Our preliminary studies indicate the significant value of assessing skeletal maturity in adolescents, which characterizes the development of the skeleton in an individual and can be used as a biomarker of regenerative potential in children and adolescents, which significantly affects the choice of treatment tactics for diseases of the hip and knee joints. In particular, we have established the dependence of reparative regeneration processes in children and adolescents on skeletal maturity in such diseases of the hip and knee joints as slipped capital of femoral epiphysis (SCFE), Perthes’ disease, femoro-acetabular conflict syndrome, spastic hip dislocation in patients with cerebral palsy, Blount’s disease. The intensity of regeneration processes in the prepubertal development allows the use of less invasive methods of surgical interventions. The purpose is to develop a methodology for determining skeletal maturity as a biomarker for establishing indications for regenerative interventional technologies in adolescent patients with hip and knee joint diseases. Materials and methods. The group for the development of the examination methodology consisted of 157 patients (86 boys and 71 girls) with hip joint pathology (hip dysplasia, Perthes disease, juvenile epiphysiolysis of the femoral head, aseptic necrosis of the femoral head, and without diagnosed hip joint pathology) and 129 patients (58 boys and 71 girls) with knee joint diseases (Blount disease, axial deformities of the lower extremities, meniscal damage and patients who were examined for complaints of pain in the knee joint area) aged 10 to 18 years. The group of a differentiated approach to the use of regenerative interventional technologies consisted of 46 adolescent patients with diseases of the hip and knee joints (SCFE, Perthes’ disease, Blount’s disease, the pathology of menisci). Results. A methodology for the use of skeletal maturity as a biomarker for establishing indications for regenerative interventional technologies in adolescent patients with diseases of the hip and knee joints has been developed, which includes the following steps: establishing the period of sexual development of the patient based on the determination of skeletal maturity based on radiographs of the hip and knee joints, establishing additional risk factors (heredity, individual characteristics of the connective tissue, the presence of chronic systemic diseases) and the severity of the disease (according to the results of questionnaires). According to the results of the analysis of the application of the methodology of distinguishing skeletal maturity as a biomarker of indications for regenerative interventional technologies in adolescent patients with diseases of the hip and knee joints, it was established that in prepuberty only 3 out of 16 examined patients (which amounted to 19%) have indications for regenerative interventional technologies, during the induction of puberty, 4 out of 9 examined patients (that is, almost 50%) had the indicated indications. Our preliminary studies indicate the significant value of assessing skeletal maturity in adolescents, as it characterizes the development of the skeleton in an individual and can serve as a biomarker for regenerative potential in children and adolescents. This assessment significantly influences the choice of treatment tactics for diseases of the hip and knee joints. Specifically, we have established a correlation between reparative regeneration processes and skeletal maturity in conditions such as slipped capital femoral epiphysis (SCFE), Perthes' disease, femoroacetabular impingement syndrome, spastic hip dislocation in patients with cerebral palsy, and Blount's disease. The intensity of regeneration processes during prepubertal development allows for the use of less invasive methods of surgical interventions. The purpose of the study was to develop a methodology for determining skeletal maturity as a biomarker for establishing indications for regenerative interventional technologies in adolescent patients with hip and knee joint diseases. Materials and methods. The study group for the development of the examination methodology included 157 patients (86 boys and 71 girls) with hip joint pathology (hip dysplasia, Perthes' disease, juvenile epiphysiolysis of the femoral head, aseptic necrosis of the femoral head, and individuals without diagnosed hip joint pathology), as well as 129 patients (58 boys and 71 girls) with knee joint diseases (Blount's disease, axial deformities of the lower extremities, meniscal damage, and patients who were examined due to complaints of knee joint pain), aged between 10 to 18 years. The group for a differentiated approach to the use of regenerative interventional technologies consisted of 46 adolescent patients with diseases of the hip and knee joints (SCFE, Perthes' disease, Blount's disease, and pathology of menisci). Results. A methodology for the use of skeletal maturity as a biomarker for establishing indications for regenerative interventional technologies in adolescent patients with diseases of the hip and knee joints has been developed, which includes the following steps: establishing the period of sexual development of the patient based on the determination of skeletal maturity based on radiographs of the hip and knee joints, establishing additional risk factors (heredity, individual characteristics of the connective tissue, the presence of chronic systemic diseases) and the severity of the disease (according to the results of questionnaires). According to the results of the analysis of the application of the methodology of distinguishing skeletal maturity as a biomarker of indications for regenerative interventional technologies in adolescent patients with diseases of the hip and knee joints, it was established that in prepuberty only 3 out of 16 examined patients (which amounted to 19%) have indications for regenerative interventional technologies, during the induction of puberty, 4 out of 9 examined patients (that is, almost 50%) had the indicated indications. Conclusions. In the prepubertal period, we recommend the use of regenerative technologies in combination with one of the risk factors or in cases with a severe or moderate course of the disease. During the induction of puberty, regenerative technologies are recommended in the presence of one of the risk factors or in cases with a severe or moderate course of the disease. In the pubertal period, due to the reduction of the individual's regenerative potential, we recommend the use of regenerative technologies for all patients.

