[Posterior Dislocation of the Shoulder with Compression Fracture of the Humeral Head. Our Experience with McLaughlin Procedure and Its Modification]. / Zadní glenohumerální luxace s impresní zlomeninou hlavice. Nase zkusenosti s operací dle McLaughlina a její modifikací.

PURPOSE OF THE STUDY The purpose of this study is to remind of the specific features of diagnosis and therapy of dorsal dislocations of the glenohumeral joint to prevent frequent neglect or misdiagnosis during primary treatment. Also, we strived to present our experience and outcomes of posterior dislocation treatment by McLaughlin procedure and its modified version. MATERIAL AND METHODS We retrospectively evaluated 7 patients who had been treated at our department in the period 2015-2019 by McLaughlin procedure or its modification. The group consisted of 5 men and 2 women aged 33-79 years. In five patients, the dislocation occurred during an epileptic seizure, in two patients during an accident. The patients were treated by McLaughlin procedure or the Neer modification of McLaughlin procedure. The deltoideopectoral surgical approach was always used. Based on the preoperative planning, we decided, or intraoperatively changed our decision, as to whether mere transposition of the subscapularis is satisfactory or whether transposition of the lesser tuberosity to the defect, a bone graft and arthroplasty are necessary. Postoperatively, the operated limb was fixed for 6 weeks in neutral position, which was followed by rehabilitation. RESULTS We evaluated subjective and objective outcomes of the surgery, the radiological finding and in 2 patients also a control CT scan. The function of the shoulder was assessed using the Constant shoulder score and the OSIS scoring system. The resulting score: the mean OSIS was 55.7 points (92.8%) and the mean Constant score was 86.2 points (86.2%), which we regard as a very good result. All patients consider the surgery successful and are satisfied with the outcome. No patient reported recurrent dislocation. DISCUSSION When treating the posterior dislocation of the shoulder, vital is the shoulder reducibility and also the presence or the size of reverse Hill-Sachs defect. The transfer of the subscapularis tendon can be performed as an open procedure or arthroscopically. Inveterate irreducible posterior dislocation of the shoulder is quite a rare diagnosis, which is why even at our department the McLauglin procedure is performed in the order of units per year only. CONCLUSIONS The surgical solution of inveterate posterior dislocation of the shoulder is hardly ever uncomplicated. The reduction alone is often insufficient and some other way of shoulder stabilisation is necessary, often times addressing the humeral head defect. In our to date experience, the McLaughlin procedure or the Neer s modification is an elegant and safe method to treat posterior dislocation with a humeral head defect. The functional outcomes are very good and enable the patients to reengage in everyday activities. Thanks to this procedure shoulder joint arthroplasty can be avoided in younger patients. Nonetheless, in defects that are greater than 50% of the head the replacement is necessary. Due to frequently associated rotator cuff injuries, the most often procedure indicated by us is the reverse total shoulder replacement. Key words: posterior dislocation of the shoulder, reverse Hill-Sachs defect, McLaughlin procedure, Neer s modification.

Treatment of Large Cartilage Defects in the Knee by Hydrogel-Based Autologous Chondrocyte Implantation: Two-Year Results of a Prospective, Multicenter, Single-Arm Phase III Trial.

OBJECTIVE: To evaluate the clinical outcome of a hydrogel-based autologous chondrocyte implantation (ACI) for large articular cartilage defects in the knee joint. DESIGN: Prospective, multicenter, single-arm, phase III clinical trial. ACI was performed in 100 patients with focal full-thickness cartilage defects ranging from 4 to 12 cm2 in size. The primary outcome measure was the responder rate at 2 years using the Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS: Two years after ACI treatment, 93% of patients were KOOS responders having improved by ≥10 points compared with their pre-operative level. The primary endpoint of the study was met and demonstrated that the KOOS response rate is markedly greater than 40% with a lower 95% CI (confidence interval) of 86.1, more than twice the pre-specified no-effect level. KOOS improvement (least squares mean) was 42.0 ± 1.8 points (95% CI between 38.4 and 45.7). Mean changes from baseline were significant in the overall KOOS and in all 5 KOOS subscores from Month 3 (first measurement) to Month 24 (inclusive) (P < 0.0001). The mean MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score after 24 months reached 80.0 points (95% CI: 70.0-90.0 points) and 92.1 points in lesions ≤ 5 cm2. CONCLUSIONS: Overall, hydrogel-based ACI proved to be a valuable treatment option for patients with large cartilage defects in the knee as demonstrated by early, statistically significant, and clinically meaningful improvement up to 2 years follow-up. Parallel to the clinical improvements, MRI analyses suggested increasing maturation, re-organization, and integration of the repair tissue. TRIAL REGISTRATION: NCT03319797; EudraCT No.: 2016-002817-22.

