EFFECT OF THE COMBINED UTILIZATION OF STATIC PROGRESSIVE STRETCHING AND PHONOPHORESIS WITH HYDROCORTISONE IN REHABILITATION OF KNEE CONTRACTURES CAUSED BY ARTHROFIBROSIS.

Arthrofibrosis is the abnormal proliferation of fibrous tissue in a joint with an unclear etiopathogenesis that leads to loss of motion, pain, muscle weakness, swelling, and functional limitation. Various methods of therapy are utilized to treat the aforementioned pathology and among them are also aggressive approaches such as static progressive stretching. The goal of the current study was to establish the superiority of the effect of the combined utilization of static progressive stretching and hydrocortisone phonophoresis over standard therapeutic exercise programs for the rehabilitation process of knee contractures caused by arthrofibrosis. 29 patients between the ages of 18 and 60 (mean age 42±4.3 y.o.) participated in the prospective randomized controlled study, 19 male (65%) and 10 female (35%) with clinical signs of type III and IV contracture of the knee, extension limitation ˃10° and flexion deficit ˃25° when compared to the uninjured side. A minimum of 3 months had passed since the initial injury or the surgical intervention in all cases. 10 male and 5 female patients were randomly distributed to Group I (experimental group) while 9 male and 5 female patients were distributed into Group II (control group) accordingly. The patients from Group I underwent a 2-week long treatment course (10 procedures) with highly concentrated (10%) hydrocortisone phonophoresis before the inception of the standard rehabilitation program while the patients from Group II went through a rehabilitation course consisting solely of static progressive stretching and a home exercise program. The effect of static progressive stretching in the rehabilitation process of knee contractures caused by arthrofibrosis is greatly improved after the utilization of ultraphonophoresis with highly concentrated hydrocortisone alongside standard home exercise programs and this effect is especially apparent in the cases of patients with type III arthrofibrosis and knee flexion contractures.

UTILIZATION OF HYDROCORTISONE ACETATE PHONOPHORESIS IN COMBINATION WITH THERAPEUTIC EXERCISE IN THE REHABILITATION MANAGEMENT OF FUNCTIONAL LIMITATIONS CAUSED BY KNEE ARTHROFIBROSIS.

Arthrofibrosis is a joint pathology during which excess collagen is produced resulting in movement limitation, inflammation and pain. Itis caused by repeated injuries or surgical interventions, which is frequently managed by using certain medications such as glucocorticosteroids.The goal of our research was to study the effect of therapeutic exercise and hydrocortisone acetate (HA) phonophoresis combination therapy on the management of the rehabilitation process of knee joint functional limitations caused by arthrofibrosis and to establish the optimal parameters of ultrasound needed to achieve therapeutic effect.25 male patients between the ages of 18 and 50 (mean age 39±3.4 years) with moderate contracture of the knee and limitation of knee flexion, which varied between 70° and 90° participated in the randomized controlled experimental research. In addition, modified Cincinnati questionnaire scale (MCSc) was used. The following 3-week rehabilitation programs were developed: : I - the control group was assigned an individual home exercise program (HEP) 5 times a week; the experimental group II was assigned a treatment program which included the same exercise in addition to phonophoresis with 10% hydrocortisone gel (mixed ultrasound gel), duration - 10 minutes, frequency - 1.0 MHz, duty cycle - 50% (Pulsed), 1.0 W/cm2 high intensity ultrasound (HEP+PWHi); the experimental group III was assigned an almost identical program to the group II with the difference being 100% (Constant) duty cycle of the ultrasound (HEP+CWHi). As for groups IV and V - these groups were assigned the same home exercise programs alongside 10 minutes of low intensity 0.5 W/cm2, 1.0MHz, 50% (HEP+PWLi) and 100% (HEP+CWLi) ultrasound accordingly with 10% hydrocortisone gel, 15 procedures total.The results of the study revealed that using phonophoresis with high concentration hydrocortisone acetate that's mixed with ultrasound gel alongside therapeutic exercise in the treatment and rehabilitation of moderate post-traumatic or post-operative extension contracture of the knee caused by arthrofibrosis can be successful, which could enable us to achieve 40-50% of progress regarding knee flexion and functioning in 3 weeks in case 1.0 Mhz, 1 W/cm2, 50% pulsed ultrasound is utilized during 10 minutes, 5 times per week.

