In a „true“ valgus knee the lateral femoral condyle is smaller in both the vertical and anteroposterior dimensions and lateral soft tissue structures are contracted. In a „false“ valgus knee there is no mismatch between anteroposterior dimensions of both condyles. The aim of the study was to preoperatively analyse patterns of passive movement of valgus knees with imageless navigation system to optimise surgical approach during subsequent total knee replacement (TKR).

TKR were prospectively performed in 50 valgus knees. After the data registration process, the kinematic analysis was performed by passive movement of the knee. The mechanical axis was recorded at 0°, 30°, 60°, 90°, and 120° of flexion. The valgus deformity persistent through the whole range of motion was called „true“ and the valgus deformity passing into varus with flexion was called „false“.

The pre-operative valgus deformity in extension ranged from 13° to 4° (mean 7.8°). We observed „true“ valgus type deformity during passive range of movement in 34 cases (68%) and „false“ type of kinematics in 16 cases (32%). The average value of valgus deviation in extension in „true“ group was 7.9° (range 13° to 4°) and in „false“ group 7.5° (range 9° to 6°). The mean difference between axis deviation in 0° to 120° range of flexion was 5.5° (range 10° to 1°) in the „true“ valgus group. In the „false“ valgus group the varus deviation was observed in 90° of flexion in all cases and mean difference between axis deviation in 0° to 120° range of flexion was 12.0° (range 14° to 10°).

Computer navigation can easily help to identify the character of valgus deformity („true“ or „false“) just before skin incision. In „true“ valgus deviation lateral approach may be necessary for appropriate soft tissue balancing during TKR surgery.

Introduction

Valgus knee deformity is associated especially with differences in anatomy between medial and lateral femoral condyles. Vertically smaller lateral condyle and more distally located medial condyle cause valgus deformity in extension. The anteroposterior dimensions of both condyles influence the knee axis in flexion. In a „true“ valgus knee there is a mismatch between both condyles in both the vertical and anteroposterior dimensions, the lateral condyle is generally smaller. In a „false“ valgus knee there is no mismatch between anteroposterior dimensions of both condyles, the knee axis changes from valgus into varus with increased degree of flexion and lateral soft tissue structures are that's why not so contracted as in „true“ valgus knee deformity, where the knee stays in valgus deviation during the whole range of motion. The aim of the study was to preoperatively identify and analyse patterns of passive movement of osteoarthritic valgus knees with imageless navigation system to optimise surgical approach and intra-operative tissue handling during subsequent total knee replacement (TKR) surgery.

Background

Posterolateral fusion (PLF) is a commonly accepted surgical procedure and overall the most common technique performed to obtain fusion in the lumbar spine. Harvesting autologous bone from the iliac crest is associated with increased operation time, blood loss, and chronic donor site pain. Allograft material has an insufficient osteoinductive potential. Bone marrow concentrate (BMC) could be an option how to promote allograft PLF healing. The purpose of the presented study was to investigate the validity of BMC addition to allografts in instrumented lumbar PLF surgery.

The biomechanical function of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) remains controversial. Some studies report that the AM bundle stabilises the knee joint in anteroposterior (AP) translation and rotational movement (both internal and external) to the same extent as the PL bundle. Others conclude that the PL bundle is more important than the AM in controlling rotational movement.

The objective of this randomised cohort study involving 60 patients (39 men and 21 women) with a mean age of 32.9 years (18 to 53) was to evaluate the function of the AM and the PL bundles of the ACL in both AP and rotational movements of the knee joint after single-bundle and double-bundle ACL reconstruction using a computer navigation system. In the double-bundle group the patients were also randomised to have the AM or the PL bundle tensioned first, with knee laxity measured after each stage of reconstruction. All patients had isolated complete ACL tears, and the presence of a meniscal injury was the only supplementary pathology permitted for inclusion in the trial. The KT-1000 arthrometer was used to apply a constant load to evaluate the AP translation and the rolimeter was used to apply a constant rotational force. For the single-bundle group deviation was measured before and after ACL reconstruction. In the double-bundle group deviation was measured for the ACL-deficient, AM- or PL-reconstructed first conditions and for the total reconstruction.

We found that the AM bundle in the double-bundle group controlled rotation as much as the single-bundle technique, and to a greater extent than the PL bundle in the double-bundle technique. The double-bundle technique increases AP translation and rotational stability in internal rotation more than the single-bundle technique.

Introduction: A.K. Henry described the region of the cross-connection between FHL tendon and FDL tendon in the mid-foot. It had been termed “master knot”. Up to now its description was not done exactly.

