[Instabilities of the Thumb Carpometacarpal Joint: Our Surgical Outcomes]. / Nestability karpometakarpálního kloubu palce ruky: nase výsledky operacního resení.

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.

[Clinical Outcomes of the Application of Platelet-Rich Fibrin during Anatomic Anterior Cruciate Ligament Reconstruction: Results of Prospective Randomised Study]. / Klinické výsledky aplikace fibrinu bohatého na desticky behem anatomické rekonstrukce predního zkrízeného vazu: výsledky prospektivní randomizované studie.

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.

[Arthroscopic Excision of Osteoid Osteoma of the Femoral Head]. / Artroskopická exstirpace osteoidního osteomu hlavice femuru.

Osteoid osteoma is a primary benign bone tumor with rare intra-articular occurrence. Our case report describes a rare case of a 21-year-old man with long-term severe pain in the right hip region caused by osteoid osteoma managed by arthroscopic excision. The clinical finding of pains and a limited range of motion did not correlate with the normal plain X-ray finding. The osteoid osteoma was suspected based on the CT scan. In literature, several methods of resection of intraarticular osteoid osteoma of the hip are described. Since our department has long specialised in arthroscopic hip surgery and based on the available examinations the tumor appeared to be located within the arthroscopic reach, we decided for arthroscopic resection of the tumor. Our study comprises a detailed description of the entire surgical procedure, the used arthroscopic approaches and the arthroscopic technique of tumor excision. The histological examination of samples taken from the mass confirmed the suspected osteoid osteoma. The success of arthroscopic excision of the tumor was later confirmed also by very positive postoperative recovery when the patient very soon experienced a considerable reduction of pain observed during our five-year follow-up of the patient (Day 13, Week 2 and 6, Year 1, 2 and 5). During the follow-up period, an increase of the Harris Hip Score (13.5 preoperatively vs 76.6/91/94/96/96 postoperatively) and a decrease in VAS (9 preoperatively vs. 3/1/1/1/1) were reported. The follow-up CT and MRI performed at 2 or 5 years after surgery did not show tumor recurrence. The case report includes also illustrations consisting of X-rays, CT and MRI scans before and after surgery as well as multiple scans taken intraoperatively. It has to be emphasized that this is a rare case and an evaluation of a larger group of patients would be necessary to verify the successful outcomes of arthroscopic technique in treatment of the hip joint osteoid osteoma.

[Unstable RAMP Lesions of the Medial Meniscus in ACL-Deficient Knee: Comparing the Outcomes of Outside-in versus All-inside Surgical Repair - a Retrospective Study]. / Nestabilní RAMP léze mediálního menisku u LCA deficientního kolena: srovnání výsledku operacní terapie technikou outside-in versus all-inside ­ retrospektivní studie.

PURPOSE OF THE STUDY We present the results of the retrospective study comparing the clinical outcomes of outside-in versus all-inside suture techniques of unstable RAMP lesions (RL) of the medial meniscus in patients with simultaneous ACL lesion with a minimum two-year follow-up. MATERIAL AND METHODS The retrospective evaluation covered two groups of patients who underwent the arthroscopic repair of unstable RL in combination with anterior cruciate ligament reconstruction (ACLR). Group 1 included 42 patients (28 men/24 women). Group 2 consisted of 36 patients (21 men/15 women). In Group 1, RL suture repair using the outside-in technique by posteromedial approach with absorbable PDS suture was performed, while in Group 2 the all-inside technique of RL suture via the standard anteromedial portal was applied using the Fast-Fix system (Smith Nephew, USA). The evaluation was done preoperatively and postoperatively with the mean follow-up of 27.9 months in Group 1 and 30.1 months in Group 2. The patients were assessed using the subjective IKDC score and the side-to-side difference (SSD) in ventral laxity was measured by Genourob (GNRB) laximeter at the applied pressure of 134 N and 250 N. Moreover, the failure rate of RAMP lesion repair, ACL graft, necessity of secondary partial meniscectomy and return to pre-injury level of sport were analysed. RESULTS The median IKDC score increased in Group 1 from 56 points preoperatively to 92 points postoperatively and in Group 2 from 58 points preoperatively to 90 points postoperatively (p>0.05). The median value of SSD in ventral laxity of the knee measured by the GNRB laximeter at the applied pressure of 134 N in Group 1 was 5.6 mm preoperatively and 1.9 mm postoperatively and in Group 2 it was 5.9 mm preoperatively and 2.3 mm postoperatively. At the pressure of 250 N, the median value in Group 1 was 7.9 mm preoperatively and 2.7 mm postoperatively and in Group 2 it was 8.1 mm preoperatively and 3.2 mm postoperatively. When comparing the SSD of the groups postoperatively, no statistically significant difference was found (p>0.05). Revision arthroscopy was performed in 8 patients. In 1 patient (2.4 %) in Group 1 and in 4 patients (11.1%) in Group 2 a rerupture of the RL of the meniscus occurred and partial meniscectomy was performed. In Group 2, statistically significant higher occurrence of the RL suture failure (p<0.05) was reported and there was a need to perform partial medial meniscectomy (p<0.05). The ACL graft failure was observed in 2 patients (4.7%) in Group 1 and in 3 patients (8.3%) in Group 2 (p>0.05). 31 evaluated patients (73.8%) from Group 1 and 24 patients (66.7%) from Group 2 (p>0.05) returned to the pre-injury level of sports activities. DISCUSSION When comparing the outcomes of individual techniques of the RL repair published in recent literature with our conclusions, we may state that the results of subjective as well as objective criteria achieved were similar to those reported by other authors worldwide. No study has so far been published which would compare the outcomes of the by us presented two surgical techniques of the RL suture in an ACL-deficient knee with a minimum follow-up of 24 months. CONCLUSIONS Both the surgical techniques of unstable RL repair in combination with the ACLR using a tendon graft result in a statistically significant improvement of clinical outcomes postoperatively. In Group 2, with the all-inside RL repair, a statistically significant higher failure rate of RL repair was confirmed as well as the need to perform secondary partial meniscectomy compared to Group 1. Key words: RAMP lesion, ACL-deficient knee, unstable medial meniscus lesion, repair of meniscus, all-inside technique, posteromedial technique, ACL reconstruction.

