PURPOSE OF THE STUDY Carpometacarpal (CMC) instabilities of the thumb joint occur after injuries or due to joint overload in patients with congenital joint hypermobility. They are often undiagnosed and, if left untreated, are the basis for the development of rhizarthrosis in young individuals. The authors present the results of the Eaton-Littler technique. MATERIAL AND METHODS The authors present a set of 53 CMC joints of patients with an average age of 26.8 years (15-43 years) operated on in the years 2005-2017. Post-traumatic conditions were found in 10 patients and in 43 cases instability was caused by hyperlaxity, also demonstrated in other joints. The operation was performed from the Wagner's modified anteroradial approach. After the operation, a plaster splint was applied for 6 weeks, after which rehabilitation (magnetotherapy, warm-up) began. Patients were evaluated using the VAS (pain at rest and during exercise), DASH score in the work module, and subjective evaluation (no difficulties, difficulties not limiting normal activities, and difficulties limiting normal activities) before surgery and 36 months after surgery. RESULTS During the preoperative assessment, the average VAS value was 5.6 at rest and 8.3 during exercise. During the VAS assessment at rest, the values at 6, 12, 24 and 36 months after surgery were 5.6, 2.9, 0.9, 1, 2 and 1.1. When evaluated in the given intervals under load, the detected values were 4.1, 2, 2.2 and 2.4. The DASH score in the work module was 81.2 before surgery, 46.3 at 6 months, 15.2 at 12 months, 17.3 at 24 months, and 18.4 at 36 months after surgery. In the subjective self-assessment made at 36 months after surgery, 39 patients (74%) assessed their condition as having no difficulties, ten patients (19%) reported difficulties that did not limit normal activities, and four patients (7%) reported difficulties limiting normal activities. DISCUSSION Most authors present the results of their surgeries in patients with post-traumatic joint instability, and they report excellent results at two to six years after surgery. There is a negligible number of studies addressing instabilities in patients with instability caused by hypermobility. When using the conventional method described by the authors in 1973, our results of the evaluation performed at 36 months after surgery are comparable to those reported by other authors. We are well aware of the fact that this is a short-term follow-up and that this method does not prevent developing degenerative changes in the case of long-term follow-up, but reduces clinical difficulties and may delay the development of severe rhizarthrosis in young individuals. CONCLUSIONS CMC instability of the thumb joint is a relatively common disorder, although not all individuals experience clinical difficulties. In the case of difficulties, the instability needs to be diagnosed and treated as this is how the development of early rhizarthrosis in the predisposed individuals can be prevented. Our conclusions suggest a possibility of a surgical solution with good results. Key words: carpometacarpal thumb joint, thumb CMC joint, carpometacarpal thumb instability, joint laxity, rhizarthrosis.
- MeSH
- artroplastiky kloubů * metody MeSH
- dospělí MeSH
- karpometakarpální klouby * chirurgie MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nestabilita kloubu * chirurgie MeSH
- palec ruky chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
PURPOSE OF THE STUDY The study retrospectively reviews the outcomes of patella stabilisation surgeries performed at our department in the period 2010-2020. It aimed to provide a more thorough evaluation, to compare the respective types of MPFL reconstruction and to confirm the beneficial effect of tibial tubercle ventromedialization on patella height. MATERIAL AND METHODS In the period 2010-2020, a total of 72 stabilisation surgeries of patellofemoral joint in 60 patients with objective patellar instability (OPI) were performed at our department. The surgical treatment outcomes were evaluated retrospectively using a questionnaire, including the postoperative Kujala score. A comprehensive examination was carried out in 42 patients (70%) who had completed the questionnaire. In case of distal realignment, the TT-TG distance and a change in the InsallSalvati index which serve as an indication for surgery, were assessed. RESULTS Altogether 42 patients (70%) and 46 surgical interventions (64%) were evaluated. The follow-up period was 1-11 years, with the mean follow-up of 6.9 years. In the studied group of patients, only 1 case (2%) of new dislocation was seen, in 2 cases (4%) the patients reported a subluxation episode. The mean score using the school grades was 1.76. Thirty-eight patients (90%) were satisfied with the surgical outcome, 39 patients would undergo a surgery in case of identical problems with the other limb. The mean postoperative Kujala score was 76.8 points, range 28-100 points. The mean TT-TG distance in the studied group with the preoperative CT scan (33x) was 15.4 mm (12-30 mm). The mean TT-TG distance in the cases indicated for tibial tubercle transposition was 22.2 mm (15-30 mm). The mean Insall-Salvati index prior to the performance