Úvod: Cílem práce bylo zhodnotit přínos subpektorální tenodézy při řešení patologických stavů ramena kombinovaných s postižením úponu nebo šlachy dlouhé hlavy bicepsu. Materiál a metody: Autoři zhodnotili retrospektivně soubor 80 náhodně vybraných pacientů, u kterých byla v letech 2009–2013 provedena artroskopie ramena. Ošetření bylo provedeno podle zjištěné patologie: débridement nebo refixace labra, débridement chrupavek nebo mikrofraktury, débridement rotátorové manžety, burzektomie a event. i kostní subakromiální dekomprese, ošetření subkorakoidálního impingementu, resekce AC kloubu apod. Pacienti se suturou manžety byli z tohoto hodnocení vyloučeni. Soubor tvoří 2 skupiny po 40 pacientech. Skupina A je z období před zavedením subpektorální tenodézy. V případě zjištění závažné patologie bicepsu byl proveden débridement, tenotomie nebo proximální tenodéza. Skupinu B tvoří pacienti od května 2012, kdy autoři začali provádět subpektorální tenodézu. U těchto pacientů autoři v případě patologie bicepsu prováděli tenotomii nebo subpektorální tenodézu. Výsledky zhodnotili pomocí skóre SPADI (Shoulder Pain and Disability Index) před operací a po operaci. Zjišťovali také subjektivní spokojenost s výsledkem léčby a to, zda by pacient znovu podstoupil operaci. Dále podrobněji analyzují podskupinu pacientů se subpektorální tenodézou. Výsledky: Průměrná hodnota SPADI u skupiny A byla 46,4 před operací a 74,2 po operaci. U skupiny B byl průměr před operací 48,1 a po operaci 93. Průměrné zlepšení bylo statisticky významně vyšší u skupiny pacientů, kde byla v případě nálezu na bicepsu prováděna subpektorální tenodéza (p = 0,003). Diskuze: Šlacha dlouhé hlavy bicepsu od určitého stupně svého poškození již nemá reparační schopnosti, a pokud ji během operace neošetříme, může způsobovat perzistující potíže v rameni i po jinak korektně provedené operaci. Tenotomie nebo subpektorální tenodéza zlepšuje v tomto případě výsledky operační léčby ramena. Subpektorální tenodéza je rychlá a efektivní alternativa ošetření léze šlachy bicepsu, zatížená minimem komplikací.

Introduction: The aim of the study was to evaluate the benefits of subpectoral biceps tenodesis when dealing with shoulder pathology combined with damaged long head of the biceps tendon. Material and methods: 80 patients who underwent shoulder arthroscopy between 2009 and 2013 were reviewed. The type of procedure differed due to concomitant pathology: labral debridement or repair, debridement of chondral lesions or microfractures, debridement of the rotator cuff, bursectomy or acromioplasty, decompression of subcoracoid impingement, AC joint resection, etc. Patients with rotator cuff repair were excluded from this evaluation. The first group of 40 patients is from the period before the authors started with subpectoral biceps tenodesis. Patients were treated with debridement, tenotomy or proximal biceps tenodesis in case of serious pathology of the biceps. The second group of 40 patients underwent arthroscopy after May 2012, when the authors started to perform subpectoral biceps tenodesis. In these patients, the authors performed debridement, tenotomy or subpectoral biceps tenodesis in cases of biceps pathology. All the patients were evaluated using the SPADI score (Shoulder Pain and Disability Index) preoperatively and postoperatively. Patient satisfaction with the treatment was evaluated. Additionally, subgroup analysis of tenodesed patients was performed. Results: Preoperative average SPADI among the first group was 46,4, whereas postoperative was 74,2. Preoperative average SPADI among the second group was 48,1, whereas postoperative was 93. SPADI improvement was statistically significantly greater (p = 0.003) in the second group, where subpectoral tenodesis was performed in the case of identifying a lesion in the long head of biceps tendon. Discussion: Inflammation of the long head of the biceps tendon does not always heal after correct surgery and, if left unaddressed, may cause persistent problems in the shoulder. Tenotomy or subpectoral tenodesis in this case improves outcomes of surgical treatment of the shoulder. Subpectoral biceps tenodesis is a fast and effective procedure with excellent outcomes and low complication rate.

