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Rotator cuff ruptures are the most common injuries of shoulder joint with an incidence of about 20 %. This pathology is more common in adults over 60 years of age because it is caused by degenerative changes in the tendon. Massive injuries account for 10–40 % of all rotator cuff injuries. Currently, there is no unified surgical tactics for the treatment of patients with massive ruptures of rotator cuff tendons.The aim. To assess the efficiency of transposition of the latissimus dorsi tendon in patients with massive ruptures of the rotator cuff tendon.Materials and methods. The study included 15 patients with Patte stage III massive ruptures of the rotator cuff who had transposition of the latissimus dorsi tendon.Results. The article presents clinical cases of surgical treatment of patients. The following criteria were assessed: mean age; time since injury; duration of the surgery; blood loss volume; functional results by the ASES (American Shoulder and Elbow Surgeons) Shoulder Score. Taking into account the ASES Shoulder Score indicators 1 year after the surgical treatment, the following results were obtained: excellent results – in 9 (53.3 %) cases; good results – in 1 (13.4 %) case; satisfactory results – in 5 (33.3 %) cases.Conclusion. When preserving the articular cartilage, the method of choice in the treatment of patients with massive ruptures of rotator cuff tendons is transposition of the latissimus dorsi tendon. At the same time, an incomplete restoration of the function of the injured limb was registered in 33.3 % of patients, which requires further study and modification of the known method of transposition of the latissimus dorsi tendon.

Background. The shoulder joint is the one most amenable to dislocation. Dislocation of the humeral head is complicated by combined injuries of the shoulder joint, and if the patient does not seek treatment on the first day after the dislocation, irreversible changes in bone and soft tissue structures are formed.The aim of this review was to analyze modern methods of diagnosis and treatment of patients with defects in the articular surfaces of the scapula and humerus head with chronic shoulder dislocations.Material and methods. To search for literature data, we used the electronic databases MEDLINE, PudMed, eLIBRARY with a selection of sources published from 2000 to 2020. The analysis was carried out on works devoted to the diagnosis, surgical treatment and complications of traumatic shoulder dislocations.Results. When analyzing the literature on the surgical treatment of shoulder dislocations, we did not find clear criteria for planning the extent of surgery. The obtained results of surgical treatment testify to well-studied technologies for treating osteochondral defects of the humeral head up to 25 % of its total area. In the presence of a defect of 50 % of humeral head area or more, satisfactory results are shown when carrying out arthroplasty of the joint using a reverse endoprosthesis. However, the treatment of defects ranging in size from 25 to 50 % is still an unexplored problem. There are single techniques using allografts, mainly in English-speaking countries and, to a lesser extent, on the territory of the Russian Federation. Thus, the search for an algorithm for choosing a surgical treatment based on multi-layer spiral computed tomography and/or magnetic resonance imaging data, and the development of a new method of surgical treatment taking into account the obtained data are priority areas in modern traumatology and orthopedics.

Massive rotator cuff tears present a challenging problem for surgeons. According to various authors, from 10 to 40 % of ruptures are massive and more often affect patients over 60 years of age with low-intensity injuries. There is currently no consensus on the classification of rotator cuff injuries. The use of MRI is the gold standard in diagnostics and surgical tactics. Treatment of patients with severe fatty degeneration, muscular atrophy and retraction of the damaged tendon presents certain difficulties. Reinsertion of the damaged rotator cuff tendon is not possible in such patients. There are many different methods of surgical and conservative treatment. In our opinion, transposition of the latissimus dorsi is the method of choice for young and active patients. With the development of new technologies, transposition of the latissimus dorsi muscle began to be performed arthroscopically. This article presents a clinical case: a woman with chronic total rupture of the supraspinatus tendon, Patte grade 3 and fatty degeneration of grade 3 by Thomazeau. The patient was also diagnosed with a secondary superior subluxation of the humeral head. The patient underwent surgical treatment: arthroscopic- associated transposition of the latissimus dorsi muscle to the greater tubercle of the humerus. There was a positive trend, an improvement in the functional result occurred already in the early postoperative period. Considering the above, the method of choice in the treatment of patients with massive ruptures of the rotator cuff tendons can be considered as transposition of the latissimus dorsi muscle, performed by the arthroscopic-associated method.

