Vol 29, No 3 (2022)

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.

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.

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.

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.

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.

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.

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

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.