• Klíčová slova
• subakromiální impingement,
• MeSH
• artroskopie metody   MeSH
• bolest ramene * chirurgie   MeSH
• dospělí MeSH
• kosterní svaly chirurgie   patologie   MeSH
• kostní šrouby MeSH
• kotvící implantáty MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření bolesti MeSH
• neparametrická statistika MeSH
• paže chirurgie   patologie   MeSH
• pooperační bolest MeSH
• rameno * chirurgie   patologie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• šlachy chirurgie   MeSH
• spokojenost pacientů statistika a číselné údaje   MeSH
• tenodéza * metody   MeSH
• tenotomie MeSH
• výběr pacientů MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

PURPOSE OF THE STUDY When treating tears of the distal biceps brachii muscle tendon, we repeatedly noticed a difference between the preoperative ultrasound findings and the operative findings. The aim of the study was to retrospectively correlate these findings in order to determine the sensitivity of the ultrasound examination in everyday orthopaedic practice. Moreover, we compared the results and complications of surgical treatment through two operative techniques used at our department. MATERIAL AND METHODS In the 2004-2016 period 20 patients underwent a surgery at our department for total tear of the distal tendon of the biceps brachii muscle. In 18 patients an ultrasound examination was performed preoperatively. In 3 patients it was repeated. Therefore, there were a total of 21 ultrasound observations made in this group of patients. Excluded were the cases of chronic tendinoses or inveterated tears. The group was divided into two sub-groups. The first sub-group was composed of patients in whom the preoperative ultrasound examination was performed by a radiologist-specialist in the musculoskeletal system, the second sub-group was composed of patients examined by a non-specialist. The ultrasound findings were compared with the operative findings. With the use of a formula for the calculation of sensitivity of the test, the sensitivity of the ultrasound examination was determined for proper recognition of a complete tear of the tendon concerned. Also, we compared the results and complications of the two operative methods applied: the technique using bone anchor vs. the Boyd-Anderson technique of transosseous reinsertion. RESULTS The sensitivity of the ultrasound examination was 91% in examinations performed by a radiologist-specialist and 40% in examinations performed by no-specialists. Both the surgical techniques brought very good results in our group of patients. The reported complications included 2 cases of temporary radial nerve palsy, 1 case of formation of heterotopic ossifications. DISCUSSION The sensitivity of ultrasound is adequate according to the literature. In our group of patients, the same applied only to examinations performed by a radiologist-specialist in the musculoskeletal system. This is because the ultrasound examination of the distal biceps tendon is a highly specialised examination. When performed by a non-specialist, the result of examination obtained in our observations is rather misleading, thus could lead to an improper method of treatment. Partial tears of this tendon are very rare according to the literature. Indirect signs of the partial tear presence at this location detected by ultrasound resulted in most cases in an incorrect diagnosis, therefore the description of a partial tear visualised by the ultrasound should be reserved exclusively for cases when intact fibrils are clearly detected during the examination. For unclear cases, the MRI scan is indicated. The results of both the surgical techniques of reinsertion applied were very good. The method using the bone anchors is technically easier to perform. Nonetheless, it has its specifics. CONCLUSIONS To diagnose correctly the tear of the distal biceps muscle tendon it is essential to perform a thorough clinical examination and to obtain the medical history of the patient, especially the mechanism of injury. Sonography can be beneficial only provided the examination is carried out by a specialist in the musculoskeletal system, with the use of appropriate device and under standard conditions. For surgical treatment of this injury we prefer the technique using a bone anchor, namely particularly since it is technically easier to perform. The functional results are very good. Key words: distal biceps tendon, elbow, tendon tear, ultrasound, suture anchors.

