[High tibial osteotomy with computer navigation for medial gonarthritis]. / Sravnitel'nye rezul'taty lecheniya medial'nogo gonartrita metodom vysokoi tibial'noi osteotomii s ispol'zovaniem komp'yuternoi navigatsii.

OBJECTIVE: To study significance of computer navigation for improving clinical and radiological results of medial gonarthritis treatment compared to non-invasive methods of lower limb axis correction control. MATERIAL AND METHODS: The study included 73 patients who were divided into 2 groups. The main group included 40 patients, the control group - 33 patients. In the main group, high tibial osteotomy was performed using computer navigation, in the control group - using non-invasive techniques. Clinical assessment was carried out according to the KSS, KOOS and VAS scales. We assessed the main reference angles of the lower limb considering X-ray data. RESULTS: Both groups were characterized by postoperative improvement of clinical results according to various scales. Computer navigation provided higher accuracy in most cases. We focused on target correction of 3° valgus. CONCLUSION: High tibial osteotomy with computer navigation or non-invasive techniques is an effective treatment method for medial gonarthritis. There are no significant differences in clinical results according to the KSS and KOOS scales, as well as X-ray data after correction. We found significant differences in VAS scores.

[EXPERIENCE IN ARTHROSCOPIC TREATMENT OF PATIENTS WITH HAGLUND'S DEFORMATION].

This study aimed to evaluate the results of treatment of patients with anterolateral chronic instability after arthroscopic stabilization of the ankle joint using anchor fixators, to determine the risk factors for the recurrence of instability after surgery and methods of their diagnosis. The study involved 28 patients from 2016 to 2020. performed 28 arthroscopic operations for chronic lateral instability. The Arthroscopic Brostrom-Gould operation was performed. 22 patients were women and 6 were men. The average age of the patient was 38.6 years (22-55 years). Ankle arthroscopy was performed using a shaver, an ablator, and an anchor fixator. All the patients were discharged the next day; immobilization of the ankle joint in the orthosis was 6 weeks from the moment of surgery. The scores were assessed by the AOFAS (American Orthopedic Society for Foot and Ankle Surgery) scale and VAS - a visual analog scale designed to measure the intensity of pain, then the patient's condition was assessed. The average follow-up was 58.4 months. The AOFAS scores significantly improved from a postoperative mean of 52.6 to 98.6 at the final grade (p˂0.005). All patients are satisfied with the result of the operation. The scores on the VAS scale were on average 6-8 points. Arthroscopic Brostrom-Gould operation has proven to be a safe and effective surgical method for treating chronic lateral instability of the ankle joint.

[Clinical and functional outcomes of valgus osteotomy in patients with medial gonarthrosis (preliminary results)]. / Rezul'taty val'giziruyushchei osteotomii u patsientov s medial'nym gonartrozom (predvaritel'nye rezul'taty).

OBJECTIVE: To analyze gait biomechanics before and after corrective osteotomies around the knee joint in patients with medial gonarthrosis. MATERIAL AND METHODS: The study recruited 5 patients (6 surgeries) with medial gonartrosis and varus knee deformity. Gait biomechanics was analyzed in preoperative period and 6 months later. The control group consisted of 20 healthy people. RESULTS: Knee joint biomechanics was almost normal in postoperative period. Amplitude of knee joint flexion was increased. Moreover, hip joint flexion-extension amplitude was increased on both sides and often exceeded normal values. Clinical results showed significant increase in IKS (from 55 to 89.6) and VAS score (from 7.7 to 2.3). Postoperative correction angle varied within 1.5-2° of valgus. CONCLUSION: Corrective osteotomy around the knee joint is effective for medial gonarthrosis. We obtained favorable clinical results and limb axis correction after surgery without significant hypercorrection. Gait biomechanics was also improved.

[Endoscopic sciatic nerve decompression]. / Endoskopicheskii nevroliz sedalishchnogo nerva.

OBJECTIVE: To improve treatment outcomes in patients with sciatic nerve neuropathy. MATERIAL AND METHODS: The first results of endoscopic sciatic nerve decompression in 6 patients with sciatic neuropathy (mean age 47±6.7 years) are presented. The authors developed and described new and unique technique for this procedure. All patients suffered severe neuropathic pain syndrome with neurologic disorders. All patients underwent endoscopic sciatic nerve decompression in prone position. RESULTS: Mean VAS score of preoperative pain syndrome was 7.8±0.37. In 3 months after surgery, this value decreased up to 1.5 scores. Complete regression of pain syndrome and significant reduction of neurologic symptoms were noted in 5 out of 6 patients (83%). CONCLUSION: Primary data characterize the developed method as an easy, minimally invasive and effective procedure for pain relief and fast recovery of lower extremity function in these patients.

[CLINICAL CASE OF ENDOSCOPIC BRACHIAL PLEXUS DECOMPRESSION IN A PATIENT WITH ROTATOR CUFF RUPTURE AND POST TRAUMATIC PLEXOPATHY].

