Introduction. Total ankle replacement has increased satisfaction in patients with osteoarthritis of the ankle. However, additional deformities are one of the limiting factors in the development of this technique.
Materials and methods. The paper analyzes results of the treatment of patients with the end-stage osteoarthritis of the ankle with varus alignment in the Federal Center in Barnaul. 58 patients underwent endoprosthetics of the ankle joint. 51 (87.9%) underwent additional procedures during the base stage of the intervention. All of these manipulations were required to restore the alignment, balance and ankle range of motion. Assessment was performed by means of VAS, AOFAS, and FAOS scales. Preoperative and postoperative static and dynamic characteristic were evaluated with «Dia-Sled Scan».
Results. Evaluation of the functional results on the scales (VAS, AOFAS, FAOS) showed a significant improvement in parameters of the postoperative period compared to the preoperative survey (P <0.05). According to the VAS scale, the mean values decreased from 6.0 points in the preoperative period to 1.0 points. On the AOFAS scale, there was an increase from 32.0 to 86.5, and on the FAOS scale from 26.0 to 87.0. Analysis of the load showed its postoperative balance in both standing and strolling models. Also, there was a change in the medio-lateral ratio in all parts of the foot after surgery and its approximation to the norm.
Conclusions. The results of treatment of osteoarthritis of the ankle joint with varus alignment are good and excellent. In most clinical cases, additional interventions were required. We can use the algorithm to correct deformations at the level of the ankle joint and below the line of the articular gap.

Introduction. Rotator cuff tears are a common shoulder pathology with an increasing incidence, reaching up to 20% in the population, while currently no downward trend is observed. Although we have witnessed remarkable advances in the diagnosis and surgical treatment based on solid science and extensive clinical practice, considerable controversy remains over the optimal reproducible clinical outcomes.
Purpose is to compare the effects of the arthroscopic treatment for medium to large rotator cuff tears with and without bone marrow aspirate concentrate (BMAC) augmentation.
Materials and methods: The prospective randomized trial will enroll eligible patients (n = 80). Patients will be randomly assigned (1:1) to the experimental group (arthroscopic rotator cuff suture repair with BMAC application) and the control group (arthroscopic rotator cuff suture repair without BMAC application). Outcomes will be assessed at 3, 6, 12 months after surgery by magnetic resonance imaging and with respect to functional scores using the scoring systems ASES, DASH, UCLA and SST.
Results: The hypothesis of the study is that the arthroscopic repair of rotator cuff tears augmented by BMAC will improve tissue integrity, while the rates of reducing pain and improving function will be comparable.
Discussion: Remarkable advances in rotator cuff repair involve the combination of cell-based and biological therapies and advanced surgical approaches. The planned prospective trial will determine the role of biological augmentation in outcomes of arthroscopic rotator tears repair.

Introduction: Functional shortening of the gastrocnemius muscle is currently considered the cause of multiple foot and ankle disorders. One of these pathologies is plantar fasciitis (PF), which can often be secondary to changes in the biomechanics of the foot. Purpose: to analyze the effectiveness of the isolated proximal release of the medial head of the gastrocnemius muscle in treatment of recurrent plantar fasciitis after failed attempts of conservative treatment.
Materials and Methods: We prospectively reviewed the results of proximal release of the medial head of the gastrocnemius in six patients (eight feet) with plantar fasciitis that recurred after at least one year of conservative treatment. The diagnosis of plantar fasciitis was confirmed with MRI and ultrasound. The average follow-up period was 20 months (3-24). During the follow-up, physical examination was performed, the strength of the gastrocnemius muscle of the operated limb was examined, and the results were assessed using the SF-36 and AOFAS scales. Pain was assessed using the VAS scale.
Results: At the last follow-up, no patient noted weakness of the gastrocnemius muscle of the operated limb. The mean SF-36 (physical component) score increased from 48.75 preoperatively to 60.93 at the final visit; the mean SF-36 score (emotional component) increased from 51.75 preoperatively to 61.9 at the final visit. The AOFAS score increased from 48.0 preoperatively to 65.4 at last follow-up. When analyzing the dynamics of pain, an improvement was noted on the VAS scale from 5.75 before surgery to 1.27 at the last follow-up.
Discussion: Plantar fasciitis in the majority of cases is associated with functional shortening of the gastrocnemius muscle. In the practice of an orthopedic surgeon, there is a large number of conservative methods of treating plantar fasciitis. Surgery should be considered when the conservative treatment fails. In patients with a confirmed diagnosis of recurrent plantar fasciitis, in the absence of other causes of heel pain and in the presence of confirmed functional shortening of the gastrocnemius muscle, the PMGR (proximal medial head of the gastrocnemius muscle release) procedure has shown clinical effectiveness and should be considered a primary surgical technique.

