Corrective lower limb osteotomies are innovative and efficient therapeutic procedures for restoring axial alignment and managing unicompartmental knee osteoarthritis. This review presents critical insights into the up-dated clinical knowledge on osteotomies for complex posttraumatic or congenital lower limb deformities with a focus on high tibial osteotomies, including a comprehensive overview of basic principles of osteotomy planning, biomechanical considerations of different implants for osteotomies and insights in specific bone deformity correction techniques. Emphasis is placed on complex cases of lower limb osteotomies associated with ligament and multiaxial instability including pediatric cases, computer-assisted navigation, external fixation for long bone deformity correction and return to sport after such osteotomies. Altogether, these advances in the experimental and clinical knowledge of complex lower limb osteotomies allow generating improved, adapted therapeutic regimens to treat congenital and acquired lower limb deformities.

OBJECTIVE. The study assessed the efficacy of anatomic cruciate ligament reconstruction (ACL-R) with antegrade bone-tendon-bone (BTB) graft performance. MATERIAL AND METHODS. The arthroscopic reconstructions of ACL were analyzed in 91 patients. The antegrade ACL-R was carried out in the first group (33 %) patients. The antegrade isometric (non anatomical) ACL-R was made in the second group (26,4 %). The retrograde anatomical plasty of ACL was performed in the third group (40,6 %). RESULTS. The rates of front and rotary stability of the knee joint and quality of life were higher in the first and the third groups. There were rarely noted degenerative changes of joint. CONCLUSIONS. The antegrade anatomical plasty should be considered as a preferable version due to relative simplicity of the method and high anatomico-functional results and at the same time, this method had significant economic benefits.

Purpose Evaluate clinical effectiveness of anatomical reconstruction of the anterior cruciate ligament (ACL) and determine the perspectives for practical health care. Material and methods The review included 706 patients who underwent arthroscopic reconstruction of the ACL and graft interference screw fixation between 2010 and 2018. ACL reconstruction was performed using either anteromedial portal (n = 396, Group I) or an isometric transtibial tunnel technique (n = 310, Group II). Outcomes were evaluated clinically and radiographically using the 2000 International Knee Documentation Committee (2000 IKDC) Subjective Knee Evaluation Form, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Lysholm scoring scale. Clinical and economic outcome measures included surgical time, rehabilitation and disability periods and period of recovery for sports performance. Results The knee anterior drawer test was equally negative and showed no significant differences in the groups. The Lachman test and the pivot shift test showed better results in Group I (p < 0.001). Contractures, atrophic femoral muscles (p < 0.05), synovitis (p < 0.01), vertical position of the femoral graft channels and pathologically extended bone channels with wind-wiper effect (p < 0.001) were more common among patients of Group II. Although knee function returned to normal, as rated with the 2000 IKDC Subjective Knee Evaluation Form, in 91.3 % of cases pathological changes in the knee (C) and severely impaired function (D) were 2.5 and 5 times less common in group I than in Group II (p < 0.05). Pain, symptoms and sport scores were significantly higher on the KOSS scale for Group I (p < 0.05). Surgical time was longer in patients of Group I (p < 0.05) who had shorter rehabilitation period (p < 0.05). Conclusion Anatomical reconstruction of ACL using anteromedial portal was shown to be a more reliable technique as compared to transtibial approach to ensure overall knee stability arranging adequate bone channels. The technique is capable to protect the graft from injury, reduce the likelihood of pain, synovitis, contractures, muscle atrophy, providing shorter rehabilitation, disability period and recovery for sport performance.

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Цель исследования: формулировка научно обоснованных рекомендаций по клиническому применению латерального экстраартикулярного тенодеза (ЛЭАТ) трансплантатом из сухожилия полусухожильной мышцы (СПСМ) как дополнительного элемента стабильности коленного сустава при анатомической антеградной пластике передней крестообразной связки (ПКС).