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Spontaneous coronary artery dissection (SCAD) is defined as a spontaneous dissection of the coronary artery wall that occurs independently of atherosclerosis, percutaneous coronary intervention, or mechanical trauma. Its distinctive feature is high prevalence in young women. This condition is associated with pregnancy and hormonal changes. A number of risk factors have been identified, including vascular pathology (most commonly fibromuscular dysplasia), other hereditary connective tissue disorders, systemic inflammatory diseases, migraine, and thyroid diseases. Nevertheless, the precise mechanisms of the pathophysiological relationship remain to be elucidated, and risk factors cannot be identified in all patients, indicating the complex and incompletely understood nature of the disease. The present article presents a case series on the development of SCAD in women and a review of the predisposing factors for the disease.

Aim. To assess the prevalence of traditional risk factors and analyze the predictors of recurrent cardiovascular events in patients with acute coronary syndrome (ACS).Material and methods. A total of 482 patients with ACS were included. The follow-up lasted three years. The composite endpoint (CE) included recurrent unstable angina, nonfatal myocardial infarction, repeated percutaneous coronary intervention (PCI), nonfatal ischemic stroke, hospitalization for decompensated heart failure, and cardiovascular death.Results. A high prevalence of traditional risk factors was revealed (dyslipidemia — 467 (96,9%), hypertension — 464 (96,3%), consumption of junk food — 450 (93,4%), sedentary lifestyle — 416 (86,3%)). During the three-year follow-up period, 90 patients had CE. Compared with patients without CE (n=392), patients with CE were significantly more likely to have a long-term CAD (69 (76,7%) vs 241 (61,5%), p=0,007), ACS accompanied by shortness of breath (50 (55,6%) vs 160 (40,9%), p=0,013); they had previously undergone myocardial revascularization (38 (42,2%) vs 116 (29,6%), p=0,024), often by PCI (36 (40,0%) vs 100 (25,5%), p=0,009), especially in the left main coronary artery (LMCA) (6 (6,7%) vs 3 (0,8%), p=0,002); they were more likely to develop in-hospital acute left ventricular failure (11 (12,2%) vs 18 (4,6%), p=0,012), had a lower hemoglobin level and hematocrit (p

Aim. To evaluate the contribution ticagrelor compared with clopidogrel therapy in patients with acute coronary syndrome (ACS) and patients with myocardial infarction (MI) to achieving the State Program "Health Development" target "decrease of cardiovascular mortality" in the country as a whole and Russian regions in 2023-2025.Material and methods. In the first year of therapy, all patients over 18 years of age with a confirmed diagnosis of ACS who were indicated for dual antiplatelet therapy (DAPT) were considered as the target population. In the second and third years, therapy was continued by patients at high risk of coronary events after MI. The number of deaths that could be additionally prevented within 1 year after diagnosis using DAPT with ticagrelor compared with DAPT with clopidogrel was calculated based on the PLATO trial. For post-MI patients, the number of deaths that could be prevented in the second and third years of therapy using DAPT with ticagrelor+acetylsalicylic acid (ASA) compared with ASA monotherapy was calculated based on the PEGASUS trial. The proportion of the target "decrease of cardiovascular mortality of the population" in 2023-2025 that can be achieved by using DAPT with ticagrelor instead of clopidogrel or ASA monotherapy was calculated.Results. The use of ticagrelor as part of DAPT for patients with ACS will make it possible (compared to DAPT with clopidogrel or ASA) to contribute to achieving "decrease of cardiovascular mortality" target in the Russian Federation:in 2023 — 8,0% due to expected prevention of 4443 cardiovascular deaths,in 2024 — 30,3% due to expected prevention of 4753 cardiovascular deaths,in 2025, 5366 cardiovascular deaths can be Conclusion. The use of ticagrelor as part of DAPT for patients with ACS will contribute to achieving "decrease of cardiovascular mortality" target in the Russian Federation.

