[Arthroscopic Superior Capsule Reconstruction with a Long Head of the Biceps Tendon Autograft: One-Year Follow-up Results]. / Rocní klinické výsledky artroskopické rekonstrukce horní kapsuly ramenního kloubu pomocí slachy dlouhé hlavy bicepsu.

PURPOSE OF THE STUDY: Superior Capsule Reconstruction (SCR) of the shoulder joint has recently been included in the portfolio of interventions as a solution to irreparable rotator cuff tears. One of the options is to use a long head of the biceps tendon (LHBT) autograft. This paper presents the fi rst clinical outcomes of the SCR of the shoulder joint using the LHBT autograft. MATERIAL AND METHODS It is a prospective non-randomised study in which 14 patients were included, namely 7 men and 7 women. The patients were evaluated using the pain VAS, UCLA (The University of California at Los Angeles) Shoulder Rating Scale and ASES (The American Shoulder and Elbow Surgeons) Shoulder Score. The minimum follow-up was 12 months after surgery. The measured values were analysed using the standard statistical methods. RESULTS From August 2020 to January 2022, a total of 14 SCR with biceps tendon autograph were performed at our department. The mean age of the patients was 62 years (40-72). The mean value of the UCLA Shoulder Score was 12.36 ± 2.92 points preoperatively, while after surgery the obtained values increased to the mean value of 28.86 ± 3.08 points. The ASES score was 25.48 ± 3.89 points preoperatively and 82.41 ± 7.95 points at one year after surgery. The preoperative mean VAS score was 6.14 ± 1.10 points and 1.36 ± 0.93 points at one year after surgery. The mean active shoulder fl exion measured preoperatively was 140 degrees, whereas at one year after surgery it was 171 degrees. The mean active abduction reached 123 degrees before surgery and 169 degrees after surgery. The mean active external rotation of the shoulder joint was 59 degrees preoperatively and 52 degrees postoperatively. The mean active external rotation at 90 degrees of abduction was 52 degrees preoperatively and 60 degrees postoperatively. Whereas the improvement as against the preoperative status measured by the UCLA, ASES and pain VAS was signifi cant, the differences in the range of motion were signifi cant in the case of active fl exion and abduction only. DISCUSSION Painful irreparable rotator cuff tear constitutes an indication for SCR. The reconstruction is performed using autografts, allografts and xenografts. In literature, several SCR surgical techniques using a long head of the biceps tendon have been presented. In most of these techniques the supraglenoid insertion of the LHBT was left intact. Our study showed a signifi - cant relief from problems and good functional outcomes at 1 year after surgery when the biceps tendon had been used. Similar results are reported also by other studies using the biceps tendon for SCR. When comparing this study and the other study we published earlier on SCR with xenografts, there is no signifi cant difference in the clinical outcomes between these two techniques. On the very contrary, they are slightly better in some parameters. CONCLUSIONS Arthroscopic SCR of the shoulder joint with the biceps tendon reports good clinical outcomes at one year after surgery both with regard to the relief from problems and range of motion. Due to low morbidity of graft harvesting, low cost, and easy surgical technique, it appears to be the fi rst-choice method for superior capsule reconstruction of an irreparable tear of supraspinatus or infraspinatus if the long head of the biceps tendon is preserved. A longer follow-up period and evaluation of a larger study population would be necessary to defi nitely confi rm the success rate of the described procedure. KEY WORDS: massive rotator cuff tears, irreparable rotator cuff tears, superior capsular reconstruction, autograft, long head of the biceps tendon.

[Posterior Tibial Slope as a Morphological Risk Factor for Anterior Cruciate Ligament Reconstruction: a Retrospective Cohort Study]. / Zadní sklon tibie jako rizikový morfologický faktor kolena u náhrady PZV: hodnocení souboru pacientu.

