Identifying iliotibial band graft length and incision site may minimise the potential risk of harming adjacent structures: A novel approach for surgeon guidance.

PURPOSE: The Iliotibial band (ITB) is a fibrous thickening of the fascia lata originating at the iliac crest and inserting at Gerdy's tubercle on the lateral tibia. The ITB significantly contributes to lateral knee stabilisation. Due to its size, tensile strength and easy access, it is widely used in orthopaedic surgery as an autograft during reconstruction procedures. Although ITB harvesting may result in complications, such as reduced knee extension or hip flexion, no safety margins or guidelines have been proposed for the procedure. Our aim was to determine the maximal safe length of an ITB graft, that is, that does not harm the lateral collateral ligament (LCL), tensor fasciae latae (TFL), gluteus maximus (GM) or adjacent structures, and reduce the complication rate. METHODS: The study included 50 lower limbs of 25 human cadavers, previously fixed in 10% formalin solution. The inclusion criterion was the lack of visible signs of surgical interventions in the study region. Forty lower limbs were included in the study: 16 female (mean age 83.1 ± 3.4 years) and 24 male (mean age 84.2 ± 6.8 years). Dissection was performed with a previously established protocol. Morphometric measurements were then obtained twice by two researchers. RESULTS: The mean femur length was 404.8 mm [female (F) = 397.3 mm, male (M) = 409.9 mm, standard deviation (SD): F = 23.8 mm, M = 24.1 mm]. The mean ITB length was 318.9 mm (F = 309.4 mm, M = 325.2 mm, SD: F = 25.7 mm, M = 33.7 mm). Longer femurs were associated with longer ITB (p < 0.05). The mean distance from the insertion of the GM to the myofascial junction of TFL and ITB was 34.6 mm (F = 34.5 mm, M = 34.6 mm, SD: F = 3.2 mm, M = 3.3 mm). The longer femurs or ITBs demonstrated a greater distance from GM insertion to the myofascial junction of the TFL and ITB (p < 0.05). CONCLUSION: ITB grafts longer than 21 cm may contribute to the greater risk of TFL rupture. Based on simple measurements of the femur length, the surgeon may assess approximate ITB length, and thus assess the length of the maximal graft length. Moreover, to avoid harming the LCL, the incision should be performed 5 cm proximal to the articular surface of the lateral femoral condyle or 13 mm proximal to the lateral femoral epicondyle. Such preparation and preoperative planning may greatly reduce the risk of complications during ITB harvesting, while performing, for instance, the over-the-top technique for anterior cruciate ligament reconstruction in skeletally immature patients. LEVEL OF THE STUDY: Basic I.

Morphological variability of lateral femoral cutaneous nerve and its potential clinical significance.

BACKGROUND: The lateral femoral cutaneous nerve is derived from the dorsal branches of the L2 and L3 spinal nerves. It travels across the pelvis and heads towards the anterior superior iliac spine. It passes under the lateral part of the inguinal ligament and then divides into two branches, which are responsible for sensory innervation of the anterolateral and lateral skin of the thigh. However, the course of this nerve can vary morphologically. Numerous differences have been observed in its exit from the pelvis and in the number of its main trunks and branches. Additionally, its angle with the inguinal ligament and its placement in relation to other structures (such as the femoral artery, femoral nerve, and the sartorius and iliacus muscles) also vary. All of these variants have potential clinical implications. Therefore, the aim of this review is to present the morphological variability of the lateral cutaneous nerve and to explore how these anatomical differences can introduce clinical concerns. MATERIALS AND METHODS: Presented review of the literature was written based on over 30 studies. Comprehensive literature search was done using PubMed in order to study the morphological variability of lateral femoral cutaneous nerve (LFCN). To be included in this review studies needed to be meet certain criteria: been published before December 2023, present information valuable to this paper (variability of lateral femoral cutaneous nerve/clinical significance). The search included how LFCN vary either among fetuses and adults in the aim of providing more complex information about the variability of this nerve. During the search key words as following were used. No particular references were excluded from the analysis. All relevant studies were included, and citation tracking was used to identify publications. RESULTS: This review presents the description of variability of LFCN and its potential clinical impact. In the review differences in adult and fetuses were considered, morphological variability were divided into 4 groups: the origin of the nerve, the way it leaves the pelvis, the branching pattern, the angle between LFCN and surrounding structures and then, clinical significance were considered basing on available literature.

