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Vol 29, No 3 (2022)

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Original study articles

One-stage revision reconstruction of the anterior cruciate ligament using autograft: retrospective cohort study

Butkova L.L., Orletsky A.K.


BACKGROUND: Revision reconstruction of the anterior cruciate ligament (ACL) is a technically more complex procedure than primary reconstruction. Recurrence of anterior instability is most often associated with a technical error during the primary operation. The primary task of revision reconstruction is to identify the cause of recurrence of anterior instability and careful preoperative planning. Thus, the principles of ACL anatomical location to be essential restore stability. This paper discusses options for revision anatomical reconstruction of the ACL, including surgical technique, preoperative preparation, and choice of autograft material.

AIM: This study aimed to evaluate the results of a one-stage revision reconstruction of the ACL and show that this method can be performed in one stage, rather than in two stages, which will lead to a reduction in the patient’s recovery time and return to usual physical activity.

MATERIALS AND METHODS: To monitor the long-term treatment results, 50 of 92 patients with revision through one-stage ACL reconstruction, who were examined 9, and 12 months after surgery, were enrolled. All patients were young, who were working from age 18 to 42 years. The mean age was 29 years. This group included only male patients. As a graft material, all patients underwent sampling of the tendons of the fine and semitendinous muscles from the diseased or the contralateral limb. To assess the treatment results, the IKDC scale, Lysholm scale, arthrometric testing on KT-1000, and functional tests were conducted.

RESULTS: The use of developed surgical approaches made it possible to obtain good treatment results in patients with recurrences of anterior instability according to the Lysholm score of 82 points. Grade II residual lateral instability was observed in two (4%) patients in the observed group and in seven (14%) patients in the control group. According to the subjective assessment of treatment outcomes, 19 patients (38%) remained satisfied with them.

CONCLUSION: The practical application of the proposed options for the location of the channels and methods for fixing the autograft in the intraosseous channels make it possible to perform revision arthroscopic reconstruction of the ACL in one stage, without additional bone grafting of the channels, which in turn reduces the treatment and recovery time of patients, as evidenced by the results.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(3):225-235
pages 225-235 views

Aspects of vertebral column resection in patients with rigid kyphotic and kyphoscoliotic deformities of different genesis of the thoracolumbar spine: multicenter retrospective observational cohort study

Gorbatyuk D.S., Kolesov S.V., Shvets V.V., Morozova N.S., Ptashnikov D.A., Mlyavykh S.O., Bratsev I.S.


BACKGROUND: Vertebral column resection (VCR) as a type of spinal osteotomy is characterized by maximum possibilities of three-dimensional correction of various etiologies: congenital, post-tuberculous, iatrogenic (after other interventions on the spine), degenerative, and vertebral spondyloptosis caused by Kümmel’s disease, and primary, and metastatic tumor lesions of the spine. Nowadays, the use of single-level VCR is far beyond its initial purpose.

OBJECTIVE: The study aimed to compare features of VCR for rigid deformities of various etiologies and management of erythrocyte blood products in the perioperative period.

MATERIALS AND METHODS: A multicenter retrospective observational cohort study analyzed data from 53 adult (aged ≥18 years) patients with kyphotic and kyphoscoliotic deformities of the thoracic and lumbar spine, distributed into four comparison groups according to the deformity genesis, namely, impaired spinal development, traumatic genesis, degenerative or idiopathic, and neoplasms of the vertebral bodies. The characteristics of VCR in these patients were compared.

RESULTS: The surgery duration was longer in VCR for spinal neoplasms (p <0.05) than for high-energy burst compression fractures of vertebral bodies and scoliotic deformities (grade IV). On average, this group also had the most cranial osteotomy level among the study groups. VCR for idiopathic scoliotic deformities is characterized by a larger intraoperative blood loss volume than other nosologies, and the differences were statistically significant. In male patients of this group, the hemoglobin level on day 1 after surgery was statistically significantly lower than in those who underwent VCR for compression fractures of the vertebral bodies or impaired vertebral development. During resection of the vertebral column for burst compression fractures of the vertebral bodies, the fixation length was less (p <0.05), with a similar intervention for developmental anomalies, deformities of postoperative genesis, and grade IV idiopathic scoliosis. VCR for grade IV idiopathic scoliosis requires a larger (p <0.05) volume of the reinfused autologous blood than for intervention for acute traumatic pathologies (burst compression fractures of the vertebral bodies).