The responsible stage of choosing the source of bone allografts is the process of examination and selection of the donor, which includes moral and ethical, legal and medical aspects. The selection of potential donors should be carried out with the participation of a qualified doctor, with a thorough collection of anamnesis, social conditions and a general medical examination. Up to 48 % of all potential donors are rejected to collect bone in the pre-operative period; up to 22 % of the received tissues are not suitable for transplantation according to the results of further examinations. Purpose – to develop a protocol for the examination of potential living donors of bone tissue based on anamnestic, clinical, laboratory and instrumental examinations to ensure the selection of high-quality bone material for the production of bone grafts. Materials and methods. From 01.01.2016 to 01.12.2021, 640 patients for hip replacement were involved in the selection of bone tissue donors. The following selection steps were applied: obtaining informed consent, filling in a questionnaire about the possibility of donation, express-tests for infections and X-ray morphometric examination based on the results of radiography of the hip joints in direct projection. Results. Based on the results of the examination of potential donors, it was established that the number of patients who were excluded from further research due to refusal to donate was 3 %, due to contraindications according to the results of filling out the questionnaire – 15 %, according to X-ray morphometric criteria – 51 %, according to the results of laboratory examination – 2 %. Conclusions. A protocol of examination of bone tissue donors for the production of scaffolds has been developed. It was established that about 30 % of all examined potential donors are suitable for donation.

Patients with congenital heart defects and cardiovascular diseases are required new approaches to surgical intervention. The use of biological cardiac implants, which are made from the extracellular matrix, is a promising trend in modern regenerative medicine. These bioimplants can completely replace defective tissue or organs, and when manufactured with strict protocols and quality control measures, can be safe and effective for therapeutic applications. The process of manufacturing bioimplants involves various risks that need to be assessed and mitigated with ongoing monitoring and evaluation necessary to ensure the highest standards of quality. Overall, this study was successfully evaluated the requirements for introducing a new medical device into practice and created a technical file that meets all necessary documentation for certification.