[Effect of a Single Dose of Tranexamic Acid Administered during Anterior Cruciate Ligament Reconstruction Using Hamstrings: a Randomized Clinical Study]. / Efekt jednorázového podání kyseliny tranexamové pri rekonstrukci predního zkrízeného vazu hamstringy: randomizovaná klinická studie.

PURPOSE OF THE STUDY Anterior cruciate ligament reconstruction is one of the most common reconstruction surgeries. The unintended consequences of the surgery are hemarthrosis, blood loss, knee swelling and postoperative pain. The purpose of the study was to evaluate the effect of a single dose of intravenous tranexamic acid (TXA) on the postoperative parameters and functional status of the knee joint 3 months after surgery. MATERIAL AND METHODS It is a prospective randomised clinical study. An intravenous injection of TXA equivalent to 15 mg/kg in 100 ml of saline solution was administered to the test group during the surgery (20 minutes before the end of the surgery). The control group was administered 100 ml of saline solution without TXA. In both groups, the following parameters were evaluated preoperatively and postoperatively (on Day 1 and Day 10 and at 1 month and 3 months): thigh circumference at 1 cm above the patella, Coupens and Yates (CY) score for swelling, and pain score (VAS). At 24 hours after the surgery, the blood loss (secretion into the drain) and decrease in hemoglobin (Hb) and hematocrit (HCT) levels compared to the preoperative levels were assessed. The functional status of the knee joint was assessed based on the Lysholm knee scoring scale and the IKDC subjective knee evaluation form preoperatively, or at 1 and 3 months postoperatively. RESULTS In the test group, a significantly lower blood loss was detected 24 hours after the surgery. The mean difference of 128 ml compared to the control group was both statistically and practically significant (p < 0.001, d =1.42). The test group showed a lower decrease in Hb and HCT levels postoperatively compared to the control group, although with no statistical significance. On the first postoperative day, slightly better results of the thigh circumference at 1 cm above the patella and of the CY score were observed in the test group. However, during the follow-up check performed postoperatively on Day 10, the differences in the thigh circumference at 1 cm above the patella, CY score and pain VAS score were negligible. The differences in the functional status of the knee joint between the two groups ascertained during the check performed 1 month and 3 months after the surgery were insignificant. DISCUSSION Our study, just like other studies, confirms a significant effect of a single dose of intravenous TXA on the volume of blood loss and early postoperative swelling, which are the parameters affecting the early postoperative course. Even though the intervention does not affect the subsequent result of surgery, it can undoubtedly be of benefit perioperatively. There is a fairly limited number of randomised clinical studies on this topic in literature, with most of them published in the last 7 years. Further research should, among other things, optimise the protocol and identify a suitable candidate for TXA administration in patients undergoing an ACL reconstruction. CONCLUSIONS Our study confirmed the positive effect of a single dose of intravenous TXA during the reconstruction of anterior cruciate ligament using hamstrings on early postoperative blood loss and early postoperative swelling, which can have a positive effect on wound healing and prevent postoperative complications. Therefore, in agreement with available literature, we recom mend administering a single dose of intravenous TXA in ACL reconstruction, unless there is a contraindication to this therapy. Key words: anterior cruciate ligament reconstruction, hamstrings tranexamic acid, single intravenous administration, clinical evaluation.

[Benefits of the Acetabular Microfracture Technique in Arthroscopic Treatment of Chondral Defects in Femoroacetabular Impingement Syndrome: Two-Year Results of a Multicenter Prospective Randomized Study]. / Prínos provedení mikrofraktur acetabula pri artroskopické terapii chondrálních defektu u femoroacetabulárního impingement syndromu: dvouleté výsledky multicentrické prospektivní randomizované studie.

PURPOSE OF THE STUDY Two-year clinical results of a multicenter prospective randomized study in patients with arthroscopically treated Femoro - acetabular Impingement syndrome and concurrently performed microfracture for grade IV chondral lesions of the acetabulum. MATERIAL AND METHODS The study evaluated a group of 55 patients of the originally enrolled 92 patients with the underlying diagnosis of FAI syndrome with intraoperatively confirmed grade IV acetabular chondropathy of up to 4 cm2 in size, who had undergone a comprehensive hip arthroscopy (correction of structural cam-type and/or pincer-type deformity, labral refixation or partial labral resection etc.) performed by two experienced surgeons. The patients were randomized intraoperatively using a closed envelope method into two groups. In Group 1 (31 patients), microfractures for chondral defects was performed, while in Group 2 the patients underwent a defect debridement procedure only. The studied group included a total of 7 professional and 48 recreational athletes (33 men and 22 women), with the mean age of 34.4 in Group 1 and 31.1 in Group 2. Preoperatively and 6, 12 and 24 months postoperatively the modified Harris Hip Score (mHHS) parameters and VAS score were evaluated and also revision surgeries, conversion to endoprosthesis, and occurrence of complications were recorded. RESULTS Preoperatively, no statistical difference between the two groups was found in the studied parameters (mHHS and VAS). Postoperatively (after 6, 12 and 24 months), in both groups a statistically significant increase in mHHS and VAS score was reported. When comparing the mHHS parameter at individual evaluated times in Group 1 and Group 2, a statistically significant difference was confirmed at 12 and 24 months after surgery (P < 0.001), namely in favour of Group 1. At 6 months postoperatively, no statistically significant difference in this parameter between the two groups was confirmed (P = 0.068). When comparing the VAS score parameter in these two groups at individual times, no statistically significant difference was confirmed at 6 and 12 months after surgery (P= 0.83 / P= 0.39). A statistically significant difference in the VAS score parameter was observed only at 24 months after surgery, namely in favour of Group 1 (P< 0.037). In the course of the follow-up period, altogether 3 patients (2 patients from Group 1) were indicated for revision hip arthroscopy and in 1 female patient an endoprosthesis was implanted. No severe intraoperative or postoperative complications were observed. DISCUSSION In agreement with other authors worldwide, the arthroscopic treatment of FAI syndrome, if indicated and performed correctly, was confirmed to improve the clinical condition of patients postoperatively, regardless of the technique used in treating the chondral defect. Based on our results as well as conclusions of other world authors, in treating the grade IV defects of smaller size it is appropriate, in treating the cartilage, to prefer the microfracture surgery, which is less demanding both technically and financially and contrary to mere debridement allows to fill the original defect by fibrocartilage tissue. CONCLUSIONS The benefits of the acetabular microfracture in patients with the FAI syndrome treated arthroscopically were confirmed. A statistically significant difference between the two studied groups was reported in the mHHS parameter at 12 and 24 months after surgery and also in the VAS parameter at 24 months in favour of the group with performed microfracture. In both the studied groups, the arthroscopy resulted in a statistically significant improvement of the assessed quality of life parameters. Key words: hip arthroscopy, femoroacetabular impingement syndrome, chondral defect, microfracture, abrasive chondroplasty.