CONCLUSION: The versatility of clinical tasks for which resection of the spinal column can be performed using the VCR technique also determines the significant heterogeneity of the patients who undergo such treatment. Knowledge of the interventions in various nosologies is very useful in vertebrological practice.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(3):237-248
pages 237-248 views

Experimental substantiation of the use of platelet-rich plasma in combination with microfracturing in the treatment of local osteochondral defects of the hyaline cartilage of the knee joint: non-randomized controlled study

Vasyukov V.A., Vorotnikov A.A., Airapetov G.A., Chekrygin S.Y., Botasheva V.S.


BACKGROUND: Dissecting osteochondritis of the knee joint is one of the common diseases accompanied by damage to the articular cartilage. Existing conservative and surgical methods of treating osteochondral defects of the hyaline cartilage do not give full satisfactory results of restorative treatment.

OBJECTIVE: This study aimed to evaluate the effectiveness of the combined method proposed for the treatment of full-layer osteochondral defects of the knee joint.

MATERIALS AND METHODS: The experiment was conducted on 27 Romanov sheep aged 5 months to 1 year and weighing 20–35 kg. All animals were conditionally divided into three experimental groups of nine animals, each of which intraoperatively modeled the osteochondral defect of the medial condyle of both hind limbs. Moreover, the left knee joint was assigned to the experimental group, whereas the right knee joint was assigned to the control group. Thus, in first experimental group, microfracturing was performed on the left knee joint in addition to the osteochondral defect of the femoral condyle; in the second experimental groups, microfracturing and platelet-rich plasma (PRP) administration; in the third experimental group, microfracturing, and PRP administration after 3 weeks. From each group, three animals were sacrificed at 1, 3, and 6 months. Results were evaluated by macro- and microscopic examination.

RESULTS: In the first experimental group, cartilage regeneration was slow. In the second experimental group using PRP, more intensive regeneration of cartilage tissue occurred. In the third experimental group, cartilage tissue regeneration occurred more intensively.

CONCLUSION: During the experiment, in which several methods of treating osteochondral defects of the knee joint were employed, the most effective was the combined method of microfracturization and PRP administration 3 weeks after surgery.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(3):249-257
pages 249-257 views

Features of ultrasound diagnostic syndesmotic ankle injuries in middle and older children: prospective comparative study

Dorokhin A.I., Adrianova A.A., Drozdov S.A., Karpovich N.I., Malchevskii V.A.


BACKGROUND: Diagnostics and treatment of syndesmotic ankle injuries in children is one of the important problems in pediatrics. The generally accepted examination algorithms and standards developed for adult patients do not apply to children. The ligamentous apparatus in children is much more elastic, and the tibiofibular space is smaller, which significantly complicates the diagnostic search.

OBJECTIVE: This study aimed to create a diagnostic algorithm for examining middle and older children with ankle joint injuries.

MATERIALS AND METHODS: To create a diagnostic algorithm, whether the ultrasonographic stress test of external foot rotation in adult practice is relevant for patients with closed growth zones was investigated. Two open cohorts of middle and older children were formed. The first cohort included children aged 11–14 years with a closed growth zone of the distal tibia, and the second cohort included children aged 15–17 years with a closed growth zone. The inclusion criteria were the absence of injuries of the studied ankle joint and the correspondence of the body mass index to the age norm.

RESULTS: The variability of the tibiofibular space during the stress test of external foot rotation in children with a closing growth zone averages 3.035 mm and in children with a closed growth zone was 2.319 mm. Data indicate a high degree of elasticity of the anterior tibial–peroneal ligament in children in contrast to adults in whom this structure is more rigid. In children experiencing pain, active muscle resistance makes the test of internal rotation ineffective, and excessive elasticity of the structure in the area of a healthy joint does not give a correct comparative result for the operator.

CONCLUSION: The use of a test with internal rotation for diagnosing damage to the distal tibiofibular syndesmosis in children with closing and closed growth zones is limited, and the operator must rely on other ultrasound signs of damage to this structure.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(3):259-268
pages 259-268 views

Multislice computed tomography in the complex assessment of deformities of long tubular bones of the lower extremities: prospective cohort study

Bagirov A.B., Suvarly P.N., Ogaryov E.V., Yeltsin A.G., Mininkov D.S., Tagizade A.N.


