BACKGROUND: One of the most debatable issues in osteochondritis dissecans (OCD) research is bone and cartilage healing assessment during OCD postoperative management. The x-ray scale developed by Wall and colleagues is a commonly used evaluation tool for OCD lesion assessment. This tool has excellent reliability but is associated with radiologic exposure. Also, it provides complete information about bone structure only, even though the articular cartilage is also involved in the pathological process. Lack of cartilage assessment combined with radiation exposure facilitated the development of the novel MRI-based OCD healing assessment tool. It could draw attention to bone and cartilage during healing assessment to improve decision-making in the postoperative period after OCD treatment. AIM: This study assesses the reliability of a developed novel MRI-based OCD healing assessment tool. MATERIALS AND METHODS: Ten patients with OCD of the femoral condyle were involved in the current study. A reliability test for the novel MRI-based assessment tool was performed with the expert group comprising six participants to assess 34 MRI studies of 10 patients. From all studies, one study was obligatory for each patient before the operative treatment, and a postoperative MRI study series was performed during the first postoperative year. Each MRI study was examined by each expert twice with a 4-week time lag. The novel MRI-based assessment tool consists of five criteria, of which the common criterion was general healing, incorporating all previously described ones. Each criterion was tested, and a two-way mixed-effects intraclass correlation coefficient (ICC) was used to assess intraobserver and interobserver reliability. RESULTS: The main parameter general healing calculations were made first. Two patients achieved full OCD lesion healing with 100 scale points and two patients with 97.5 and 98.5 points, respectively. Other patients reached the cut-off value of 75 points and were defined as healed with minimally detectable changes on MRI. Second, a two-way mixed-effects ICC calculation was performed. The bone marrow extension parameter reached the value of 0.972, the extent of the union 0.984, bone structure 0.977, and articular cartilage intensity and structure 0.977. The general healing parameter reached the value of 0.993. These values corresponded to the excellent marks according to the guidelines for ICC assessment. The novel MRI-based assessment tool showed excellent intraobserver and interobserver reliability. CONCLUSIONS: The novel MRI-based assessment tool permits assessing bony and cartilage structures while making decisions about OCD lesion healing in the postoperative period. The novel OCD healing assessment tool has excellent intraobserver and interobserver reliability. Also, it is recommended for use in clinical and research practice since a study revealed a correlation of the MRI healing score with that of the clinical assessment tool.

INTRODUCTION. Rehabilitation of children with knee joint injuries is very relevant due to a high prevalence of such a localization of injuries leading to loss of limb function and often requiring surgical treatment and intensive rehabilitation. AIM. To establish scientifically the isolated use of low-frequency pulsed electrostatic field and in combination with robotic mechanotherapy in treatment of the knee joint capsular ligamentous apparatus injuries in children. MATERIAL AND METHODS. 60 children aged 13 to 18 years with damage to the capsular ligamentous apparatus of the knee joint were included in the clinical study. The study group was represented by 30 children receiving a combined effect of the low-frequency pulsed electrostatic field and robotic mechanotherapy. A comparison group of 30 children was exposed to the low-frequency pulsed electrostatic field. Medical rehabilitation was prescribed in the early post-immobilization period after arthroscopic operations. To determine the effectiveness of medical rehabilitation techniques, we used orthopedic status assessment, a subjacent determination of the severity of pain syndrome according to the VAS, clinical assessment of motor deficit, laser Doppler flowmetry, ultrasound examination of knee joints, infrared thermography, and psychological testing using the Spielberg-Hanin scale. RESULTS AND DISCUSSION. A prospective open randomized comparative study revealed a more pronounced regression of pain syndrome, earlier restoration of the motions in the injured joint, and relief of posttraumatic synovitis signs when using two physical factors in children with damage to the capsule-ligament apparatus of the knee joint in combination. The clinical and functional results obtained are of great importance in injuries of the knee joint with the risk of contracture formation in the postoperative period. CONCLUSION. High therapeutic efficacy, good tolerability of procedures, and the absence of adverse reactions substantiate expediency of the low frequency pulsed electrostatic field introduction in combination with robotic mechanotherapy for injuries of the capsular ligamentous apparatus of the knee joint in children into the practice of children’s medical and preventive medical organizations.

