COMPARISON OF THE CLINICAL RESULTS FROM THE RECONSTRUCTION OF АCL WITH AUTOGRAFT AND ALLOGRAFT TISSUE.

The ACL is the primary stabilizer of the knee joint. The injury leads to instability of the knee joint, which is a trigger for the subsequent destructive changes of the intra-articular structures such as menisci and cartilage of the joint surfaces. The most affected group is people of an active age, engaged in amateur sports. Also, this pathology is an occupational hazard in the military. In this community, ACL injuries have reached 3.24% in men and 3.51% in women, with increasing trends, especially among women. This data is derived from a study by Keller Army Hospital, West Point, New York. In this study we selected 2 groups of patients - operated with autograft and operated with allograft. The groups included 25 patients followed for a period of 18 months. The tissues used for ACL reconstruction were: 1) for allograft - BTB donor tissue / allograft / 2) for autologous transplantation - mm. Semitendinosus et Gracillis / autograft /. After the operation, the patients are placed in a rehabilitation program in five interconnected phases. The way they are performed allows the principle of gradual loading and constant feedback between the patient and the physiotherapist to be observed. Each of the phases has specific goals in the rehabilitation cycle, which has a certain approximate duration. After completion of the rehabilitation process, the clinical outcomes of both groups were compared using the International Documentation Committee (IKDC), Lysholm, and three in-house diagnostic methods. Our own diagnostic methods are Power test (a strength simulator is used, which directly examines the strength of the limb in flexion and extension in real life test. The results from IKDC were in favor of the autograft group (92.82) and from Lischolm of the allograft group (92.24). In terms of the power test the results were in favor of the allograft group. The result from the Power 1 test clearly shows statistically significant difference in symmetry of power in flexion and extension which is better in the allograft group compared to the autograft group. In our research we did not come across such a test in other studies. In conclusion we proved that the development of a single strict rehabilitation protocol focusing on the principle of gradual increase in workloads achieves comparable results in the frequency of re-rupture in both the allograft and auto-graft groups.

SURGICAL TREATMENT OF OLD PELVIC INJURIES.

The authors of the article carried out a retrospective analysis of the case histories of 43 patients (age from 20 to 66 years) with chronic pelvic injuries, hospitalized in 2010-2019. The damage type was assessed according to the AO classification. At the previous stages of treatment, conservative stabilization of the pelvis was used - 12 (27.9%) patients, external fixation - 21 (48.8%) and unsuccessful internal fixation - 10 (23.3%) cases. Patients were divided into two groups: I - 34 (79.1%) cases with unconsolidated or incorrectly consolidating lesions, which underwent reconstruction of chronic lesions within from 3 weeks to 4 months; II - 9 (20.9%) people with pseudoarthrosis or consolidated with significant deformity, later than 4 months. To determine the type of injury and preoperative planning, clinical and radiological diagnostics, as well as computed tomography, were used. The residual postoperative displacement was assessed according to the Pohlemann classification. To analyze long-term results, the Majeet system of functional assessment of pelvic fractures was used. During surgery, anatomical reduction was achieved in 30 (69.8%) patients, satisfactory - in 8 (18.6%), insufficient reduction more than 10 mm - in 5 (11.6%). Intraoperative bleeding occurred in 5 (11.6%) cases. In the early postoperative period 1 (2.3%) patients died. Postoperative wound inflammation requiring revision occurred in 9 (20.9%) cases. Loss of reduction followed by reosteosynthesis in 4 (9.3%) patients. The performed surgical treatment of chronic pelvic fractures made it possible to achieve excellent and good results in 56.4% of cases; improve the qualitative assessment of health by 74.4% and increase the functional assessment by 24 - 46 points from the initial one.

[Management policy for osteoarthritis of the knee joint]. / Likuval'na taktyka pry osteoartrozi kolinnoho suhloba.

Osteoarthrosis of the knee joint (KJA) is a most prevalent orthopedic disease. There are some questions as to the policy of treating KJA that remain to be decided. Results are analyzed of treating 3243 patients with KJA (stage I--889 individuals, stage II--1276 ones, stage III--1078 patients) over the period 1983-2000. The patients underwent nonoperative treatment, arthroscopic operations, plasty of the ligamentous apparatus, osteotomy, arthrodesis, total endoprothetics. Our scheme proposed some time ago allowed judgement about the function of the knee joint. Recommendations are given in the article, that include the following: Arthroscopic operations should be widely used during stage I and II for the debridgement of the joint to be done, the proper recovery of the ligamentous apparatus to be ensured. Correcting osteotomy is indicated in axial deformity of the joint at stage I to II. Total andoprothetics is indicated at stage III osteoarthrosis and also at stage II in case of joint instability and axial deformity.

[Neurodystrophic syndrome in patients with fractures of the distal epimetaphysis of the radius]. / Neirodistroficheskii sindrom u bo'lnykh s perelomami dista'lnogo épimetafiza luchevoi kosti.

The authors analyse the development of the neurodystrophic syndrome (NDS) after fracture of the distal epimetaphysis of the radius in 67 patients. Rapidly and slowly progressive forms of NDS development were distinguished. Thermographic examination of 20 patients gives evidence of disturbed tonus of the microcirculatory channel in NDS. Laser therapy, magnetic field, and hypothermia were used in the treatment of patients with NDS. The developed system of NDS prognostication in fractures of the distal radial epimetaphysis and preventive treatment of risk group patients allowed the frequency of this complication to be reduced.

