Skip to main content
SpringerLink
Log in

Stabilizing effect of the transferred conjoined tendon on shoulder stability

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

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° abduction and 90° 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Abrams JS, Savoie FH III, Tauro JC, Bradley JP (2002) Recent advances in the evaluation and treatment of shoulder instability: anterior, posterior, and multidirectional. Arthroscopy 18(Suppl 2):1–13

    PubMed  Google Scholar 

  2. Aronen JG, Regan K (1984) Decreasing the incidence of recurrence of first time anterior shoulder dislocations with rehabilitation. Am J Sports Med 12:283–291

    PubMed  CAS  Google Scholar 

  3. Barber FA, Snyder SJ, Abrams JS, Fanelli GC, Savoie FH III (2003) Arthroscopic Bankart reconstruction with a bioabsorbable anchor. J Shoulder Elbow Surg 12:535–538

    Article  PubMed  Google Scholar 

  4. Bottoni CR, Smith EL, Berkowitz MJ, Towle RB, Moore JH (2006) Arthroscopic versus open shoulder stabilization for recurrent anterior instability: a prospective randomized clinical trial. Am J Sports Med 34:1730–1737

    Article  PubMed  Google Scholar 

  5. Boytchev B (1951) Treatment of recurrent shoulder instability. Minerva Orthop 2:377–379

    Google Scholar 

  6. Burkhead WZ Jr, Rockwood CA Jr (1992) Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg Am 74:890–896

    PubMed  Google Scholar 

  7. Chatterjee ND, Nath C, Pal AK, Baksi DP (2002) Modified Boytchev procedure for the treatment of recurrent anterior dislocation of the shoulder. Int Orthop 26:7–9

    Article  PubMed  CAS  Google Scholar 

  8. Conforty B (1980) The results of the Boytchev procedure for treatment of recurrent dislocation of the shoulder. Int Orthop 4:127–132

    PubMed  CAS  Google Scholar 

  9. Dalsgaard HL, Gothgen CB, Hoogmartens MJ (2000) The Boytchev procedure for recurrent anterior dislocation of the shoulder: a controversial technique. Acta Orthop Belg 66:248–250

    PubMed  CAS  Google Scholar 

  10. Dietz SO, Bartl C, Magosch P, Lichtenberg S, Habermeyer P (2006) Intra-articular volume assessment in glenohumeral instability. Knee Surg Sports Traumatol Arthrosc 14:189–192

    Article  PubMed  CAS  Google Scholar 

  11. Fabbriciani C, Milano G, Demontis A, Fadda S, Ziranu F, Mulas PD (2004) Arthroscopic versus open treatment of Bankart lesion of the shoulder: a prospective randomized study. Arthroscopy 20:456–462

    Article  PubMed  Google Scholar 

  12. Ha’Eri GB (1986) Boytchev procedure for the treatment of anterior shoulder instability. Clin Orthop 206:196–201

    PubMed  Google Scholar 

  13. Halder AM, Halder CG, Zhao KD, O’Driscoll SW, Morrey BF, An KN (2001) Dynamic inferior stabilizers of the shoulder joint. Clin Biomech 16:138–143

    Article  CAS  Google Scholar 

  14. Itoi E, Kuechle DK, Newman SR, Morrey BF, An KN (1993) Stabilising function of the biceps in stable and unstable shoulders. J Bone Joint Surg Br 75:546–550

    PubMed  CAS  Google Scholar 

  15. Itoi E, Newman SR, Kuechle DK, Morrey BF, An KN (1994) Dynamic anterior stabilisers of the shoulder with the arm in abduction. J Bone Joint Surg Br 76:834–836

    PubMed  CAS  Google Scholar 

  16. Karduna AR, Williams GR, Williams JL, Iannotti JP (1996) Kinematics of the glenohumeral joint: influences of muscle forces, ligamentous constraints, and articular geometry. J Orthop Res 14:986–993

