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PURPOSE OF THE STUDY: Injury to the posterior cruciate ligament (PCL) is relatively rare and, if combined with avulsion fracture of the PCL insertion site, it accounts for only a small number of knee injuries. This is why PCL avulsion fracture is an easily missed diagnosis resulting in knee instability and arthritis development. The aim of this study was to show the necessity of surgical treatment of these injuries. MATERIAL: Between January 2004 and September 2005, four patients with PCL injury underwent surgery. Three had avulsion fracture at the PCL insertion site, and in one the avulsion fracture involved also the intercondylar eminence. The average follow- up was 15 months, with a range of 5 to 20 months. METHODS: The diagnosis was based on clinical examination, plain X-ray and MRI results. After arthroscopic treatment of the anterior compartment, the posterior compartment was treated from the posteromedial and the posterolateral approach. Using a K-wire for guidance, a tunnel was drilled and the fragment was fixed with an absorbable cannulated screw. Postoperatively, the limb was immobilized in a rigid brace at a 20 degrees flexion for 4 weeks followed by passive exercise rehabilitation. Within 10 weeks of surgery full weight-bearing was possible in all patients. Outcome evaluation was based on clinical, radiographic and MRI examination shortly after surgery and at 3-month follow-up. RESULTS: None of the four treated knee joints had any post-operative instability. The PCL was in a correct position and showed appropriate tension on MRI scans. DISCUSSION: Today arthroscopically-assisted operations are preferred to conservative treatment or open osteosynthesis. An exact diagnosis is best made on the basis MRI examination. To fix the bony fragment, various techniques can be used, such as hooked nail, screw, K-wire or traction suture through the proximal tibia. The method used usually depends on the size of a bony fragment. CONCLUSIONS: The advantages of arthroscopic surgery include faster healing and rehabilitation and less pain and trauma associated with the operative procedure. A readily performed arthroscopic procedure prevents knee joint instability and arthritis development. The outcomes achieved in our patients give support to the indication for surgical treatment in this kind of knee injury.

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The aim of this report is to draw attention to new possibilities of treating chondral lesions of the talus, using a solid chondral graft consisting of autologous chondrocytes grown on a three-dimensional matrix of the tissue glue Tissucol. This method is used in grade II to grade IV chronic lesions and grade IV acute lesions, as classified according to the Berndt and Harty system. Patients' age at implantation should not exceed 40 years. When a lesion is found by arthroscopy on the talar dome, a part of cartilage from a non-weight-bearing surface, most frequently the neck of the talus or the anterior edge of the tibia, is collected. The cartilage is sent to the tissue bank. The preparation of a chondral graft (fragmentation, isolation and cultivation of chondrocytes) takes from 15 to 35 days. After shaping the graft from chondrocytes and Tissucol tissue glue in a special mould, transplantation is carried out. In 2003 we used this method in two patients. They both were male sportsmen, football players, aged 35 and 30 years, respectively. At the time of this report, the former patient was 8 months and the latter 3 months after implantation. The first patient, aged 35, was without complaints at 8 months after implantation. The other patient, a 30-year-old football player, who was still followed up, was without complaints and continued with rehabilitation and full weight-bearing of the extremity. Magnetic resonance imaging performed 3 months post-operatively showed good incorporation of the chondral graft in both patients.

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PURPOSE OF THE STUDY: To present the results of a new method for treatment of cartilage defects of the patella, using a solid graft produced by chondrocytes on a three-dimensional matrix. MATERIAL AND METHODS: Chondrocyte transplantation is indicated in deep and extensive chondral and osteochondral defects of all large joints in patients at 18 to 40 years of age. When, on arthroscopic examination, a defect of patellar cartilage was found, healthy cartilage was collected from a non-weight-bearing surface, i. e., the intercondyllar fossa. In the tissue bank, the cartilage was fragmented, chondrocytes were isolated enzymatically and cultivated in vitro under a permanent assessment for cell quality. The cultivation period ranged from 15 to 35 days. Subsequently, a solid graft was prepared with the use of Tissucol glue, a three-dimensional matrix. The graft was transplanted after arthroscopic verification of the defect by an open, minimally invasive procedure with tourniquet application, with the patient receiving antibiotics. The result of chondral graft implantation was checked by second-look arthroscopy involving removal of a small sample of the integrated chondral graft taken for histological and morphological examination. Another method of post-operative assessment was examination by magnetic resonance imaging (MRI). Solid chondral graft transplantation was used in three patients (two men and one women) treated in the Department of Orthopedics, University Hospital Brno, between May 2001 and December 2003. Their average age at the time of surgery was 31 years (range, 27 to 38 years). The average follow-up was 22 months (range, 2 to 33 months). The post-operative stage of he cartilage was assessed by MRI in one patient and by second-look arthroscopy also in one patient. RESULTS: Two patients fully resumed their daily activities, sports including, at 6 months after the treatment, with one reporting mild chondropathic problems and the other being without complaints. In the third patient at 2 months after surgery, the treatment had not been completed yet. The patella examined by MRI at 18 months after surgery showed a confluent, high layer of hyaline cartilage covering the articular surface. Second-look arthroscopy and histological examination also revealed healthy hyaline cartilage. No serious complications were recorded. DISCUSSION: Autologous chondrocyte transplantation is indicated in younger, active patients with cartilage defects exceeding 2 cm2 and in patients undergoing revision surgery for any defect. The success rate of this procedure has been reported to be over 90 %. One year after transplantation, the cartilage had characteristics of a healthy tissue, as assessed by MRI. Biopsy examination showed that the grafts, chondrocytes as well as osteocytes maintained their integrity at 2 to 12 months after surgery. CONCLUSIONS: The aim of this paper was to define and check indications, to develop the surgical technique, to improve post-operative management and to evaluate mid-term results of the treatment of cartilage defects on the patella.