PURPOSE OF THE STUDY Increased tibial slope facilitates anterior translation of tibia relative to the femur, thereby increasing the load on both the native and replaced anterior cruciate ligament. This study aims to retrospectively review the posterior tibial slope in a cohort of our patients after the ACL reconstruction and revision ACL reconstruction. Based on the results obtained by measurements, we aimed to confirm or disprove the claim that the increased posterior tibial slope is one of the risk factors of the ACL reconstruction failure. Another aim of the study was to assess whether there are any correlations between the posterior tibial slope and basic somatic parameters (height, weight, BMI) or the patient s age. MATERIAL AND METHODS The posterior tibial slope was measured retrospectively on lateral X-rays of 375 patients. There were 83 revision reconstructions and 292 primary reconstructions performed. The patient s age at the time of injury, height and weight were recorded and the BMI was calculated. The findings were then statistically analysed. RESULTS The mean posterior tibial slope in 292 primary reconstructions was 8.6 degrees, whereas the mean posterior tibial slope in 83 revision reconstructions was 12.3 degrees. The difference between the studied groups was statistically (p<0.0001) and substantively significant (d=1.35). In the breakdown into men and women, the mean tibial slope was 8.6 degrees in the group of men with primary reconstruction and 12.4 degrees in the group of men with revision reconstruction (p < 0.0001, d = 1.38). A similar result was achieved in women where in the group with primary reconstruction the mean tibial slope was 8.4 degrees, while in the group with revision reconstruction it was 12.3 degrees (p < 0.0001, d = 1.41). Furthermore, a higher age in men at the time of revision surgery (p = 0.009; d = 0.46) and a lower BMI in women at the time of revision surgery (p = 0.0342; d = 0.12) were observed. Conversely, neither height nor weight were different, both when comparing the whole groups and the groups in a breakdown by sex. DISCUSSION As regards the main aim, our results are in line with the results reported by majority of other authors, and they are substantively significant. The posterior tibial slope is a significant risk factor in anterior cruciate ligament replacements, with tibial slope above 12 degrees increasing the risk of ligament failure, namely both in men and women. On the other hand, this is obviously not the sole cause of the ACL reconstruction failure since there are also other risk parameters. It is not yet clear whether it makes sense to indicate correction osteotomy before the ACL replacement in all patients with an increased posterior tibial slope. CONCLUSIONS Our study confirmed a greater posterior tibial slope in the revision reconstruction group compared to the primary reconstruction group. Thus, we confirmed that greater posterior tibial slope may be a factor leading to the ACL reconstruction failure. Since the posterior tibial slope is easily measured on the baseline X-rays, we recommend to perform this measurement routinely before each ACL reconstruction. In the case of a high posterior tibial slope, slope correction should be considered to prevent potential ACL reconstruction failure. Key words: anterior cruciate ligament reconstruction, ACL graft failure, morphological risk factors, posterior tibial slope.

[Arthroscopic Bankart Repair with Remplissage for Anterior Instability: Functional Outcomes, Risk of Failure]. / Artroskopická Bankartova operace se soucasnou remplissage: funkcní výsledky, riziko selhání.

PURPOSE OF THE STUDY This study aimed to evaluate the clinical outcomes and the rate of recurrence in patients who had undergone arthroscopic Bankart repair with remplissage for anterior instability of the glenohumeral joint. MATERIAL AND METHODS The study included 96 arthroscopic Bankart procedures with remplissage performed between 2013 and 2019 at our department in 93 patients (81 men and 12 women; with the mean age of 33 years). We gathered and analysed preoperative data, including a 3D-CT scan of the affected shoulder. Apart from stability, the functional results were assessed postoperatively using the WOSI, SSV, Rowe score, and by measuring the strength of shoulder girdle muscles. The non-parametric MannWhitney U-test was used to identify the predisposing factors for recurrence of glenohumeral instability. RESULTS The arthroscopic Bankart repair with remplissage was indicated in 74 shoulders for primary TUBS and in 22 shoulders as a revision procedure. The recurrent instability was observed in 13 of 96 operated shoulders (13.5%). Subjective instability (positive apprehension test in the extreme positions of the shoulder joint, in abduction and external rotation in particular) was reported by 10 patients (10/13; 77%), three patients experienced a redislocation of the glenohumeral joint in the postoperative follow-up (3/13 patients; 23%). The risk of recurrence of the glenohumeral instability was not correlated with either the number of previous stabilisation procedures, or any other preoperative or intraoperative parameters. Conversely, a new postoperative injury was a factor of key importance. The patients with recurrent instability (subjective instability or glenohumeral dislocation) achieved a significantly lower Rowe score, SSV, postoperative VAS, and worse overall satisfaction with the procedure compared to the group with no recurrent instability. The remplissage induced minor limitations of external rotation at 0° abduction and internal rotation at 90° abduction. After rehabilitation, the muscle strength of the operated shoulder in both groups was comparable to that of the untreated shoulder in all planes of the shoulder range of motion. DISCUSSION Our study confirms the clinical relevance of the addition of remplissage to the arthroscopic Bankart procedure for reducing the rate of recurrent glenohumeral instability in TUBS with a clinically significant Hill-Sachs lesion. Satisfaction with the surgical outcome is high; the functional outcomes are very good, including muscle strength. Surprisingly, though, the risk of recurrent instability does not correlate with the number of implants used in the stabilisation procedure. CONCLUSIONS Addition of remplissage to the arthroscopic Bankart stabilisation in patients with a clinically significant Hill-Sachs lesion shows a low risk of recurrence of glenohumeral instability after surgery compared to the conventional arthroscopic Bankart repair alone. The remplissage does cause minor restrictions in the glenohumeral joint external rotation, but it was not reflected in the satisfaction of patients or a lower clinical score of the shoulder joint. The preoperative assessment of the HillSachs lesion using the "glenoid track" on a 3D-CT scan helps improve the preoperative planning and prediction of outcomes of the stabilisation procedure. Key words: glenohumeral instability, Bankart defect, Hill-Sachs lesion, Bankart repair, remplissage, arthroscopy.