BACKGROUND:Hook nail deformity is one of the widespread post-traumatic deformities of distal phalanges. The affected finger has decreased function and loses its characteristic appearance. Onlyafew publications explored this problem in children. In this study, we presentasurgical correction technique for this deformity by the combination of two existing reconstructive methods, i.e., the antenna procedure and the reverse-flow homodigital island flap. CLINICAL CASES:Aseries of clinical cases of patients aged 3, 5, and 17 years who underwent hook nail deformity correction was analyzed. These children underwent the combination of the antenna procedure and reverse-flow homodigital island flap. In all three cases, the deformities were corrected, andanacceptable appearance, and function of the fingers were achieved. DISCUSSION:Various methods of hook nail deformity correction have proven themselves and affirmed by literature data. The method described herein may be considered reliable, as demonstrated by the clinical cases. CONCLUSIONS:We consider the combination of the antenna procedure and reverse-flow homodigital island flap asajustified method. However, issues raised in this technique require further investigation.

Introduction. Dissecting osteochondritis (RO) is based on damage to the subchondral bone, leading to its detachment and sequestration separately or together with articular cartilage with the possible formation of a free bone-cartilage fragment. The disease occurs more often in adolescents, accompanied by an increased risk of early arthrosis of the knee joint. Chronic traumatization of the subchondral bone leads to insufficient blood supply to a certain area of the growth zone of the secondary point of ossification of the femoral epiphysis, to ischemia and subsequent necrosis of the subchondral bone, which, according to modern literature, is the leading cause of the formation of the lesion. The typical localization of the RO focus is the lateral part of the medial condyle of the femur along the supporting surface. The present clinical analysis presents cases of atypical localization of dissecting osteochondritis with clinical features, specific signs on MRI, as well as various tactical approaches to treatment.Material and methods. This clinical review presents 3 cases of sequestration of the posterior lateral condyle of the femur in adolescents. Despite the similarity of the clinical picture and the MRI data, the features of the foci of RO were found in all children, which determined the need for an individual approach to therapeutic tactics. All children required surgical treatment, which was performed in the Department of Traumatology and Orthopedics of the N.F. Filatov DGKB in different volumes in each case: from transchondral osteoperforations and fixation of an osteochondral fragment with a screw to debridement of a fragmented focus with removal of osteochondral fragments.Results. All 3 clinical cases are united by atypical localization of the focus in the posterior lateral condyles of the femurs, the clinical course of the disease in the form of a low-intensity long-term pain syndrome, as well as the results of MRI of the knee joint. Most researchers adhere to the classical multifactorial etiological theory of dissecting osteochondritis, according to which the main mechanism of the origin of the lesion is mechanical overload of the subchondral bone with subsequent disruption of blood supply in it at the border with the secondary point of ossification of the femoral epiphysis. However, there is also data in the literature on congenital ossification disorder in the cartilaginous part of the growth zone of the secondary ossification point as the morphological basis of dissecting osteochondritis. The presented clinical cases cast doubt on the generally accepted model of primary damage to the subchondral bone as the only possible cause of the formation of the focus of RO, since patients have, among other things, signs of impaired ossification of the secondary ossification point of the femoral condyle, in one of whom a violation of ossification of the secondary ossification center was also determined in the patella in the form of patella bipartita.Conclusion. Inspite of all similarities connecting these cases there is still lack of data to judge about separate type of the OCD because every separate type of disease usually have particular morphological basis. There is a need of partial biopsy of these lesions to confirm or refute our hypothesis of posterior condylar separation being separate type of OCD. However these cases undoubtedly require particular managementwith special attention to timing of appropriate diagnostic procedures and surgical management to perform in time prior to osteochondral fragment separation. In case of the absence of any complaintswith particular MRI appearance of fragmented bone in the lesion with impaired ossificationindividual treatment planneeds to be defined.