BACKGROUND: Progress in science is attributed to improvements in research methods. The rapid development in diagnostic radiology observed in the last two decades has opened fundamentally new opportunities for clinical medicine, making practically all organs, and tissue structures of the human body accessible for research. Computer technology in medicine makes it possible to assess in more detail deformities of the lower extremity and improve methods of surgical treatment that determine the individual correction of the shape of the deformed bone.

AIM: To comprehensively assess deformities of the long bones of the lower extremities using modern methods of radiation diagnostics – computed tomography.

MATERIALS AND METHODS: Surgery, as the main treatment of patients with deformities of the long bones of the limbs, cannot be effectively implemented without knowing detailed appearance of the femur and tibia and all the elements of the deformity. Angular deformities of the long bones are usually assessed by plain radiographs in frontal and lateral projections, and rotational deformities of the long bones are assessed by multislice computed tomography.

RESULTS: In the National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov and Clinic of Scientific Medicine, computed tomography studies of the long bones of the lower extremities and hip and lower limb deformities were performed from 2015 to 2022. The study involved 265 patients aged <65 years, who were divided according to the type of deformity.

CONCLUSION: Complex X-ray diagnostics for deformities of the long bones of the lower extremities according to our method allows us to represent the deformity not only in planimetric, but also in stereometric terms. This helps eliminate projection–angular and volumetric– rotational deformations.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(3):269-277
pages 269-277 views

Medical simulator for the training of traumatologists: pilot work

Paramonov T.A., Markin I.V., An V.R., Kushnarev S.V., Potapov P.K., Vedishchev K.A., Varlamova N.V., Muzafarov A.R., Baykiev R.R., Zhurbin E.A., Otavin D.A., Zabirova I.A.


BACKGROUND: Pelvic fractures are one of the most complex and fatal injuries because numerous large blood vessels are affected. They entail partial or complete loss of working capacity and have a high mortality rate. In medical practice, the number of pelvic fractures is fewer than that of other types of fractures, and specialists often lack practical experience and skills in the treatment. Thus, for the training, or advanced training of specialists, more serious theoretical training is required, which is unproductive without high-quality training simulators and models.

AIM: The study aimed to develop and manufacture an easy-to-use simulator that mimics human soft tissues and makes it possible to comprehensively prepare and educate specialists in the technique of installing an external fixation device for unstable pelvic fractures.

MATERIALS AND METHODS: To create the simulator, several main stages were completed: obtaining samples of the pelvic bones, making a mold for casting, and directly assembling the simulator. To obtain bone samples, computed tomography scans and magnetic resonance therapy images were used, on which a three-dimensional (3D) model of the pelvic bones was obtained. Based on this model, anatomically accurate copies of the pelvic bones were made using additive technologies. Then, a 3D digital computer model was developed, and a mold for casting the finished product was made. Bone samples were placed inside the mold, and the mold was gradually filled with a gelatin–glycerin compound, which after hardening mimics human soft tissues.

RESULTS: A prototype of a medical simulator for teaching the installation of the concomitant injury kit apparatus for unstable pelvic fractures was made.

CONCLUSION: The manufactured simulator can be widely used in educating and training specialists given its sufficiently high anatomical accuracy, ease of maintenance, and good potential for mass production.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(3):279-288
pages 279-288 views

Clinical case reports

Total resection of the symphysis pubis in a patient with postpartum symphysitis: clinical case

Gudushauri Y.G., Kakabadze M.G., Lazarev A.F., Konovalov V.V., Kalinin E.I., Marychev I.N.


BACKGROUND: Complete rupture of the symphysis during childbirth is a rare but serious complication, with a frequency of 0.03%–3%. Small partial tears with minor discrepancies are an indication of conservative therapy, which only requires the use of a pelvic brace. Larger symphyseal tears should be treated with surgery and fixation.

CLINICAL CASE DESCRIPTION: This report presents a clinical case of successful orthopedic correction of symphysitis after delivery by cesarean section. A 25-year-old patient underwent total resection of the symphysis pubis with supra-acetabular fixation and external fixation device of a rod arrangement for 12 weeks.

CONCLUSION: Several surgical techniques in combination with defect plasty with biocomposite material KollapAn-С made it possible to achieve a long-term positive result.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(3):289-296
pages 289-296 views


Low-energy fracture of the proximal femur in older age groups as a factor of excess mortality: literature review

Rodionova S.S., Asi K.A., Krivova A.V., Samarin M.A., Solomyannik I.A.