[Incidence, Morphology and Clinical Significance of Hill-Sachs Lesions in Shoulder Instability - CT Scan Evaluation of the Group of Patients]. / Incidence, morfologie a klinický význam HillovýchSachsových lézí u nestabilních ramenních kloubu ­ CT hodnocení souboru pacientu.

PURPOSE OF THE STUDY Shoulder instability is often times accompanied by associated injuries caused by the humeral head displacement. These are primarily bone lesions on the head and socket of the glenohumeral joint. The purpose of this study was to evaluate the frequency, morphology and clinical significance of bone lesions in shoulder instabilities in a group of patients operated in our department for glenohumeral instability between 2012 and 2019. MATERIAL AND METHODS The ongoing evaluation included 373 patients with trauma and habitual instability who had undergone surgery in our department in the period from 2012 to 2019. All patients underwent a preoperative 3D CT scan of the shoulder joint. Subsequently, the morphology and clinical significance of individual bone lesions were evaluated based on the older Burkhart s concept of engaging/nonengaging lesions and the newer concept of glenoid track by Yamamoto and Di Giacomo of 2007, 2014 or 2020. RESULTS The frequency of Hill-Sachs lesion was 83.4% (311) in our group of patients. In nearly two thirds (211 cases) also a bone defect on glenoid was detected (59.3%). When comparing the basic types of instabilities, in the TUBS group the Hill-Sachs lesions were present up to twice as often as in the group with AMBRI instability. Clinically significant Hill-Sachs lesions according to the older concept of engaging/ nonengaging lesions of Burkhart were reported in 104 cases (34%). Clinically significant lesions according to the newer concept of Yamamoto and DiGiacomo (the so-called off-track lesions) were observed in 173 cases (55.6%). Classified as critical were the clinically insignificant lesions (the so-called on-track lesions), which by their location were near the glenoid track. These lesions were found in 80 patients. After adding up the significant (off-track) and critical on-track lesions, we arrived at 253 (81.4%) clinically significant lesions based on the updated Yamamoto concept. DISCUSSION The frequency of Hill-Sachs lesions and glenoid defects identified by us is close to the upper limit of the range described in literature (8 to 100%). Based on the recent study by Yamamoto, added to these defects were the so-called peripheral ontrack defects, the clinical significance of which is currently indisputable. The oldest classification into engaging/nonengaging lesions revealed only 34% of the significant lesions, but this concept does not evaluate the glenoid defect. The newer concept by Yamamoto/DiGiacomo resulted in detecting 55.6% of significant Hill-Sachs lesions. The latest modification of the glenoid track of 2020, which includes also the on-track lesions in the critical zone among the significant lesions, in our group of patients classified 81% of lesions as clinically significant. CONCLUSIONS Our study confirmed the very frequent occurrence of clinically significant Hill-Sachs lesions in shoulder instabilities. Therefore, for the sake of successful shoulder stabilisation surgery detailed preoperative planning with 3D CT of the shoulder joint and evaluation of the associated bone lesions are necessary. The highest detection of clinically significant lesions was achieved by the latest modification of the glenoid track concept. Future studies will have to prove the effect of this classification on the result of surgical treatment. Key words: shoulder instability, glenoid track; bone defects, Hill-Sachs lesion; bipolar lesions; 3D CT evaluation.

[Arthroscopic Superior Capsule Reconstruction Using the DX Reinforcement Matrix in Patients with Irreparable Rotator Cuff Tears - Pilot Data]. / První výsledky artroskopické rekonstrukce horní kapsuly ramenního kloubu u nereparabilní ruptury manzety rotátoru pomocí DX Reinforcement Matrix.