Posttraumatic brachial plexopathy - is an actual problem, which is usually seen after shoulder area trauma and is often accompanied with intraarticular pathology. In case of failed conservative treatment, open brachial plexus decompression is an effective procedure, however, it is pretty traumatic and is accompanied by number of complications and recurrences, what explains the necessity of development of low-traumatic, miniinvasive alternative techniques. Purpose - develop a new mini-invasive endoscopic technique of brachial plexus decompression. The new technique of fully endoscopic brachial plexus decompression was developed and presented in a 60-years old male patient with posttraumatic plexopathy and rotator cuff tear. Short-term clinical results were followed-up. The patient had a severe neuropathic pain syndrome in shoulder area before the surgery, there were neurologic impairments in upper extremity. The aspects of surgical technique are represented step-by-step. According to VAS scale the severity of pain syndrome in the patient before the surgery was 9 points, 6 months after surgery decreased to 2 points. Patient underlines the regression of neurologic problems, increasing of strength in the hand. The preliminary results do let us characterize the developed technique of endoscopic brachial plexus decompression as a low-traumatic and effective alternative to open decompression, which eliminates pain syndrome and promotes early restoration of normal function of arm in patients with post-traumatic brachial plexus pathology, and which can be easily combined with intra-articular pathology treatment - rotator cuff rupture suturing.

[EXPERIENCE OF USING INSPACE SUBACROMIAL BALLOON FOR TREATMENT OF PATIENTS WITH LARGE AND MASSIVE ROTATOR CUFF TEARS].

The large and massive rotator cuff tears lead to a significant decrease in the shoulder joint (SJ) function and the development of severe pain syndrome in it. Frequently, such injuries are difficult to recover fully, and the number of relapses after their recovery is quite high. The combined method of rotator cuff repair single-row suture anchor technique with concomitant use of a subacromial balloon spacer, allows to achieve the best results in the treatment of this group of patients. Objective - improvement of the treatment results in patients with large and massive rotator cuff injuries. The results of treatment using a single-row suture anchor technique with concomitant use of a subacromial balloon spacer have been described in 25 patients (mean age 58±5 years) with large and massive rotator cuff injuries. In the study were involved the patients with 1-2 grade of fatty muscle atrophy according to the Goutallier classification, and retraction of the damaged tendons did not exceed 2 degrees. The mean UCLA activity scores prior to the surgery was 16±3 points (15-19), and in 12 months after the surgery 33±1 points (32-34), respectively. All the results obtained were regarded as: good and excellent. The obtained results evidence the advantage of the combined method of rotator cuff repair by insulated suture.

[THE CONCEPT OF SURGICAL TREATMENT OF INTRA-ARTICULAR FRACTURES OF THE DISTAL FEMUR: LCP PLATE OR RETROGRADE INTRAMEDULLARY NAIL].

This study compares the results of treatment of two groups of patients who underwent osteosynthesis of intra-articular fractures of the distal femur using the LCP plate and an intramedullary retrograde nail. 89 patients with fractures of the distal femur were divided into 2 groups: group I (n=43) - patients who underwent osteosynthesis of intra-articular fractures of the distal femur using an LCP bone plate and group II (n=46) - using an intramedullary retrograde pin. The comparison was carried out according to the duration of the surgical operation, the amount of time elapsed from the moment of injury to surgery, and blood loss. In group II with intramedullary osteosynthesis, the time of surgical treatment was statistically significantly less than in the group of bone osteosynthesis - 45 minutes and 65 minutes, respectively. Reducing the duration of the operation leads to better functional treatment results. The reduction of the operation time when installing a retrograde intramedullary pin is due to the easier installation technique of this type of retainer and the use of minimally invasive approaches.In patients after surgical interventions, complications were detected in both groups. The nature and frequency of complications in the groups are approximately the same. Infectious complications in the early postoperative period occurred in 4 (9.3%) patients in the group of bone osteosynthesis and 4 (8.6%) - in the group of intramedullary osteosynthesis. In all cases, superficial infection of the postoperative wound within the skin and subcutaneous fat was noted. In the group of bone osteosynthesis, 2 (4.6%) patients in the long-term period were diagnosed with a deep infection of the femoral osteosynthesis area, which required repeated surgical intervention. No cases of deep infection were recorded in the intramedullary osteosynthesis group.In the group of patients who underwent bone osteosynthesis, osteoarthritis of the knee joint of the I degree was detected in 35 (81.4%) patients, in 8 (18.6%) - after 3.5 years of follow-up, the formation of osteoarthritis of the II degree was noted. In the group of patients using intramedullary osteosynthesis, grade I arthrosis was detected in 36 (78.2%) patients, and grade II - in 10 (21.8%) patients. 3,5 years after the operation, there was no need for knee replacement in any patient.The retrograde intramedullary osteosynthesis technique of femoral condyle fractures in the long-term period revealed the best functional indicators.

[EXPERIENCE IN ARTHROSCOPIC TREATMENT OF PATIENTS WITH HAGLUND'S DEFORMATION].

The goal of this study was to evaluate the results of arthroscopic calcaneoplasty for the treatment of posterior calcaneal bursitis and Haglund's disease. The study involved 28 patients who underwent 30 arthroscopic surgeries for Haglund's disease from 2015 to 2019. Retrocalcanealneoplasty and supracalcaneoplasty were performed using a shaver, an ablator; with the help of a drill, the bone was resected until the contact in the Achilles tendon was eliminated in the position of dorsiflexion of the foot. All patients were discharged the next day and allowed full leg load in the second week after surgery. The AOFAS (American Orthopedic Society for Foot and Ankle Surgery) and VAS scores were calculated, and the patient's condition was estimated. Results: The average follow-up was 58.4 months. The AOFAS scores significantly improved from the average 52.6 to 98.6 at the final estimation (p˂0.005). All patients were satisfied with the result of the surgery. VAS scores were low. Conclusion: Arthroscopic calcaneoplasty has proven to be a safe and effective surgical method for the treatment of posterior calcaneal bursitis and Haglund's disease.