Aim. This study aims to assess the incidence of heart failure (HF) and associated mortality, and also the burden on the healthcare system in the subjects of Russian Federation, based on the HF encoding data.Material and methods. We made a structured request for the number of patients with HF and the number of cases of providing medical care in 2019. HF was understood to mean the presence of at least one of the codes I09.9, I11.0, I13.0, I13.2, I25.5, I42.0, I42.5, I42.6, I42.7, I42.8, I42.9, I43.0, I43.1, I43.2, I43.8, I50.X (expanded encoding) according to International Classification of Diseases 10th Revision. The code I50.X was considered separately (the standard HF enconding).Results. The information about the incidence of HF, associated mortality and burden on the healthcare system was obtained from 15 subjects (53,6% from those that gave the data according to the request; the adult population is 18,9% from total adult population of Russian Federation). We noted significant heterogeneity between the regions. The median of the incidence of HF and associated mortality was 2,6 and 3,2% in accordance with the data of the expanded encoding, and 0,21 and 11,3% — according to the standard HF encoding. The presence of the code I50.x was observed in average in 9,4% of all cases of HF and defined the patients who frequently used emergency medical services and were frequently hospitalized (60 (18, 96) and 48 (20, 137) cases per 100 patients versus 9 (5, 24) and 17 (10, 70) cases in the expanded encoding).Conclusion. According to the encoding, the indicators of the incidence of HF and associated mortality vary greatly between the regions, the median values are 2,6 and 3,2% in expanded and 0,21 and 11,3% in standard approaches. In the standard encoding, there were more frequent use of emergency medical services and less number of outpatient visits. The development and introduction of a unified approach to encoding and recording the cases of HF will provide obtaining objective statistical data and using them for management decisions.

Secondary prevention should be actively implemented at all stages of treatment and rehabilitation of patients after acute coronary syndrome (ACS). The integration of remote monitoring of patients with the transfer of vital and laboratory data into clinical practice seems promising.Aim. To evaluate the clinical and patient-centered effectiveness of the original 12-month combined face-to-face and telecare program in patients with recent ACS.Material and methods. For the present analysis the data from 84 (out of 100) patients (median age, 56 (50;61) years, 70 males) was used. These patients had to have hypertension and/or type 2 diabetes and an ACS with percutaneous revascularization within 12 months. Their low-density lipoprotein cholesterol (LDL-C) had to be above 2,4 mmol/L. Telehealth program supplemented routine care. A program contained electronic self-control diaries for blood pressure (BP) and lipid profile, and teleconsulting service (text chat). Mandatory face-to-face visits were carried out at 3 and 12 months after the enrollment. The primary end point was ∆LDL-C. Additional clinical and patient-specific endpoints were evaluated.Results. At the 12-month visit, there was a significant decrease in LDL-C by 1,6 (-2,3;-0,9) mmol/L. Besides the initial LDL-C value, the decrease in LDL-C was associated with the proper adherence to keeping diaries of BP and lipid profile (β=0,7), and the number of text messages sent by the doctor in the 1st month after the enrollment (β=0,04). In more adherent patients, the ∆LDL-C was greater by 0,49 mmol/L (95% CI (-1,2; -0,1)) after adjustment for abovementioned covariates. In 35 patients (42%), target LDL-C was achieved, in 60 patients (71%) — a decrease ≥1 mmol/l. Other lipids also have changed for the better. Moreover, adherent patients were twice as likely to achieve the target LDL-C (OR 2,2; 95% CI (0,6; 3,8)) than non-adherent ones. A decrease in office systolic BP by 5,8 mm Hg was shown (p=0,03). The number of physician-to-patient messages exceeded those from patients to physician (median 143 and 111 per patient for 12 months, respectively). The quality of life has improved, but only in terms of emotions. Satisfaction with the program remained high at all timepoints of the study.Conclusion. Our study showed the effectiveness of the integrated care in ACS patients with the telehealth tool included. Commitment to BP self-monitoring, as well as active consultative support at the first stages of rehabilitation, contributes to additional dynamic control of lipid profile, timely correction of lipid-lowering therapy with the achievement of the target LDL-C level. Most of the patients did not experience any difficulties in using the program and are ready to recommend integrated approach to other peers.