Aim: In this study we were investigating the exact structure of the tendons connection and possibilities of the tendons transfer in the region of foot; especially for repairing extended or neglected Achilles ruptures.

Methods: Both feet in 30 cadavers (17 men, 13 women) had been prepared. The distance from proximal part of the knot to the distal insertion of FHL and the distance from the end of FHL origin to the proximal part of the knot had been measured. This values had been compared with the foot length.

Results: In the investigated group of cadavers had not been found any direct junction between FHL and FDL tendons proximally from the branching FDL for fingers. There is an interconnection from the FHL tendon to distal part of FDL for 2nd eventually for 3rd finger (distally from FDL branching). We did not find any connection described in anatomical study of E. O’Sullivan (Clinical Anatomy18: 121 – 125, 2005).

The average distance from the point of interconnection on the FHL to its insertion was 13,8 cm (9,8 cm–19,4 cm), from the end of muscle origin 17,9 cm (15,7 cm–19,6 cm).

The approximate distances after the conversion to the foot length were 0,70 times foot length and 0,55 times foot length.

Conclusions: There is no direct junction between FHL and FDL tendons proximally from the branching FDL for fingers. The suture of the tendons distally from the cut of transferred tendon and proximally from FDL branching is necessary to keep the correct flexion of all fingers.

Background: The goal of the current prospective randomised radiological study was to determine the accuracy of conventional and computer-assisted femoral component implantation in surface arthroplasty (SRA).

Methods: The standard implantation of SRA started at author’s institution in 2004; the learning curve lasted one year. From January 2006 have authors available a kinematic navigation system „Ci’ (DePuy International Ltd, Leeds, UK) for navigation of the femoral component of SRA „ASR’ (DePuy International Ltd, Leeds, UK). We analysed on standard radiographs the femoral component positioning after 30 conventionally instrumented (Group 1) and 30 navigated (Group 2) SRA femoral components. Posterolateral approach was used in all cases. The average age of 42 men and 18 women during surgery was 54? 8 (44–64) years; body mass index was 26,3? 3,7 (21,5–39,1) kg/cm2. We evaluated: varus or valgus orientation, horizontal femoral offset, and translation of the component.

Results: The varus-valgus positioning was more accurate in Group 2 (p < 0,05). The tendency to implant the femoral component in mild valgus position (2,8° in Group 1 compared to 2,1° in Group 2), more distally and ventrally in the femoral neck (in Group 1) and with femoral offset increase (4,8mm in Group 1 compared to 3,4mm in Group 2) was found. The femoral offset was restored more accurately in the navigated group (p < 0,05). The difference in component translation in relation to the femoral neck between both groups was statistically significant (p < 0,05) – it was more precise in the navigated group. No notching of the femoral neck was observed in both groups.

Conclusions: It is possible to achieve very accurate positioning of the femoral component with use of the ASR? manual tripod aiming device. But the navigation system enables a more accurate insertion of the femoral component. This benefit clearly weigh against an additional time cost of about 10 minutes because of navigation.

Introduction: The most critical step in the ACL reconstruction is placement of the femoral and tibial tunnels into which the graft is secured. The purpose of this prospective randomised study was to assess biomechanical, radiographic and functional results after single-bundle anterior cruciate ligament (ACL) reconstruction using navigation system.

Materials and Methods: 80 patients were treated for chronic rupture of the ACL. They were involved in a prospective randomized double-blinded study. All patients gave informed consent. 40 patients underwent ACL reconstruction using OrthoPilot navigation system (Group 1) and in other 40 patients was the surgery done by standard manually targeting technique (Group 2). The anterior laxity was measured using a KT-1000 arthrometer. Femoral and tibial tunnel position was evaluated radiologically according to the method described by Bernard/Hertel and Harner, respectively. The questionnaire-based Lysholm scale was included to compare functional state in both groups. The follow-up was at least 2 years.

Results: The knees in Group 1 were as stable as those in Group 2 during the arthrometer testing with lower value of dispersion. The postoperative Lysholm score had the same value in both groups. Statistical differences exist between anterior-posterior femoral tunnel placement when comparing the navigated and standard technique; in Group 1 were found out more exact results. No significant complications were observed.

Conclusions: Used computer kinematic system improves accuracy of the antero-posterior femoral tunnel placement. It also decreases dispersion of biomechanical stability values. This device renders the procedure more reliable and may so reduce the rate of revision surgery.

Introduction: Large chronic tears of the supra and infraspinatus tendons lead to pain and dysfunction of the shoulder. If conservative treatment fails and repair is impossible, transfer of the latissimus dorsi (LD) muscle can be attempted to substitute for lost of supero-posterior cuff function.