• MeSH
• dospělí MeSH
• korelace dat MeSH
• kosterní svaly * patologie   patofyziologie   MeSH
• kotvící implantáty * MeSH
• lidé MeSH
• neuropatie nervus radialis * diagnóza   etiologie   MeSH
• paže diagnostické zobrazování   patofyziologie   MeSH
• pooperační komplikace * diagnóza   etiologie   MeSH
• poranění šlachy * diagnóza   patofyziologie   chirurgie   MeSH
• senzitivita a specificita MeSH
• šlachy diagnostické zobrazování   MeSH
• tenodéza * škodlivé účinky   přístrojové vybavení   metody   MeSH
• ultrasonografie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: The aim of the study was to present the long term results of primary tenodesis in the treatment of distal biceps tendon rupture. METHODS: Patients previously treated for distal tendon rupture were evaluated. In all cases anatomical reattachment with a single-incision through the anterior approach was performed with either a screw and washer (modified McReynolds technique) or a Mitek Anchor. Analysis was performed using clinical and radiological examination and DASH score at the end of 2011. RESULTS: Twenty-one patients (21 males; mean age: 47.5 years) were treated for distal biceps tendon rupture. Fixation was performed using the modified McReynolds technique in 11 and Mitek Anchor in 10 patients. The McReynold technique had excellent result in 63.6% of patients, a 9.1% risk of implant failure and a mean DASH score of 7.8. The Mitek Anchor technique had excellent result in 60% of patients, a 10% risk of implant failure and a mean DASH score of 7.4. CONCLUSION: Operative treatment for distal biceps tendon rupture appears to be a safe and effective method and consistently yields good results.

• MeSH
• časové faktory MeSH
• hojení ran MeSH
• kostní šrouby * MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• následné studie MeSH
• poranění paže chirurgie   MeSH
• poranění šlachy chirurgie   MeSH
• retrospektivní studie MeSH
• ruptura MeSH
• šicí techniky přístrojové vybavení   MeSH
• tenodéza metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: T o evaluate the treatment of rupture of the distal biceps brachii tendon in a group of patients treated at the UHO Department of Trauma Surgery. To evaluate the results of the treatment, including the representation of individual complications. It is a retrospective study. INTRODUCTION: It summarizes the results of treatment of the ruptures of distal biceps brachii tendon using a single-incision approach and reinsertions using fixation anchors. METHODOLOGY: Retrospective study of a cohort of 69 patients treated with this injury at the Department of Trauma Surgery between 2010 and 2019. RESULTS: During this period, 69 patients were treated using the studied surgical technique. In the majority of patients, right upper limb injuries were predominant. The predominant mechanism of injury was load lifting. Most of the patients were male. The average surgery time from injury was 1.4 days. All patients were operated using a single-incision approach and a fixation anchor, the most commonly used type of anchor being the Fastin anchor. The average treatment period was 4.13 months. The limitation of elbow joint mobility as a permanent consequence after completion of the treatment was as follows: on average, extension was limited by 3.35 degrees, flexion by 6.58 degrees, forearm supination by 8.53 degrees, and forearm pronation by 7.42 degrees. The average Mayo elbow score was 93.5 degrees. Postoperative complications occurred in 14.5 % of cases, most of them were transient neurological complications and fewer were early infections. In one case there was a release of the fixation anchor. CONCLUSION: Reinsertion of rupture of the distal biceps brachii tendon by a single-incision approach using fixation anchors appears to be a suitable method of surgical treatment of this injury.

• MeSH
• lidé MeSH
• ortopedické výkony metody   MeSH
• poranění paže chirurgie   etiologie   MeSH
• poranění šlachy chirurgie   MeSH
• tenodéza metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

• MeSH
• artroskopie metody   MeSH
• kosterní svaly MeSH
• lidé středního věku MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• pooperační komplikace MeSH
• pooperační péče MeSH
• poranění rotátorové manžety * diagnóza   patofyziologie   terapie   MeSH
• radiografie metody   MeSH
• ramenní kloub patofyziologie   patologie   MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• senioři MeSH
• šlachy hamstringů * transplantace   MeSH
• statistika jako téma MeSH
• tenodéza metody   přístrojové vybavení   MeSH
• tenotomie * metody   přístrojové vybavení   MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH

• MeSH
• bolest ramene diagnóza   etiologie   chirurgie   MeSH
• kosterní svaly MeSH
• lidé MeSH
• ruptura etiologie   chirurgie   komplikace   MeSH
• tendinopatie * etiologie   chirurgie   MeSH
• tenodéza metody   MeSH
• Check Tag
• lidé MeSH

• Klíčová slova
• šlacha bicepsu,
• MeSH
• artroskopie metody   využití   MeSH
• kosterní svaly fyziologie   patologie   zranění   MeSH
• kotvící implantáty MeSH
• lidé MeSH
• průzkumy a dotazníky využití   MeSH
• ramenní kloub chirurgie   MeSH
• spokojenost pacientů MeSH
• tenodéza metody   MeSH
• výsledek terapie MeSH
• zákroky plastické chirurgie MeSH
• Check Tag
• lidé MeSH

