TERRA ORTHOPAEDICA

Our Experience in the Correction of Acetabular Dysplasia Using the Proposed Modification of Pelvic Osteotomy

V.L. Suvorov — 2025-02-03

Introduction. The proper application of pelvic osteotomies for the surgical treatment of developmental dysplasia of the hip (DDH) plays a key role in correcting acetabular dysplasia and preventing secondary hip osteoarthritis. For the correct application of pelvic osteotomies, it is mandatory to understand the three-dimensional morphology of the acetabulum and accurately determine the direction of acetabular dysplasia correction. Currently, there is no described pelvic osteotomy, which can improve femoral head coverage in any direction without significant technical limitations.

Objective. This study aims to evaluate the outcomes of the modified Salter pelvic osteotomy performed at the Department of Reconstructive Orthopedics and Traumatology for Children and Adolescents at the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine.”

Materials and Methods. 21 patients with DDH aged 2-6 years were selected for the retrospective study; 3-D acetabular morphology was assessed with further application of the proposed modified Salter osteotomy for correcting acetabular dysplasia.

Results. A methodology for assessing the 3-D morphology of the acetabulum and determining the correction vectors for acetabular dysplasia was developed and implemented; the mid-term postoperative results after applying the proposed modification of Salter pelvic osteotomy were evaluated. The modification demonstrated significant improvement in acetabular parameters: preoperative acetabular index (AI) was 46.8 ± 12°, postoperative AI was 24.3 ± 5.1°, with a mean correction of 23.1 ± 4.9°. Further positive dynamics were observed: AI at 6 months postoperatively was 19.8 ± 4.7°, and at the final follow-up examination, it reached 15.6 ± 4.4°, while Wiberg’s angle improved to 23.3 ± 3.9°. Excellent and good clinical outcomes were observed in 57.2% and 33.3% of cases, respectively, with radiological outcomes showing excellent and good results in 66.7% and 23.8% of cases. A relatively high rate of femoral head avascular necrosis (AVN) (33.3%) correlated with a high percentage of patients with complete hip dislocation (61.9%). However, most patients with AVN (23.8%) subsequently experienced near-complete or complete restoration of femoral head structure and shape.

Conclusions. 3-D acetabular morphology assessment is a key factor for the successful surgical correction of residual acetabular dysplasia in DDH cases. The proposed modification of the Salter pelvic osteotomy provides excellent and good mid-term clinical and radiological outcomes in most cases.

Effectiveness of Physical Therapy with Kinesio Taping in the Treatment of Patients with Knee Ligament Injuries

V.P. Cherniak — 2025-02-03

Background. Kinesio taping is a therapeutic technique gaining popularity in knee injury treatment. The method is based on the use of a highly elastic adhesive material that allows free mobility of the treated body area.

Objective. The aim of this study was to evaluate the effectiveness of kinesio taping in restoring joint functionality.

Materials and Methods. A comparative analysis was conducted between two groups of patients: the control group (basic rehabilitation) and the experimental group (basic rehabilitation with kinesio taping).

Results. At baseline, both groups had comparable clinical and functional indicators, including pain level, the Oswestry Disability Index, knee joint range of motion, and muscle strength. After the rehabilitation course, both groups demonstrated positive dynamics, with knee flexion amplitude improving by approximately 90% and extension by 70%. However, the kinesio taping group demonstrated statistically significant advantages: muscle strength increased by 36.46% (versus 14-17% in the control group), Lower Extremity Functional Scale scores improved by 44.55% (versus 5.33%), postural stability increased by 29.85% (versus 0.73%), and Hauser’s walking index improved by 30.51% (versus 3.33%). No statistically significant between-group differences were found in pain reduction (approximately 49% in both groups) and improvement in the Oswestry Disability Index (approximately 52%).

Discussion. These results can be explained by the fact that kinesio taping provides additional proprioceptive stimulation and mechanical support during rehabilitation exercises, facilitating more effective recovery of muscle strength and postural control.

Conclusions. The study confirms that incorporating kinesio taping into comprehensive rehabilitation program significantly enhances its effectiveness, particularly in restoring muscle strength, postural control and overall lower limb functionality, although showing no advantages in pain control or certain specific functional parameters compared to standard rehabilitation programs. These findings have important practical implications for optimizing rehabilitation protocols and rational use of kinesio taping in physical therapy for patients with knee ligament injuries.

Analysis of the Effectiveness of Platelet-Rich Plasma in the Treatment of Discogenic Pain Syndrome of the Lumbar Spine

M.S. Chervatiuk — 2025-02-03

Objective. This study aims to evaluate the effectiveness of intradiscal injection of platelet-rich plasma (PRP) in the treatment of discogenic pain syndrome of the lumbar spine.

Materials and Methods. The study was conducted from July 2022 to September 2024 at the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine.” Patients diagnosed with discogenic pain syndrome received intradiscal PRP injections. The effectiveness was assessed at 1 and 6 months post-treatment using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), and MRI findings (Pfirrmann classification).

Results. One month after the injection, VAS scores decreased by more than 3 points in 21.2% of patients, by 2 points in 18.1%, and by 1 point in 39.3%. Six months after the injection, VAS scores decreased by more than 3 points in 54.5% of patients, by 2 points in 12.2%, and by 1 point in 21.2%. On average, VAS scores decreased by 30% one month after injection and by 46% six months after treatment compared to baseline. The average ODI scores decreased to 8.06% one month after injection and to 6.67% six months after injection, respectively. MRI evaluation of intervertebral disc changes using the Pfirrmann classification did not reveal statistically significant differences but showed a tendency toward a reduction in degenerative changes 6 months after the injection.