Microstructure evolution in amorphous Hf-B-Si-C-N high temperature resistant coatings after annealing to 1500 °C in air.

Recently, amorphous Hf-B-Si-C-N coatings found to demonstrate superior high-temperature oxidation resistance. The microstructure evolution of two coatings, Hf7B23Si22C6N40 and Hf6B21Si19C4N47, annealed to 1500 °C in air is investigated to understand their high oxidation resistance. The annealed coatings develop a two-layered structure comprising of the original as-deposited film followed by an oxidized layer. In both films, the oxidized layer possesses the same microstructure with HfO2 nanoparticles dispersed in an amorphous SiOx-based matrix. The bottom layer in the Hf6B21Si19C4N47 coating remains amorphous after annealing while Hf7B23Si22C6N40 recrystallized partially showing a nanocrystalline structure of HfB2 and HfN nanoparticles separated by h-Si3N4 and h-BN boundaries. The HfB2 and HfN nanostructures form a sandwich structure with a HfB2 strip being atomically coherent to HfN skins via (111)-Hf monolayers. In spite of the different bottom layer structure, the oxidized/bottom layer interface of both films was found to exhibit a similar microstructure with a fine distribution of HfO2 nanoparticles surrounded by SiO2 quartz boundaries. The high-temperature oxidation resistance of both films is attributed to the particular evolving microstructure consisting of HfO2 nanoparticles within a dense SiOx-based matrix and quartz SiO2 in front of the oxidized/bottom layer interface acting as a barrier for oxygen and thermal diffusion.

[Combined Symptomatic Treatment of Groin Pain Syndrome in Professional Football Players - Prospective Study Results]. / Kombinovaná symptomatická terapie syndromu bolestivého trísla u profesionálních fotbalistu ­ výsledky prospektivní studie.

PURPOSE OF THE STUDY The results of the prospective study evaluating the outcomes of a combined therapeutic approach of non-operative therapy of Groin Pain Syndrome (GPS) in professional football players are presented. MATERIAL AND METHODS The evaluated cohort consisted of a total of 31 football players of a professional football club divided into two groups. The Group 1 included 10 symptomatic patients suffering from GPS for at least 4 weeks, the Control Group 2 included 21 healthy football players not suffering from GPS. The symptomatic patients with GPS who had undergone any surgery or had sustained any major injury to their low back, groins, hip or knee joints were excluded from the study. It was a prospective non-randomized study. The results were evaluated using the HAGOS (Copenhagen Hip and Groin Outcome Score) questionnaire, which in Group 1 compared the results before the initiation of the new combined therapeutic approach of non-operative therapy developed by us and the results after the end of this treatment, i.e. after 6 weeks. Moreover, the HAGOS was used to compare the results of the Group 1 after the treatment and the Control Group 2, i.e. the healthy football players. The HAGOS evaluated six separate areas: Pain, Symptoms, Physical function in daily living, Physical function in sport and recreation, Participation in physical activities, and hip and/or groin-related Quality of Life. The resulting score for each domain ranges from 0 to 100 (100 = no problems, 0 = extreme problems). The results were statistically evaluated by an independent statistician. RESULTS In Group 1, after the end of the treatment a statistically significant improvement was observed in all the parameters assessed by HAGOS. Pain (70 before the treatment, 95 after the treatment), Symptoms (58.9 before/85.7 after), Physical function in daily living (70 before/100 after), Physical function in sport (46.9 before/90.6 after), Participation in physical activities (43.8 before/100 after), Quality of Life (66.3 before/95 after). When comparing the two groups, before the treatment a statistically significant difference was found in all the six parameters assessed by HAGOS, while after the treatment no significant difference between Group 1 and Group 2 was detected. DISCUSSION The most important result of our study is that by applying the new combined therapeutic approach of the GPS nonoperative therapy developed by us better HAGOS score were achieved in our cohort than those achieved by other types of non-operative therapy presented in recent literature. The approach proposed by us is more successful in terms of the speed of return to sport (6 weeks) than the multimodal therapy programme (12 weeks) and Training programme (18 weeks). CONCLUSIONS The results of this prospective study confirm that the Group 1 having undergone the 6-weeek long combined symptomatic non-operative therapy of GPS proposed by us showed a statistically significant improvement in all the parameters assessed by HAGOS and these values showed no statistically significant difference from those of the Control Group of healthy individuals. Key words: Groin Pain Syndrome (GPS), professional football player, HAGOS (Copenhagen Hip and Groin Outcome), symptomatic therapy.

[Outcomes of Treatment of Calcaneal Fractures Using Locking Compression Plate with or without Augmentation]. / Výsledky lécení zlomeniny patní kosti LCP dlahou s augmentací a bez augmentace.