of tibial tubercle ventromedialization was 1.33 (1-1.74). Postoperatively, the index decreased by 0.11 on average (-0.00 to -0.26) to 1.22 (0.92-1.63). No infectious complications were presented in the studied group. DISCUSSION In patients with recurrent patellar dislocation, the instability is often times caused by pathomorphologic anomalies of the patellofemoral joint. In patients with clinically expressed patellar instability and physiological values of the TT-TG distance, an isolated proximal realignment is performed by medial patellofemoral ligament (MPFL) reconstruction. In the case of pathological values of the TT-TG distance, distal realignment is performed by tibial tubercle ventromedialization to achieve physiological values of the TT-TG distance. In the studied group, tibial tubercle ventromedialization helped decrease the Insall-Salvati index by 0.11 points on average. This has a positive side effect on the patella height, thus on increasing its stability in the femoral groove. In patients with both proximal and distal malalignment, a two-stage surgery is performed. In the isolated cases of severe instability or if symptoms of lateral patellar hyperpressure are present, musculus vastus medialis transfer or arthroscopic lateral release are performed as well. CONCLUSIONS When correctly indicated, proximal, distal realignment or their combination can bring very good functional outcomes with a low risk of recurrent dislocation and postoperative complications. The importance of MPFL reconstruction is confirmed by low incidence of recurrent dislocation in the group investigated in this study, namely when compared with studies referred to in this paper, in which the patients underwent patellar stabilisation using the Elmslie-Trillat procedure. Conversely, leaving the bone malalignment untreated during the isolated MPFL reconstruction increases the risk of its failure. Judging from the obtained results, tibial tubercle ventromedialization also has a positive effect on the patella height through its distalization. Provided the stabilisation procedure is correctly indicated and performed, the patients can get back to their normal activities, often even sports activities. Key words: objective patellar instability, patellar stabilisation, MPFL, tibial tubercle transposition.
- MeSH
- dislokace kloubu * MeSH
- kloubní ligamenta chirurgie MeSH
- lidé MeSH
- luxace pately * chirurgie MeSH
- nestabilita kloubu * chirurgie MeSH
- patela chirurgie MeSH
- patelofemorální kloub * chirurgie MeSH
- retrospektivní studie MeSH
- tibie chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
PURPOSE OF THE STUDY It was a prospective, randomised, unblinded study. Effects of the application of platelet-rich fibrin (PRF) on the anatomic anterior ligament reconstruction were examined. MATERIAL AND METHODS A total of 40 patients who underwent a surgery between 2012 and 2014 were enrolled in the study. The patients were randomised into two groups: the group with PRF application (n=20) and the group without PRF application (n=20, control group). The study included 11 women and 29 men, with the mean age at the time of inclusion into the study 29.1 years. Vivostat ® PRF was obtained perioperatively from the patient s blood and applied intraoperatively to the hamstring tendon graft. The ACL graft healing was assessed through magnetic resonance (MRI) at 6 and 12 months postoperatively. The clinical outcomes (the Lysholm score and the IKDC Subjective score, return to pre-injury sport levels, Pivot-shift test, graft failure) as well as standardised laxity measurements using GenouRob arthrometer were performed preoperatively and 12 months after surgery. RESULTS The study was completed by thirty-three (33) patients (17 in the PRF group and 16 in the control group). In two cases, postoperative graft failure was reported (both cases in the control group). No significant differences were found in the process of graft ligamentization evaluated through MRI (p=0.07). No significant difference between the groups was identified with respect to return to pre-injury sport levels (p=0.232), or the Lysholm score and IKDC Subjective score (p=0.259, and p=0.364 respectively). The postoperative knee laxity measurement using Genourob arthrometer did not reveal any significant differences between the PRF group and the control group. DISCUSSION Results similar to those arrived at by our study have recently been published also by other authors worldwide. We can therefore assume that the application of PRF can be of benefit, especially at the early stage of healing. The results still need to be verified on a larger study group, the study design should focus on the development in the early postoperative period. CONCLUSIONS In our study group, no significant difference was observed in the evaluated subjective and objective clinical parameters. Only the parameter regarding the ACL graft failure fell just short of statistical significance, namely to the disadvantage of the group without the PRF application. Key words: anterior cruciate ligament, arthroscopy, anatomic ACL reconstruction, magnetic resonance imaging of the graft, platelet-rich fibrin, graft healing, MRI signal intensity of the graft.