Control of cardiovascular diseases (CVDs), which are the cause of premature mortality and high economic costs, is one of the priorities of social policy. Human resources are a key link in health system performance. In Russia, there is a significant geographical heterogeneity in the distribution of medical workers and structural disproportions in certain specialties. Regional differences in the availability of specialists in cardiology system have not been studied enough.Aim. To perform a comparative benchmark analysis of coverage by specialists involved in healthcare provision to patients with cardiovascular diseases in the regions of the Northwestern Federal District (NWFD), identifying regional differences for the period from 2015 to 2019.Material and methods. To assess the number of specialists involved in providing care to patients with CVDs, data from the federal statistical monitoring forms №30 “Information on a medical organization” for 2015-2019 of the subjects of the Northwestern Federal District were used. Multiple linear regression was used to compare the basic estimated parameters of provision per 10000 population with specialists at the level of district as a whole and in NWFD regions with data for Russia as a whole. P

The article presents the results of a study of individual psychological factors that are potentially significant for the development of Internet addiction (IA), carried out as part of the Russian interdisciplinary research project to identify a system of high-risk markers for developing IA. As a result of the analysis, a model of psychological predictors of IA was obtained, which includes personality characteristics — high nonplanning impulsiveness (as a lack of forethought and ability to follow future plans), and low self-direction (concerning to Cloninger’s psychobiological model of personality). Additionally, childhood experiences of living in a community with a high level of violence were included in the model as one of the psychological predictors. The male gender also entered one of the final models as a risk factor for the development of IA. The results can be used as the basis for the development of targeted psychological assistance programs and preventive measures aimed at improving the specific characteristics of inhibitory control and the development of self-awareness.

The main objective of secondary prevention measures is to modify key risk factors such as hypertension (HTN) and dyslipidemia in patients with established cardiovascular diseases. Its proper implementation improves both short- and long-term outcomes. Telehealth technologies contributes to faster achievement of target levels and better control of key risk factors.Aim. To establish a comprehensive personalized follow-up framework for patients recovered from an acute coronary syndrome (ACS) that integrates telehealth software and to test its clinical and patient-centered efficacy.Material and methods. The three-month follow-up data of 50 patients (50% of planned enrollees; median age, 57 years [53; 61]; males, 84%) who suffered ACS with myocardial revascularization and low-density lipoprotein cholesterol (LDL-C) at least 2,5 mmol/L at admission. We introduced the simple and save telehealth software for home BP monitoring and lipid profiling. The basic demographic, clinical and laboratory characteristics of patients were described, as well as the changes lipid profile, office and home BP over this period was analyzed. The primary endpoint was a change in LDL-C after 3 months. In addition, we also focused on pharmacological therapy and its dynamics, as well as on remote counseling and patient’ experience with the mobile application.Results. Three months after inclusion, we have noted significant decrease of total cholesterol (-1,67 mmol/L, p

Aim. To evaluate the effect of the use of the double antiplatelet therapy (DAT) with ticagrelor compared to DAT with clopidogrel and antithrombotic therapy with acetyl salicylic acid (ASA) in patients with acute coronary syndrome and patients with high coronary risk on the target indicator (CP) of the state program (GP) “Development of Healthcare” and the federal project “Fight against cardiovascular diseases” — reducing mortality from diseases of the circulatory system (BSC).Material and methods. All adult Russian patients with a diagnosis of ACS eligible for DAT were considered as the target population; in the second and third years, only patients with high coronary risk continued treatment. The calculation of the number of deaths that can be prevented using DAT ticagrelor 90 mg + ASA vs DAT of clopidogrel + ASA within 1st year from the date of diagnosis was based on the clinical efficacy data of the PLATO study. The number of deaths that can be prevented with the use of DAT ticagrelor 60 mg + ASA — instead of ASA monotherapy patients with a history of myocardial infarction was made based in the clinical efficacy results of the PEGASUS study. It was calculated what proportion of the target indicators could be achieved in 2022-24 years by using DAT with ticagrelor instead of clopidogrel or ASA monotherapy.Results. The use of DAT with ticagrelor vs DAT with clopidogrel or ASA for the treatment of patients with ACS will prevent additional 5389, 5704 and 6012 deaths in 2022-2024, that will ensure the implementation of the CP “reduction of mortality from BSC” GP “Development of healthcare” in the Russian Federation by 36,9%, 26,0% and 20,6% respectively.Conclusion. The use of DAT with ticagrelor for the treatment of patients with acute coronary syndrome ensure the implementation of the CP “reduction of mortality from BSC” GP “Development of healthcare” in the Russian Federation in 2024 by 20,6%.