[Allofit cementless acetabular component: five-year experience]. / Necementovaná jamka Allofit--petileté zkusenosti.

PURPOSE OF THE STUDY: To evaluate the mid-term results of using the Allofit cementless acetabular cup for primary hip replacement. MATERIAL AND METHOD: The Allofit cup is a cementless hemispherical acetabular component. The macrostructure on the external surface, including 1200 concentrically arranged teeth, and the rough-blasted surface of the biocompatible pure titanium provide good conditions for press-fit fixation. From 1998 to 2005 we used it in 182 cases of primary total hip replacement (THR) in 164 patients. (18 patients had bilateral THRs) The average age at the time of surgery was 58.3 years in men (range, 39-74 years) and 64.1 years in women (range, 33-80 years). We used the Bauer anterolateral approach as our standard procedure. The cup was combined with one of six types of cemented or cementless stems and a 28-mm ceramic head. At a minimum follow-up of five years, we evaluated clinical and radiological findings, i.e., the Harris hip score, radiological signs of loosening, migration and polyethylene wear. The average follow-up was 7.4 years (range, 5-11 years). For more accurate reading of X-ray films, the photographs were zoomed to 115%. RESULTS: The final evaluation included 147 primary THRs in 129 patients. We recorded no intra-operative complications. The average Harris hip score increased from pre-operative 44 to post-operative 87 points (range, 31-100). The loosening of a cup occurred in three patients (2.1%), of which two were infected (1.4%) and one was aseptic (0.7%). We had to replace the polyethylene insert in three patients, in one for abnormally high polyethylene wear and, in two, because of a ceramic head fracture due to a fall. Cup migration was not recorded. Eight cups (5.4%) had a thin (less than 1 mm) radiolucent line without signs of loosening. Polyethylene wear indicated by an asymmetric position of the head was detected by the Dorr method in 32 cups (21.8%). A shift of the head centre towards the proximal pole of the titanium shell ranged from 0.4 to 6.0 mm. The average polyethylene wear of all cups was 0.29 mm in 5 years, which is 0.06 mm per year. DISCUSSION: The Allofit acetabular cup is suitable for younger patients with good bone quality. In elderly patients or in those with severe osteoporosis, we preferably indicate cemented components. Press-fit cups can also be used in patients with postdysplastic osteoarthritis of the hip on condition that enough bone is left around the cup margin for press-fit fixation. CONCLUSIONS: Cementless press-fit cups have very good outcomes, even in a long-term follow-up. Our experience gives support to these results because of a low number of hips with loosening, both septic and aseptic, or polyethylene wear of the primary implanted acetabular cup, and no cup migration in our patients. The five-year survival rate of the Allofit acetabular cup was 95.8%.

[Arthritis development following untreated scapholunate instability of the wrist]. / Rozvoj artrózy po nelécené skafolunátní nestabilite zápestí.

PURPOSE OF THE STUDY: Complete disruption of the scapholunate (SL) ligament results in the development of arthritic lesions known as scapholunate advanced collapse (SLAC) of the wrist. MATERIAL AND METHODS: The authors present the results of a prospective study of seven patients in whom radiography showed an acute com- plete rupture of the scapholunate ligament and who refused SL ligament reconstruction.This group (1) was compared with a group of 17 patients (2) who underwent ligament reconstruction soon? after an acute rupture had been detected. All patients were examined at 36 months after injury for hand function and pain using the Wrightington Hospital Wrist Scoring (WHWS) System, and for the presence or absence of SLAC by radiography. Group 1 patients underwent arthroscopic examination in order to evaluate the extent of arthritic lesions. RESULTS: As assessed by the WHWS system, in group 1 excellent, good and satisfactory results were achieved in 29%, 42% and 29% of the patients, respectively in group 2 these results were found in 59%, 35% and 6% of the patients. The radiography showed, in group 1, 14% patients free from SLAC, 43% with stage I SLAC, 29% with stage IIa SLAC and 14% with stage IIb SLAC. In group 2, 94% of the patients were free from signs of SLAC and 6% had stage IIa SLAC due to infectious complications. The arthroscopic evaluation of group 1 revealed SLAC signs in all ;patients as follows: stage I, 29% stage IIa, 42% and stage IIb, 29%. CONCLUSIONS: In patients with complete disruption of the SL ligament there is a rapid onset of arthritic lesions in the wrist detectable by radiography. Arthroscopic examination, however, shows a much higher extent of damage to cartilage of the wrist. Key words: wrist arthritis, scapholunal instability, arthroscopy of the wrist.