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PURPOSE OF THE STUDY: The purpose of the current report was to present our initial experience with an arthroscopic technique for anterior stabilization of the shoulder with an anchor in 64 patients who had recurrent anterior glenohumeral instability. MATERIAL: The application of arthroscopic techniques for the operative treatment of recurrent anterior instability of the glenohumeral joint has generated widespread interest. The goal of all arthroscopic techniques for stabilization of the shoulder is the re-establishment of a functioning inferior glenohumeral ligament. This is achieved by reattaching the avulsed anteroinferior aspect of the labrum or capsule to the anterior aspect of the glenoid neck with one of a variety of methods. Arthroscopically assisted repair of the anterior aspect of the labrum with use of a bioabsorbable/nonabsorbable suture with an anchor was performed in 64 consecutive patients who had chronic anterior instability of the shoulder. The average age of the patients was twenty-seven years (range, sixteen to fifty-two years). The etiology of the instability was a traumatic injury in 53 patients. All fifty-three shoulders had a Bankart lesion. The patients were evaluated at an average of 18 months (range, 3 to 36 months) after the procedure. METHODS: During shoulder arthroscopy in typical laying position with traction applied on upper extremity we made diagnosis of capsule defect or laxity in all the cases. Using anchor technique we sutured capsule defect, or tightened loose capsule to glenoid rim. Two or three sutures were used. The anchors were Mitek GII implants, or Arthrex screws, with non-absorbable sutures in most cases. RESULTS: Fifty (78 per cent) of the patients were asymptomatic and were able to participate in sports without restriction. The repair was considered to have failed in three (4.5 per cent) of the patients. In one of them, the failure resulted from a single traumatic reinjury during participation in a contact sport, and was treated operatively. The remaining two failures occurred atraumatically. DISCUSSION: It is difficult to compare the results from the present study with those from other reports on arthroscopic techniques of anterior stabilization because of variation among the indications, the techniques, and the implants that were used. The degree of capsular laxity is central to the success or failure of arthroscopic stabilization. CONCLUSION: Anterior stabilization of the shoulder with an anchor may be indicated for patients who have anterior instability with or without Bankart lesion and need suture of the lesion and capsulorrhaphy or capsular imbrication to reduce the joint volume.

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The authors followed up the impact of a plaster applied in idiopathic scolioses on the pulmonary functions measured by microcomputer spirometer. Pulmonary functions were examined in 24 patients prior to the operation of scoliosis and after the operation in the plaster and in 20 patients treated only by the plaster and on 45th day after its removal. The results of both groups were statistically evaluated by a Student t-test at 1 % level of significance by a personal computer Commodore 16. The results of the examination have shown that the plaster as a therapeutical device in idiopathic scolioses considerably restricts the respiratory functions. Simultaneously there occurs deterioration of the compliance of thoracic wall, a necessary increased activity of the chest and muscles in breathing, alveolar hypoventilation with the retention of CO2. Vital capacity has been reduced by 20 % on the average in operated patients and by 10 % in non-operated idiopathic scolioses in the plaster. In our present conditions, despite the negative impact on respiratory functions by after-treatment of idiopathic scolioses in the plaster, the operation for lengthening of the trunk with the correction of the curvature serves as prevention of the increase of pulmonary insufficiency at the adult age. In the course of two years after operation the respiratory functions start to improve again. Longterm active regime of breathing gymnastics in the patients with idiopathic scoliosis further reduces the negative impact of the plaster on respiratory functions. Key words: idiopathic scoliosis, pulmonary functions, plaster, breathing gymnastics.

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The authors describe surgical techniques used in 48 patients with sequelae of injuries of the thoracolumbar spine and the achieved results. Twenty-one patients were treated by an anterior operation, 14 by posterior operation and 13 a combination of both. The anterior operation involved 1) simple stabilization by autografts or 2) release, correction of the kyphosis and fusion and 3) elimination of the affected body of the vertebra and replacement by a massive allograft. If reliable stability was not achieved, instrumentation was added. In posterior operation they always stabilized the spine by instrumentation and added fusion. In the remaining patients they combined the posterior and anterior operation. The anterior operations were, if necessary, supplemented by decompression, when using the posterior approach they decompressed by the posterolateral route. As to complications which called for re-operation, instrumentation failed once and twice a pseudoarthrosis was repaired. Pain disappeared or receded substantially in 86%. Of 30 patients with a partial nervous lesion 14 (47%) improved, in two slight deterioration occurred.

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