The extent of the problem of heart failure determines the priority of the intention of developing and implementing an optimal model of medical care for this group of patients. The article describes the key components of the heart failure medical care (continuity, patient routing, educational activities) and provides examples of documents, protocols, checklists that can be used in real clinical practice by specialists in medical organizations in the regions of the Russian Federation.

Aim. To analyze prevalence of heart failure (HF), clinical and demographic characteristics, health care utilization, and outcomes according to the used International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes in regional integrated electronic health record database in Saint Petersburg.Material and methods. The retrospective analysis of the Saint Petersburg regional integrated electronic health record database for 2019 was performed. At least one of the following ICD-10 codes has been considered as HF case: I50.x (standard coding) and/or I11.0, I13.0, I13.2, I25.5, I42.0, I42.9, I09.9, I43.0, I43.1, I43.2, I43.8, I42.5, I42.6, I42.7, I42.8 (extended coding).Results. A total of 64070 adult patients with HF had medical encounters in 2019, 34,5% of whom were identified using standard coding, 65,5% — using extended coding. The combination of codes was observed in 9,9% of cases. HF prevalence/mortality was 1,4%/6,8% in general, as well as 0,49%/15,7% and 0,93%/2,1% with standard and extended coding, respectively. HF patients had high healthcare utilization with the mean number of 14 encounters per patient per year. Actually, 24% of patients had more than 20 both inpatient and outpatient encounters and 54% of patients — at least 1 all-cause hospitalization during the year. Encounters of patients with HF accounted for 4,3% of all visits, 6,5% of all hospitalizations, 4,1% of all outpatient visits and 9,7% of all emergency contacts during the year. Patients identified by the standard coding compared with the extended coding had older age and higher incidence of comorbidities, as well as greater hospitalization and death rates, but lower number of outpatient visits.Conclusion. The prevalence of HF among the adult population of Saint. Petersburg in 2019 was 1,4%. HF was characterized by a high health care utilization and mortality rate reaching 15,7 % per year. The use of different approaches to coding presumably could help to identify different groups of patients with HF, which requires the adaptation of healthcare models and an active monitoring system to reduce the risk of adverse events.

Coronary artery disease (CAD) is the most common cardiovascular disease and the leading cause of morbidity and mortality. Acute coronary syndrome (ACS) as an abrupt destabilization of CAD, multiplies the risk of cardiovascular events. To reduce the incidence of recurrent cardiovascular events, timely tackling potentially reversible risk factors such as hypertension and/or hyperglycemia is imperative. However, a solid basis for a secondary prevention lies in the treatment of dyslipidemia and begins in the first hours of hospital admission. Despite considerable evidence regarding the efficacy and safety of lipid-lowering therapy, averagely only one third of patients maintain control of lipids. The main challenges are low adherence, poor continuity of medical care, and the lack of an ambulatory routine follow-up. Telehealth solutions are believed to address these barriers and may be considered as an add-on to in-person patient care. Telemonitoring of vital and laboratory parameters, remote patient counseling can be introduced into routine care delivery. Telemedicine shows promise for fostering better clinical effect, and provides health-related quality of life improvement.It is planned to conduct a pilot observational study aimed to create and to test an integrated solution, i.e. telemonitoring and remote counseling in patients of very high cardiovascular risk with ACS followed by myocardial revascularization. The goal is to determine the clinical effectiveness, i.e achievement of target values of blood pressure, lipid profile and glycemia, and patient-centeredness of this approach.

Cardiovascular morbidity and mortality are associated with high demographic and economic losses. Their decrease is one of the main lines of development and improvement of the world health systems. An analysis of the current situation in the Russian Federation (RF) demonstrates that the areas of concern in system for cardiovascular diseases (CVD) patients’ care are the insufficient and untimely identification of cardiovascular risk factors, as well as their ineffective management due to the incomplete implementation of existing risk stratification guidelines and decision making. To achieve the aim of reducing mortality from cardiovascular diseases by 2024 and further preserving of this tendency, along with the introduction of a long-term population-based strategy for creating a healthy lifestyle, it is necessary to shift the focus from emergency care and performing high-tech interventions to long-term management of cardiovascular risks. The introduction of a new model of specialized care for cardiovascular diseases, the cardiovascular risk management system, is aimed at the efficient use of healthcare resources and providing the reduction in cardiovascular mortality.

