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PURPOSE OF THE STUDYLatissimus dorsi transfer is a relatively complicated procedure subsequently requiring an active, long-term physical therapy. The surgeon's performance and a patient's effort are therefore of worth consideration. However, sutures of massive rotator cuff tears do not always produce good results. The aim of the study is to evaluate the role of latissimus dorsi transfer in the treatment of these shoulder pathologies. MATERIALA total of 21 patients were evaluated. Their age at the time of surgery ranged from 48 to 63 years, with an average of 54.8 years. A minimum follow-up was three years, the average was 47 months (70-36 months). The indication for surgery included a massive rotator cuff tear, without symptoms of arthropathy and with normal subscapularis muscle function, which had been resistant to conservative treatment for 6 months at least. In 13 patients, transfer was performed after previous surgery on the rotator cuff. METHODSThe procedure was carried out in a lateral position. The latissimus dorsi tendon was cut off just at its attachment to the humerus, the muscle was mobilised and the musculo-tendinous flap was released to reach the proximal operative wound and to cover the greater tuberosity of the proximal humerus. A shoulder abduction splint was used to immobilise the upper extremity for 6 weeks. Active and supervised individual physical therapy followed. RESULTSSubjective evaluation was excellent in 10, good in 9, and poor in 2 patients. The average Constant-Murley score improved by 32.25 points as compared before surgery (from 38.50 to 70.75). The evaluation of active arm elevation in the frontal plane showed improvement in 16 patients (77 %) by 40° on average, no change in five patients (23 %), and no deterioration in any of the patients. Active external rotation with the arm held at the body side improved by 14° on average. Progression of radiographic changes indicating arthropathy was recorded in five patients. Post-operative haematoma, developed three patients it was treated by needle aspiration in one, and drainage in two patients. DISCUSIONThe results presented here are in agreement with those reported in the international literature. The method of latissimus dorsi transfer shows poorer outcomes after previous attempts to suture of massive rotator cuff tears. In patients with a restricted range of motion before surgery, the post-operative shoulder motion achieved at the final evaluation is also lower. CONCLUSIONSWhen based on a correct indication, latissimus dorsi transfer with an uncomplicated post-operative therapy will result in improvement of shoulder function and pain relief, and it is therefore justified. One of the prerequisites for good results is the initial patient's consent with a supervised, active and long-term post-operative physical therapy. The transfer itself is a demanding surgical procedure associated with several risks and it should therefore be performed by an experienced and competent surgeon with a deep knowledge of shoulder girdle anatomy.

PURPOSE OF THE STUDYThe preoperative planning in habitual dislocation of the patella should take into account all pathologies and the procedure should address all abnormalities. One of them might be also the rotational deformity of the femur. The purpose of this prospective study was to confirm the hypothesis that the only correction of pathological femoral anteversion by derotational intertrochanteric osteotomy (in the absence of another pathology) or the correction of femoral anteversion with simultaneous reconstruction of the patellofemoral joint provide adequate stability for the patellofemoral joint, with respect to the elimination of the risk of recurrent dislocation of the patella.

PURPOSE OF THE STUDYKnee injuries accompanied by anterior cruciate ligament (ACL) tears can also result in rotational instability of the joint. Subsequent insufficient rotational stability after the ACL reconstruction can be a direct consequence also of injuries to lateral knee structures, specifically the anterolateral ligament (ALL). This residual postoperative rotational instability may be prevented by multiple surgical techniques. The purpose of this study was (1) to evaluate the knee stability in internal rotation after the "anatomical" single-bundle (SB) anterior cruciate ligament reconstruction together with ALL reconstruction compared to the double-bundle (DB) ACL reconstruction two years after surgery; (2) to compare the knee joint stability after the ACL and ALL reconstruction with the healthy contralateral knee joint. MATERIAL AND METHODSAll the measurements were conducted by the computer navigation system. The study included 20 patients after the single-bundle ACL and ALL reconstruction and 20 patients after the double-bundle ACL reconstruction. The follow-up examination was carried out at 25 months after surgery on average (24 months at least).All measurements were performed in both the healthy and operated knee. Once the data necessary for navigation were determined, the patient remained in standing position with both feet firmly placed on the mat with intermalleolar distance of 20 cm. Then, at 30-degree flexion of the knee joints, the patient first performed the joint internal rotation by trunk torsion, followed by external rotation. Each measurement was repeated 3 times. A non-parametric t-test was used for statistical processing. RESULTSThe mean internal rotation in the injured knee joint was 19.1 degrees preoperatively and 8.1 degrees postoperatively, while in the healthy knee it was 8.4 degrees. External rotation was not assessed. The reported internal rotation in the knees after DB ACL reconstruction was 9.2 degrees (p ≥ 0.05). DISCUSSIONThe double-bundle ACL reconstruction is a complex technique that can lead to many intraoperative and postoperative complications. Grafts harvested from both hamstrings can have an effect on the rotational stability of the joint. In order to restore the knee rotational stability with fewer potential complications, the method of choice can be the ACL reconstruction using the quadriceps femoris muscle graft and the ALL reconstruction using the gracilis muscle graft, leaving the semitendinosus tendon intact. CONCLUSIONSThe obtained values reveal that the single-bundle ACL reconstruction in combination with ALL reconstruction results in the same internal rotational stability in the knee joint as the double-bundle ACL reconstruction. Similar joint rotational stability is observed in all the knee joints reconstructed with the use of these techniques and in the contralateral healthy knee joint.