Purpose: To evaluate the clinical outcomes and postoperative complications of partial resection of the medial sesamoid bone by arthroscopic method.
Materials and methods: The present case series included 16 patients who underwent arthroscopic partial resection of the sesamoid. Preoperative evaluation included a complete medical history, physical examination using a passive axial compression test, radiographic evaluation, MRI, and CT. Postoperative complications, level of activity, number of days required for daily return to normal life were recorded; for athletes, the ability to return to sports and the level of postoperative athletic performance; for dancers, the ability to return to professional activities. Pre- and postoperative pain was assessed using a visual analogue scale. Outcome measures were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) clinical rating scale.
Result: According to the postoperative assessment at the end of the observation period, the VAS scores improved compared to the preoperative level from 6.1±1.1 (range: 5-8) to 0.9±0.9 (range: 0-3). AOFAS scores preoperatively averaged 54.3 ± 7.2 (range: 44–66) and improved to 90.8 ± 7.7 (range: 78–100) postoperatively. The mean duration to return to activity was 6.3 ± 2.7 months (range: 2–12 months). All 8 athletes returned to active sports after an average of 5.8 ± 2.8 months (range: 2-10 months). However, two patients had not achieved pre-injury athletic performance at the end of the follow-up period.
Conclusion: Partial resection of the medial sesamoid bone by arthroscopic method is an effective and reliable treatment for osteoarthritis of metatarsomesamoid complex, but further comparative studies of the results of open and arthroscopic procedures are needed.

The aim of the study is to develop a biomechanical model of the knee joint with a detailed representation of the patellofemoral segment, taking into account the normal anatomy of bones, joints, ligaments and muscles, and to study the movement of the patella during passive knee flexion.
Materials and Methods: The model architecture was created using the OpenSim platform. The model includes a 6-DOF patellofemoral joint, patellar stabilizers—medial patellofemoral ligament (MPFL), medial patellotibial ligament (MPTL), lateral retinaculum (LR), and patellar contact surfaces. Gmsh and Paraview were used to create contact surfaces. Simulations of passive knee flexion with sequential exclusion of patellar stabilizers were performed to evaluate their effect on patellar motion.
Results: The developed biomechanical model allows a detailed analysis of the normal dynamics of the patella and the role of various anatomical structures in its functioning, which makes it suitable for further research. An experiment involving all ligaments shows the physiological norm. Disabling the MPTL has minimal effect on patellar tilt and movement due to its small size. Deactivation of the MPFL results in increased lateral tilt and patellar displacement. Deactivation of LR components 1 and 2 causes greater medial tilt and displacement, and deactivation of LR components 3 and 4 results in increased lateral displacement and small additional medial tilt.

