bmjourБайкальский медицинский журналBaikal Medical Journal2949-0715Irkutsk State Medical University10.57256/2949-0715-2025-4-2-71-78bmjour-296Research ArticleОригинальные статьиOriginal articlesОПЕРАТИВНОЕ ЛЕЧЕНИЕ СТОЙКИХ И РЕЦИДИВИРУЮЩИХ ВЫВИХОВ НАДКОЛЕННИКАSURGICAL TREATMENT OF PERSISTENT AND RECURRENT PATELLAR DISLOCATIONShttps://orcid.org/0000-0002-0846-8455КомогорцевИгорь ЕвгеньевичKomogortsevIgor E.

д.м.н., профессор, заведующий кафедрой травматологии и ортопедии

Dr. Sci. (Med.), Professor, Head of the Department of Traumatology and orthopedics

komogor57@mail.ruКрасовскийАлексей ЮрьевичKrasovskyAlexey Iu.

врач травматолог-ортопед, руководитель направления

traumatologist-orthopedist, head of department

ksad1971@yandex.ruКалашниковИван ВикторовичKalashnikovIvan V.

врач травматолог-ортопед

traumatologist-orthopedist

irkmed20@yandex.ruhttps://orcid.org/0000-0003-1995-0623ИльинАндрей АлсагаровичIlinAdrey A.

заведующий отделением травматологии и ортопедии №2, врач травматолог-ортопед, ОГБУЗ «Иркутская городская клиническая больница № 3»

Head of the Department of Traumatology and Orthopedics № 2, traumatologist-orthopedist

Aaio84@mail.ruУрбановАнатолий ГеоргиевичUrbanovAnatoliy G.

врач травматолог-ортопед

traumatologist-orthopedist

info@gkb3.irk.ruНамогуруевАлександр БатоевичNamoguruevAlexander B.

врач травматолог-ортопед

traumatologist-orthopedist

Namoguruev@bk.ruhttps://orcid.org/0000-0001-5426-0412МелкоступовАлексей АнатольевичMelkostupovAlexey A.

ассистент кафедры травматологии и ортопедии

Assistant Professor, Department of Traumatology and Orthopedics

traumairk@yandex.ruhttps://orcid.org/0000-0002-0750-5699АнгарскаяЕкатерина ГеннадьевнаAngarskayaEkaterina G.

ассистент кафедры травматологии и ортопедии

Assistant Professor, Department of Traumatology and Orthopedics

yekaterina.angarskaja@yandex.ruhttps://orcid.org/0009-0002-2799-6656КомогорцеваЕвгения ГеоргиевнаKomogortsevaEvgeniya G.

д.м.н., профессор кафедры госпитальной терапии

Dr. Sci. (Med.), Professor of the Department of Hospital Therapy

komogor57@mail.ruИркутский государственный медицинский университет, ИркутскРоссияIrkutsk State Medical UniversityRussian FederationКЛИНИКА ЭКСПЕРТ ИРКУТСКРоссияEXPERT CLINIC IRKUTSKRussian FederationИркутская городская клиническая больница №3РоссияIrkutsk City Clinical Hospital № 3Russian Federation202510062025427178Copyright © Комогорцев И.Е., Красовский А.Ю., Калашников И.В., Ильин А.А., Урбанов А.Г., Намогуруев А.Б., Мелкоступов А.А., Ангарская Е.Г., Комогорцева Е.Г., 20252025Комогорцев И.Е., Красовский А.Ю., Калашников И.В., Ильин А.А., Урбанов А.Г., Намогуруев А.Б., Мелкоступов А.А., Ангарская Е.Г., Комогорцева Е.Г.Komogortsev I.E., Krasovsky A.I., Kalashnikov I.V., Ilin A.A., Urbanov A.G., Namoguruev A.B., Melkostupov A.A., Angarskaya E.G., Komogortseva E.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.bmjour.ru/jour/article/view/296Введение

Введение. Повреждения и биомеханические нарушения пателлафеморального сочленения существенно ухудшают общее функциональное состояние коленного сустава.

