Purpose of the study— to evaluate surgical treatment outcomes of the patients with chronical patella instabilitywho underwent double bundle transpatellar reconstruction of medial patella-femoral ligament (MPFL) by a semitendinous tendon autograft. Material and methods.26 patients with minimal 12 months follow up were included into the study. In all casessemitendinous tendon autograft was inserted through a vertical tunnel in the patella, formed in a loop, and fixed in femoral tunnel by a biodegradable screw. Preoperative MRIs were used to evaluate trochlear dysplasia type by D. Dejour classification, tibial tubercle to trochlear groove distance (TT-TG) and Insall-Salvati ratio. Postoperative x-rays were used to measure femoral tunnel angle (FTA), postoperative MRIs — to measure diameter of patella tunnel (d_Pat), distance from tunnel to medial border of patella (MPM) and diameter of tunnel in medial femoral condyle (d_Fem). Functional outcomes were evaluated by Kujala Score, Lysholm and IKDC, also the authors assessed the level of sports activity prior to and after the surgery. Results.Age median of the patients at the moment of procedure was 22 years. MRI data prior to surgery reportedthat the majority of patients suffered from B type of trochlear dysplasia, median TT-TG distance was 14.6 mm, median Insall-Salvati ratio was 1.1 mm. Postoperative x-rays and MRIs demonstrated median FTA of 18°, d_Pat median — 5.4 mm, MPM median — 7.0 mm, d_Fem median — 8.2 mm, no implant migrations were observed. Subjective assessment scores demonstrated excellent outcomes: Kujala Score — 96, IKDC — 87.4, Lysholm — 91. No secondary dislocations during follow up were reported, 48% of patients returned to sports on the pre-surgery or higher level, 52% of patients returned to sports with decreased activity. Conclusion.Transpatellar reconstruction of MPFL by semitendinous tendon autograft proved to be the efficienttreatment method of chronical patella instability.

The analysis of the evolution of meniscal repair techniques starting of the arthrotomic interventions to procedures under arthroscopic control is presented. Long-term results as well as the surgical techniques are discussed.

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Purpose – to assess the influence of combined femoral fixation technique during arthroscopic ACL reconstruction on the femoral tunnel widening at long term follow-up.Material and methods. 99 patients with primary hamstring tendon (HT) ACL reconstruction performed in 2007-2008 were analyzed. In the study group (42 patients) on the femoral side a combined cortical suspension (Endobutton CL, Smith Nephew) and transverse (Rigid Fix, Depuy Mitek) fixation of graft was used. In control group, isolated cortical suspension fixation (Endobutton CL, Smith Nephew) was used. On the tibial side for graft fixation a biodegradable screw (Biointrafix, DePuy Mitek) was used in all cases. Tunnel widening was calculated in percentage against primary tunnel diameter created during the surgery. MRI data were exported to eFilm (Merge Healthcare software), measurement of femoral tunnel diameters was performed on T1 sequences in coronal and sagittal planes on three different levels.Results. The mean age at the last follow up in the study group was 38.9±1.4, in control group – 38,6±1,08. The median time from surgery to follow up was 9 years and 4 months in the study group and 8 years 7 months in the controls. The incidence of graft failure in the study group was reported as 14.3%, while in the control group as 17,5%. The median femoral tunnel widening was larger in the control group at the joint aperture and midsection levels both in coronal and sagittal plane, although there was no statistically significant differences (p0,05).Conclusion. The combination of cortical suspension and transverse HT femoral graft fixation technique is likely to reduce tunnel enlargement at the long term follow-up. However further research and larger sample groups are required.