Remplissage May Decrease the Redislocation Rate After Arthroscopic Bankart Repair in Patients With an Engaging Hill-Sachs Defect: A Systematic Review and Meta-analysis of Studies With Minimal 2-Year Follow-up.

BACKGROUND: The redislocation rate after arthroscopic Bankart repair (BR) among patients with a Hill-Sachs lesion (HSL) may be reduced with the use of remplissage. PURPOSE: To investigate the outcomes of adding remplissage to an arthroscopic BR in patients with concomitant HSL. STUDY DESIGN: Meta-analysis; Level of evidence, 3. METHODS: PubMed and ScienceDirect databases were searched between February 2022 and April 2023 with the terms "remplissage" and "shoulder instability" according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were formed using the population, intervention, control, and outcome method; the investigation included studies that compared BR with and without remplissage and had ≥24 months of follow-up. RESULTS: From 802 articles found during the initial search, 7 studies with a total of 837 patients-558 receiving isolated BR (BR group) and 279 receiving BR with remplissage (BR+REMP)-were included. The probability of recurrence of instability among patients with an engaging HSL was significantly diminished in the BR+REMP group compared with the BR group (odds ratio, 0.11; 95% CI, 0.05 to 0.24; P < .001). Regarding shoulder range of motion, the BR+REMP group achieved increased forward flexion (mean difference [MD], 1.97°; 95% CI, 1.49° to 2.46°; P < .001) and decreased external rotation in adduction (MD, -1.43°; 95% CI, -2.40° to -0.46°; P = .004) compared with the BR group. Regarding patient-reported outcome measures, the BR+REMP group had Rowe (MD, 2.53; 95% CI, -1.48 to 6.54; P = .21) and Western Ontario Shoulder Instability Index (WOSI) (MD, -61.60; 95% CI, -148.03 to 24.82; P = .162) scores that were comparable with those of the BR group. CONCLUSION: Remplissage resulted in a 9-fold decrease in the recurrence of instability after arthroscopic BR in patients with HSL. Remplissage not only led to an increase in forward flexion but also only slightly limited patients' external rotation in adduction. WOSI and Rowe scores after remplissage at the final 24-month follow-up were comparable with those obtained after isolated Bankart repair.

Anatomic Variations of the Calcaneofibular Ligament.

BACKGROUND: The lateral ankle joint comprises the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). The purpose of this study was to propose a classification of CFL morphology. METHODS: The material comprised 120 paired lower limbs from human cadavers (30 male, 30 female), mean age 62.3 years. The morphology was carefully assessed, and morphometric measurements were performed. RESULTS: A 4-part method for anatomic classification can be suggested based on our study. Type 1 (48.3%), the most common type, was characterized by a bandlike morphology. Type 2 (9.2%) was characterized by a Y-shaped band, and type 3 (21.7%) by a V-shaped band. Type 4 (20.8%) was characterized by the presence of 2 or 3 bands. Type 2 and 4 were divided into further subtypes based on origin footprint. CONCLUSION: The aim of our study was to describe variations of calcaneofibular ligament. Our proposed 4-part classification may be of value in clinical practice in future recognition of CFL injuries and in its repair or reconstruction. CLINICAL RELEVANCE: The anatomy of the CFL plays an important role in stability of the ankle. Greater recognition of anatomical variation may help improve reconstructive options for patients with chronic lateral ankle instability.

Mobility of the lumbo-pelvic-hip complex (spinopelvic mobility) and sagittal spinal alignment - implications for surgeons performing hip arthroplasty.

INTRODUCTION: The optimal positioning of the hip prosthesis components is influenced by the mobility and balance of the spine. The present study classifies patients with pathology of the spino-pelvic-hip complex, showing possible methods of preventing hip dislocations after arthroplasty. HYPOTHESIS: Hip-Spine Classification helps arthroplasty surgeons to implant components in more patient-specific position. MATERIALS AND METHODS: The group of 100 patients treated with total hip arthroplasty. Antero-posterior (AP) X-rays of the pelvis in a standing position, lateral spine (standing and sitting) and AP of the pelvis (supine after the procedure) were analyzed. We analyzed a change in sacral tilt value when changing from standing to sitting (∆SS), Pelvic Incidence (PI), Lumbar Lordosis (LL) Mismatch, sagittal lumbar pelvic balance (standing position). Patients were classified according to the Hip-Spine Classification. Postoperatively, the inclination and anteversion of the implanted acetabular component were measured. RESULTS: In our study 1 A was diagnosed in 61% of all cases, 1B in 18%, 2 A in 16%, 2B in 5%. 50 out of 61 (82%) in group 1 A were placed within the Levinnek "safe zone". In 1B, 2 A, 2B, the position of the acetabular component was influenced by both the spinopelvic mobility and sagittal spinal balance. The mean inclination was 43.35° and the anteversion was 17.4°. CONCLUSIONS: Categorizing patients according to Hip-Spine Classification one can identify possible consequences the patients at risk. Pathology of the spino-pelvic-hipcomplex can lead to destabilization or dislocation of hip after surgery even though implanted according to Lewinnek's indications. Our findings suggest that Lewinnek safe zone should be abandoned in favor of the concept of functional safe zones.