- MeSH
- fibrin bohatý na krevní destičky * MeSH
- kolenní kloub chirurgie MeSH
- lidé MeSH
- nestabilita kloubu * chirurgie MeSH
- poranění předního zkříženého vazu * chirurgie MeSH
- prospektivní studie MeSH
- rekonstrukce předního zkříženého vazu * metody MeSH
- šlachy hamstringů * transplantace MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
INTRODUCTION: The aim of this prospective randomised study was to evaluate clinical results and rotational stability at least 2 years after single-bundle anatomic anterior cruciate ligament reconstruction using a quadriceps tendon graft with bone block (BT) and bone-patellar tendon-bone graft (BTB). MATERIALS AND METHODS: In both groups (BT and BTB), 40 patients selected prospectively at random were evaluated. The mean follow-up after the surgery was 28 months (range 24-33 months). A navigation system was used to measure rotational stability of the knee joint. Cincinnati, Lysholm, and IKDC scores and visual analog score (VAS) were used to evaluate clinical results and the non-parametric Wilcoxon test was used for the statistical analysis. RESULTS: After the BT reconstruction, the mean internal rotation of the tibia (IR) was 9.5°. In the contralateral healthy knee joint, IR was 8.6° at average. After the BTB reconstruction, the mean IR was 9.9°. In the contralateral healthy knee joint, IR was 8.7° at average. We did not find any statistically significant difference in IR stability between BT and BTB reconstruction. In terms of clinical results, regarding the VAS, patients perceive significantly more pain after the BTB reconstruction (p < 0.05). Kneeling was reported more difficult and painful after BTB reconstruction. CONCLUSIONS: The BT reconstruction of the ACL provides similar clinical results, less pain, better flexion and the same rotational stability of the knee in comparison with the BTB reconstruction.
- MeSH
- bolest chirurgie MeSH
- kolenní kloub chirurgie MeSH
- lidé MeSH
- nestabilita kloubu * chirurgie MeSH
- poranění předního zkříženého vazu * chirurgie MeSH
- prospektivní studie MeSH
- rekonstrukce předního zkříženého vazu * metody MeSH
- šlachy chirurgie MeSH
- štěp kost-čéškový vaz-kost MeSH
- štěp z vazu čéšky chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
PURPOSE OF THE STUDY This study aimed to evaluate the clinical outcomes and the rate of recurrence in patients who had undergone arthroscopic Bankart repair with remplissage for anterior instability of the glenohumeral joint. MATERIAL AND METHODS The study included 96 arthroscopic Bankart procedures with remplissage performed between 2013 and 2019 at our department in 93 patients (81 men and 12 women; with the mean age of 33 years). We gathered and analysed preoperative data, including a 3D-CT scan of the affected shoulder. Apart from stability, the functional results were assessed postoperatively using the WOSI, SSV, Rowe score, and by measuring the strength of shoulder girdle muscles. The non-parametric MannWhitney U-test was used to identify the predisposing factors for recurrence of glenohumeral instability. RESULTS The arthroscopic Bankart repair with remplissage was indicated in 74 shoulders for primary TUBS and in 22 shoulders as a revision procedure. The recurrent instability was observed in 13 of 96 operated shoulders (13.5%). Subjective instability (positive apprehension test in the extreme positions of the shoulder joint, in abduction and external rotation in particular) was reported by 10 patients (10/13; 77%), three patients experienced a redislocation of the glenohumeral joint in the postoperative follow-up (3/13 patients; 23%). The risk of recurrence of the glenohumeral instability was not correlated with either the number of previous stabilisation procedures, or any other preoperative or intraoperative parameters. Conversely, a new postoperative injury was a factor of key importance. The patients with recurrent instability (subjective instability or glenohumeral dislocation) achieved a significantly lower Rowe score, SSV, postoperative VAS, and worse overall satisfaction with the procedure compared to the group with no recurrent instability. The remplissage induced minor limitations of external rotation at 0° abduction and internal rotation at 90° abduction. After rehabilitation, the muscle strength of the operated shoulder in both groups was comparable to that of the untreated shoulder in all planes of the shoulder range of motion. DISCUSSION Our study confirms the clinical relevance of the addition of remplissage to the arthroscopic Bankart procedure for reducing the rate of recurrent glenohumeral instability in TUBS with a clinically significant Hill-Sachs lesion. Satisfaction with the surgical outcome is high; the functional outcomes are very good, including muscle strength. Surprisingly, though, the risk of recurrent instability does not correlate with the number of implants used in the stabilisation procedure. CONCLUSIONS Addition of remplissage to the arthroscopic Bankart stabilisation in patients with a clinically significant Hill-Sachs lesion shows a low risk of recurrence of glenohumeral instability after surgery compared to the conventional arthroscopic Bankart repair alone. The remplissage does cause minor restrictions in the glenohumeral joint external rotation, but it was not reflected in the satisfaction of patients or a lower clinical score of the shoulder joint. The preoperative assessment of the HillSachs lesion using the "glenoid track" on a 3D-CT scan helps improve the preoperative planning and prediction of outcomes of the stabilisation procedure. Key words: glenohumeral instability, Bankart defect, Hill-Sachs lesion, Bankart repair, remplissage, arthroscopy.