PURPOSE OF THE STUDY The retrospective study aims to compare the outcomes of augmentation of neutral triangle formed after the calcaneal fracture reduction with osteosynthesis using the locking compression plate with the outcomes of osteosynthesis without augmentation. MATERIAL AND METHODS In the period from 2005 to January 2011, 98 patients with 114 calcaneal fractures were treated by open reduction and internal fixation (ORIF) method with the use of calcaneal plate. The group included 15 women (15.3%) and 83 men (84.7%), with the mean age of 39.2 years (12-62 years). There were 16 cases of bilateral calcaneal fractures, of which 2 in women (12.5%) and 14 in men (87.5%). The fractures were classified based on the Sanders classification as Type I -IV. The patients with Type II and III fracture according to the Sanders classification were indicated for surgical treatment with ORIF using the calcaneal LCP. The defect in the region of neutral triangle of the calcaneus was filled with the injectable hydroxyapatite cement. The cohort of operated patients was evaluated based on the AOFAS (American Orthopaedic Foot and Ankle Society) Clinical Rating System. The bilateral fractures were not evaluated. This group shows a substantially higher occurrence of associated injuries, which causes strong distortion of results. RESULTS The cohort of 82 operated patients with Sanders Type II and III fractures were evaluated. In 20 fractures (24.4%) the defect in the calcaneus body was filled with hydroxyapatite cement. In osteosynthesis without defect augmentation an excellent result was achieved in 21 patients (33.9%). A good result was reported in 24 patients (38.7%), a satisfactory result in 12 patients (19.4%) and a poor result in 5 patients (8.0%). In patients with osteosynthesis of the calcaneus with augmentation, an excellent result was achieved in 6 cases (30%), a good result in 5 cases (25%), a satisfactory result in 7 cases (35%) and a poor result in 2 cases (10%). Early postoperative complications were observed in a total of 13 patients (15.8%). In osteosynthesis without defect augmentation, there were 2 cases of wound dehiscence (3.2%), 3 cases of marginal skin necrosis (4.8%), 4 cases of superficial wound infection (6.4%) and 1 case of deep wound infection (1.6%). In patients with performed augmentation, wound dehiscence was seen in 1 case (5%), superficial wound infection in 1 case (5%) and superficial marginal skin necrosis in 1 case (5%). Deep wound infection was not reported in this group. DISCUSSION A question frequently discussed is the filling of defect in the diaphysis of calcaneus. Brodt et al. state a statistically higher stability of the calcaneus in osteosynthesis with augmentation, but he does not use the locking plate. Longino in his study compares the results of calcaneal osteosynthesis with spongioplasty with a graft from pelvis and without it and does not observe any major differences in the final outcome in his cohort. Elsner evaluates the results in 18 patients, in whom calcium phosphate cement augmentation was used for osteosynthesis. Over the period of three years he did not observe a higher rate of complications. Schildhauer assesses the early load of the calcaneus with tricalcium phosphate cement augmentation. After three weeks of full loading no loss of reduction was found. Thordarson evaluates 11 operated patients with Sanders type II and III calcaneal fracture. The defect of the calcaneus was filled by calcium phosphate cement. In this small group 1 case of serious infection complication and 1 loss of reduction with full load at six weeks after the surgery were observed. In our group no differences were observed between the outcomes of patients with performed or not performed defect augmentation in the neutral triangle site. A higher percentage of complications in patients with filled defect of the calcaneus was not observed either. CONCLUSIONS The operative treatment of displaced intra-articular fractures consisting of open reduction from extended lateral approach and internal calcaneal LCP fixation brings good results. We concluded that there is no statistically significant difference in the results of osteosynthesis with a locking plate alone and combined with augmentation of diaphyseal defect of the calcaneus. Filling of the diaphyseal defect in the calcaneus is not necessary, it neither accelerates the healing, nor brings better treatment outcomes Key words: calcaneal fracture, cement augmentation of defect, locking plate, extended lateral approach.

[Evaluation of the MRI Findings on a Tendon Graft after the Anatomic Anterior Cruciate Ligament Reconstruction in Patients with Versus without the Application of Platelet-Rich Fibrin - Results of the Prospective Randomised Study]. / Zhodnocení MRI nálezu na slachovém stepu po anatomické rekonstrukci predního zkrízeného vazu u pacientu s aplikací versus bez aplikace fibrinu bohatého na krevní desticky ­ výsledky prospektivní randomizované studie.

PURPOSE OF THE STUDY The purpose of the prospective randomised study was to assess the benefits of the platelet-rich fibrin (PRF) application during the anatomic anterior cruciate ligament reconstruction (ACLR) for tendon graft healing. MATERIAL AND METHODS The study included 40 patients with an isolated rupture of the anterior cruciate ligament in the knee. The MRI findings on the tendon graft were evaluated at 6 months and 12 months after the surgery in a total of 33 patients, namely in 10 women/23 men (21 right knee/12 left knee), with the mean age of 29.1 years and at the mean follow-up of 15.9 weeks after the injury. The randomisation using envelopes was carried out at the beginning of arthroscopy either in the group with the PRF application (Group 1) (17 patients) or in the group without the PRF application (Group 2) (16 patients). The followed-up patients underwent the ACLR with targeting the femoral tunnel through anteromedial portal using the autografts of m. semitendinosusand m. graciliswith Tightrope femoral fixation and Inion implant in tibia. In Group 1, during the surgery PRF was applied both in the drilled tunnels (intraosseously) and directly to the surface of the tendon graft itself (intraarticular part). The Group 2 was a control group in which the same intervention was performed, however without the PRF application. In the 6 th and 12 th month after the surgery, the signal intensity of the knee and occurrence of the ACL graft failure, bone (marrow) oedema rate near the tunnels were assessed by an independent radiologist using a 3 Tesla MRI. RESULTS In the 6 th and also in the 12 th postoperative month, neither a complete, nor a partial graft failure was found in the group with PRF, whereas in Group 2 a complete or a partial graft failure was observed in 12.5% (p = 0.23). In the 6th month, a bone marrow oedema near the intraosseous parts of the graft was reported in 94.1% of patients in Group 1 and in 81.3% of patients in Group 2, while in the 12 th month it was 23.5% of evaluated patients in Group 1 and 37.5% patients in Group 2. The differences between the two groups were not statistically significant in the 6 th (p = 0.096) or in the 12 th month (p = 0.43). In the 6 th month, a fully ligamentised graft was found in 52.9% of patients in Group 1 and in 37.5% of patients in Group 2 (p = 0.061), a partially ligamentised graft was present in 47.1% of patients in Group 1 and in 50% of patients in Group 2. In the 12 th month, a fully ligamentised graft was seen in 94.1% of patients in Group 1 and in 75% of patients in Group 2 (p = 0.26) and a partially ligamentised graft was present in 5.9% of patients in Group 1 and in 12.5% of patients in Group 2. In the remaining 12.5% of patients in Group 2, the finding was assessed as a graft with no signs of ligamentisation. DISCUSSION We have not encountered a paper in the Czech or world literature which would present results of a similar study, i.e. which would evaluate the potential benefits of the platelet-rich fibrin application in the course of the anatomic anterior cruciate ligament reconstruction. Majority of studies evaluate the benefits of the application of platelet-rich plasma aimed to achieve a positive effect on the LCA graft healing. CONCLUSIONS Our study proved a higher percentage of ligamentisation and healed grafts into the bone as well as a lower occurrence of graft failure in the group with PRF compared to the group without the PRF application, namely both in the 6 th and in the 12 th month. Nonetheless, the differences between the two groups assessed at the same time were not statistically significant. 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.