A very rare case of the accessory palmaris longus muscle and clinical significance.

The palmaris longus muscle is located in the forearm region. It morphological variability was noted during standard anatomical dissection of the upper limb. The muscle was characterized by a normal course, i.e. originating from the medial humeral epicondyle and inserting to the palmaris aponeurosis, but a small additional tendon attached to the flexor retinaculum was observed in its distal part. An accessory palmaris longus muscle was also observed nearby. Interestingly, this accessory muscle was reversed, and the first part was not muscular, but tendinous, represented by two tendons originating from the common muscular mass attached to the medial epicondyle of the humerus; these later connected together, creating one muscle belly distally attached to the flexor retinaculum. This additional structure was innervated by a neural branch from the median nerve and the ulnar artery was responsible for blood supply. The course of the median nerve is also clinically important, because before entering the carpal tunnel, it was located directly under the accessory palmaris longus muscle. In turn, the ulnar artery passed through a special hole created by the flexor digiti minimi brevis and flexor retinaculum, before passing under the palmaris brevis muscle.

Congenital, Acquired, and Trauma-Related Risk Factors for Thoracic Outlet Syndrome-Review of the Literature.

Thoracic outlet syndrome is a group of disorders that affect the upper extremity and neck, resulting in compression of the neurovascular bundle that exits the thoracic outlet. Depending on the type of compressed structure, the arterial, venous, and neurogenic forms of TOS are distinguished. In some populations, e.g., in certain groups of athletes, some sources report incidence rates as high as about 80 cases per 1000 people, while in the general population, it is equal to 2-4 per 1000. Although the pathogenesis of this condition appears relatively simple, there are a very large number of overlapping risk factors that drive such a high incidence in certain risk groups. Undoubtedly, a thorough knowledge of them and their etiology is essential to estimate the risk of TOS or make a quick and accurate diagnosis.

The accessory heads of the quadriceps femoris muscle may affect the layering of the quadriceps tendon and potential graft harvest lengths.

PURPOSE: The aim of the study was to assess the quadriceps femoris system for the presence of additional layers. METHODS: One hundred and twenty-eight lower limbs fixed in 10% formalin were examined. RESULTS: Five types of quadriceps tendon layering were found based on the accessory heads of the quadriceps muscle. Type I (55%)-represented by four heads and four layers, and it was something new because standard orthopaedic textbooks described quadriceps tendon as a structure composed of only three layers. Type II (27.4%)-the first four layers were the same as in Type 1, but the accessory tendon of the fifth head of the quadriceps femoris muscle had the deepest attachments. Type III (10.9%)-this type included 6 heads of quadriceps femoris. It consisted of five layers. Type IV (3.1%)-this type included 7 quadriceps femoris heads. This type consisted of only four layers. Type V (3.1%)-this type included 8 heads of the quadriceps femoris heads. This type consist of 5 layers. CONCLUSION: The findings of this study provide a detailed anatomy of the quadriceps tendon including the accessory tendons of the accessory heads of the quadriceps tendon. The accessory heads of the quadriceps femoris muscle contribute to the layering of the quadriceps tendon. The second conclusion of this study is the development of safe distances depending on the types. Not all types are perfect for harvesting-Type IV seems to be the safest type, in turn Type V the most dangerous.

An Analysis of the Preoperative Factors, Spinopelvic Mobility and Sagittal Spinal Alignment in Pre-THA Patients.

