Modified Boytchev Procedure for Recurrent Anterior Dislocation of Shoulder- Experience from a Tertiary Care Institute

Abstract

Introduction: Post traumatic shoulder dislocation has very high recurrence rates. Most surgical procedures described lead to decreased range of motion and have high complication rates. Modified Boytchev technique is one of the popular techniques for recurrent shoulder dislocation. Aim: To see functional results of Modified Boytchev procedure along with anterior capsular plication. Materials and Methods: This was an open prospective study in which patients presenting with recurrent anterior dislocation of shoulder were enrolled from January 2014 to December 2017. It was conducted in the Department of Orthopaedics in a tertiary care teaching hospital. In the series, 41 patients underwent Modified Boytchev procedure with capsular plication. Followup was done using Oxford Instability Shoulder Score (OISS) and objective range of motion measurements. All data was tabulated and statistically analysed with paired t-test using recent version of SPSS. Results: Five patients in the study were lost to follow-up and hence excluded from the study. Mean age in the series was 30.8 years. A total 33 (91.6%) of patients were male and 3 (8.3%) were females. Out of 36 patients, 32 (88.9%) had dominant shoulder involvement. Average number of dislocations at presentation was 5. Mean follow-up period was 38 months (24 to 62 months). Mean OISS score before surgery was 21.2±6.86 which improved to 41.08±4.01 at six months (p <0.05) after surgery, 42.22±3.04 at one year and 42.4±2.78 at two years (p <0.05), respectively. Mean external rotation deficit at 0° improved from 16.72°±5.12 preoperatively to 8.91°±2.52 at 6 months, 7.83°±2.38 at one year and 7.30°±2.26 at two years (p <0.05). Mean external rotation deficit at 90° improved from 20.72°±4.60 preoperatively to 10.30°±2.73 at six months (p <0.05), 8.38°±2.69 at one year and 7.72°±2.01 at two years after surgery (p <0.05). Average forward flexion deficit was 0.61°±0.84 preoperatively which increased postoperatively to 6.25°±4.14, 3.36°±2.67 and 2.41°±2.06 at six months, one year and two years respectively (p <0.05). There were no major complications reported. Conclusion: Modified Boytchev procedure with capsular plication is a reliable and reproducible procedure with excellent results. Technically, it is less demanding than other procedures and has minimal complication rates. Procedure involves minimal cost and is an acceptable method of treatment in countries with limited resources.

Keywords

• capsular plication
• conjoint tendon
• coracoid
• rerouting
• shoulder dislocation