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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.

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

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.

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.

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.