Novosti
Khirurgii
This journal is
indexed in Scopus

Year 2016 Vol. 24 No 5

TRANSPLANTOLOGY

DOI: https://dx.doi.org/10.18484/2305-0047.2016.5.473   |  

G.P. KOTELNIKOV, Y.V. LARTSEV, D.S. KUDASHEV, S.D. ZUEV-RATNIKOV, I. S. SHORIN

MOSAIC CHONDROPLASTY OF FULL-THICKNESS DEFECTS OF KNEE ARTICULAR SURFACES IN ITS DESTRUCTIVE DYSTROPHIC LESIONS

SBEE HPE "Samara State Medical University",
Samara.
The Russian Federation

Objectives. The improvement of the operative treatment results of patients with full-thickness destructive and dystrophic defects of the articular cartilage of the knee joint based on a new method of chondroplasty application.
Methods. The patients were divided into two clinical groups according the method of the operative treatment. The patients (n=34, 49%) were enrolled into the first group. They were operated on using Hangodys mosaic chondroplasty technique (1992). The patients of the second group (n=35, 51%) subjected to a proposed mosaic chondroplasty based on the use of bone spongy autograft taken extra-articularly as a plastic material for defect replacement. Comparative evaluation of operative treatment results of the indicated clinical groups of patients was carried out 3, 6 and 36 months after the operation. Treatment response was assessed according the indicators WOMAC-index, Lequesne index, parameteres of the functional electromyography, stabilometry and podometry that allowed calculating integral indicators i and using it in the mathematical models of the system (clinical and functional status of the lower limb) and analyse them.
Results. Comparative analysis of the mathematical models (clinical and functional status of the knee) demonstrated more expressed clinical remission and functional recovery of the lower limb comparing to the Hangodys method within 3-6 months after the operation.However, if in those terms a clear trend of reduction of integral indicator i with its striving to the value, corresponded to norm, the reversed increasing of i value identical for both groups was observed later in terms of 36 months after the operation. It testifies the regression of the achieved compensation and is considered to be an unfavorable criterion of prognosis of the pathological process progression.
Conclusion. The proposed method of chondroplasty of the articular cartilage defects of the knee joint provided significantly greater structural and functional recovery of the knee and and may be recommended for clinical use.

Keywords: knee joint, hyaline cartilage defect, destructive-dystrophic diseases, stabilometry, chondroplasty
p. 473-481 of the original issue
References
  1. Korzh NA, Golovakha ML, Orlianskii V. Povrezhdeniia khriashcha kolennogo sustava: monografiia [Injuries of the knee cartilage: a monograph]. Zaporozh'e, Ukraina: Prosvita; 2013. 128 p.
  2. Kotel'nikov GP, Lartsev IuV. Osteoartroz [Osteoarthritis]: ruk. Moscow, RF: GEOTAR-Media; 2009. 208p.
  3. Steinwachs MR, Kreuz PC, Guhlke-Steinwachs U, Niemeyer P. Current treatment for cartilage damage in the patellofemoral joint. Orthopade. 2008 Sep;37(9):841-47. doi: 10.1007/s00132-008-1290-9. [Article in German]
  4. Kushner FD, Skott VN, Skuderi ZhR. Khirurgiia kolennogo sustava [Surgery of the knee joint]. Krasenkov PV, per. s angl. Moscow, RF: Med lit; 2014. 274 p.
  5. Aaron RK, Skolnick AH, Reinert SE, Ciombor DM. Arthroscopic débridement for osteoarthritis of the knee. J Bone Joint Surg Am. 2006 May;88(5):936-43.
  6. Goldring SR. Role of bone in osteoarthritis pathogenesis. Med Clin North Am. 2009 Jan;93(1):25-35, xv. doi: 10.1016/j.mcna.2008.09.006.
  7. Bielby RC, Boccaccini AR, Polak JM, Buttery LD. In vitro differentiation and in vivo mineralization of osteogenic cells derived from human embryonic stem cells. Tissue Eng. 2004 Sep-Oct;10(9-10):1518-25.
  8. Bae DK, Yoon KH, Song SJ. Cartilage healing after microfracture in osteoarthritic knees. Arthroscopy. 2006 Apr;22(4):367-74.
  9. Malanin DA, Pisarev VB, Novochadov VV. Vosstanovlenie povrezhdenii khriashcha v kolennom sustave: eksperimental'nye i klinicheskie aspekty [Restoration of damaged cartilage in the knee joint: experimental and clinical aspects]. Volgograd, RF; 2010. 455 p.
  10. Wright TM, Maher SA. Current and novel approaches to treating chondral lesions. J Bone Joint Surg Am. 2009 Feb;91(Suppl 1):120-5. doi: 10.2106/JBJS.H.01390.
  11. Eismont OL, Borisov AV, Maliuk BV, Bukach DV. Artroskopicheskaia diagnostika i lechenie lokal'nykh povrezhdenii sustavnogo khriashcha kolennogo sustava [Arthroscopic diagnosis and treatment of local injuries the articular cartilage of the knee joint]. Ortopediia Travmatologiia i Protezirovanie. 2007;(2):111-14.
  12. Bhattacharjee A, McCarthy HS, Tins B, Roberts S, Kuiper JH, Harrison PE, et al. Autologous Bone Plug Supplemented With Autologous Chondrocyte Implantation in Osteochondral Defects of the Knee. Am J Sports Med. 2016 May;44(5):1249-59. doi: 10.1177/0363546516631739.
  13. Kotel'nikov GP, Lartsev IuV, Smirnitskii AM. Sposob autoplastiki sustavnykh poverkhnostei kolennogo sustava [A method autoplasty articular surfaces of the knee joint]. Patent RF 2239377. 10.11.2004.
  14. Orlianskii V, Golovakha MV, Shabus R. Korrigiruiushchie osteotomii v oblasti kolennogo sustava [Corrective osteotomy of the knee joint]. Dnepropetrovsk, Ukraina: Porogi; 2009. 160 p.
  15. Preston CF, Fulkerson EW, Meislin R, Di Cesare PE. Osteotomy about the knee: applications, techniques, and results. J Knee Surg. 2005 Oct;18(4):258-72.
Address for correspondence:
443099, Russian Federation, Samara,
Chapaevskaya st., 89, Samara State Medical University,
department of traumatology, orthopedics and
extreme surgery named after Academician AF Krasnov.
Tel: +79276076209
E-mail: dr.kudashev@gmail.com
Kudashev Dmitry Sergeevich
Information about the authors:
Kotelnikov G.P. MD, Academician of RAS, Professor, Head of department of traumatology, orthopedics and extreme surgery named after Academician of RAS Krasnov A.F. SBEE HPE "Samara State Medical University".
Lartsev Y.V. MD, Professor of department of traumatology, orthopedics and extreme surgery named after Academician of RAS Krasnov A.F., Head, department N2 of traumatology-orthopedics SBEE HPE "Samara State Medical University".
Kudashev D.S. PhD, traumatologist-orthopedist SBEE HPE "Samara State Medical University", department N2 of traumatology-orthopedics, Assistant of department of traumatology, orthopedics and extreme surgery named after Academician of RAS Krasnov A.F.
Zuev-Ratnikov S.D. PhD, traumatologist-orthopedist, SBEE HPE "Samara State Medical University", department N2 of traumatology-orthopedics of clinics, Assistant of department of traumatology, orthopedics and extreme surgery named after Academician of RAS Krasnov A.F.
Shorin I.S. Post-graduate student, SBEE HPE "Samara State Medical University", department of traumatology, orthopedics and extreme surgery named after Academician of RAS Krasnov A.F.
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