[Anatomical All-Inside Anterior Cruciate Ligament Reconstruction Using Quadrupled Semitendinosus Tendon Graft with Posteromedial Harvest - Clinical Results of Prospective Study at a Minimum 12-Months Follow-up]. / Anatomická all-inside rekonstrukce predního zkrízeného vazu kvadrustepemm. semitendinosus odebraným posteromediálním prístupem ­ klinické výsledky prospektivní studie s minimálním odstupem 12 mesícu od operace.

PURPOSE OF THE STUDY This original paper aims to present the conclusions of the prospective study evaluating the clinical results of anatomical all-inside ACL reconstruction using quadrupled semitendinosustendon graft with posteromedial harvest using suspensory fixation by Tightrope implants at the follow-up of at least 12 months. MATERIAL AND METHODS The prospective study included a total of 119 patients (74 men/39 women) with the mean age of 28.3 (18-52) years, in whom demographic data was collected and a clinical examination was performed. The patients satisfying the "inclusion" and "exclusion" criteria were enrolled in the study and subsequently underwent the same, aforementioned surgical procedure performed by a single surgeon. Preoperatively and at a minimum 12-month follow-up the following subjective criteria were evaluated using the Lysholm and IKDC subjective scores and the Visual Analogue Scale (VAS) (0-10). The objective parameters comprised the side-to-side difference in anterior knee laxity assessed by Genourob arthrometer with an applied pressure of 134 and 250 N, anterior drawer test, and the pivot shift test. The occurrence of graft failure, complications and return to pre-injury sport levels were monitored. The obtained data was statistically evaluated at the statistical significance level of 0.05. RESULTS A total of 89 patients were assessed at the follow-up of at least 12 months after the surgery. The median Lysholm score increased over time from 58.7 preoperatively to 94.2 postoperatively (p < 0.05) and the IKDC subjective score went up from 46.3 to 91.4 (p < 0.05). The median postoperative VAS kept decreasing from 7.3 (Day 2), 5.1 (Day 14), 3.1 (Week 6), 1.2 (Month 6) to 0.3 at 12 months after the surgical procedure. Preoperatively, the results were significantly positive (i.e. C, D) in 52.8% (C) and 21.4% (D), whereas postoperatively the results of the PST were significantly positive only in 4%. Therefore, the surgical procedure was conducive to a statistically significant decrease in rotational knee laxity over time (p < 0.05). The median side-to-side difference in anterior laxity of the operated knee objectively assessed by GNRB arthrometer with the applied pressure of 134 N was 4.2 mm (3.1-6.8) as against the postoperative 1.2 mm (0.4-2.1) and with the applied pressure of 250 N it was 6.2 mm (4.6-8.7) prior to the surgical procedure versus 2.4 mm (1.6-3.5) postoperatively. That concerned a statistically significant decrease of postoperative side-to-side difference in anterior laxity of the operated knee at both the measured pressures (p < 0.05). The graft failed in 3 patients only (3.4%), no major complications associated with the surgical procedure were observed and 62 of the evaluated patients (69.6%) were able to return to the pre-injury level of sport within one year after the surgery. DISCUSSION When comparing the results obtained by our study with the conclusions of clinical studies carried out by other authors and evaluating similar clinical parameters with the identical surgical technique applied, it is obvious that in our group of patients we achieved similar clinical results as the other authors from abroad. CONCLUSIONS The results of our study showed that the all-inside ACL anatomical reconstruction using quadrupled semitendinosus tendon graft with posteromedial harvest with suspensory fixation by Tightrope implants at one year after the surgery bring very good subjective as well as objective clinical results and minimum complications. Key words:anterior cruciate ligament tear, anatomical ACL reconstruction, all-inside technique, posteromedial harvest, quadrupled semitendinosustendon graft, retrograde drilling, suspensory graft fixation.

[Evaluation of Clinical Outcomes of Arthroscopical Treatment of Femoroacetabular Impingement Hip Syndrome - 2-Year Outcomes]. / Hodnocení klinických výsledku vyuzití artroskopie kycelního kloubu v terapii femoroacetabulárního impingementu kycelního kloubu ­ dvouleté výsledky.

PURPOSE OF THE STUDY Hip arthroscopy is a widely used method of treatment of hip pathology. It is a technically demanding procedure for which accurate indication is critical. The indication criteria, however, are not yet fully supported by long term results of large patient groups in recent literature. The purpose of our study is to present the 2-year outcomes after hip arthroscopy. MATERIAL AND METHODS In our study 203 patients (110 women, 93 men) with the mean age of 34 years (17-67 years) were evaluated. The mean NAHS score was 87/100 at 24 months after the surgery, which represents a statistically significant improvement compared to the preoperative values (p < 0.02). RESULTS The patients were divided into four groups based on their clinical results. Group 1 with NAHS score of 90-100 included 84 patients, Group 2 with NAHS 80-90 had 86 patients, Group 3 with NAHS 70-80 had 17 patients, and Group 4 with NAHS below 70 consisted of 10 patients. The rate of serious complications was 6% (12/197 patients). CONCLUSIONS Hip arthroscopy is an effective and safe method of treatment of hip pathology. It is a technically demanding procedure that requires exact indication criteria in order to reach excellent clinical results. Key words: hip arthroscopy, femoroacetabular impingement, labral lesion, hip pain.

Predictability of tick-borne encephalitis fluctuations.

Tick-borne encephalitis is a serious arboviral infection with unstable dynamics and profound inter-annual fluctuations in case numbers. A dependable predictive model has been sought since the discovery of the disease. The present study demonstrates that four superimposed cycles, approximately 2·4, 3, 5·4, and 10·4 years long, can account for three-fifths of the variation in the disease fluctuations over central Europe. Using harmonic regression, these cycles can be projected into the future, yielding forecasts of sufficient accuracy for up to 4 years ahead. For the years 2016-2018, this model predicts elevated incidence levels in most parts of the region.

[Clinical Results of Endoscopic Treatment of Greater Trochanteric Pain Syndrome]. / Výsledky endoskopické terapie bolestivého syndromu velkého trochanteru.