Method: In 2003 nad 2004, twenty five patients with an average age of 54,8 years (range, 51 to 62 years) who had ongoing pain and impaired function underwent the LD transfer after ultrasonographic examination and diagnostic arthroscopy as a primary surgery. The patients were examined at an average of fourteen months (range, twelve to twenty six months) after the operation. The results were assessed with use of Constant-Murley score pre–and postoperatively.

Results: The mean Constant-Murley score increased from 32,50 points preoperatively to 78,75 points postoperatively. The mean score for pain improved of 8,75 points (from 3,75 to 12,50), activities of daily living improved of 10,00 points (from 6,00 to 16,00), range of motion of 15,00 points (from 14,00 to 29,00) and strengh improved of 11,50 points (from 8,75 to 21,25). 20 patients (80%) were very satisfied and 5 patients (20%) were satisfied. The postoperative pain relief was left as the predominant improvement. No patient was disappointed. All patients stated that they would have the operative procedure again under similar circumstances. There was only one complication – subcutaneous haematoma treated with revision and drainage.

Conclusions: Our results indicate that LD transfer is a reasonable approach for salvage of a massive tear of the supero-posterior rotator cuff. Despite the difficult operation technique and long rehabilitation phase, this procedure improves the subjective and objective findings.

Introduction: The aim of this study was to prove the effectiveness of the CT-free OrthoPilot navigation system (Aesculap-B. Braun, Tuttlingen, Germany).

Material and Method: 40 ACL reconstructions with and 40 without use of this navigation system were performed from 2005. The software calculated the isometry of the reconstructed ligament in respect of its tibial and femoral insertions. Both tunnels were then drilled with use of navigation. In the controll group, the procedure was performed in standard manner. The femoral tunnel position was evaluated according to the method described by Harner and the tibial tunnel according to Bernard and Hertel. The joint stability was measured with use of KT-1000. The clinical results were evaluated according to Lysholm.

Results: The femoral tunnel was in the navigated group localised in the ideal position with a mean deviation up to 8 % from the ideal tunnel center in 35 cases (87,5 %) and in the acceptable position with a mean deviation up to 14 % in 5 cases (12,5 %). In the controll group was the femoral tunnel localised in the ideal position in 14 cases (35,0 %), in the acceptable position in 14 cases (35 %) and in the wrong position in 12 cases (30 %).

The tibial tunnel was in the navigated and also in the controll group localised in the ideal position in zone B in 37 cases (92,5 %).

The mean additinal operation time caused by Ortho-Pilot navigation was 11 minutes. No complications were observed in both groups. There was no difference in Lysholm score between both groups. The dispersion of the stability values was greater in the controll group.

Conclusions: The kinematic navigation system permited more correct placement of femoral drilling tunnel then the standard technique.

Aim: Aim of this prospectiv study is to present the first results of the grafted open-wedge high tibial osteotomy performed with aid of the computer-guided kinematic navigation and with use of the stable internal LCP-fixation. An arthroscopy preceded every operation.

Method: 20 cases were operated on in the year 2002 and 2003 by means of this method. The outcomes were evaluated minimally 2 years after the surgery clinically and radiologically.

Results: Before the osteotomy, the mean anatomic lateral tibiofemoral angle (aLTFA) was 181,1°. The desired 2° „overcorrection“ of valgus (aLTFA 172°) was found on X-rays postoperatively in all cases. The mean correction was 9,1°. The achieved correction wasn’t lost during 2 years of the follow-up. The osteotomy healed in all cases up to 4 months. The full range of motion remained after the surgery in all cases. All patients were satisfied with their results.

Conclusion: The computer-assisted open-wedge high tibial osteotomy with tricortical grafts stabilized by means of LCP-fixation gives exact and reproductable results without correction lost.

Aims: The aim of this paper was to evaluate the position of the endoprosthesis after standard and navigated insertion in both sagittal and frontal planes. Methods: From October 2000 to March 2002, 90 Search Evolution TKR were performed in 65 females and 25 males with mean age 68 years because of primary or post-traumatic osteoarthritis. Every third patient received this endoprosthesis without use of navigation. The study sample was so divided into two groups. The þrst group was constituted of 60 patients with TKRs inserted with use of navigation. The second group was formed by 30 patients with TKRs inserted with standard manner. All results were statistically analyzed. Results: The mean lateral tibiofemoral angle was in the 1st group 174,3¡ and in the 2nd group 174,9¡, the mean lateral distal femoral angle was in the 1st group 83,5¡ and in the 2nd group 83,7¡, the mean medial proximal tibial angle was in the 1st group 88,9¡ and in the 2nd group 89,2¡, the mean posterior distal femoral angle was in the 1st group 88,5¡ and in the 2nd group 86,6¡, the mean posterior proximal tibial angle was in the 1st group 88,9¡ and in the 2nd group 88,2¡. The femorotibial axis deviation from 174¡ was greater than 2¡ in the 1st group in 12,3% and in the 2nd group in 27,8% of cases. Conclusions: Kinematic navigation affords a possibility to place both femoral and tibial components more precisely than in implantation with standard manner. The more precise femoral component position in sagittal plane was achieved with navigation in this study.