Hip arthroplasty is a very effective medical procedure. The optimal positioning of the components and the functioning of the endoprosthesis are influenced, among other things, by the mobility and balance of the spine. The aim of the study was to analyze the factors influencing the mobility of the lumbar-pelvic-iliac complex (spinopelvic mobility) together with the assessment of sagittal spinal alignment in patients prior to THA (total hip arthroplasty). Patients who underwent hip replacement surgery due to advanced osteoarthritis of the hip were enrolled in the study (n = 103). The sociodemographic characteristics, BMI, radiological advancement of the degenerative disease, quality of life, and range of joint mobility were completed using a proprietary questionnaire, the EQ-5D-5L questionnaire, and a clinical examination. X-ray images were analyzed: AP of the pelvis standing up, lateral of the spine standing and sitting. Key parameters were measured as ∆SS-change in sacrum angle value when changing from standing to sitting position and pelvic incidence (PI)-lumbar lordosis (LL) mismatch-sagittal lumbar pelvic balance measured in standing position. The patients were assigned to the appropriate groups according to the Hip-Spine Classification: normal group: 1A (n = 65; 63.1%), abnormal groups: 1B (n = 17; 16.5%), 2A (n = 16; 15.5%), 2B (n = 5; 4.9%). A correlation was shown between the abnormal groups and the individual components of PROMs in the scope of the self-service and normal activities categories (EQ-5D and EQ-VAS). However, the strength of the relationship turned out to be moderate, and the remaining components of the survey were statistically insignificant. The remaining factors analyzed, i.e., age, BMI, the range of hip motion, the presence of contracture in the joint in a clinical examination, and the radiological advancement of osteoarthritis on the Tonnis scale, do not predict abnormal relationships between the spine and the pelvis in our patients waiting for THA. Therefore, further investigations are needed to evaluate the correlation between preoperative factors and the lumbar-pelvic-iliac complex in patients prior to planned hip arthroplasty.

Time of Return to Work (RTW) May Not Correlate with Patient-Reported Outcomes Measurements (PROM) at Minimum One Year Post Arthroscopic Bankart Repair.

It is widely recognized that work serves a dual role by not only ensuring financial independence but also functioning as a vital source of psychosocial well-being and contributing significantly to the attribution of meaning in life. The cost of work disability can be a multifactorial problem for both employers and workers; thus the inability to return to work (RTW) may have a destructive effect on mental health and confidence. Shoulder surgery is one of the conditions that inevitably impacts patients' ability to work. As current data focus on restoring range of motion, strength, and the patients' activity, to this day the data about RTW post shoulder surgery remain limited. The purpose of this study was to evaluate the return-to-work time of patients treated with an arthroscopic Bankart repair and to evaluate if patient-reported outcomes (PROM) correlate with the incapacity to work after an arthroscopic Bankart repair. We performed a retrospective review by conducting a questionnaire with patients more than 12 months after surgery and we identified 31 patients who met the criteria for the study and were able to contact 17 of them. In this paper we demonstrated that on average among groups working physically and at the office we may expect patients who underwent arthroscopic Bankart repair to return to work within 7 weeks from the surgery, with office workers tending to return significantly faster with an average of 2.5 weeks (p = 0.0239).

Coexistence of rare varieties of palmaris profundus and flexor superficialis muscle.

The superficial layer of the anterior compartment of the forearm is characterized by different morphological variations. During standard anatomical dissection, two morphological variations in the superficial compartment of the forearm were observed. The first one was the palmaris profundus, which originated from the radius and distally fused with the tendon to 3rd digit (from the flexor digitorum superficialis muscle) inserted on the medial phalanx of the third digit. The second variation was a distinct superficial flexor of the 4th digit represented by one muscle belly with originated from a common mass from the medial humeral epicondyle, passes through the carpal tunnel, and is inserted into the medial phalanx of the fourth digit. The flexor digitorum superficialis muscle was located deeply to it and it was divided only into three tendons (to 2nd, 3rd, and 5th digits). Tendons connected to the 2nd and 3rd digits were crossed with each other at the level of carpal tunnel. From the humeroulnar head of the flexor digitorum superficialis muscle, an additional muscle belly was arising and its tendon was fused with the superficial flexor of the fourth digit. Knowledge about morphological variations in this region is clinically important because of the direct correlation with the median nerve, and the possibility to cause carpal tunnel syndrome.

Immunohistochemical analysis of the ligamentum mucosum is the key to understand its clinical usefulness.

