Lumbar pain holds one of the leading positions of prevalence in the world. The common cause of vertebrogenic pain syndrome is spondylarthrosis. Conservative management of spondylarthrosis does not consistently provide an evident therapeutic effect. Open surgical treatment of spondylarthrosis also has a number of disadvantages due to a high risk of postoperative complications and high injury rate. Experimental determination of optimal operational modes of the devices for laser osteoperforation of lumbar facet joints was the purpose of this study. The experiment was performed in March 2020. Within the experiment, laser osteoperforation of lumbar facet joints was performed in experimental animals (mini pigs) with simultaneous measurement of the temperature on the surface and within the tissue and with further histological examination of bone material. The Ethics Committee Approval for the experiment was preliminarily obtained. The highest temperature of 79 °С was registered while performing open laser osteoperforation of the facet joint. Eventually, the following optimal operational modes of laser devices were determined: 2.0 W in continuous mode for radiation with the wavelength of 0.97 µm, and 5.0 W in pulse-periodic mode for radiation with the wavelength of 1.56 µm at the pulse length of 100.0 ms and the pause length of 50.0 ms. Histological examination results were obtained. The optimal modes of laser exposure while performing osteoperforation of facet joints were experimentally worked through and determined, which was further proven by the histological examination data. It makes sense to continue the exploratory development to implement the method in clinical practice.

Objective: to select optimal parameters of two-wave near-infrared laser irradiation for the arthroscopic treatment of chondromalacia foci in the articular cartilage. Material and methods. Bull articular cartilages were treated with laser light delivered by a fifi ber and having various parameters. Human articular cartilages with chondromalacia foci taken during the total knee replacement were also treated with laser light delivered by a fifi ber and having various parameters. The processed cartilage samples were examined macroscopically and then histologically. Changes in the structure of ar[1] ticular cartilage after laser irradiation were assessed. Results. A two-second irradiation with two-wave laser light (λ = 0.97 μm / 30 W and λ = 1.55 μm / 15 W) causes a rapid “melting” of lesion margins without macroscopically visible carbonization with a wide thermally affected zone in the irradiated area. Histologically, cartilage preparations irradiated with two-wave laser light (wavelengths λ = 1.55 μm / 5 W and λ = 0.97 μm / 3 W) for 2 sec demonstrated slight changes in the cartilage structure without thermal destruction of chondrocytes. Conclusion. The optimal combination for laser irradiation of the cartilage tissue in the saline solution environment which restores articular cartilage shape is two-wave laser light λ = 0.97 μm at power of 3 W and λ = 1.55 μm at power of 5 W from the distance of 1–2 mm under 2 sec exposure.

Transmission and scanner electronic microscopy was used to study the influence of laser radiation upon the articular cartilage and subchondral bone. Laser radiation with maximum power (up to 70 W) was generated using surgical laser plant Lamin-1 with 1.06 m wave length in air environment. Data obtained showed that zone of thermal lesion surrounding the defect ranged from 0.8 to 1.0 mm. Articular cartilage and subchondral bone outside the thermal lesion zone preserved specific ultrastructural architectonics. Those data gave evidence of a little traumatic effect of laser using Lamin1 and the possibilities of laser application for surgical interventions in traumatology and orthopaedics.

BACKGROUND: Osteoarthritis (OA) of the knee joint is a common disease and a significant medical, social, and economic problem. Synovitis can be revealed at all stages of ОА, contributing to the progression of cartilage damage, increased pain, and impaired joint function. In patients with OA, the morphological pattern of the synovial membrane structure has characteristic features, such as hyperplasia, sublimating fibrosis, and stromal vascularization. Laser radiation is widely used in medicine. Exposure of two working wavelengths (0.97 m and 1.56 m) to the synovial membrane may lead to good results in the treatment of synovitis. AIM: This study aimed to improve treatment outcomes in patients with chronic synovitis of the knee joint by applying radiation of two different wavelengths. MATERIALS AND METHODS: Treatment outcomes of 50 patients with chronic synovitis of the knee joint, aged 23 to 67 years, with stages IIIV gonarthrosis according to the KellgrenLawrence classification, were prospectively analyzed. All patients underwent arthroscopic sanation and laser partial synovectomy using LSP-IRE-Polus apparatus (OOO NTO IRE-Polus, Russia), with a wavelength of 0.97 m (pulse 100 ms, pause 50 ms) in a pulsed-periodic mode and 1.56 m with a power of 5 W in a continuous mode. Surveys were conducted preoperatively and at 3, 6, and 12 months postoperatively using the following scales and questionnaires: Visual Analog Pain Scale (VAS), Lequesne index, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS: The mean age (Ms) of the study subjects, body mass index, and the duration of synovitis were 45.3213.1, 28.634.72 kg/m2, and 2.261.91 years, respectively. Statistically significant improvements in the VAS, WOMAC, Lequesne, and KOOS scales were observed three months after surgery, whereas much more better results were obtained at six months and remained the same within 12 months after surgery (p 0.05). CONCLUSIONS: The results suggest that the proposed technique could be introduced into clinical practice.