ASSESSMENT OF RISKS OF DEVOLEPMENT OF ARTHROFIBROSIS AND PREVENTION OF KNEE EXTENSION DEFICIT SUBSEQUENT TO AN ANTERIOR CRUTIATE LIGAMENT RECONSTRUCTION.

The goal of our research was to study the impact of various risk-factors on the development of arthrofibrosis in patients with knee extension restriction on an early stage. The aforementioned research was carried out in the Sports Medicine and Rehabilitation Clinical Center and First University Clinic of Tbilisi State Medical University during the 2016-2020 y.y. and it is based upon the findings derived from the retrospective analysis of 38 male patient cases (mean age 25.42±5.85) with undergone ACL reconstruction and the assessment of importance of the impact of various risk-factors on developing a clinically confirmed knee arthrofibrosis. In order to identify the important role of pain as a risk factor in the development of knee arthrofibrosis, the patients were divided into 2 groups (A and B). Group A consisted of 17 patients with confirmed arthrofibrosis while group B consisted of 21 patients whose rehabilitation process resulted in complete eradication of knee join extension deficit. During the comparison of data on the average level of pain between the patients from groups A and B a reliable difference was identified (p=0.048). The presence of pain is in direct correlation with arthrofibrosis development process in the knee (R= -0.65), therefore, together with joint ROM (Range of motion) restriction, it can be considered as one of the most noteworthy preconditions among the risk-factors that were part of our research. To increase the efficiency of the rehabilitation process after a ACL reconstruction procedure when knee extension deficit alongside with pain is present, according to the Creaky Joints Pain - CJP scale ≥4, it is most appropriate to incorporate more aggressive interventions into the rehabilitation program and, at the same time, to utilize pain management methods actively during the early stage (after 2 weeks) in order to eradicate knee extension restriction and prevent arthrofibrosis.

[Effects of combined administration of ripronat and rotavit royal on the working capacity of the young football players].

The goal of the study was evaluation of the impact of the pharmaceutical preparations Ripronat and Rotavit Royal on the physical working capacity and psychomotor performance of the young football players during their basic preparatory period of physical conditioning. Blinded placebo controlled study was performed on 50 male football players (mean age 19,8 ± 3,2 years). The football players were divided into three groups: study group (n=30), placebo group (n=10) and control group (n=10). Study group in turn were divided in two subgroups: subgroup A (n=15, receiving ripronat and rotavit royal) and subgroup B (n=15, receiving only ripronat). In all groups following tests were performed before and after four weeks of the medical administration: 1.Watt max bicycle test. 2. Wingate cykletest. 3. Psychomotor performance including reaction time and relaxation abilities. Results of our study allow us to conclude that ripronat increase the aerobic capacity and psychomotor performance of football players, and it would be recommended for administration during early stages of training, when main emphasis is made on aerobic performance.

[Experience on treatment of children with otorhinolaryngological diseases by low intensity laser irradiation].

Among diseases of children of young age dominate pathologies of otorhinolaryngological profile. Due to good blood circulation characteristics of these organs and also predominantly inflammatory or allergic nature of these diseases, laser therapy is considered to be an effective therapeutic procedure in the otorhinolaryngology. It is well known, that one of the characteristics of laser irradiation is the improvement of microcirculation in the cases of diseases involving inflammatory and allergic mechanisms. Treatment of 445 children and teenagers aged 2-15 with the following diseases: pollinosis (68), adenoiditis and rhino-sinusitis (198), tonsillitis (64) and otitis (115) was carried out simultaneously with infrared and red laser irradiations. The positive results were achieved in 85% of patients. The results achieved by us with simultaneous irradiations using infrared and red lasers prove the effectiveness of these methods for treatment of otorhinolaryngological diseases.

[Different variants of kidney lesions in gout]. / O razlichnykh variantakh porazheniia pochek pri podagre.

Two observations of gout with typical articular changes but different variants of renal involvement are presented. One of the cases had typical gouty kidneys, the other had moderate changes typical of gout but with the prevalence of membranous and proliferative processes in the glomeruli with glomerulosclerosis as the end point. Examination of materials from this case in polarized light showed the presence of urate crystals not only in tubules but also in glomeruli.