Ligamentum Mucosum(LM) is a ligamentous structure within the synovial layer of the knee joint capsule. For a long time LM was perceived as the vestigial remnant from the embryological development of the knee. Being treated as an irrelevant structure LM was often the first victim of shaver during arthroscopy. However, last years have shown increased interest in this structure due to its potentially significant clinical role. Our aim was to classify LM based on its morphological characteristics and examine its microanatomy using immunohistochemical analysis to reveal the potential clinical value for surgeons. We have examined sixteen fresh frozen lower limbs, 6 females (mean age 83.1 ± 3.4 years) and 10 males (mean age 84.2 ± 6.8 years). Classical histological H+E stain was routinely conducted. Subsequently, CD31 antibody (DAKO, Monoclonal Mouse Anti-Human, Clone JC70A) was used to mark vascular epithelium. Monoclonal Mouse Anti-Human Neurofilament Protein (NFP) antibody (DAKO, Clone 2F11) was used to expose the nerves. Moreover, we have conducted arthroscopic visualizing and suturing LM to the torn ACL during routinely performed arthroscopic suturing of the ACL. The dissection process has revealed that LM was present only in 75% of cases. Histological examination confirmed the presence of longitudinal collagen fiber bundles in all samples. Tiny nerves were confirmed by NFP, along the subsynovial layer in all samples. CD-31 immunostain revealed the presence of many vascular vessels along the entire ligament, especially well developed at its distal end. Our study has revealed that LM contains rich vascular network. Thus, it may be a donor for the revascularization process after ACL tear or reconstruction which may improve the recovery. Another great advantage of the LM is the presence of nerves along the subsynovial layer, hopefully they may serve as the source of reinnervation and hence better clinical outcome. Based on our results we believe that seemingly irrelevant LM may be very useful during surgical procedures in the knee region. Suturing LM to the ACL may not only prevent the infrapatellar fat pad from subluxation but also improve the blood flow and reinnervation of the injured ACL. Until now there are only a few studies examining microanatomy of the LM. This basic knowledge may serve as the foundation for surgical procedures. Hopefully our findings may be useful for surgeons while planning surgical procedures or clinicians while diagnosing patients who suffer anterior knee pain.

An assessment of the dietary habits among road cyclists competing in amateur races.

From year to year, practicing various sports by amateur athletes is becoming more and more popular. One of such sports is road cycling. To achieve very good sports performance athletes should pay attention not only to physical activity but also to proper nutrition and hydration of the body. The aim of the study was to assess amateur cyclists' dietary habits, especially nutrition and hydration, including assessment of the regularity of eating meals, type of consuming products and fluid intake preferences. The study recruited 41 men aged 23-75 years (43.76 ± 13.25) participating in amateur race road cycling. To obtain information about nutrition and hydration, an original questionnaire was used. Out of all participants, 65.9% declared that they pay attention to their diet, and as many as 75.6% indicated that they eat meals regularly. The vast majority (43.9%) of the cyclists declared consuming four meals a day. Most of the cyclists consumed meat products several times a week-73.2% and dairy products-43.9%. The participants most often chose only one portion of fruit (41.5%) and vegetables (31.7%) during the day. The vast majority of cyclists consumed 3 L of fluids on a training day-51.2%. It turned out that all of the athletes hydrated during training: before it was 68.3% and after training-92.7%. We conclude that the amateur cyclists pay a lot of attention to their nutrition and hydration. During the day, most athletes eat an appropriate amount of meals on a regular basis and drink the right amount of fluids. However, eating of dairy, fruits and vegetables, or hydrating before exercising is insufficient.

A new look at quadriceps tendon - Is it really composed of three layers?

BACKGROUND: The aim of this study was to qualitatively and quantitatively describe the anatomy of the QT including its size, its layers and relationship between layers. METHODS: Sixty lower limbs (15 females and 15 males fixed in 10% formalin were examined. A retrospective analysis of 20 thigh MRI examinations was performed (10 males, and 10 females). RESULTS: In all dissected specimens, the quadriceps femoris was composed of 4 layers: superficial (first layer), middle (second layer), middle-deep (third layer) and deep (fourth layer). The first layer (superficial) was formed by the rectus femoris tendon and fascia. The second layer was composed of tendons of the vastus medialis and superficial part of the vastus lateralis. The third layer was formed by the intermediate part of the vastus lateralis. The fourth layer was composed of the tendon of the vastus intermedius. This type of anatomy was visualized in 4 males and 2 female on MRI scans. CONCLUSION: The findings of this study provide a detailed anatomy of the quadriceps tendon. There were 4 different layers of the QT consistently found in all specimens. The first layer was independent and composed by the rectus femoris tendon, the second was formed by the superficial part of the vastus lateralis and vastus medialis. The third layer was formed by the intermediate part of the vastus lateralis, and the deepest fourth layer was composed of the vastus intermedius. This detailed structural anatomy was also able to be visualized on MRI scans.