Currently, the treatment of distal tibia osteomyelitis remains a hot topic for discussion. Nowadays, the search for an optimal treatment method is relevant. The traditional method involves radical segmental bone resection to the level of healthy tissue, which in turn leads to bone defect, which significantly increases treatment and rehabilitation time

Connection between complications (local and general) and lesions as well as prolonged irritation of biologically active zones by pins during external intraosseous osteosynthesis was detected and proved. Preventive measures of those complications were elaborated. Those preventive measures included insertion of pins beyond active zones after preliminary marking of active points (or canal). Observance of those rules provided decrease of the complication rate by 1.6 times when hinge-distraction devices were used and decrease by 1.8 times in application of reposition- fixation devices. When complications occurred the most radical treatment was either removal of pin that injured the biologically active point or reinsertion of that pin beyond the zone. Analysis of 770 cases (320 patients with hinge-distraction devices and 450 patients with reposition- fixation devices) was taken as a principle of that work.

Background: The treatment of patients with chronic synovitis of the knee joint is a challenge faced by many doctors all around the world. Treatment of this pathology is often a difficult task. Aim. The aim of the study was improving the results of treatment of patients with chronic synovitis of the knee joint by applying two wavelengths of radiation. Material and methods. The treatment results of 50 patients with chronic synovitis of the knee joint aged 23 to 67 years with stage II-IV osteoarthritis according to the Kellgren-Lawrence classification were analyzed. All patients underwent arthroscopic sanation, partial laser synovectomy using LSP-IRE-Polus apparatus, wavelength 0,97 microns in pulse-periodic mode (pulse 100 ms, pause 50 ms) with power 5 W and wavelength 1,56 microns in continuous mode with power 5 W. Morphological examination of the synovial membrane and capsule was performed. Preoperative, 3, 6 and 12 month postoperative questionnaires were administered using the following scales and questionnaires: VAS, Leken index, WOMAC and KOOS. Results. Mean age (M) was 45.32±131, BMI 28.63±4.72kg/m2, duration of synovitis 2.26±1.91 years. A statistically significant improvement on the VAS, WOMAC, Leken, KOOS scales was noted by the 3rd month of postoperative follow-up. By the 6th month postoperatively, the results had further improved. The achieved results were preserved up to 12 months after surgery (P <0.05). Conclusion. The results suggest that the proposed technique may be introduced into clinical practice.

Purpose To ascertain the role of autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) in the tendon regeneration. Methods The study was conducted on 58 Achilles tendons from 29 laboratory Chinchilla adult rabbits. The central bundles of 48 tendons were partially removed and substituted with a tissue-engineered construct consisting of a collagen sponge either loaded with BM-MSCs (n = 24) or cell free (n = 24), placed inside a Vicryl mesh tube. The ends of the resected tendon were inserted in the construct to reach a direct contact with the sponge and sutured to the tube. The animals were sacrificed three and six months post-surgery. Ten intact tendons from five rabbits were used as an untreated control. The tissue samples (n = 30) were stained with haematoxylin and eosin, Picrosirius red, primary antibodies to collagen types I and III and studied by bright-field, phase-contrast, polarized light, and scanning electron microscopies followed by semi-quantitative morphometry. Results Six months results of cell-loaded scaffolds demonstrated parallel collagen fibres, spindle-shaped tenocytes, and neoangiogenesis. In the control cell-free group, the injured areas were filled with a nonspecific fibrotic tissue with minor foci of incomplete regeneration. The biomechanical tests of 28 tendons taken from 14 rabbits showed that the stiffness of the cell-based reconstructed tendons increased to 98% of the value for the intact samples. Conclusion The obtained results support the hypothesis that the application of BM-MSCs in a tissue-engineered tendon construct leads to the restitution of the tendon tissue.