[Arthroscopy techniques in the treatment of extension contractures of the knee joint after total knee arthroplasty]. / Zastosuvannia artroskopichnoï tekhniky v likuvanni rozhynal'noï kontraktury kolinnoho suhloba pislia total'noho endoprotezuvannia.

Results are analyzed of treatment of four patients presenting with extension contractures of the knee joint after total knee replacement with the aid of the arthroscopic arthrolysis technique. All patients demonstrated increase in the joint movement size. The conclusion reached was that in the incipient manifestations of the knee joint extension contractures, the arthroscopic arthrolysis technique is superior to the conventional one.

[Effect of chondroprotectors in the treatment and prophylaxis of the knee joint osteoarthrosis]. / Rol' khondroprotektoriv u likuvanni ta profilaktytsi osteoartrozu kolinnoho suhloba.

An analysis is presented of employment of hyalgan (1% solution of hyaluronic acid) in 29 patients with osteoarthrosis of the knee joint (KJOA). The patients were divided into three groups. Group I comprized 9 patients with prior arthroscopic interventions in the knee joint with stage I KJOA; group II was 5 patients having undergone plasty of the anterior cruciate ligament with stage I KJOA; group III was 15 patients with stage II-III KJOA. Hyalgan (20 mg) was administered once per week for 5 weeks. Intensity of the pain syndrome was assessed by using a visual-analogue scale together with time-related thermal gradient with the aid of the remote infrared thermography technique. Hyalgan enhances efficiency of treatment of KJOA.

[The anatomy of the knee joint from the standpoint of endoprosthesis implantation]. / Anatomiia kolennogo sustava s pozitsii implantatsii éndoproteza.

An important anatomical structures and relations, having significance in conduction of operation of the knee joint endoprosthesis implantation, are depicted.

[Endoprosthesis of the knee joint]. / Endoprotezuvannia kolinnoho suhloba.

The experience of primary total endoprosthesis of a knee joint for restoration of its motility and stability was presented. Prostheses "Zimmer MG II", "Zimmer I B II", "Richards-Genesis", "Richards-Trigon-C", "Aesculap Mul. II", "Howmedica-kinematics" were implanted in 16 patients with gonarthrosis and rheumatoid arthritis stage III. One to four-year follow-up result after the operation was excellent in 68.75% patients, good--in 25%, fair--in 6.25%.

[Application of proximal correction osteotomy of the tibia in treatment of the knee joint osteoarthrosis]. / Vykorystannia proksymal'noï koryhuiuchoï osteotomiï velykohomilkovoï kistky v likuvanni osteoartrozu kolinnoho suhloba.

High osteotomy of tibia is the method of choice in patients with osteoarthrosis (OA) of the knee joint (KJ) medial portion of I and II stage. To secure positive postoperative result achievement high proximal osteotomy was combined with other interventions, directed on elimination of other morphological or functional disorders of the KJ. We have performed treatment of 43 patients with OA of KJ of II stage with the varus deformity, to whom correcting osteotomy "Opening Wedge". In all of them arthroscopy of the KJ was done, in 14--with stimultant arthroscopic plasty of anterior cruciform ligament, in 17--arthroscopic chondroplasty of articular surface defects of processus lateralis os femoris, in 12--arthroscopic KJ debridement, in 24--partial meniscusectomy. An excellent and good result was noted in 33 patients. Miniinvasive combined reconstructive-restorational interventions are effective in OA of II stage with disorder of an axis or an axis and the KJ stability.

[Analgesia after orthopedic interventions]. / Analheziia pislia vykonannia ortopedychnykh vtruchan'.

The efficacy of application of tramadol and naclofen for analgesia after performance of orthopedic operations was studied up. There were examined 112 patients, to whom were done total endoprosthesis of coxofemoral joint, 19--total endoprosthesis of the knee joint, 54--the knee joint arthroscopy. The analgesia efficacy was estimated according to visual-analogue scale and to the sensations index. High efficacy of the tramadol application for postoperative analgesia was established. In patients, to whom tramadol and naclofen were administered, maximal analgetic effect was noted.

[Application of the apparatus autohemotransfusion in endoprosthesis of big joints]. / Zastosuvannia aparatnoï aytohemotransfuziï pry endoprotezuvanni velykykh suhlobiv.

We observed 16 patients in whom the method of camera intraoperation reinfusion of washed erythrocytes was used during endoprosthetics of joints. For reinfusion we used the system Elmd-500 (Electromedics Inc., USA). The concentration of hemoglobin in peripheral blood remained stable in early and late post-operation period. No complications after transfusion of washed erythrocytes were observed.

[Analysis of complications of operation for appendicular peritonitis in children]. / Analiz oslozhnenii posle operatsii po povodu appendikuliarnogo peritonita u detei]

Complications, occurred after the operation for appendicular peritonitis in children, were analyzed. The frequency of the complications occurrence in patients with an acute catarrhal appendicitis had constituted 1.4%, with phlegmonous one--3.5%, gangrenous--12.1%, gangrenous appendicitis with local restricted peritonitis--18.9%, with diffuse purulent peritonitis--42%. The dependence of the complications frequency on character and severity of primary changes in abdominal cavity was established.

[Total endoprosthesis of knee joint for the severe deformity of the femoral and tibial condyles]. / Total'noe éndoprotezirovanie kolennogo sustava po povodu vyrazhennoi deformatsii myshchelkov bedrennoi i bol'shebertsovoi kostei]

The method of knee joint endoprosthesis for its pronounced deformity was proposed. As a transplant there was applied the ceramic hydroxiapatite, manufactured according to special technology. The implant was fixed on the transplant adjusted.