The frequency of unsatisfactory results of surgical treatment of patients with a fracture of the proximal humerus remains high and is up to 40 %. This is primarily due to the early instability of the metal structure against the background of osteoporosis and as a consequence of non-fusion of the fracture and the formation of a false joint. The aim of the study was to evaluate the effectiveness and safety of a new surgical method for treating patients with a fracture of the proximal humerus against the background of critical osteoporosis. After the approval of the local ethics Committee, 2 groups of 10 patients were formed in the clinic: the patients of main group were operated by the proposed method; the group of clinical comparison was operated by the standard method. In all clinical cases, fractures of the proximal humerus were consolidated on control radiographs. VAS assessment the pain syndrome in the early postoperative period showed that there were no statistically significant differences in the shoulder joint area in the groups. Three months after surgery, when assessing the volume of movement in the shoulder joint (without the participation of the scapula), there was a statistically significant improvement in the main group: abduction – by 35° and external rotation – by 25° (p

Background. Currently, work continues to improve the methods of arthroscopic reconstruction of the anterior cruciate ligament with an autograft, aimed at reducing the risk of postoperative failure.Aim of the study. To assess the immediate results of using a new method of preparing an autograft for anterior cruciate ligament plasty.Materials and methods. The analysis of the results of surgical treatment of 28 patients with old complete traumatic rupture of the anterior cruciate ligament, who were treated in the Department of traumatology and orthopedics of the Irkutsk Scientific Center of Surgery and Traumatology, was carried out. The patients were men aged 18 to 40 years. The common thing for all patients was the All-inside arthroscopic plasty of the anterior cruciate ligament. Two groups of patients were formed depending on the method of preparation of the autograft. The first group consisted of 18 patients in whom a well-known technique was used, including the formation of a four-bundle autograft from one tendon of the semitendinosus muscle. In 10 patients of the second group, a new method of preparing an autograft was used, including the stage of preliminary determination of the required length and thickness of the autograft, and the stage of forming an autograft from the tendon of the semitendinosus and gracilis muscles on the common tendon pedicle.Results. Comparative analysis of the immediate results of arthroscopic plasty of the anterior cruciate ligament with an autograft in case of its old complete traumatic injury revealed a significantly lower number of undesirable consequences when using a new method of preparing an autograft. In two cases, persistence of the pain syndrome associated with arthritic changes in the joint was observed, in one patient there was a restriction of movements in the knee joint, no synovitis, a sensation of instability of the knee joint, ruptures and detachments of the autograft were found. All patients were satisfied with the achieved result.Conclusion. A new method of preparing an autograft for plasty of the anterior cruciate ligament allows achieving anatomical reconstruction of the anterior cruciate ligament, optimal function of the knee joint, reducing pain, significantly reducing the risk of developing knee instability, ruptures and abruptions of the autograft in the postoperative period due to an individual approach, increasing the strength of the autograft and the strength of its fixation in the bone canals.

Researches performed in the past 20 years show the necessity of the restoration of anatomic position of anterior cruciate ligament as the main stabilizing structure of the joint in combination with the restoration of other injured elements and correction of deformities, which affect the outcomes of the treatment.Complexity of the restoration of anatomic position of torn anterior cruciate ligament is caused by its wide area of contact in combination with relatively small sectional area through the joint cavity. More detailed study of topographic anatomy of anterior cruciate ligament allowed the researchers to explain this phenomenon, which pushed them closer to the solution of the problem.Systemic anatomy of anterior cruciate ligament include two bundles - anteromedial bundle and posterolateral bundle. Double bundle plasty of anterior cruciate ligament restored anatomy to its nearly normal condition, but single bundle plasty is used much more often because of its simpler technique. However, the researchers still cannot reach a consensus in the choosing of single or double beam plasty at the restoration of anterior cruciate ligament.

