument. Grupe 3: Five cases had their screw inserted using the Type 2 instrument. Angles of inserted screw toward the coracoid process were compared in each group and were measured in antero-postero views, scapular outlet views and axial views by plain X-ray after the modified Boytchev procedure. The angles of Group 1 revealed a larger deviation than one of Group 1 and Group 2. The angles of Group 2 and Group 3 were less than the one of Group 1 in A-P views and Y-views. Using the improved drilling instrument for the coracoid process (Type 2), a hole can be easily made in the center of the coracoid process.The Type 2 instrument is available for various shoulder operations, for example, Bankart's procedure, capsular shift, Dewar's procedure, Bristow's procedure and total replacement of the shoulder joint.