PURPOSE OF THE STUDY Irreparable rotator cuff tear continues to be a point of discussion. Several surgical techniques have been proposed so far. None of them, however, can be considered the method of choice. This study presents the first clinical results of superior capsule reconstruction (SCR) using the DX Reinforcement Matrix. MATERIAL AND METHODS The evaluation included patients with the minimum follow-up of 6 months. The follow-up period in these patients was 1 year (6-18 months) on average. The active (AROM) and passive (PROM) ranges of motion were assessed-anterior flexion, abduction, external rotation and external rotation at 90° abduction. The patients were assessed using clinical scores before and after the surgery-pain assessment scale (VAS), UCLA (University of California at Los Angeles) Shoulder Rating Scale and ASES (American Shoulder and Elbow Surgeons) Shoulder Score. RESULTS In the period from October 2016 to October 2018, a total of 20 SCRs were performed. The mean age of patients was 61 years. Nine patients were clinically assessed, with the mean follow-up of 1 year. The mean UCLA Shoulder Score was 10 points preoperatively. Postoperatively, the values went up to 29 points on average. The reported ASES score was 23.8 points preoperatively. Postoperatively, the mean score was 73.2 points. The VAS subjective pain score ranged around 7 points before the surgery. After the surgery, the mean VAS score was 2 points. The mean active shoulder flexion was 74° preoperatively and 161° postoperatively. The mean active abduction was 74° preoperatively and 161° postoperatively. The mean active external rotation of the shoulder joint was 20° preoperatively and 56° postoperatively. The mean active external rotation at 90° abduction was 21° preoperatively and 82° postoperatively. The changes in all the followed-up mean parameters of UCLA, ASES, VAS, AROM and PROM reported by our group show a relatively high level of substantive significance. DISCUSSION Results of arthroscopic superior capsule reconstruction using the DX Reinforcement Matrix have not been published in literature so far. Compared to the results for fascia lata published in literature, our results are slightly worse. By contrast, our results are similar to those achieved by human dermal allograft. CONCLUSIONS Arthroscopic superior capsule reconstruction currently appears to be the method of choice in unreconstructed supraspinatus and infraspinatus tear. Our group of patients shows that early clinical outcomes of SCR using xenograft are very promising. A significant pain relief and a considerable improvement in the range of motion of the operated shoulder joint were observed. No complication specifically associated with the use of xenograft has been reported as yet. A longer follow-up period and assessment of a larger group of patients will be necessary to confirm the success of this surgical procedure. Key words: massive rotator cuff tears; irreparable rotator cuff tears; superior capsular reconstruction; xenograft; DX Reinforcement Matrix.

[Short-Term Outcomes of Endoscopic Treatment of Inferior Calcar Calcanei in Patients with Plantar Fasciitis]. / Krátkodobé výsledky endoskopické ablace patní ostruhy u pacientu s plantární fasciitidou.

PURPOSE OF THE STUDY The prospective study evaluates the short-term outcomes of endoscopic treatment of calcar calcanei in patients who underwent unsuccessfully more than 6 months of conservative therapy. MATERIAL AND METHODS Our study included 34 patients with refractory plantar fasciitis, in whom endoscopic treatment of inferior calcar calcanei with partial plantar fasciotomy was performed in the period from 01. 01. 2009 to 31. 07. 2015. The assessed parameters were the following: level of function, pain relief and patient satisfaction on the FAAM (Foot and Ankle Ability Measure) score and VAS (Visual Analog Scale) score with the minimum follow-up of 1 year. RESULTS A marked increase in the FAAM score from 39.2 preoperatively to 94.0 one year after the surgery and also a major pain relief on the VAS score from the initial 8 to the median 0 were observed. In total, 79.4% of patients were symptom-free one year after the surgery. The recurrence of calcar calcanei or ossification was seen on the radiograph taken one year after the surgery in 8 patients (23.5 %). DISCUSSION In our opinion, the most important outcome of our study is the considerable reduction in pain postoperatively (the median VAS score declined from 8 to 0 one year after the surgery) and concurrently a notable increase in the FAAM score (from 39.2 preoperatively to 94.0 one year after the surgery). Similar results of endoscopic partial fasciotomy were achieved also by some other authors. Therefore, this method can be considered validated. It has also been proven that the correlation between the calcar calcanei recurrence, or a higher BMI and recurrence of symptoms postoperatively is insignificant. CONCLUSIONS The endoscopic treatment of inferior calcar calcanei and plantar fasciotomy with denervation of fascial attachment is a fast, minimally invasive and safe method which brings very satisfactory results in the treatment of refractory plantar fasciitis. It is evidenced by subjective patient satisfaction, great function improvement, considerable pain relief after the surgery together with a minimum incidence of complications. Kew words:hindfoot, plantar heel pain, plantar fasciitis, arthroscopic treatment, short-term results.