- MeSH
- artroskopie metody MeSH
- Bankartova léze * chirurgie MeSH
- dospělí MeSH
- lidé MeSH
- luxace ramenního kloubu * chirurgie MeSH
- nestabilita kloubu * etiologie chirurgie MeSH
- ramenní kloub * diagnostické zobrazování chirurgie MeSH
- rameno MeSH
- recidiva MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
Bio-absorbable anchors are widely used for Bankart repair in shoulder instability surgery. Suture anchor placement for labral repair may give rise to osteolysis and/or create stress risers in the glenoid rim, which may be the underlying reasons for glenoid rim fracture with a fracture line passing through previous anchor placement sites, the so-called "postage stamp fracture". Intraarticular fractures of the glenoid have been treated via open reduction and internal fixation through an arthrotomy, which may lead to potential postoperative complications like infection, neurovascular injuries, joint stiffness, and a long recovery period. Thus, arthroscopic techniques for the reduction and fixation of glenoid fractures have been developed. We present a case of anterior glenoid rim postage stamp fracture 9 years after glenohumeral instability surgery in a 29- year-old male. The fracture and recurrent instability were treated via arthroscopic Bankart revision repair and arthroscopic assisted percutaneous screw fixation, where the arthroscopic fracture reduction and definitive fixation were performed separately and before Bankart repair, which is different from the techniques defined in the literature previously. The patient was able to return to work at 6 weeks, to fitness training without pain or restriction at 3 months, and contact sports 6 months postoperatively. Key words: Bankart fractures, bony Bankart lesion, osseous Bankart lesion, shoulder dislocation, arthroscopy.
- MeSH
- artroskopie MeSH
- dospělí MeSH
- filatelie * MeSH
- kostní šrouby MeSH
- lidé MeSH
- lopatka MeSH
- luxace ramenního kloubu * chirurgie MeSH
- nestabilita kloubu * etiologie chirurgie MeSH
- ramenní kloub * chirurgie MeSH
- recidiva MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE OF THE STUDY Knee injuries accompanied by anterior cruciate ligament (ACL) tears can also result in rotational instability of the joint. Subsequent insufficient rotational stability after the ACL reconstruction can be a direct consequence also of injuries to lateral knee structures, specifically the anterolateral ligament (ALL). This residual postoperative rotational instability may be prevented by multiple surgical techniques. The purpose of this study was (1) to evaluate the knee stability in internal rotation after the "anatomical" single-bundle (SB) anterior cruciate ligament reconstruction together with ALL reconstruction compared to the double-bundle (DB) ACL reconstruction two years after surgery; (2) to compare the knee joint stability after the ACL and ALL reconstruction with the healthy contralateral knee joint. MATERIAL AND METHODS All the measurements were conducted by the computer navigation system. The study included 20 patients after the single-bundle ACL and ALL reconstruction and 20 patients after the double-bundle ACL reconstruction. The follow-up examination was carried out at 25 months after surgery on average (24 months at least). All measurements were performed in both the healthy and operated knee. Once the data necessary for navigation were determined, the patient remained in standing position with both feet firmly placed on the mat with intermalleolar distance of 20 cm. Then, at 30-degree flexion of the knee joints, the patient first performed the joint internal rotation by trunk torsion, followed by external rotation. Each measurement was repeated 3 times. A non-parametric t-test was used for statistical processing. RESULTS The mean internal rotation in the injured knee joint was 19.1 degrees preoperatively and 8.1 degrees postoperatively, while in the healthy knee it was 8.4 degrees. External rotation was not assessed. The reported internal rotation in the knees after DB ACL reconstruction was 9.2 degrees (p ≥ 0.05). DISCUSSION The double-bundle ACL reconstruction is a complex technique that can lead to many intraoperative and postoperative complications. Grafts harvested from both hamstrings can have an effect on the rotational stability of the joint. In order to restore the knee rotational stability with fewer potential complications, the method of choice can be the ACL reconstruction using the quadriceps femoris muscle graft and the ALL reconstruction using the gracilis muscle graft, leaving the semitendinosus tendon intact. CONCLUSIONS The obtained values reveal that the single-bundle ACL reconstruction in combination with ALL reconstruction results in the same internal rotational stability in the knee joint as the double-bundle ACL reconstruction. Similar joint rotational stability is observed in all the knee joints reconstructed with the use of these techniques and in the contralateral healthy knee joint. Key words: anterolateral ligament, anterior cruciate ligament, internal rotational stability, objective measurement.