Conclusions. The use of platelet-rich plasma significantly reduced pain and improved quality of life in patients with discogenic pain syndrome who participated in the study 6 months after treatment initiation. It is also important to note that PRP therapy is safe due to the autologous nature of the product. Additionally, no clinically significant side effects or complications were observed. The results allow us to conclude that PRP therapy is effective in treating discogenic pain syndrome.

Replacement of Calcaneal Defects due to Mine-Blast Injury with Femoral Head Allograft. Case Studies and Brief Review of the Literature

A.P. Liabakh — 2025-02-03

Summary. Two cases of post-traumatic defects of the calcaneus resulting from mine-blast injury (stepping on a mine) are presented. After appropriate sequential treatment, the calcaneal defects were replaced with an allogeneic femoral head. The follow-up periods were 20 and 6 months, respectively. A review of the literature is presented.

Orthopedic Manifestations of Spinal Muscular Atrophy: Clarified and Unresolved Theoretical and Practical Issues

A.M. Zyma — 2025-02-03

Summary. Spinal muscular atrophy (SMA) is an autosomal recessive disorder characterized by progressive weakness and muscle atrophy resulting from degeneration of neurons in the spinal and bulbar parts of the brain.

Objective. This study aims to analyze the literature devoted to the diagnosis and treatment of orthopedic pathologies in patients with various forms of SMA.

Materials and Methods. The study is based on a retrospective review of articles focused on the diagnosis and treatment of patients with SMA. The PubMed database was searched for articles published between 2010 and 2024, with a focus on materials from the last five years.

Results and Discussion. The literature search on musculoskeletal pathologies in SMA revealed a limited number of studies addressing the clinical and orthopedic manifestations of SMA and their dependence on the type of disease. There is practically no information on changes in the structural and functional state of bone tissue and muscle structures in patients with SMA. No unified classification has been found that defines the impairment of the functional state of the lower extremities depending on the muscle strength deficit, the type of orthopedic manifestations, and the degree of loss of function affecting independent movement. The analysis of the literature indicates a lack of consensus regarding surgical strategies for the treatment of orthopedic manifestations of SMA; the features of surgical interventions for the correction of certain orthopedic manifestations are also not covered, and a system for medical correction of disorders in the structural state of the bone system in SMA has not been developed.

Conclusions. The pathology of the musculoskeletal system in SMA requires a detailed fundamental study considering the type of disease, its progression, the condition of muscle and bone structures, patient age, the type and severity of orthopedic pathology, while the methods used for its correction require further development and improvement.

Fibrous Dysplasia: From Historical Approaches to Modern Treatment Perspectives

A.M. Zyma — 2025-02-03

Objective. This study aims to analyze scientific literature on fibrous dysplasia (FD) and highlight the state of diagnosis and treatment of orthopedic pathology in patients with various forms of FD.

Materials and Methods. This article is based on a retrospective review of papers by various authors on the treatment of patients with FD. Articles were selected from scientific databases such as SCOPUS, Web of Science, and Google Scholar. The selected articles were reviewed in chronological order according to the topic of the study.

Results and Discussion. The article provides a systematic analysis of treatment approaches for patients with FD at different stages of the development of science. Modern diagnostic and therapeutic approaches are also analyzed, with particular attention given to the molecular-genetic aspects of the disease’s etiology, particularly mutations in the GNAS gene, which underlie bone growth regulation disorders. Current treatment approaches, including the use of bisphosphonates and various types of surgical interventions, are discussed.

Conclusions. A review of the scientific literature and analysis of historical aspects related to FD indicate both significant achievements of the orthopedic community in the diagnosis and treatment of FD, as well as significant challenges that will require further resolution. Changing views on the etiology and pathogenesis of the disease, as well as the identification of genetic mutations during early fetal development, have led to the recognition of FD as a stem cell disease. This provides new leverage for doctors and researchers to use stem cells in the treatment of patients with this pathology. Research on FD and the identification of this pathology as a result of stem cell disease has allowed scientists to explore new therapeutic approaches based on the use of mesenchymal stem cells (MSCs). MSCs can be used to correct bone tissue disorders since they can differentiate into osteoblasts and promote bone tissue remodeling. This opens the possibility for MSC transplantation or modification of their functioning to restore bone structures affected by FD. In our opinion, one promising area is the study of the osteogenic activity of MSCs from pathological sites, as this may help develop new regeneration strategies. There is a limited number of studies indicating the potential for bone defect reconstruction through the combination of MSCs and allomaterial.

Stromal Vascular Fraction of Adipose Tissue: Prospects for Use in the Treatment of Osteoarthritis and Articular Cartilage Injuries (Literature Review)

O.O. Kostrub — 2025-02-03

Summary. Osteoarthritis (OA) is a chronic, progressive, degenerative-dystrophic joint disease primarily caused by damage to the articular cartilage. Conservative pharmacological treatment of OA consists of prescribing nonsteroidal anti-inflammatory drugs, chondroprotectors, hyaluronic acid injections, and therapeutic blockades with glucocorticosteroids. The use of orthobiological agents represents an alternative method in OA treatment. Among the variety of orthobiological approaches, adipose tissue serves as a new and attractive source of stem cells for the treatment of OA. The stromal vascular fraction creates an environment where stem cells can interact and stimulate regeneration.