The conclusion of the Expert Council reports an agreement on the place of the P2Y12 receptor blocker prasugrel in the early invasive treatment of patients with acute coronary syndrome ACS, according to the results of the multicenter randomized controlled study ISAR-REACT 5. Prasugrel should be considered the preferred P2Y12 receptor blocker in the planned primary percutaneous coronary intervention and early invasive management of patients with ST segment elevation ACS. Herewith, prasugrel intake in patients with non-ST segment elevation ACS is preferable after coronary angiography and decision for coronary stenting.

Clinical demonstration of the development of acute non-coronarogenic myocardial lesion in a patient with intraoperative rupture of the arterial aneurysm of the basilar artery. Neurogenic cardiomyopathy should be considered in the differential diagnostics of acute heart failure in patients with acute cerebral lesion.

Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation.

The potential impact on cardiovascular morbidity and mortality have become one of the most important issues of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 may be associated with more frequent development of acute cardiovascular complications, while patients with established cardiovascular diseases are characterized by a higher risk of severe infection and adverse in-hospital outcomes. Due to the spread scale of the pandemic, understanding the long-term cardiovascular consequences of COVID-19 is of no less importance. Inability to extrapolate available international data to the Russian population has led to the initiation of a national multicenter study (registry) of patients recovered from COVID-19 and with concomitant involvement of the cardiovascular system or with baseline severe cardiovascular diseases. The article presents its rationale, design and implications of the results for clinical practice.

Raised life expectancy of patients with cardiovascular diseases (CVD), due to continuous progress in drug treatment options and widespread use of innovate technologies, increase the burden of CVD on healthcare system. The development of human resources by highly qualified specialists is of fundamental importance. For the rational use of human resources to achieve the targets of federal project on the prevention of cardiovascular diseases, it is necessary not only to analyze the actual situation with medical staffing, but also the potential effects of staff shortages and imbalances on mortality. The review presents evidence of associations between staffing and quality of care and CVD outcomes.

Aim. To assess the additional effect of ticagrelor as part of dual antiplatelet therapy (DAPT) compared with DAPT with clopidogrel and acetylsalicylic acid (ASA) monotherapy on the achievement of goals of federal project on the prevention of cardiovascular diseases: “reduction of cardiovascular mortality” and “reduction of mortality from myocardial infarction (MI)”.Material and methods. In the first year of treatment, all adult Russian patients with documented acute coronary syndrome (ACS), who had indications for DAPT, were considered as the target population. In the second and third years, treat -ment was continued only by patients with a high risk of thrombotic events. The calculation of the number of deaths that can be prevented using DAPT with ti -cagrelor 90 mg + ASA instead of clopidogrel + ASA during the first year was based on the data of the PLATO trial. To calculate the number of deaths that can be prevented using DAPT with ticagrelor 60 mg + ASA instead of ASA monotherapy, we used the data of PEGASUS trial for patients with a history of MI within the past 2 years.Then the proportion of goals that can be achieved in 2021-2023 was calculated when using DAPT with ticagrelor instead of clopidogrel or ASA monotherapy.Results. The use of ticagrelor within DAPT for patients with ACS will allow (compared to DAPT with clopidogrel and ASA monotherapy):— to prevent an additional 5389, 5702 and 6009 deaths in 2021, 2022, and 2023, respectively, achieving the target of federal project on the prevention of cardiovascular diseases “reduction of cardiovascular mortality” by 18,4, 19,4 and 20,5%, respectively.In addition, the use of ticagrelor within DAPT for patients with ACS compared with clopidogrel or ASA monotherapy will also allow:— to prevent an additional 957, 1013 and 1067 deaths due to MI in 2021, 2022, and 2023, respectively, achieving the target of federal project on the prevention of cardiovascular diseases “reduction of mortality from MI” by 50,2%, 49,3% and 51,9%, respectively.Conclusion. The use of ticagrelor in patients with ACS will reduce cardiovascular mortality and contribute on the achievement of goals of federal project on the prevention of cardiovascular diseases.

