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Introduction Anterior cruciate ligament (ACL) reconstruction with quadrupled hamstring tendon autograft is a safe and reproducible surgery with good functional outcomes. Currently there is no consensus on capability of graft diameter planning. Objectives To investigate the influence of anthropometric data and cross-sectional area of semitendinosus (ST) and gracilis (GR) tendons according to preoperative magnetic resonance imaging (MRI) on intraoperative graft diameter. Material and methods The study included 111 consecutive patients (69 men and 42 women), who underwent ACL reconstruction with quadrupled hamstring autograft between 2015 to 2018. Height, weight and BMI were recorded in all patients preoperatively. Semitendinosus and gracilis tendons cross sectional areas (CSAst and CSAgr, respectively) were evaluated on preoperative MRI axial images. We also calculated doubled and quadrupled graft diameters (CSAst+gr and CSA4p, respectively) based on obtained MRI data. Collection of intraoperative data included length of each tendon separately, length and diameter of the resulting autograft. We used linear regression and Pearson correlation coefficient were used. The crosssectional areas were correlated to antropometric and intraoperative data. Using logistic regression, we determined the probability of obtaining a graft diameter of ≥ 7.5 mm. A critical level of statistical significance was set as 5 % (p ≤ 0.05). Results The median age accounted 37.4 ± 0.89 (13–58) years, height – 174.6 ± 0.84 (156–200) cm, weight – 78.5 ± 1.52 (45–120) kg, BMI – 25.6 ± 0.37 ( 18.49–41.5). Intraoperatively GR average length was 224.7 ± 3.06 (80–340) mm, ST – 256.3 ± 2.97 (160–340) mm, quadrupled graft – 111.3 ± 1.42 (80–140) mm. The most common graft diameter was 7 mm in females and 7.5 mm in males. We found strong positive correlation between graft diameter and CSA4p, СSAst+gr, CSAst, weight and height. Linear regression showed that graft diameter was influenced by CSA4p, СSAst+gr, CSAst and height. If CSA4p was ≥ 72 mm2, the probability of obtaining a graft of ≥ 7.5 mm at the time of surgery reached 90.6 %. Conclusion CSA4p may be used as a predictive characteristic for graft diameter preoperative planning. Our findings show that graft diameter was mainly influenced by height, СSAst+gr, CSAst and CSA4p.

Background. The shoulder MRI is one of the main methods for the rotator cuff injuries diagnostics and determination of the further treatment tactics. The agreement in the MRI data interpretation among specialists regarding different types of shoulder ruptures is an integral part of diagnostic test validity evaluation. The purpose of this study was to assess the agreement in the MRI data interpretation in the patients with shoulder rotator cuff pathology among trauma surgeons, as well as between trauma surgeons and a radiologist. Materials and Methods. The study was a retrospective analysis of the MRI data and surgical reports regarding 57 patients with various shoulder pathologies undergone the shoulder MRI and arthroscopic shoulder revisions in the period from 2017 to 2019. There were 38 (67%) men and 19 (33%) women among the patients. The average age of the patients was 52.7±13.6 years. The sensitivity and specificity, as well as the shoulder MRI inter-rater reliability were assessed in the course of the study. Results. The rotator cuff pathology was revealed in 52 patients: supraspinatus tendon injury in 98% of cases, supraspinatus and infraspinatus tendon — in 26%, isolated subscapularis tendon injury — in 2%, supraspinatus and subscapularis tendon — in 39%. The maximal concordance in the MRI data interpretation was achieved in the patients with full-thickness supraspinatus tendon rupture, as well as with the supraspinatus tendon calcifications. However, significant disagreement was found between orthopedists with different work experience in determination of the presence and type of infraspinatus and subscapularis tendons pathology and supraspinatus tendon incomplete ruptures and tendinitis. Conclusion. The high agreement in the MRI data interpretation in determining the pathology of the shoulder rotator cuff among trauma surgeons, as well as between trauma surgeons and radiologists, was observed only regarding the supraspinatus tendon, calcifying tendonitis and full-thickness injury. The diagnosis of tendinitis and incomplete tendon rupture remains difficult. Their interpretation results vary greatly. It is also worth noting the heterogeneity of the results of diagnostics of the infraspinatus and subscapularis tendon pathology.

Р е в м о о р т о п е д и я и р е а б и л и т а ц и я

The purpose of this study: to evaluate the results of conservative treatment of isolated grade II and III PCL rupture in athletes.Materials and methods. The study included 36 patients who were athletes at a professional level, with isolated PCL rupture, and have been treated non-operative in the period from 2012 to 2020. The non-operative protocol of isolated lesions of the PCL involve, bracing with posterior leg support, rehabilitation program determined by the symptoms and physical signs.Results. After 2 years from injury, the average score on the Tegner scale was 9 (5–10) (p=0.42). 32 (89%) patients returned to the previous level of sports activity, the average score on the Tegner scale was 9 (7–10). The mean time to return to sports-specific training was 10.6 (4–27) weeks, and the mean time to return to full competitive sport was 16.4 (10–40) weeks. Conclusion. The non-operative management of isolated, Hughston grade II and III PCL injuries gives excellent functional outcomes with a high proportion returning to the same level of sport.