[Scapholunate instability of the wrist following distal radius fracture]. / Skafolunátní nestability zápestí po zlomeninách distálního radia.

PURPOSE OF THE STUDY: Scapholunate (SL) ligament disruption frequently occurs together with distal radius fractures. If it is not diagnosed and treated, instability develops and will eventually be manifested as arthritic lesions known as scapholunate advanced collapse (SLAC) of the wrist. The aim of this study was to record the occurrence of SL ligament disruption in the patients treated conservatively for displaced fractures of the distal radius and to find out which fracture types are most often associated with injury to the SL ligament. MATERIAL AND METHODS: A total of 75 patients treated conservatively for distal radius fractures in 1997-98 were included in the study. The group comprised 41 women and 34 men, with fractures of the right upper limb in 44 and fractures of the left upper limb in 31 patients. They all were at active age, i. e., between 18 and 60 years, and came for a check-up 3 years after injury. They were examined for radiographic findings of SL instability and signs of SLAC development. Radiographs obtained after injury and images taken after reduction and then after bone union were retrospectively evaluated to look for signs of SL instability. The initial fractures were categorized on the AO classification and, for each fracture type, the percent of patients with co-existent SL instability was assessed. RESULTS: In the group of 75 patients examined at 3 years after injury, 16 (27 %) wrists showed radiographic signs of instability, with SLAC development in 13 patients and no arthritic lesions in three. All patients with SL instability reported pain, restricted range of motion in the wrist or reduced grip strength. The distribution of instability in relation to AO fracture type, expressed as percent, was as follows: SL instability associated with type A2 fracture was found in 38 %, with type A3 fracture in 17 %, and with type B in 25 % of the patients. SL instability was associated with type C1, type C2 and type C3 in 21 %, 27 % and 8 % of the patients, respectively. In radiographs taken after reduction, signs of damage to the SL ligament were apparent in 56 % of these patients. Radiographic findings at 6 weeks after injury showed signs of SL instability in as many as 81 % of the patients. DISCUSSION: Our results show that SL instability is found in association with type A2 and type A3 fractures, in which trauma force is "used" to break the distal radius and subsequently, due to carpal supination, to disrupt the SL ligament. In type B1 fractures, SL disruption results from an avulsion fracture of the radial styloid process due to ulnar deviation of the wrist. The retrospective evaluation of radiographs revealed that, immediately after reduction, signs of SL instability were obvious in 56 % of the cases. At that stage the condition could have been treated by K-wire transfixation and reattachment of the SL ligament. At 6 weeks, radiographic evidence of SL ligament disruption was found in 81 % of the patients. Even at that stage repair would have been possible by either reattachment or reconstruction of the ligament. It is apparent from these results that the evaluation of radiographic findings after reduction and during follow-up should also focus on other changes in the wrist in addition to signs of bone union. CONCLUSIONS: Fractures of the distal radius are no longer frequent only in elderly women, as has recently been common, but they are found more and more often in active young persons. Because their bones are healthier, soft tissues are affected more frequently. Injury to the SL joint results in the development of arthritic lesions which may rapidly progress in active patients. SLAC development can be prevented by early diagnosis of soft tissue lesions on X-ray images, because these are usually apparent after reduction or at follow-up. If doubts arise, arthroscopy or another examination should be done, even though these may not be sufficiently reliable.

[Consequennce of nontreatment scapholunate instability of the wrist]. / Následky nelécené skafolunátní nestability zápestí.

Authors evaluate the results of patients with acute rupture of the scapholunate (SL) ligament, demonstrated by arthroscopy, in this study. One group of patients was treated with reinsertion of SL ligament by the help of Mitek anchor. In the other group there were patients with diagnosed total rupture of SL ligament which rejected the reinsertion of the ligament. Authors evaluate results of both groups 24 months after the injury. On the basis of clinical and X-ray results, even after such short time, reasonably worse results for the group without performed reinsertion were determined. Even X-ray documented arthrotic changes of scapholunate advanced collapse (SLAC) type were present.