The increasing prevalence of heart failure (HF) serves as a reverse side of the effective treatment for cardiovascular diseases (CVD) and increasing patient survival. Data on the epidemiology of HF and related mortality in Russia are limited. According to the EPOCHA trial (hospital phase), the prevalence of HF in the Russian Federation is 7%. HF can significantly contribute to cardiovascular mortality. However, its recognition is limited by the peculiarities of the mortality coding system in Russia. The article presents the authors’ view on the registration of HF-related morbidity and mortality cases and perspectives of using left ventricular ejection fraction

The high and growing incidence and mortality of patients with heart failure (HF) should receive priority attention when developing an action plan to reduce cardiovascular mortality in the Russian Federation. The article provides an analysis of the implemented elements of HF care in 40 Russian regions (Northwestern, North Caucasian, Volga, Southern Federal districts), some of the best practices, as well as prospects for implementation of the cardiovascular risk management system.

Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic

The article focuses on the issue of damaged handheld device data extraction with the help of JTAG and Chip-Off technologies. Practical experiments were conducted to extract data from an HTC Wildfire S phone using the JTAG interface and from a BQ S-4525 Vienna phone using the Chip-Off technology. Also discussed are the knowledge and skills required for successful application of these methods by practitioners.

In several unrelated small samples examined correlation between genetic risk of chemical dependence, calculated on the basis of the contribution of geomarkers dopamine system, and phenotype of adolescents 14-17 years of age, not suffering from addiction. When genetic risk increases, the tendency to behavioural disorders increases, the tendency to abandon positive forms of self-assertion increases, the intensity of euphoria increases at the first drug samples, and the ability to predict the consequences of drug use decreases. The obtained correlations may be important for understanding the mechanism of dependence formation in adolescents with high genetic risk and development of individual prevention programs. However, these observations need to be confirmed in more representative studies.

Therapeutic potential of replacement of one antiagregant by another one in patients receiving double antiaggregant therapy Double antiaggregant therapy reduces the risk of adverse cardiovascular events. There are currently several P2Y12 platelet receptor inhibitors available, which suggests that not only optimal therapy needs to be chosen, but a patient can also be switched from one drug to another. At present, there are limited research data, as well as guidelines based largely on the experts’ opinions on replacing one drug by another. The existing options for changing double antiaggregant therapy should be taken into account in order to achieve optimal treatment outcomes for each patient.

The role of antithrombotic therapy in cardiology has increased substantially over the past decades. On the one hand, mortality causes monitoring, undertaken by certain countries as wellas on the global level under the auspices of the World Health Organization, demonstrate the leading role of thrombosis as a pathogenetic mechanism underlying the majority of premature deaths. The role of this mechanism is revealed by the excellent words of Jens Dedichen (1959): "Man lives with arteriosclerosis, and dies of the complicating thrombosis." [1] On the other hand, the widespread use of antithrombotic therapy is associated not only with the need to prevent both primary and, largely, recurring cardiovascular events, but also with a spread of minimally invasive revascularization techniques. Enovascular interventions the number of which has rapidly grown in in Russia over the past years, became a truly effective and safe treatment thanks to the present-day antithrombotic therapy.

The paper considers the issue of pulse laser heating of double-layer system in which the first layer is transparent relative to the actuating flow and the second is a highly lossy one. Temperature profiles of heating double-layer system at different lengths of actuating pulse have been obtained by the numerical simulation technique. It was shown that heating maximum position does not conform to medium interface. The results obtained were used when analyzing the process of laser separation of gallium nitride crystal from sapphire substrate.