PURPOSE OF THE STUDY In this study the results of arthroscopic repair of massive rotator cuff tears are evaluated and compared with those of mini-open surgery published in Part 1. MATERIAL By the year 2006, of 176 patients undergoing the reconstruction of massive rotator cuff tears in our department, 77 were treated by arthroscopy. In this group there were 50 men; the dominant arm was operated on more frequently (60x). The average age of the patients was 55 years (range, 37-74). METHODS Surgery is carried out under combination of general anesthesia and an interscalene brachial plexus block, in a lateral recumbent position, with traction applied to the axis of the limb abducted at 40 degrees. Standard arthroscopic portals are used. After exploration of the glenohumeral Joint and thorough bursectomy, the torn rotator cuff tendons are mobilized and an insertion site is prepared. Using Spiralok (Mitek) anchors loaded with two Strands of Orthocord suture, the tendons are re-attached with mattress stitches by means of an arthroscopic grasper (Mitek). We use the Standard single-row technique with re-insertion at the original site. in indicated cases we carry out tenotomy or tenodesis of the long head biceps tendon. Acromionplasty follows only in type III acromion cases. After surgery the limb is immobilized in a Gilchrist bandage for 5 weeks during which, in accordance with the strength of re-attachment, passive exercise is carried out. Rehabilitation therapy should continue for 6 months at least. The results were evaluated on the basis of the UCLA (University of California at Los Angeles) shoulder rating System and the Constant scoring System. Using the school marking System (1, best; 5, worst) we asked about patients' satisfaction with surgery and their willingness to undergo the same Operation again. RESULTS Of the 77 patients treated for massive rotator cuff tears by arthroscopic repair up to 2006, 40 were fully evaluated.The average pre-operative Constant score was 48.4 (26-83) points and the UCLA score was 13.8 (6-25) points; post-operatively, these values increased up to 85.45 and 30.35 points, respectively. In addition to rotator cuff repair, we performed tenotomy or tenodesis of the long head biceps tendon (31x; in seven cases a tendon rupture was present), acromioplasty (17x), acromioclavicular Joint resection (3x), subscapular muscle reconstruction (5x) and treatment for shoulder instability (3x). In four patients we recorded the following complications: transient paresis of the upper extremity one, infection in one, and long-term secretion from the ventral portal in two patients. They were completely treated. All patients were satisfied with the treatment outcome and expressed willingness to undergo the surgery again, if needed. DISCUSION Although the arthroscopic repair of a massive rotator cuff tear is a technically demanding procedure with a long learning curve, since 2005 all rotator cuff repairs at our department have been carried out arthroscopically The results achie-ved are comparable with those of the mini-open surgery and, in addition, this method allows us to treat all co-existent pathologies at one stage. The Spiralock anchor (Mitek) proved to be an optimal implant for re-attachment of the rotator cuff tendons. No evaluation of a similar patient group is available in the relevant Czech literature, but the results are in agreement with those of published international studies. CONCLUSION Arthroscopic rotator cuff repair can be recommended as the procedure fully comparable with the open technique. Becau-se of the possibility to diagnose and treat all shoulder pathologies at one stage, all rotator cuff repairs at present carried out at our department are arthroscopic procedures.

• MeSH
• artroskopie klasifikace   metody   využití   MeSH
• interpretace statistických dat MeSH
• magnetická rezonanční tomografie metody   využití   MeSH
• miniinvazivní chirurgické výkony ekonomika   metody   statistika a číselné údaje   MeSH
• poranění rotátorové manžety MeSH
• poranění šlachy chirurgie   komplikace   patologie   MeSH
• radiografie metody   využití   MeSH
• rotátorová manžeta chirurgie   MeSH
• ruptura chirurgie   MeSH

• MeSH
• muskuloskeletální systém chirurgie   patologie   MeSH
• ortopedické výkony MeSH
• sportovní úrazy chirurgie   MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie
• chirurgie
• tělovýchovné lékařství
• NLK Publikační typ
• kolektivní monografie

• MeSH
• loket chirurgie   MeSH
• rameno chirurgie   MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie
• chirurgie
• NLK Publikační typ
• učebnice vysokých škol
• kolektivní monografie