Introduction. The proportion of injuries of the rotational cuff is from 65 to 84 % of all injuries of the shoulder joint. This pathology is more often registered in people over 60 years old. It is far from always that during initial visits, patients are given the correct diagnosis. Most patients are treated conservatively with short-term improvement or without dynamics. The main diagnostic method is an MRI of the shoulder joint, where we can see soft tissue structures. The proportion of massive rupture of the tendons of the supraspinatus muscle is 10-40 % of all ruptures of the rotator cuff.The more time passes from the moment of injury to surgical treatment, the more pronounced are the retraction and degenerative changes in tendons. A special category is occupied by patients with chronic rupture of the tendon of the supraspinatus muscle with a retraction of more than 5 cm (Patte grade III) and Thomazeau grade 3 fatty degeneration.In this category of patients, it is not possible to re-insert the tendons of the rotational cuff of the shoulder.Objective: to evaluate the clinical effectiveness of surgical treatment of a patient with retinal tendon retraction (Patte grade III) and Thomazeau grade 3 fatty degeneration.Materials and methods. The clinical case is presented: a man with a chronic total rupture of the tendon of the supraspinatus, infraspinatus muscle (Patte grade III) and Thomazeau grade 3 fatty degeneration. Secondary upper subluxation of the head of the humerus is revealed. The patient underwent surgical treatment: transposition of the latissimus dorsi muscle on the large tubercle of the humerus.Results. Six months after the operation, the patient restored the function of the upper limb, pain was stopped. Conclusion. Given the functional result, transposition of the latissimus dorsi tendon can be considered the technique of choice for inoperable tendon rupture of the supraspinatus muscle.

Fractures associated with osteoporosis, due to the high prevalence and high percentage of related complications, are a serious problem for modern traumatology and orthopedics. Among all injuries of the upper extremities, fractures in the proximal humerus occur in 32-65 % of cases. Fractures of the proximal humerus account for 4-5 % of all fractures and 50 % of fractures of the humerus. The aim of the research was to develop a new method for the surgical treatment of fractures of the proximal humerus against the background of osteoporosis and to evaluate the clinical effectiveness of the new method. A pilot study was conducted to evaluate the clinical efficacy and safety of surgical treatment of patients with a fracture of the proximal humerus. The results showed that the new "Method for the surgical treatment of patients with a fracture of the proximal humerus" is clinically effective and safe. Additional intramedullary bone stabilization of the proximal humerus with a fibular autograft allows for more rigid and stable fixation of fragments, especially in the presence of critical osteoporosis. The early restoration of passive and active movements in the shoulder joint made it possible to fully restore the function of the limb in a severe fracture of the proximal section.

Single-center randomized controlled partially blinded research aimed at the determination of functional results of surgical treatment of patients with Achilles tendon injury of different Myerson stages was carried out in the clinic of Irkutsk Scientific Centre of Surgery and Traumatology. Based on the analysis of surgical treatment of 20 patients with Achilles tendon divided into two groups (with Myerson stage 11 and stage 111 diastasis) we showed the effectiveness of surgical treatment using plantar muscle flexor tendon. We assessed the following criteria: 1) time from the moment of injury, diastasis length, duration of surgery; 2) pain syndrome after the surgery, omission of additional mobility aids and equipment; 3) AOFAS functional results. While the analysis we found statistically significant differences in studied groups by the criteria "time from the moment of injury" and "diastasis length". As the result of the research we found statistically significant differences by "duration of surgery» criterion. In consequence of using plantar muscle flexor tendon as a stabilizing factor at the restoration of Achilles tendon we didn't register the differences between the groups by the level and duration of pain syndrome after the surgery, terms of the omission of additional mobility aids and equipment after the surgery and also in AOFAS functional results.