[Arthroscopic stabilisation of the shoulder. Risk factors for its failure]. / Proc selhávají artroskopické stabilizacní operace na ramenn??m kloubu.

PURPOSE OF THE STUDY: Shoulder instability adversely affects the quality of life and restricts the functional capacity of the upper extremity involved. Today stabilisation surgery is almost always performed arthroscopically. The aim of this study was to present our experience with arthroscopic stabilisation of the shoulder and to identify risk factors responsible for its failure. MATERIAL AND METHODS: The group of 110 patients with recurrent anterior dislocation of the shoulder, who were treated between January 2007 and December 2010, consisted of 19 women and 91 men with an average age of 27 years (range, 14 to 56) at the time of surgery. Patients who had a concomitant tear of the rotator cuff or of the long head tendon of the biceps were excluded from the study. The minimum follow-up period was 2 years. The patients were evaluated for signs of clinical instability. Function was evaluated using WOSI, Constant-Murley and Rowe-Zarins. Statistical methods were used to assess factors leading to failed arthroscopic stabilisation. RESULTS: At final follow-up, 17 patients (17 shoulders, 15.3%) had re-dislocation or subluxation of the joint treated. Age over 20 years reduced the probability of re-dislocation (odds ratio, OR=0.87; p=0.021) while the finding of an engaging Hill-Sachs lesion increased the risk of re-dislocation (OR=5.53; p=0.0028). The presence of a bony Bankart lesion had only a marginal effect on the probability of re-dislocation (p=0.0512). In stable shoulders the average pre-operative values improved to the final follow-up values as follows: WOSI index, 53.65 ± 5.6 to 94.8 ± 5.2 (p<0.0001); Constant-Murley score, 78.9 ± 6.1 to 95.6 ± 4.4 (p<0.0001); and Rowe-Zarins score, 53.3 ± 6.7 to 92.9 ± 7.8 (p<0.0001). No peri-operative complication was recorded. DISCUSSION: Our study confirmed the role of 3D CT examination before arthroscopic stabilisation of the shoulder joint. The exact identification of bone injury and its extent is of prognostic importance. At the same time special attention should be paid to surgical and post-operative tactics in patients operated on before their 20 years of age. On the other hand, no risks were found to be associated with gender, sports activities, the number of previous dislocations, types of anchors, suture material or knot tying. CONCLUSIONS: Arthroscopic stabilisation of the shoulder significantly relieves pain and improves shoulder function in 85% of the patients with anterior shoulder dislocation. The risk that this stabilisation surgery will fail increases with lower age of the patient and the presence of an engaging Hill-Sachs lesion.

[Evolution of the technique of arthroscopic reinsertion of the rotator cuff. Our experience from the years 1998 to 2008]. / Vývoj operacní techniky artroskopické reinzerce manzety rotátoru: nase zkusenosti z let 1998-2008.