Taking into account the increasing number of patients with osteoporosis and, accordingly, related fractures, mortality, as a possible outcome of a fracture, is an extremely urgent problem for both the patient and healthcare system. The mortality rate after a proximal femoral fracture, especially in the first 6 months, includes deaths directly, or indirectly associated with the fracture and deaths due to concomitant diseases. The influence of these two components of mortality remains a subject of discussion. This review aimed to analyze the influence of factors directly or indirectly associated with a fracture of the proximal femur and mortality.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(3):297-306
pages 297-306 views

Embolization of the arteries in the relief of joint and near joint pain: how, when and in whom? A review

Medjidov K.M., Parshikov M.V., Ginzburg L.M., Solov’yev Y.S., Uzhakhov I.M.


This paper presents the results of embolization of popliteal artery branches as an innovative technique to treat pain syndrome not relieved by standard conservative methods for osteoarthritis of the knee joint. The study aimed to evaluate available data on the efficacy and safety of popliteal artery branch embolization in the treatment of pain syndrome in osteoarthritis. Relevant studies on the use of embolization at various degrees of gonarthrosis were analyzed. The results were evaluated using the visual analog scale and Western Ontario and McMaster University Osteoarthritis Index. The performance of patients improved based on both scales, and minor complications resolved on their own. Embolization of the branches of the popliteal artery with insufficiency is a promising and effective treatment method for patients with pain due to osteoarthritis of the knee joint of various degrees, and no serious complications have been identified in the procedures, making it safe.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(3):307-316
pages 307-316 views

Causes of unsatisfactory results of arthroplasty of the knee joint osteoarthritis in long-term postoperative period: literature review

Tkachenko A.N., Dulaev A.K., Spichko A.A., Mansurov J.S., Khaidarov V.M., Balgley A.G., Urazovskaya I.L., Khromov A.A., Ulhaq E., Tsololo Y.B.


In Russia and globally, total knee arthroplasty (TKA) has been increasingly performed. The high quality of implants, improvement of arthroplasty technologies, and accumulated practical experiences of surgeons did not considerably reduce the frequency of complications and unsatisfactory operative outcomes. The negative consequences of knee replacement are determined both intraoperatively and postoperatively. This review aimed to analyze the literature on the frequency and complications of knee arthroplasty and their causes in the long-term postoperative period. In recent decades, the number of patients who are not satisfied with TKA outcomes has been increasing. Moreover, information about complications, their frequency, their causes, and possibilities of preventing negative consequences remains contradictory. Surgical treatment of complications requires particular attention, with surgical site infections as the most common. Recent studies highlight the important of evaluating surgical site infections during and after TKA, especially for deep infectious complications after TKA, which leads to hospitalizations, and reoperations. To date, many studies have investigated early postoperative complications leading to negative consequences in the long-term postoperative period. In addition, in the absence of postoperative complications, the service life of the implant is limited, and unsatisfactory TKA outcomes were attributed to wear and tear of the endoprosthesis. Domestic and international studies about premature or unreasonable TKA, as one of the reasons for negative osteoarthritis treatment outcomes, are increasing. The discussion about the indications and contraindications for knee arthroplasty continues. This literature review discusses the current state of this topic.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(3):317-328
pages 317-328 views


Congratulations to Academician of the Russian Academy of Sciences Aleksey G. Baindurashvili on his 75th anniversary!


Brief biography and scientific achievements of Aleksey G. Baindurashvili, congratulations on the 75th anniversary.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(3):329-331
pages 329-331 views


In memory of Nikolai A. Shesternya


On July 1, 2022, at the age of 83, a remarkable person, a famous scientist, teacher, professor of the Department of Traumatology and Orthopedics of the Priorov National Medical Research Center for Traumatology and Orthopedics Nikolay A. Shesternya has passed away. The life of Nikolai Andreevich is a vivid example of selfless service to the chosen cause! His books have become constant companions of many traumatologists. Nikolai Andreevich was distinguished by humanity, intelligence and the highest professionalism. The team of Priorov National Medical Research Center for Traumatology and Orthopedics mourns the loss, the bright memory of a talented doctor, scientist, teacher, cheerful and charming person will forever remain in hearts of friends, colleagues and students.

N.N. Priorov Journal of Traumatology and Orthopedics. 2022;29(3):333-334
pages 333-334 views

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