    Article  PubMed  CAS  Google Scholar 

  17. Kido T, Itoi E, Lee SB, Neale PG, An KN (2003) Dynamic stabilizing function of the deltoid muscle in shoulders with anterior instability. Am J Sports Med 31:399–403

    PubMed  Google Scholar 

  18. Levy AS, Kelly BT, Lintner SA, Osbahr DC, Speer KP (2001) Function of the long head of the biceps at the shoulder: electromyographic analysis. J Shoulder Elbow Surg 10:250–255

    Article  PubMed  CAS  Google Scholar 

  19. Lubowitz J, Bartolozzi A, Rubinstein D, Ciccotti M, Schweitzer M, Nazarian L, Lombardi J, Dellose S, Landsdorf A, Miller L (1996) How much does inferior capsular shift reduce shoulder volume. Clin Orthop 328:86–90

    Article  PubMed  Google Scholar 

  20. Malicky DM, Soslowsky LJ, Blasier RB, Shyr Y (1996) Anterior glenohumeral stabilization factors: progressive effects in a biomechanical model. J Orthop Res 14:282–288

    Article  PubMed  CAS  Google Scholar 

  21. Morrey B, Itoi E, An KN (1998) Biomechanics of the shoulder. In: Rockwood C Jr, Matsen FA III (eds) The shoulder. 2nd edn. WB Saunders, Philadelphia, pp 890–896

    Google Scholar 

  22. Panjabi MM, Brand RA Jr, White AA III (1976) Mechanical properties of the human thoracic spine. J Bone Joint Surg Am 58:642–652

    PubMed  CAS  Google Scholar 

  23. Panjabi MM, Summers DJ, Pelker RR, Videman T, Friedlaender GE, Southwick WO (1986) Three-dimensional load–displacement curves due to forces on the cervical spine. J Orthop Res 4:152–161

    Article  PubMed  CAS  Google Scholar 

  24. Sethi N, Wright R, Yamaguchi K (1999) Disorders of the long head of the biceps tendon. J Shoulder Elbow Surg 8:644–654

    Article  PubMed  CAS  Google Scholar 

  25. Shibata Y, Honjo N, Shinoda T, Kumano T, Naito M (2004) Pressure between the humeral head and the subscapularis tendon after the modified Boytchev procedure. J Shoulder Elbow Surg 13:170–173

    Article  PubMed  Google Scholar 

  26. Stokes DA, Savoie FH III, Field LD, Ramsey JR (2003) Arthroscopic repair of anterior glenohumeral instability and rotator interval lesions. Orthop Clin North Am 34:529–538

    Article  PubMed  Google Scholar 

  27. Tauro JC (2000) Arthroscopic inferior capsular split and advancement for anterior and inferior shoulder instability: technique and results at 2- to 5-year follow-up. Arthroscopy 16:451–456

    Article  PubMed  CAS  Google Scholar 

  28. Yoneda B, Welsh RP, MacIntosh DL (1982) Conservative treatment of shoulder dislocation in young males. J Bone Joint Surg Br 64:254–255

    Google Scholar 

  29. Zamora-Navas P, Borras Verdera A, Porras Garcia J, Padilla Marquez A, Linares P (2001) Long-term results of the Boytchev procedure for the treatment of recurrent dislocation of the shoulder. Acta Orthop Belg 67:233–235

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China

    Lei-Sheng Jiang, Yi-Min Cui, Zhi-De Zhou & Li-Yang Dai

Authors
  1. Lei-Sheng Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yi-Min Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhi-De Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Li-Yang Dai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Li-Yang Dai.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jiang, LS., Cui, YM., Zhou, ZD. et al. Stabilizing effect of the transferred conjoined tendon on shoulder stability. Knee Surg Sports Traumatol Arthrosc 15, 800–805 (2007). https://doi.org/10.1007/s00167-006-0239-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-006-0239-y

Keywords

Search

Navigation