PURPOSE OF THE STUDY: A rotator cuff tear is a relatively frequent cause of pain and restricted motion of the shoulder. Some orthopaedists believe that any attempt at rotator cuff reconstruction will fail. The aim of this paper is to present our experience with arthroscopic reconstruction of rotator cuff tears. MATERIAL AND METHODS: Between January 1998 and December 2008, 319 patients with an early diagnosis of rotator cuff rupture were treated. The group included 67 women and 252 men, with an average age of 37 years (range, 24 to 71 years) at the time of surgery. The patients indicated for arthroscopic reconstruction had to show free motion of the shoulder, had a full thickness tear up to 3 cm in size in the sagittal plane and a Patte stage 2 tear in the frontal plane at the maximum. The outcome of surgery was evaluated at one year of follow-up and included the patient's self-assessment, modified UCLA score and incidence of complications. The probability of failure was calculated as an odds ratio of an implant failure to failure of the other implants and the probability of repeat surgery in a given implant was calculated as a relative risk in relation to the other implants. RESULTS: The average operative time was 52 minutes (range, 25 to 85); the average UCLA score increased from 10 to 31 points (p<0.00001). An excellent or a good result was achieved in 80% of the patients. Rotator cuff reconstruction failed in 32 patients (11%), of whom 22 (7.6%) underwent revision surgery. The failure was due to migration of rotator cuff anchors or thread failure in 14 patients (14/32; 44%). The GII anchors showed the highest risk of failure, with the odds ratio of 5.55 (95 % CI, 2.22 to 13.84) for mechanical failure of the method and a relative risk of revision surgery of 7.62 (95% CI, 2.86 to 20.27). For comparison, the RC anchors had the odds ratio for mechanical failure equal to 0.55 (95 % CI, 0.25 to 1.24) and the relative risk of repeat surgery equal to 0.41 (95% CI, 0.12 to 1.43). In addition, 18 complications were recorded. The frequency of deep wound infection was 0.7% (2/319). Six patients (2.1%) required repeat surgery for symptomatic bursitis and adhesive capsulitis. DISCUSSION: A recent meta-analysis has found no significant difference between the results of surgical rotator cuff reconstruction and its conservative treatment. We do not support this view but present here evidence that, when certain conditions are fulfilled, arthroscopic reconstruction can produce a very good clinical outcome. CONCLUSIONS: The arthroscopic reconstruction of a rotator cuff tears results in a marked relief of pain and improved joint function. An ideal candidate for this treatment should show passive free motion at the shoulder joint, no clinical signs of bursitis, and mobilisable tendon stumps of the torn rotator cuff. In addition, these patients should be highly motivated for post-operative rehabilitation. A suture device was most effective in rotator cuff repair. For good fixation into the bone it is recommended to use special implants that have a minimal risk of dislodgement or anchor thread failure.

[Experiences and first outcome of posterior ankle arthroscopy]. / Artroskopie zadního hlezna - nase zkusenosti a první výsledky.

PURPOSE OF THE STUDY: Many hind foot problems can be treated by endoscopic procedures. It is essential to identify the best candidates for this treatment and also to assess the risk associated with these surgeries. Here we present our first experience with posterior ankle arthroscopy. MATERIAL AND METHODS: Between September 2007 and September 2009, we performed 21 arthroscopic procedures on the posterior ankle (one-stage combined anterior and posterior surgery, 11x; posterior procedure, 7x; two-stage anterior and posterior surgery, 3x). The group included 21 patients, 18 men and three women, with an average age of 36 years (20 to 64) at the time of surgery. The average follow-up was 27 months (16 to 38). Both posterolateral and posteromedial approaches were used, with major landmarks being the processus posterior tali, posterior talofibular ligament and long flexor tendon of the big toe. Surgery was performed by experienced specialists. Outcome evaluation was based on the AOFAS and Kitaoka clinical rating scales and the complication rate. RESULTS: In our group, the diagnoses treated by arthroscopic surgery were as follows: arthrofibrosis (16x; 76 %), hypertrophic processus posterior tali (13x; 62 %), and loose intra-articular bodies (8x; 38 %). All patients reported improvement in clinical condition after surgery. The differences between the mean pre- and post-operative values were 24 points for the AOFAS score (58 versus 82; p<0.00015) and 23 points for the Kitaoka score (58 versus 81; p < 0.00015). The most effective outcomes were achieved in the patients operated on for loose bodies or hypertrophic processus posterior tali. The worst result was found in the patient with advanced arthritis of the ankle that had to undergo arthrodesis 13 months following arthroscopic treatment. There were eight complications in five patients (24 %), including excessive bleeding in five cases, temporary loss of sensation in two, and a damaged tendon of the long flexor of the big toe. DISCUSSION: Arthroscopic surgery has recently been advocated by many authors. The majority of them have reported good results and an acceptable risk of complications. Almost all use either the posteromedial or the lateral approach, which are anatomically safe procedures. Surgery is followed by a thorough rehabilitation programme that allows most patients to resume their normal daily activities in 8 weeks. Our results were not so good because we mostly treated post-traumatic conditions, with advanced ankle arthritis in several patients. CONCLUSIONS: Arthroscopy is an effective method for treating both intra- and extra-articular pathologies in the posterior ankle. The best effect of treatment was recorded in posterior tibiotalar impingement syndrome or after extraction of loose intra-articular bodies. In advanced ankle arthritis, on the other hand, the use of arthroscopic treatment should be carefully considered. The risk of complications is high and the procedure requires good knowledge of anatomy and high surgical skills.