[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.

[HYBRID OSTEOCHONDRAL TRANSPLANTATION - A NEW METHOD FOR SURGICAL TREATMENT OF OSTEOCHONDRITIS DISSECANS OF THE KNEE JOINT].

Knee osteochondritis desiccans, or Koenig's disease, is commonly found in active young people engaged in manual labor, sports etc., i.e. socially active population. Today, we have a good number of surgical methods to treatment of this disorder; however, there is still much controversy about their application, and no single approach is considered to be the optimal one. Plus, high-quality biomaterials required for the intervention are sometimes unavailable. The analysis of the results of treatment of patients (spanning several years) proved urgency of the problem and highlighted the necessity to solve a number of related issues. This paper presents the optimal method for surgical correction of Koenig's disease - "hybrid osteochondral transplantation". Indications for surgical intervention are justified, the technique of the operation is described, recommendations are given based on the practical experience of the authors. An analysis of the use of this technique in 27 patients showed its high efficiency, which allows the authors to recommend it for widespread use in clinical practice.