The first description of surgical treatment of anterior cruciate ligament injuries has become known about a hundred years ago. At the beginning, complete ruptures of the anterior cruciate ligament was treated by open restoration with arthrotomy. At present, open ACL plasty is practically out of use, except for single cases. In recent decades, worldwide, surgical treatment of knee ligament injuries has been performed with arthroscopic techniques. It has long been proven that arthroscopic operations are able to restore the primary anatomy of the damaged joint, combining anatomical validity and minimal traumaticity, pathogenetic justification and high functional efficiency. For more than 50 years, surgeons have been offered many different materials and methods for ACL reconstruction, but nevertheless there is currently no consensus on the choice of rational treatment tactics and the percentage of unsatisfactory results remains significant. Based on the data of modern authors, it can be concluded that the issue of knee joint ligaments damage not only does not lose its relevance, but, on the contrary, due to the increased interest in active lifestyle, it becomes more and more popular and studied. The article presents various views on the basic methods of arthroscopic restoration of the anterior cruciate ligament of the knee joint at the present stage of the development of surgery.

Incidence rate of primary synovial chondromatosis of the shoulder joint makes 15-28 %. It is a rare benign lesion of synovial membrane of the joint featured by multiple foci of cartilaginous metaplasia in tissues of the membrane. Differential diagnostics should be conducted with the diseases, accompanied by formation of intra-articular loose bodies (secondary chondromatosis) at osteochondritis dissecans, osteochondral fracture of the humeral head, and tuberculous rheumatism. But the critical role belongs to histopathology report and molecular genetic analysis. Synovial chondromatosis most frequently afflicts one of the major joints (knee, hip, elbow, or shoulder). The pathology develops mainly in young men. Published descriptions of the development of this shoulderjoint lesion are very sparse. Diagnostics becomes possible only on the grounds of histological examination of cartilage flaps removed from the joint. Present treatment of synovial chondromatosis includes removal of intra-articular cartilage bodies, either with open surgery or by arthroscopic approach. The authors of the article present the clinical example of diagnostics and surgical treatment of the patient with primary synovial chondromatosis. The disease, aged more than 4years, was accompanied with limited movements in the shoulder joint. Postoperative check-up examination established restored volume of movements and no pain syndrome in the joint. The patient came back to everyday routine and amateur sport. Therefore, adequate volume of surgical intervention excludes the recurrence of the disease in early and remote postoperative period. The patient is able to work and participate in routine physical activity.

Heel tendon injuries is the most common trauma of tendomuscular apparatus. Old ruptures of heel tendon occur in 58 % of cases in humans. The aim of the research was to estimate the effectiveness of treatment of the patients with old ruptures of heel tendon with Myerson type III defects who had tendon reconstruction on Chernavsky and short plaster splint immobilization of lower extremity for 4 weeks. We operated 10 patients using reconstruction on Chernavsky in our clinic from 2012 to 2014 (average age - 47,6 ± 12,0 years, 8 males and 2 females). All patients had old ruptures of heel tendon. Average time from the moment of trauma till the operation was 112,6 ± 80,4 days. Diastasis between the ends of tendon was 5,8 ± 0,7 cm that corresponds to Myerson type 111. Average term of staying at hospital was 10 ± 2 days. We didn't register any complications in postoperative period. Term of plaster immobilization of the operated extremity was 4 weeks. AOFAS score was 34,2 ± 6,8 points at the control examination in 1,5 months that corresponds to bad functional result. We registered good functional results (88,6 ± 3,5 points) in 3 months. 1n 6 months, functional results were 95,9 ± 1,6 points. 1n 12 months after the operation average score was 97,9 ± 2,1 points that corresponds to excellent functional result. Using heel tendon reconstruction on Chernavsky at the Myerson type 111 defects in combination with short plaster immobilization and early activization of patients allows to decrease term of rehabilitation of patients after the operation.