Introduction: With the increase in the number of primary arthroplasty, the need for revision joint arthroplasty is steadily growing, which in turn requires new approaches such as 3D printing and materials for their implementation. One of the main areas of 3D printing of medical implants from biocompatible materials today is titanium alloy Ti6Al4V.
Objectives: To evaluate the degree of osseointegration of titanium alloy Ti6Al4V depending on structural porosity in an in vivo study.
Methods: We used a graph of a porous structure based on Ti6Al4V to study biological characteristics. These included cell adhesion, cell morphology, and cell proliferation, as well as osseointegration. We evaluated these in an in vivo experiment by creating samples in the form of cylinders with a diameter of 4 mm and a height of 8 mm, in several copies with different cell widths. The cell width of the porous structure was included in four different ranges: 0.3-0.39 mm, 0.4-0.45 mm, 0.46-0.49, and 0.5-0.59. All samples had a beam thickness of 0.45-0.5 mm, so four groups were formed. Ten clinically healthy animals were used in the experiment, and the graphs were observed for up to 30 days.
Results: Based on an in vivo experimental study, we have proven that Ti6Al4V titanium alloy samples with a porosity of 0.4–0.49 mm provide better bone tissue regeneration.
Conclusion: The obtained results can be associated with the correlation between bone pore sizes and graph porosity. However, this requires further research into the issue and subsequent studies. The findings obtained can be utilized to fill bone defects during personalized endoprosthetics using 3D components, allowing for a long-lasting service life.

Introduction. Stenosing tenosynovitis of the first toe is a very rare disease, accompanied by pain in the ankle joint and blocking the movement of the first toe. More common among dancers and professional athletes. Foreign literature contains descriptive cases of treating patients with various methods without an in-depth study of the epidemiology of the disease.
Purpose of the study. Description of surgical treatment of a rare case of bilateral stenosing tenosynovitis of the first toe in a young patient.
Clinical case. We present a case of successful surgical treatment of bilateral stenosing tenosynovitis of the first toe in a young patient whose work was not associated with occupational risk factors or heavy physical work. Sequential dissection of the tendon sheath and its supporting adhesions was performed on both feet. As a result of complex surgical and subsequent rehabilitation treatment, crunching and clicking disappeared, and the movements of the first fingers were restored in full.
Conclusion. The development of degenerative and inflammatory changes in the sheaths of the flexor pollicis longus tendon, leading to blocking of movements, is not always associated with occupational overload. Surgical treatment allows rapid clinical improvement.

Objective: Clarify the role of visual differential diagnosis in detecting aseptic (avascular) necrosis and stress fracture of the sesamoid bone.
Review writing methodology. A total of 42 scientific papers were found using Cochrane Library, Scopus, and PubMed databases for search using the queries: "sesamoid bone", "aseptic necrosis", "avascular necrosis", "osteonecrosis", "stress fracture". Twenty-nine sources were selected for the review. The time interval of the analyzed literature: 2000-2023. Conclusion. It is concluded that it is important to perform differential diagnosis of aseptic necrosis and stress fracture of the sesamoid bone in different localizations. Slight sclerosis enhancement detected on computed tomography confirms the presence of osteonecrosis of the sesamoid bone, whereas an irregularly shaped fragment with poorly corticated edges on the radiograph indicates a fracture. Radiologic studies, including radiography, CT, and MRI, provide useful information about the presence and pathology involving these bones and should be used in conjunction with clinical findings to guide patient management.

Introduction. Patella alta or high-riding patella is important and independent risk factor of patellar instability and can lead to development of pathologies of knee joint: patellar dislocation, osteoarthritis, patellar tendinopathy, patellofemoral pain syndrome, rupture of the anterior cruciate ligament and Osgood-Schlatter disease.
Materials and methods. Our research includes data analysis of literature of PubMed and Russian national electronic scientific library eLIBRARY with the aim of assessing the prevalence of patella alta, specificities of the influence of this risk factor to the biomechanics of the knee joint and to the development of patellofemoral joint instability, diagnostic methods, further methods of complex treatment and the possibility of returning to sports activities at the professional level (especially in physically active children).
Conclusion. Clinical and radiological diagnostics of patella alta doesn’t present difficulties. Reliable radiological indexes have been determined – modified Insall – Salvati index and Caton – Deschamps index. The last one has shown high reliability in children as well. In most cases patella alta is not isolated risk factor and it is observed in the combination with the most common risk factors of patellar instability.
The comprehensive approach is required in the study of patella alta in various pathologies of the knee joint, conservative treatment and the differential approach to a surgery of patellar dislocation with this risk factor between the reconstruction of the medial patellofemoral ligament, or combined reconstruction of the medial patellofemoral ligament and the medial patellotibial ligament, or distalization of the tuberosity of the tibia, or imbrication of the patellar tendon.