Introduction Surgical treatment of massive non-repaired injuries of the rotator cuff of the shoulder (RCS) is associated with many difficulties for orthopedic traumatologists. Standard refixation is ineffective in these patients and there no any generally accepted treatment strategies. Therefore, there is a need to look for alternative methods of reconstruction. The aim of the study was to develop a new technique for the reconstruction of irreparable ruptures of the RCS, comparing its clinical effectiveness with the technique of partial reconstruction. Materials and methods The study included 58 patients with massive irreparable injuries of the RCS, who underwent arthroscopic reconstruction of the RCS in the time period from 2017 to 2020 at the FSBI "FCTA" of the Ministry of Health of Russia (Cheboksary). Thirty patients of group I (control group) underwent partial reconstruction of the cuff, and 28 patients of group II had reconstruction according to the technique developed by us. The essence is additional plasty of the rotators using tendon autograft from the long fibular muscle and the proximal biceps. The average follow-up period was 30.7 ± 5.6 months. The results were evaluated using the VAS, ASES, UCLA, CSS scales, X-ray and MRI data. Results Good and excellent results according to the UCLA-ASES-CSS scales were achieved in 53.6 % in patients of group II versus 26.7 % in patients of group I (p = 0.036). In group I, VAS was 2.1 ± 1.8 and in group II – 1.0 ± 1.1 (p = 0.02). The average value of the acromiohumeral interval was 6.7 ± 2.7 mm after using the modified RCS reconstruction technique, versus 3.6 ± 2.1 mm in the control group of patients (p < 0.0001). According to MRI data, the rate of full-layer repeated ruptures of the RCS tendons after reconstruction using the modified technique was significantly lower, 17.9 % versus 56.7 % in the group of partial reconstruction technique (p = 0.002). Four patients from group I underwent revision surgery, and two of them required arthroplasty with a reversible endoprosthesis due to the progression of arthritic changes in the shoulder joint. Conclusion The developed technique for reconstruction of ”irreparable" massive injuries of the RCS allows restoring vertical balance in the shoulder joint, significantly improves clinical and functional indicators, reduces the number of repeated ruptures of the rotator tendons in comparison with the method of partial reconstruction.

Introduction Traumatic anterior dislocation of the shoulder usually results in chronic recurrent shoulder instability, especially in young adults. To reduce the rate of recurrent dislocations, various options of osteoplastic operations have been proposed. The purpose of our study is to determine the significance of anatomical and functional disorders in patients with anterior shoulder joint instability; to evaluate the results of the methods for surgical treatment of patients with anterior recurrent instability of the shoulder joint, depending on the anatomical and functional disorders. Materials and methods The results of diagnostic examination and treatment of 169 patients with recurrent post-traumatic dislocation of the shoulder who were operated on at the Federal State Budgetary Organization “Federal Center for Traumatology, Orthopedics and Arthroplasty” (Cheboksary) were analyzed. The average age of patients was 31.1 ± 13.1 years; the average period of postoperative follow-up was 49.5 ± 24.0 months. Clinical data were assessed by angulometry, using the ROWE, ASES, UCLA, VAS scales. The size of bone defects was determined using radiological methods. 99 patients (58.6 %) underwent arthroscopic Bankart repair, 24 patients (14.2 %) with more than 15 % anterior glenoid bone defect underwent Latarjet operation. Bankart + Remplissage surgery was performed in 39 patients (23.1 %), Latarjet + Remplissage in 7 (4.1 %) patients. Results Bone defect of the glenoid of more than 15 % of the area was detected in 32 patients. Hill-Sachs grade 3 injury was reported in 24 patients. Most of these patients had a history of more than 20 dislocation episodes. Hyperelasticity of the shoulder joint was found in 34 patients. In the postoperative period, there was a slight improvement in the mean indicators of flexion and abduction in the shoulder joint from 174.2 ± 15.9° and 170.6 ± 17.8° to 175.6 ± 9.3° and 173.0 ± 12.3°, respectively. The mean external rotation worsened from 61.6 ± 25.7° to 55.9 ± 14.4°. Indicators of the ROWE, ASES, UCLA rating scales improved significantly from 38.5 ± 8.5, 76.0 ± 13.2 and 20.8 ± 3.0 to 89.9 ± 17.5, 94.0 ± 7.1 and 32.7 ± 3.7 points, respectively. Poor results were observed in 7 patients (4.1 %), of which three had a relapse. Conclusions Critically significant anatomical and functional disorders in patients with anterior instability of the shoulder joint are the defect of the anterior rim of the articular process of the scapula more than 15 %, the defect of the posterior surface of the humeral head (Hill-Sachs defect) of grade 3, hyperelasticity of the soft tissues of the shoulder joint. The severity of bone defects is directly proportional to the total number of dislocations. The effectiveness of surgical techniques for stabilizing the shoulder joint, depending on the above anatomical and functional disorders, was 95.9 %.