PURPOSE OF THE STUDY This retrospective study aims to present short-term clinical outcomes of endoscopic treatment of patients with greater trochanteric pain syndrome (GTPS). MATERIAL AND METHODS The evaluated study population was composed of a total of 19 patients (16 women, 3 men) with the mean age of 47 years (19-63 years). In twelve cases the right hip joint was affected, in the remaining seven cases it was the left side. The retrospective evaluation was carried out only in patients with greater trochanteric pain syndrome caused by independent chronic trochanteric bursitis without the presence of m. gluteus medius tear not responding to at least 3 months of conservative treatment. In patients from the followed-up study population, endoscopic trochanteric bursectomy was performed alone or in combination with iliotibial band release. The clinical results were evaluated preoperatively and with a minimum follow-up period of 1 year after the surgery (mean 16 months). The Visual Analogue Scale (VAS) for assessment of pain and WOMAC (Western Ontario MacMaster) score were used. In both the evaluated criteria (VAS and WOMAC score) preoperative and postoperative results were compared. Moreover, duration of surgery and presence of postoperative complications were assessed. Statistical evaluation of clinical results was carried out by an independent statistician. In order to compare the parameter of WOMAC score and VAS pre- and post-operatively the Mann-Whitney Exact Test was used. The statistical significance was set at 0.05. RESULTS The preoperative VAS score ranged 5-9 (mean 7.6) and the postoperative VAS ranged 0-5 (mean 2.3). The WOMAC score ranged 56.3-69.7 (mean 64.2) preoperatively and 79.8-98.3 (mean 89.7) postoperatively. When both the evaluated parameters of VAS and WOMAC score were compared in time, a statistically significant improvement (p<0.05) was achieved postoperatively. The mean duration of surgical procedure was 68 minutes. Moreover, in peritrochanteric space apart from chronic bursitis also another pathology was found in a total of 14 cases (74%). In six cases (32%) it was a mild degeneration of m. gluteus medius (treated only with debridement) and in eight patients who underwent surgery (42%) the dorsal third of tractus iliotibialis was hypertrophic and protruding into bursa (treated with an incision of the hypertrophied part of the band). No serious neurovascular or thromboembolic complications were recorded. Only minor postoperative complications in a total of 7 patients who underwent surgery (37%) occurred. DISCUSSION There are lots of studies in literature presenting the results of endoscopic treatment of GTPS either using an independent trochanteric bursectomy or its combination with iliotibial band release. In our study we succeeded in achieving similar clinical results as those achieved by the other authors engaged in this area. CONCLUSIONS It has been proven in this retrospective study that the technique of endoscopic trochanteric bursectomy in patients with greater trochanteric pain syndrome yields statistically significant improvement of clinical results with the concurrent minimum incidence of postoperative complications. Key words: greater trochanteric pain syndrome, peritrochanteric space, recalcitrant trochanteric bursitis, hip arthroscopy, endoscopic trochanteric bursectomy, iliotibial band release.

[Correlation between the Arthroscopic and MRI Findings in Patients Active in Sports with Clinically Suspected Acetabular Labral Tear - Prospective Study Results]. / Korelace artroskopického a MR nálezu u sportovne aktivních pacientu s klinicky suspektní lézí acetabulárního labra ­ výsledky prospektivní studie.

PURPOSE OF THE STUDY The aim of our prospective study was to establish correlation between the arthro-MRI and arthroscopic findings in patients active in sports clinically suspected of having a hip labral tear. We sought to identify the benefits of arthro-MRI for clinical practice prior to the considered hip arthroscopy. MATERIAL AND METHODS The prospective study included 34 patients with hip pain and clinically suspected of having a labral tear. The group consisted of 19 men (55.9%) and 15 women (44.1%) of the mean age of 32.2 years (18 to 50 years). All our patients were active athletes, either professional (12; 35.3%) or recreational (22; 64.7%). Included in the study were exclusively patients aged 18-50 with hip pain lasting longer than 3 months, not responding to conservative therapy, with normal X-ray findings, or FAI syndrome. The patients underwent arthro-MRI and subsequently also hip arthroscopy, namely within no more than 3 months. The description of findings was translated into simple numerical scales, assessed using Spearman s rank correlation coefficient. We also examined the specificity, sensitivity, positive and negative predictive values and the odds ratio at various cut-off values of the scale for arthro-MRI. The statistical significance was set at the alpha level = 5%. The quality of tests was also evaluated using the ROC curve. RESULTS In hips assessed by the radiologist as reliably with no pathological finding (MRI type 1) the negative predictive value achieves 83.3% and the positive predictive value of 85.7%, with 96.0% sensitivity and 55.6% specificity. When evaluating the reliably negative finding together with the likely negative finding (MRI type 2) as against the pathological and certainly pathological findings (MRI type 3 and 4), the negative predictive value is 57.1%, the positive predictive value 95.0%, the specificity 88.9% and the sensitivity 76.0%. DISCUSSION In our study, the values achieved were comparable to or better than those reported by foreign authors in their studies establishing correlations between the arthro-MRI and intraoperative findings. Significantly higher was primarily the negative predictive value. CONCLUSIONS The results of our study indicate that the arthro-MRI performed as a part of preoperative examination prior to hip arthroscopy has adequate specificity and sensitivity in patients with suspected labral tear. Based on this examination a decision can be made as to whether to perform arthroscopy. Our study also shows that it is essential to have a highly competent radiologist to evaluate the arthro-MRI results. Key words: hip arthroscopy, labral tears, arthro-MRI, hip joint, predictive value of tests, sensitivity and specificity, minimally invasive surgical procedures/methods.

Cyclic patterns in the central European tick-borne encephalitis incidence series.

Tick-borne encephalitis (TBE) is peculiar due to its unstable dynamics with profound inter-annual fluctuations in case numbers - a phenomenon not well understood to date. Possible reasons - apart from variable human contact with TBE foci - include external factors, e.g. climatic forcing, autonomous oscillations of the disease system itself, or a combined action of both. Spectral analysis of TBE data from six regions of central Europe (CE) revealed that the ostensibly chaotic dynamics can be explained in terms of four superposed (quasi-)periodical oscillations: a quasi-biennial, triennial, pentennial, and a decadal cycle. These oscillations exhibit a high degree of regularity and synchrony across CE. Nevertheless, some amplitude and phase variations are responsible for regional differences in incidence patterns. In addition, periodic changes occur in the degree of synchrony in the regions: marked in-phase periods alternate with rather off-phase periods. Such a feature in the disease dynamics implies that it arises as basically diverging self-oscillations of local disease systems which, at intervals, receive synchronizing impulses, such as periodic variations in food availability for key hosts driven by external factors. This makes the disease dynamics synchronized over a large area during peaks in the synchronization signal, shifting to asynchrony in the time in between.