- MeSH
- biomechanika MeSH
- kolenní kloub chirurgie MeSH
- lidé MeSH
- mrtvola MeSH
- nestabilita kloubu * etiologie chirurgie MeSH
- poranění předního zkříženého vazu * chirurgie MeSH
- rekonstrukce předního zkříženého vazu * MeSH
- rozsah kloubních pohybů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: S pelvitrochanterickou insuficiencí, resp. s nedostatečnou funkcí abduktorů kyčle se setkáváme stále častěji. Pokud s tímto problémem pacient na naši ambulanci přijde, své potíže popisuje vesměs jako významné. Cílem předkládané práce bylo zhodnotit výsledky rekonstrukce abduktorového mechanismu podle Whitesida.Materiál a metoda: Skupinu tvořili tři muži a čtyři ženy v průměrném věku 67 let (56–74 let). V podskupině po kyčelních náhradách se vždy jednalo o implantaci anterolaterálním přístupem, u dvou mužů šlo již o stav po revizním výkonu. Ve všech případech byl Trendelenburgův příznak jasně vyjádřen.Výsledky: Výsledek Trendelenburgova testu byl hodnocen u pěti pacientů jako + – a u dvou pacientů jako –, v žádném případě jsme po operaci už pelvifemorální insuficienci nepozorovali. Všichni pacienti zvládli vleže na zdravém boku aktivní abdukci operované končetiny, dvě ženy ne v plném rozsahu. Zatímco před operací chodili všichni pacienti s oporou jedné nebo dvou holí, po operaci si ponechaly „pro jistotu“ jednu hůl dvě pacientky. Vyjádřeno bodovým hodnocením užitého skóre, stav se u pacientů zlepšil průměrně ze 7 bodů na 13 bodů.Diskuse: Řešení pelvitrochanterické insuficience není snadné a dosud byly popsány v zásadě jen tři operační metody – prostá reinzerce šlachy, rekonstrukce pomocí aloštěpu (Achillova šlacha nebo extenzorový mechanismus kolena) a transfer poloviny m. gluteus maximus. Posledně zmíněná technika dává podle našich dosavadních zkušeností dobré výsledky.
Introduction: Deficiency of the abductor mechanism of the hip causes almost always a painful limp and significantly decreases the quality of life of patients. Lesion of the gluteus medius muscle can be induced by some causes, the most frequent one is the injury during the hip replacement. There are not many surgical techniques described to solve this problem. The purpose of the study was to evaluate resuts after the transfer of the anterior portion of the gluteus maximus muscle according to Whiteside.Material and Methods: Seven patients were surgically treated using the Whiteside’s technique. The group of patients was formed by four women and three men in the mean age of 67 years. Six of them underwent a total hip replacement using an anterolateral approach before. Trendelenburg sign was clearly expressed in all cases. The follow-up was 12 months.Results: Trendelenburg sign was negativ in all cases. All patients were able to perform an active abduction lying horizontally in the lateral position. All patients were able to walk without a cane and have substantial improvements in the Merle d ́Aubigné and Postel score. Discussion: There are only a few surgical techniques described to repair the deficient abductor mechanism. Except for the direct repair, reconstructions using the gluteus maximus transfer or an allograft can be used. The first technique gives acceptable results.
- Klíčová slova
- pelvitrochanterická insuficience,
- MeSH
- chirurgické laloky MeSH
- hýždě * chirurgie zranění MeSH
- kosterní svaly chirurgie patofyziologie MeSH
- kyčelní kloub chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu škodlivé účinky MeSH
- nestabilita kloubu * chirurgie etiologie MeSH
- ortopedické výkony metody statistika a číselné údaje MeSH
- pooperační komplikace chirurgie etiologie MeSH
- poranění šlachy komplikace MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- klinické zkoušky MeSH