More than 20 years of experience with Dega transiliac osteotomy in the treatment of dislocated hip joints in children with cerebral palsy.

Cerebral palsy in children, which is the result of a nonprogressing damage to the central nervous system, causes motor and posture disorders that change with age. The level of child activity correlates with the hip dislocation risk. It most often affects nonwalking patients and those with tetraparesis or oblique pelvis. The aim of the study was to assess the effectiveness and clinical value of Dega pelvic osteotomy with accompanying directional femoral bone osteotomy after minimum of 20 years from surgery of patients with cerebral palsy. The conducted research was retrospective and concerned the children operated at our Hospital. The assessment was carried out in 346 children with spastic hip during the years 1993-2000. The inclusion criteria were applied: unilateral dislocation of the hip, the observation period of at least 20 years, pelvic osteotomy by Dega method and combined with varus derotation femur osteotomy. The analysis involved fifteen patients. The follow-up period was minimum 20 years (20-27 years). The average migration percentage decreased from 88% down to 25%, and an improved range of mobility was observed in the operated joint after surgery. However, the range of mobility was again significantly reduced during the last control examination after a minimum of 20 years. In all hips, the degenerative joint disease was present. Pelvic transiliac osteotomy, according to Dega, with VDRO, ensures very effective correction of the deficit in femoral head coverage by the acetabulum in the upper, lateral and posterior parts. However, it does not prevent the development of the early degenerative disease of the joint.

How to Differentiate Pronator Syndrome from Carpal Tunnel Syndrome: A Comprehensive Clinical Comparison.

The diagnostic process that allows pronator syndrome to be differentiated reliably from carpal tunnel syndrome remains a challenge for clinicians, as evidenced by the most common cause of pronator syndrome misdiagnosis: carpal tunnel syndrome. Pronator syndrome can be caused by compression of the median nerve as it passes through the anatomical structures of the forearm, while carpal tunnel syndrome refers to one particular topographic area within which compression occurs, the carpal tunnel. The present narrative review is a complex clinical comparison of the two syndromes with their anatomical backgrounds involving topographical relationships, morphology, clinical picture, differential diagnosis, and therapeutic options. It discusses the most frequently used diagnostic techniques and their correct interpretations. Its main goal is to provide an up-to-date picture of the current understanding of the disease processes and their etiologies, to establish an appropriate diagnosis, and introduce relevant treatment benefiting the patient.

A proposal for a new classification of the long head of the biceps brachii.

INTRODUCTION: The anterior compartment of the arm consists of three muscles: the biceps brachii, brachialis and coracobrachialis. The aim of the present study was to characterize possible variations in the morphology of the proximal attachments of the long head of the biceps brachii and to propose an accurate classification of the area which can be useful for planning surgical procedures and planning rehabilitation in the region. MATERIALS AND METHODS: Eighty (40 left and 40 right, 40 female, 40 male) upper limbs fixed in 10% formalin solution were examined. RESULTS: The main tendon of the long head of the biceps brachii demonstrated three types of attachment. The most common type, Type I (53.75%), was characterized by a single attachment only for the supraglenoid tubercle. Type III (33.75%) was characterized by a single attachment to the glenoid labrum. Type II (12.5%) was characterized by a double attachment to the glenoid labrum and the supraglenoid tubercle. Additionally, two types of the accessory tendon of the long head of the biceps brachii were identified (Type A-B). Type A (14 cases) was attached to the capsule of the humeral joint, and Type B (six cases) was attached to the greater tubercle of the humerus. CONCLUSION: The long head of the biceps brachii is characterized by high morphological variability. The new classification proposes three types of proximal attachment (I-III), with two types of accessory long head of the biceps brachii (A-B) tendon. A thorough understanding of the morphological variability of the long head of the biceps brachii is necessary when planning arthroscopic procedures or even planning rehabilitation procedures.

Early Results of Total Cementless Hip Joint Arthroplasty with a Conical Screw Cup.