[Augmentation of the Anterior Cruciate Ligament in Patients with Symptomatic Isolated Tear of Anteromedial or Posterolateral Bundle: Evaluation of Two-Year Clinical Results]. / Augmentace predního zkrízeného vazu u pacientu se symptomatickou izolovanou rupturou anteromediální nebo posterolaterální porce: zhodnocení dvouletých klinických výsledku.

PURPOSE OF THE STUDY: We present the results of a prospective study of patients with symptomatic partial ACL tears comparing the pre-operative findings with the clinical results at two years after anterior cruciate ligament (ACL) augmentation. MATERIAL AND METHODS: A total of 29 patients (7 women, 22 men; average age, 27.8 years) who were diagnosed with an isolated tear of the posterolateral (PL) bundle (18 patients) or the anteromedial (AM) bundle (11 patients) at 9 to 24 weeks after injury, and underwent ACL augmentation by isolated PL or AM bundle replacement, were evaluated. The characteristics assessed before surgery and at two years after it included the Lysholm and subjective IKDC scores and knee laxity measurement with a GNRB arthrometer (at 134 N and 250 N) and its assessment by the Lachman, anterior drawer and pivot shift tests. In addition, the presence of cyclop syndrome, graft failure and post-operative complications were evaluated. RESULTS: The patients with isolated reconstruction of the PL bundle showed post-operatively statistically significant improvement in the degree of rotational knee laxity (p < 0.05) and the ventral knee laxity assessed by the Lachman test (p < 0.05). Postoperative improvement in the anterior drawer test results was not statistically significant (p = 0.07). The median value of side-to-side difference in knee laxity measured with the GNRB arthrometer decreased at 134 N from 1.7 mm pre-operatively to 0.8 mm at two years post-operatively (p < 0.05) and, at 250 N, from 2.8 mm to 1.5 mm (p < 0.05). The median Lysholm score increased from 74 to 91 points at two post-operative years and the median IKDC score improved from 76 to 92 points (p < 0.05). Graft failure was reported in one patient (5.6%) and 14 subjects (77.8%) reported return to pre-injury sports activities. The patients undergoing isolated reconstruction of the AM bundle achieved, at two years after surgery, a statistically significant decrease in positivity of the Lachman and anterior drawer tests (p < 0.05), while the results of the pivot shift test did not improve significantly (p = 0.09). The decrease in median values of side-to-side difference in knee laxity measured with the GNRB arthrometer was from pre-operative 3.1 mm to 1.2 mm at 134 N (p < 0.05) and from 6.2 mm to 1.9 mm at 250N (p < 0.05). The median Lysholm and IKDC scores increased from 68 to 92 points and from 70 to 94 points, respectively (p < 0.05). Nine patients (81.9%) reported return to pre-injury participation in sports. Apart from early wound bleeding in one patient, no complications were recorded. DISCUSSION: By permitting maintenance of a healthy bundle and replacement of only a torn one, ACL augmentation provides several benefits. It allows for accelerated revascularization and re-innervation of the graft through mechanoreceptors of the healthy portion; it enables the surgeon to get a good anatomical orientation and achieve precise tunnel reaming; in addition the healthy bundle provides protection for the graft in the early post-operative period. Thus rehabilitation can be faster and also return to sports activities. CONCLUSIONS: Our results show that ACL augmentation using isolated replacement of either the AM or the PL bundle brings about statistically significant improvement of all subjective and most of the objective criteria by two years after surgery.

[Anatomical ACL reconstruction by a double- versus a single-bundle technique. Prospective randomised study of short-term clinical results]. / Anatomická rekonstrukce LCA double- versus single-bundle technikou - zhodnocení krátkodobých klinických výsledku prospektivní randomizované studie.

PURPOSE OF THE STUDY: The aim of the study is to present a comparison of short-term results of double- versus single-bundle anatomical reconstruction of the anterior cruciate ligament (ACL) using hamstring endons and their fixation with absorbable interference screws. MATERIAL AND METHODS: A total of 110 patients with an isolated ACL lesion and the healthy contralateral knee who met the indication criteria for ACL double bundle reconstruction (TISL, 14 mm; ICNW, 12 mm) were intra-operatively allocated at random to either double-bundle group (DB, n=55) or single-bundle group (SB, n=55). At 12 months after surgery, 97 patients (DB group, n=49; SB group, n=48), comprising 68 men and 29 women, were evaluated; the average age was 29.1 years and the injury-to-surgery interval was 15.9 weeks. Pre- and post-operative subjective criteria involved the IKDC and Lysholm score. Objectively, the occurrence of graft failure, range of motion deficit, return to pre-injury sports activity, side-to-side difference in anterior laxity of both knees in 20° flexion on a GNRB laximeter at an applied pressure of 124 N and 250 N, and pivot shift phenomenon were assessed. RESULTS: No statistically significant difference was found in pre-operative values between the two groups. Post-operatively, there were no significant differences in the occurrence of complete graft failure (p=0.0755; DB group, n=0; SB group, n=3), range-of-motion deficit (p=0.2277-0.9788) or return to pre-operative sports activity (p=0.2322). In the DB group, side-to-side anterior tibial shifts at a pressure of 124 N (medians=1.3 mm and 2.1 mm for DB and SB groups, respectively; p=0.0007) and at a pressure of 250 N (DB group =2.1 mm; SB group = 3.1 mm; p<0.0001) were significantly different from the corresponding values in the SB group. Positive results for the pivot shift test (PST) were significantly less frequent in the DB than the SB group (Chi-square test =0.0112). The SB group patients had a 2.9-times (odds ratio, 2.8704) higher risk of positive postoperative PST results than the DB group patients. In both groups, a comparison of pre- and post-operative criteria showed significant improvement in both the subjective and the objective results. DISCUSSION: The results of this study, in accordance with other authors' conclusions, suggest that the double-bundle technique provides better control over rotational and anterior knee laxity and therefore restores knee biomechanics better. However, other literature data do not confirm any significantly better outcomes of this method. Since only short-term results have been obtained so far, the study will continue because only the long-term results can provide conclusive evidence of an advantage of one technique over the other. CONCLUSIONS: Our study showed significantly better restoration of knee rotational and anterior laxity in the patients undergoing anatomical reconstruction of the ACL by the double-bundle technique. The other evaluated criteria did not differ in relation to the technique used.