According to the results of multi-layer spiral CT, the main reason of shoulder instability is a bone defect of scapula articular surface. Frequency of poor results after common surgical treatment is high and runs up to 30 % of cases. The aim of the research was to estimate long-term results of surgical treatment of patients with chronic posttraumatic anterior shoulder instability at the edge bone defect of scapula articular surface using restoration of the anatomy of scapula articular surface by free autograft. We conducted open controlled prospective randomized study in the clinic of Irkutsk Scientific Center of Surgery and Traumatology. Estimation of long-term results of surgical treatment was conducted by the next criteria: functional (range of motions of operated upper extremity), subjective (visual analogue scale of pain, integral estimation of functional results by Rowe - Zarins and DASH scales), objective (X-ray imaging of shoulder joint in -x views and multi-layer spiral CT) and complications. Estimation of functional and anatomic results of 34 patients in 3 years after the operation proved clinical effectiveness of proposed surgical method. Overall level of conclusiveness of the research can be defined as level B and the effect of treatment as class I. Therefore, using free autograft from iliac crest allows to restore lost surface of scapula cavity more than 15 % of total surface.

Traumatic isolated injury of deltoid muscle is a rare nosological orthopedic injury that occurs in 1,3 % of all shoulder joint injuries. In normal state function of shoulder joint is provided by deltoid muscle up to 50 % of capacity in scapular area. Degree of abolition of function of shoulder joint depends on the degree of deltoid muscle injury. Differential diagnosis is necessary to conduct with other traumatic injuries accompanied with such upper limb dysfunctions as chronic posterior humerus head dislocation, injury of rotatory cuff tendon, chronic complete or partial disorder of deltoid muscle integrity. The article contains clinical case of diagnostics and surgical treatment of the patient with isolated old deltoid muscle injury of more than 2 years accompanied with combined contracture of shoulder joint. Check-up examination in 6 months after the operation showed full restoration of a function of upper limb and no complaints. Results of control MRT examination of shoulder joint in 11 months after the operation showed full adhesion of tendomuscular autograft with acromial process of scapula.

Injury of rotator cuff tendon is a common cause of pain and dysfunction of shoulder joint. The aim. of this study was to evaluate clinical efficiency of surgical treatment of patients with old total rupture of rotator cuff tendon. 63 patients were operated in clinic of Scientific Center of Reconstructive and. Restorative Surgery SB RAMS during 2007—2012. Average age of the patients was 47,6 ±2,1 years. Patients were randomized into two groups of clinical comparison. Patients of the first group had open reinsertion of rotator cuff tendons with transosseous sutures. Patients of the second group had the same procedure with use of an additional metal construction. The observation period differed from 3 months to 5 years (26 ± 5,1 months in average). As the result of the research positive results were in 83,1 % and 82,4 % of cases respectively at the assessment with use of UCLA scale. Reinsertion of full rupture of rotator cuff tendons in spite of risk of trauma of operative treatment is an operation. of choice that gives maximum prospects to the restoration of patients' capability. But analyzed technical defects of known methods caused the creation of a new method of surgical treatment of old injuries of rotator cuff tendon and. the device for its realization.

Systematic analysis of literature concerning treatment of patient with chronic posttraumatic instability of shoulder joint in historical aspect was realized. Main tendencies of development of surgical orthopedics including evolution of both palliative and. reconstructive surgical methods for shoulder joint were revealed. On the basis of more than 50 literature sources we managed to estimate progress of scientific researches from the point of view of evidence-based medicine. By the end of 1980s main directions in correction of described nosology which were determined by the level of device-dependent visualization were formed. Necessity of brand new change in mini-invasive surgery of deep and chronic injuries of shoulder joint structures according to the literary data caused, future creation of a new direction based on advanced extended data of pathogenesis of shoulder joint instability.

Main reason of shoulder joint instability is bone defect of scapula cavity. The number of unsatisfactory outcomes after surgical treatment is still high. The aim. of the research was to improve surgical technique of treatment of patients with chronic posttraumatic anteromedial instability of shoulder joint at the bone defect of articular process of the scapula. Open controlled prospective randomized research was carried out in the clinics of SCRRS SB RAMS. Clinical effectiveness of proposed medical technology was proved on the basis of analysis of operative treatment of 34 patients during 6 months after the operation. We used Bristow - Latarjet bone plastics for comparison.