BACKGROUND: With the development of hip arthroplasty, there are increasingly more indications for effective use of this surgical method. Endoprostheses are now being more and more commonly used in difficult cases of secondary coxarthrosis and in increasingly younger patients. The aim of this study is to present the early results of hip joint arthroplasty with the Zweymüller conical screw cup. MATERIALS AND METHODS: The study enrolled 117 patients (64 women and 53 men) who underwent a total of 123 hip joint arthroplasties with the Zweymüller conical screw cup. The mean age of the patients at surgery was 60.8 years (range: 26-81 years). The mean follow-up period was 7.7 years (range: 5-12.6 years). RESULTS: Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.3 points. The outcomes were classified as excellent in 42 cases (34.15%), good in 56 cases (45.53%), satisfactory in 14 (11.38%) and poor in 11 cases. Poor results were always associated with implant loosening. Heterotopic ossification was noted in 8 cases (6.5%). According to the Kaplan-Meier estimator, 5-year survival probability was 91.1% for the whole implant and 94.3% for the stem alone. CONCLUSIONS: 1. Our follow-up data (from a mean follow-up period of more than 7 years) indicate that the Zwey-müller conical screw cup affords excellent clinical and functional results in patients operated on for advanced hip osteoarthritis. 2. In patients correctly qualified for this procedure, with good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. As only medium-term follow-up data are available, there may be more cases of loosening over time, indicating a need of regular long-term follow-up.

A proposal for a new classification of the Coracobrachialis longus: A rare case or a new, distinct muscle?

BACKGROUND: The coracobrachialis muscle, along with the brachialis and biceps brachii muscles, belong to the anterior group of the brachial region. It is characterized by high level of morphological variabilities, with a common variation being the coracobrachialis longus (CBL) muscle. The CBL may be recognized as a distal part of the coracobrachialis muscle, originating from the anteromedial surface of the humerus, however, the two muscles are distinct from each other, and the distal attachment of the CBL is longer and located closer to the elbow joint. The CBL muscle may also be inserted on to various structures. The aim of the present study was to determine the frequency of the CBL muscle among a studied population, and to prepare a classification based on its morphological features. MATERIAL AND METHODS: Classical anatomical dissection was performed on 100 upper limbs from fifty human cadavers (30 female and 20 male) fixed in 10% formalin solution. RESULTS: The coracobrachialis muscle was found in all individuals, and the CBL muscle was present in 11%, i.e. 11 upper limbs: four women, and seven men; five left and six right. Significantly, in all cadavers in which the coracobrachialis longus was found, its presence was unilateral (five left and six right). A new classification of the CBL can be proposed based on its insertion: Type I characterized by a distal attachment located on the medial epicondyle (73% of all cases of the CBL) and Type II by an insertion into the olecranon (27% of all cases of the CBL). CONCLUSION: The CBL muscle is morphologically variable. More studies focused on the course of this muscle among various populations are needed. Nevertheless, our findings indicate that the CBL muscle could be classified as a distinct muscle.

Early Results of Cementless Hip Joint Arthroplasty with the Straight Zweymller Stem.

BACKGROUND: Total cementless hip joint arthroplasty is a method commonly used in the treatment of advanced hip osteoarthritis. The aim of this paper is to present the early results of hip joint arthroplasty with the straight Zweymller stem. MATERIALS AND METHODS: The study enrolled 117 patients (64 women and 53 men) who underwent a total of 123 hip joint arthroplasties with the straight Zweymller stem. The mean age of the patients at surgery was 60.8 years (range: 26-81 years). The mean follow-up period was 7.7 years (range: 5-12.6 years). RESULTS: Pre-operative Merle dAubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.3 points. The outcomes were classified as excellent in 42 cases (34.15%), good in 56 cases (45.53%), satisfactory in 14 (11.38%) and poor in 11 cases. Poor results were always associated with implant loosening. Heterotopic ossification was noted in 8 cases (6.5%). According to the Kaplan-Meier estimator, 5-year survival probability was 91.1% for the whole implant and 95.1% for the stem alone. CONCLUSIONS: 1. Our follow-up data (from a mean follow-up period of more than 7 years) indicate that the straight Zweymller stem affords excellent clinical and functional results in patients operated on for advanced hip osteoarthritis. 2. In patients correctly qualified for this procedure, with good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. As only medium-term follow-up data are available, there may be more cases of loosening (mainly of the acetabular cup) over time, indicating a need of regular long-term follow-up.