Цель исследования

Цель исследования. Оценить эффективность известных способов оперативного лечения стойких, а также рецидивирующих вывихов надколенника и уточнить показания к их применению в зависимости от вида хронической нестабильности.

Материалы и методы

Материалы и методы. Оперативное лечение проведено 24 пациентам с нестабильностью надколенника, которые разделены на 4 группы, согласно классификации Blumensaat: 1. стойкие привычные подвывихи 2. стойкие привычные вывихи 3. рецидивирующие посттравматические вывихи 4. стойкие перманентные вывихи.

Применены клинические, рентгенологические, магнитно-резонансные и артроскопические методы.

Результаты

Результаты: У 10 пациентов, со стойкими привычными подвывихами надколенника, выполнен перкутанный шов медиального ретинакулюма по Yamamoto и релиз латерального ретинакулюма.

У 8 пациентов при стойких привычных вывихах надколенника выполнен  релиз латерального ретинакулюма и анкерный шов пателлафеморальной связки к внутреннему краю надколенника, с использованием двух титановых фиксаторов Fastin.

У 4 пациентов с рецидивами после оперативного лечения привычных вывихов надколенника (швы медиального ретинакулюма по Yamamoto), проведена аутопластика медиальной пателлафеморальной связки сухожилием полусухожильной мышцы по Schottle-Weiler в нашей модификации.

У 2 пациентов с перманентным стойким вывихом надколенника, выполнен релиз латерального ретинакулюма с мобилизацией сухожилия прямой головки квадрицепса и транспозицией бугристости тибиа со связкой надколенника (медиализация и низведение). 

При изучении отдалённых результатов в сроки от 6 до 7 лет, у всех  пациентов отсутствовали рецидивы вывихов и подвывихов надколенника. Сохранялась полная амплитуда движений в коленном суставе.

Заключение

Заключение. Проведённое исследование показало, что индивидуализированный выбор хирургической тактики на основе классификации Blumensaat и сроков травмы, с применением модифицированных малоинвазивных методик, обеспечивает надёжную стабилизацию надколенника и стойкие функциональные результаты в отдалённом периоде.

Background

Background. Damage and biomechanical disorders of the patella-femoral articulation significantly worsen the general functional state of the knee joint.

Aim

Aim. To evaluate the effectiveness of known methods of surgical treatment of persistent and recurrent patellar dislocations and to clarify the indications for their use depending on the type of chronic instability.

Materials and methods

Materials and methods. Surgical treatment was performed on 24 patients with patellar instability, which were divided into 4 groups according to the Blumensaat classification: 1. persistent habitual subluxations 2. persistent habitual dislocations 3. recurrent post-traumatic dislocations 4. persistent permanent dislocations.

Clinical, radiological, magnetic resonance and arthroscopic methods were used.

Results

Results. In 10 patients with persistent habitual subluxations of the patella, a percutaneous suture of the medial retinaculum according to Yamamoto and release of the lateral retinaculum were performed.

In 8 patients with persistent habitual dislocations of the patella, a release of the lateral retinaculum and an anchor suture of the patellafemoral ligament to the inner edge of the patella were performed, using two titanium Fastin fixators.

In 4 patients with relapses after surgical treatment of habitual dislocations of the patella (suturing of the medial retinaculum according to Yamamoto), autoplasty of the medial patellafemoral ligament with the tendon of the semitendinosus muscle according to Schottle-Weiler in our modification was performed. In 2 patients with permanent persistent dislocation of the patella, the release of the lateral retinaculum with mobilization of the tendon of the straight head of the quadriceps and transposition of the tibia tuberosity with the patellar ligament (medialization and reduction) were performed.

When studying the remote results in periods from 6 to 7 years, all patients had no recurrence of dislocations and subluxations of the patella. The full range of motion in the knee joint was preserved.

Conclusion

Conclusion. The conducted study demonstrated that an individualized selection of surgical strategy, based on the Blumensaat classification and time elapsed since injury, combined with modified minimally invasive techniques, ensures reliable patellar stabilization and sustained functional outcomes in the long-term period.

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The authors declare that there are no conflicts of interest present.