The outcomes of the Berman-Gartland osteotomy in 26 feet (20 children) from 1995 to 1999 were evaluated. Average age at time of operation: 8 years, 3 months (range 37 to 194 months). Average age at follow-up: 2 years, 5 months (range 2 to 70 months).

The osteotomy is performed in tourniquet from three lengthwise incisions and fixed by Kirschner wires and plaster of Paris for six weeks. Only patients with idiopathic PEC were included in this study. Average age at time of primary operation was ten months. For analysis, the type and percentage of preceding operations were: pantalar release (40%), posterior release (12%), and tendo calcaneus elongation (8%). Eight feet (30%) were not primarily surgically treated. Indicated for metatarsal osteotomy were: footwear difficulty (92%), gait instability (65%), and muscle spasm (56%). Average adduction deformity of the forefoot was clinically assessed as 30 degrees (20 to 45 degrees). Forefoot rigidity was evaluated according to Black as grade II (14 feet) and grade III (12 feet).

Radiograph assessment was made by the use of T-I.MTT and C-V.MTT angle changes in the dorsoplantar weight-bearing view. We succeeded in correcting the average values of T-I.MTT angle from 28 degrees (range 20 to 43 degrees) preoperatively to 4 degrees (range 2 to 15 degrees) postoperatively, and C-V.MTT angle from 16 degrees (range 8 to 24 degrees) to 2 degrees (range -5 to 7 degrees). Isolated metatarsal varus deformity was found in 12 feet, in combination with talo-navicalar joint hypercorrection in nine feet, and in combination with residual talo-navicular joint subluxation in five feet.

Calcaneocuboid joint displacement was classified as grade I and II in 16 and 3 feet respectively. Preoperative residual displacement was not found in seven feet.

Complications were noted in three metatarsal nonunions (2% of 130 osteotomized metatarses), four pin migrations, one superficial infection, and one persistent forefoot swelling.

At final follow-up, clinical findings and outcomes were assessed as excellent in 16 feet (62%) and good in 10 feet (38%). We recorded no inferior result. An apparent relationship was not found between the type and timing of preceding operations and varus forefoot deformity persistence. In 19 feet (73%), residual grade I and grade II tibial subluxation of the cuboid bone was found.

The authors reviewed a group of 24 patients (26 hips) who had been managed with open reduction through an anterolateral approach from 1981 to 1985. Eight patients with an inadequate clinical (6) or roentgenographic (2) follow-up were excluded from the study. The purpose was to evaluate 18-year results of nine hips operated in pre-walking age up to 12 months and nine hips operated later. All patients were operated by the senior doctor. The goals of management are concentric reduction and its maintenance in order to provide the optimum environment for development of the hip joint.

The average age of the children at the time of operation was seven months (range 3–10 months) in the first group and 32 months (range 15–60 months) in the second group. Open reduction was performed if a stable reduction could not be achieved with traction as demonstrated with arthrography.

Evaluation of the first group: marginal dislocation was found in one hip (11.1%) and in the rest of cases the head was highly dislocated. A simultaneous derotational femoral osteotomy was added in the course of four reductions (44.4%) and in three of these cases a subsequent Salter osteotomy was performed. Five hips (55.6%) were reduced without additional femoral osteotomy and in three of these cases, a subsequent combination of Salter and derotational varisation osteotomy was performed. Average age at the time of the subsequent operation was 31 months (range 19–44 months).

In the second group, only high dislocations were found and each procedure was accompanied with simultaneous and subsequent interventions. At the final follow-up of the first group, the clinical findings were evaluated as Severin class A in eight hips (88.9%) and class B in one hip (11.1%). Three hips (33.3%) were Severin roentgenographic class I, and six hips (66.7%) were class II. Six hips (66.7%) showed avascular necrosis classified as Ogden-Bucholz Type I (3) and Type II (3). No significant degenerative changes were found. In the second group, the results were worse – two patients had already had THAs implanted.

The results are excellent or good in children operated in the pre-walking age. The results in patients operated later are worse. We consider this method to be useful for the treatment of congenital dislocation of the hip.