Comparative Evaluation of the Efficacy of Arthroscopic Bankart Repair and Modified Boytchev Technique for Surgical Correction of Recurrent Dislocations of Shoulder

Abstract

ABSTRACT Introduction: Recurrent shoulder dislocation can be tackled by many ways. In Modified Boytchev procedure rerouting the tip of coracoid process with conjoint tendon is done under subscapularis. Arthroscopic Bankart repair involves reattaching the over stretched or torn labrum and capsule with suture anchors. The evidence regarding the relative effectiveness of modified boytchev vs arthroscopic bankart repair remains unclear. Aim: To study the efficacy and functional outcomes of modified Boytchev vs arthroscopic Bankart repair in recurrent shoulder dislocation. Materials and Methods: This Hospital based prospective observational study was carried out in the Department of Orthopaedic Surgery, SSKM Hospital and IPGME&R, Kolkata, West Bengal, India during the period of 20 months between January 2015 and August 2016. Total 30 cases were included of which 15 cases were treated by modified boytchev technique and 15 cases were treated by arthroscopic repair of bankart lesion. Results: Out of 15 patients in arthroscopic group, 2 (13.4%) had recurrence, one had apprehension and one had mild subluxation. Out of 15 patients in modified boytchev group only 1 (6.7%) had recurrence with positive apprehension. The comparison of the final external rotation showed a significant difference between the two groups (p-value-0.006). The mean final external rotation was higher in the arthroscopic bankart group with 71.6 degrees as compared to 63.733 degrees in the modified boytchev group. The comparison of the final Constant Murley Scores (CMS) between the two groups also came out to be very significant (p-value 0.036) with the arthroscopic bankart group having a mean of 90.2667 as compared to modified boytchev group having a mean of 83.6667. There were 9 excellent (60%), 4 good (26.7%), 1 fair (6.7%) and 1 poor (6.7%) CMS grading in arthroscopic bankart group. In modified boytchev group there were 6 excellent (40%), 6 good (40%), 3 fair (20%) and 0 poor CMS grading. Conclusion: In the present study, the rate of infection was more in modified boytchev technique due to it being an open procedure, the postoperative external rotation was less and CMS were lower when compared to arthroscopic bankart repair; but it had a lower rate of recurrence when compared to arthroscopic group. Modified boytchev technique still provided the patients a reasonable function and stable shoulder at low cost when compared to the costly and technically demanding arthroscopic surgery.

Keywords

• instability shoulder
• muscle sling
• shoulder arthroscopy
• suture anchor