Boytchev procedure for the treatment of anterior shoulder instability

Most of the operative techniques described for the treatment of recurrent anterior dislocations or subluxations of the shoulder have two distinct disadvantages: the need to immobilize the arm for several weeks and loss of external rotation. These disadvantages provided an incentive for conducting a clinical evaluation of an operation originally described by Boytchev and modified by the author. In this procedure, the conjoined tendons of the coracobrachialis and the short head of the biceps with the detached tip of the coracoid process are rerouted posterior to the subscapularis muscle and reattached to the coracoid process, providing a dynamic muscular sling immediately anteroinferior to the glenohumeral joint, especially when the arm is in a vulnerable position of abduction and external rotation. A total of 26 repairs with a minimal follow-up period of two years were reviewed. There were 22 men and four women with an average age of 22 years. The results were satisfactory in all patients. Loss of external rotation of less than 15 degrees was noted in eight patients. There were no redislocations. This procedure provides immediate stability to the shoulder allowing range of motion exercises to begin from the first postoperative day.