[Arthroscopic transcapsular iliopsoas tenotomy from the peripheral versus the central compartment in internal snapping hip syndrome. Short-term results of a prospective randomised study]. / Artroskopická transkapsulární tenotomie iliopsoatu u vnitrního typu syndromu lupavé kycle z periferního versus centrálního kompartementu: krátkodobé výsledky prospektivní randomizované studie.

PURPOSE OF THE STUDY: In this prospective randomised study, the short-term results of arthroscopic transcapsular iliopsoas tenotomy approached from the peripheral versus the central compartment for internal snapping hip syndrome are presented. MATERIAL AND METHODS: A group of 19 patients (15 women and four men; mean age, 24.3 years) who underwent arthroscopic transcapsular iliopsoas tenotomy for internal snapping hip syndrome in the period between September 2010 and December 2011 were prospectively evaluated. No injury, hip surgery or feeling of hip instability was recorded in their personal histories. Radiographs did not show any dysplasia, retroversion of the acetabulum or cam lesions. The patients were allocated to two groups using sealed envelope randomisation: Group 1 patients (n=10) were treated by tenotomy from the peripheral compartment and group 2 patients (n=9) underwent tenotomy from the central compartment during traction of the lower extremity. The evaluation included pre-operative 3T MRI findings, arthroscopically detected intra-articular lesions, duration of traction and post-operative complications. The pre-operative WOMAC scores were compared with those at one-year follow-up. In comparison of the two groups, the Mann-Whitney exact test was used for WOMAC scores and Fisher's exact test for post-operative complications. Statistical significance was set at a 0.05 level. RESULTS: In comparing post-operative complications, a significant difference (p=0.0468) between the groups was found only for genital paresthesia, which did not occur in group 1. The other differences were not statistically significant. The pre-operative WOMAC scores did not differ significantly between the groups (p=0.79). The post-operative WOMAC scores were significantly higher in group 1 (p=0.02). In each group the change in WOMAC scores was different and was statistically significant in group 1 (p=0.0014). Associated intra-articular hip pathologies, most frequently synovitis of the peripheral compartment, acetabular chondropathy, or labral lesions, were diagnosed in 90% of group 1 patients and in 66.7% of group 2 patients. DISCUSSION: Most of the authors comparing the results of two different ilioproas tenotomy techniques at one-year follow-up did not report any statistically significant differences in WOMAC scores between them. In accordance with the data reported, an increase in the post-operative WOMAC score, i.e., improvement of clinical outcome, was achieved in all our patients and, in group 1, it was significantly higher (p=0.0015), as compared with a similar study by Ilizaliturri. However, further follow-up of the patients and evaluation of long-term results will be necessary. CONCLUSIONS: The technique of arthroscopic ilioproas tenotomy approached from the peripheral compartment resulted in significantly fewer cases of genital paresthesia and provided significantly better clinical outcomes in comparison with tenotomy from the central compartment.

[Open reduction and plate fixation (ORIF LCP) for treatment of bilateral calcaneal fractures]. / Výsledky lécení oboustranné zlomeniny patní kosti otevrenou repozicí a vnitrní fixací (ORIF LCP).

PURPOSE OF THE STUDY: Calcaneal fractures are frequent injuries which may interfere with the patient's daily activities for a long time. They usually occur as the result of an axial load causing impaction of the talus into the calcaneus. They can also be bilateral. Falls and jumps from height are the most frequent causes. MATERIAL AND METHODS: Between August 2005 and December 2011, the method of open reduction and internal fixation (ORIF) with a calcaneal locking compression plate (LCP) was used to treat 98 patients with 114 calcaneal fractures. Of these, 16 were bilateral fractures found in two women and 14 men. In each patient, plain lateral and axial X-ray films of the calcaneus were taken on the day of injury. Computer tomography (CT) scans in the sagittal, transverse and coronary planes were obtained. Based on these, the fractures were classified as type I to type IV according to the Sanders system. The patients with type II and type III calcaneal fractures were indicated for ORIF treatment. The results were evaluated using the Rowe score. RESULTS: The most frequent cause of fracture was a fall or a jump from height, which was recorded in 81 patients. Bilateral fractures were found in 16 patients. Of the 98 patients, excellent results were in 31, good in 39, satisfactory in 20 and poor in eight patients, as assessed with the Rowe score. Unilateral fractures achieved excellent results in 28, good in 35, satisfactory in 15 and poor in four patients. The results in bilateral fractures were excellent in three, good in four, satisfactory in five and poor in four patients. Early post-operative complications were recorded in a total of 24 patients, of whom 13 had unilateral and 11 had bilateral fractures. DISCUSSION: The Sanders classification based on CT examination is used as an indication scheme in our department. Type II and type III fractures are indicated for ORIF treatment. A calcaneal LCP and an extended lateral approach are preferred. This allows for an almost perfect view of the fracture, an accurate reduction of the subtalar and calcaneocuboid joints and a stable internal fixation. In the patients with bilateral fractures, the occurrence of complications, multiple trauma and associated injuries was significantly higher. Also, they had less satisfactory results than the patients with unilateral fractures. CONCLUSIONS: The surgical treatment of intra-articular fractures using open reduction from the extended lateral approach and internal fixation with a calcaneal LCP has achieved good results. CT scans are necessary for the diagnosis, fracture classification and indication for a surgical procedure. The timing of surgery plays a decisive role. Open fractures and fractures associated with severe soft tissue injury are treated urgently, other fractures at an appropriate time. Our results showed a significantly higher rate of complications in the patients with bilateral calcaneal fractures, as compared with the patients with unilateral fractures, as well as less satisfactory outcomes. High-energy trauma resulting in bilateral fractures predisposes to comminuted fractures with dislocation, which leads to more serious damage to subtalar joint function.