Recent studies show that among people with an active lifestyle about 6-10 % of injuries are acute injuries of the knee joints, namely – meniscus tear. The main treatment options for traumatic meniscus tears include surgical arthroscopic partial meniscectomy or meniscus reconstruction, and conservative regenerative injection techniques. Today, the choice of treatment tactics remains controversial. The purpose of the study was to evaluate the effectiveness of regenerative injection techniques in comparison with partial resection of the menisci and non-steroidal anti-inflammatory drugs together with the systematic use of kinesiotherapy for traumatic meniscus injuries. Materials and methods. The results of еру treatment of 154 patients with traumatic meniscus injuries were evaluated. Group 1 (n = 53) received intra-articular injection of plasma enriched with growth factors with a high platelet concentration of at least 1 million/μL and a high number of leukocytes (L-PRP/L-PCP) in combination with low molecular weight hyaluronic acid; the number of injections from 3 to 6 with an interval between injections of 2 weeks. Group 2 (n = 49) received NSAID therapy (orally, 1 tablet twice daily, 7 days with a break of 1 week) for 2 months and a course of physiotherapy exercises. Patients in group 3 underwent arthroscopic partial meniscectomy, followed by recommendations for motor regime. Evaluations were performed using VAS scale, WOMAC questionnaire and KOOS survey scale at 3, 6, 12, 24, and 36 months after the end of treatment. Results. The obtained results demonstrated the effectiveness of intra-articular use of L-PRP/L-PCP in the treatment of traumatic meniscus tears in the short term (up to 3 months) and in the long term (up to 3 years), represented by the improvement of joint function and a significant reduction in the level of pain, which was observed in patients of group №1 after 36 months: by VAS 1.2 ± 0.5 cm, questionnaire KOOS 94.5 ± 4.8 points, and WOMAC 4.0 ± 1.9, (p <0.05). The use of nonsteroidal anti-inflammatory drugs and physiotherapy exercises is not effective in the short term (3-6 months), and over time the condition of patients only worsens: after 36 months VAS 7.6 ± 1.9 cm, KOOS questionnaire 24.9 ± 3 , 9 points (p < 0.05), and WOMAC 72.2 ± 7.1, (p < 0.01 compared to primary data). Partial arthroscopic meniscal resection can reduce pain and restore functional status to satisfactory within one year, with further progression of pain symptoms and functional limitations in the second and third year of the study, which is reflected in the results after 36 months: for VAS 5.7 ± 1.9 cm, questionnaire for COOS 47.1 ± 5.7 points, and WOMAC 64.1 ± 5.9, (p < 0.05 compared to primary data). Conclusion. Intra-articular administration of L-PRP/L-PCP with hyaluronic acid can improve functionality and reduce pain in patients with traumatic meniscus injuries for up to 3 years. The use of NSAIDs and kinesiotherapy is not effective at all stages of follow-up. As for the use of arthroscopic partial resection, it provides an opportunity to get rid of pain and improve the capabilities of patients with traumatic meniscus tears for up to 12 months.

The use of bone scaffolds in traumatology and orthopedics is an extremely important issue. The growing number of cases of significant bone defects, in particular after revision arthroplasty, combat trauma and due to the introduction of new methods of reconstructive surgery of bones and joints, requires more detailed studies of the using different osteoplastic materials. Materials and methods. As scaffolds used 4 types of materials that are most often used in the clinic for the correction of bone defects - ceramic hydroxylapatite, beta-tricalcium phosphate, allogeneic bone matrix treated with gamma irradiation, allogeneic bone matrix scaffold. The effect of matrices on the viability of normal human fibroblasts (M19 cell line) in cell culture in vitro was studied. The viability of cells after their co-cultivation with scaffolds was determined by colorimetric method by staining with crystal violet. To obtain an osteoinductive effect used platelet-rich plasma (PRP), standardized by the method of Araki with some modifications. The proliferative activity of fibroblasts was assessed by the level of expression of the proliferation marker Ki-67 by immunocytochemical analysis. Results. It was found that the least pronounced antiproliferative effect is shown by allogeneic bone matrix treated with gamma irradiation. Data on the complex effect of co-cultivation of fibroblasts with scaffolds in the presence of PRP on cell viability and proliferative activity were obtained. It was found that PRP improves the survival of fibroblasts by 15-30 % and increases their proliferative activity by 35-75 %. Delipidization of scaffold from allogeneic bone matrix, heat-treated by local bone bank technology, increased its biocompatibility with human fibroblasts. Conclusions. According to the results of a comparative analysis of the impact of different scaffolds on the viability of normal human fibroblasts, it was found that scaffolds from allogeneic bone matrix have the least pronounced antiproliferative effect. Platelet-rich plasma has been shown to improve fibroblast survival and increase their proliferative activity. Treatment with 70 % ethyl alcohol scaffold from allogeneic bone matrix, heat-treated by local bone bank technology, increased its biocompatibility with human fibroblasts.