Background: The present study focuses on investigation of Intra-articular PDT mechanisms for OA treatment. Also, a search for determination of the most effective dose of chlorin e6 (Ce6) for anti-inflammatory PDT of OA was carried out. Methods: The study was carried out on laboratory animals (11 Chinchilla rabbits, 1 year, 2.5 kg) with a gonarthritis model of post-traumatic OA. According to the instructions for using Photoditazin (Ce6 based PS) for PDT of human oncological and non-oncological diseases, the recommended dose is 0.7-1.2 mg/kg. For studies on rabbits, taking into account the conversion coefficient (3.2), the PS doses of 2.4, 3.2 and 6.4 mg/kg were selected. Fluorescence spectra were measured intra-articular before and after PDT using spectrometer with fiber-optic probe. The intrajoint PDT was carried out using a laser (662 +/- 10 nm) and a fiber-optic catheter with a cylindrical diffuser inside a sapphire needle for a uniform distribution of the laser radiation. The immunohistochemical study was carried out by staining the samples with caspase-3. Results: Histological and immunohistochemical analysis showed that the best PS dose for intravenous administration for PDT of rabbit gonarthritis is 3.2 mg/kg. The PS concentration directly in the synovial tissue was 0.5 mg/kg, and this was enough to achieve the most positive results to reduce the caspase-3 level. Conclusion: The caspase-3 level correlates well with other signs of inflammation in the synovial membrane (edema, etc.). Therefore, to assess the PDT effectiveness in the treatment of gonarthritis accompanied by synovitis, it is sufficient to analyze only for caspase-3. The efficacy of PDT with Ce6 showed that 3.2 mg/kg PS dose (1 mg/kg for a human) is the most effective.

This study focuses on investigation of intra-articular photodynamic therapy (PDT) mechanisms for osteoarthritis (OA) treatment. Also, a search for determination of the most effective dose of photosensitizer (PS) chlorine e6 (Ce6) for anti-inflammatory PDT of OA was carried out. It was found that to assess the PDT effectiveness in the treatment of OA accompanied by synovitis, it is sufficient to analyze for caspase-3 with the condition that the biopsy sample is taken 2-3 days after PDT. The results of the study on the efficacy of PDT with Photoditazin at various administered doses in the treatment of OA showed that 3.2 mg/kg PS dose (1 mg/kg for a human) is the most effective.

Purpose. To improve the cure of knee osteoarthirtis using a combination of arthroscopic laser surgery and intraosseous infiltration of autologous platelet-rich plasma (PRP). Material and methods. 32 patients (18 men and 14 women) with osteoarthrosis (OA) of the knee joint, degree II–III (by Kellgren–Lawrence classification), participated in the study. By MRI findings, all patients had meniscus and cartilage damage. The arthroscopic intervention was done with laser device «LSP IRE Polyus», wavelength 0.97 mkm. In addition to the arthroscopy, patients were made extra-articular intraosseous infiltration of autologous platelet-rich plasma topically into the altered subchondral bone under the control of an electronic optical transducer (OEC Fluorostar 7900 COMPACT 2). The evaluation of treatment efficacy was made using WOMAC and KOOS knee function assessment scales, as well as VAS scale (pain intensity) before surgery and 1 and 3 months after the treatment beginning. Results. In 3 months, WOMAC scale showed the improved knee joint function by 25.38 points, KOOS scale – by 37.4 points and VAS scale – by 35 points (p < 0.01). Thus, the performed curative technique increased the support capacity, range of motion in the knee joint, less pain – all these contributed to the achievement of prolonged effect.

We studied the possibility of restoring the integrity of the Achilles tendon in rabbits using autologous multipotent stromal cells. Collagen or gelatin sponges populated with cells were placed in a resorbable Vicryl mesh tube and this tissue-engineered construct was introduced into a defect of the middle part of the Achilles tendon. In 4 months, histological analysis showed complete regeneration of the tendon with the formation of parallel collagen fibers, spindle-shaped tenocytes, and newly formed vessels.

Background: The new methods of osteoarthritis treatment are in constant demand due to the complexity of the early diagnosis and therapy. Specific features of Chlorin e6 derivative (Ce6) accumulation in knee joint tissues and the efficiency of photodynamic therapy (PDT) of gonarthritis were studied.Methods: The experimental research was conducted on the model of posttraumatic gonarthritis on rabbits. The analysis of dynamics of change of Ce6 concentration in tissues of a knee joint was carried out by the method of fluorescent diagnostics. The intra-joint PDT was carried out using 662 nm laser with energy density of 120-150 j/cm(2) and a sapphire diffuser. An analysis of slices was conducted to confirm the anti-inflammatory effect through apoptosis.Results: The method of fluorescent spectroscopy revealed that the highest amount of Ce6 was accumulated in the synovial membrane of a damaged knee joint 2.5 h after its intravenous introduction. On 14th day after gonarthritis modeling but before PDT the synovial membrane showed signs of synovitis. On 21st day after PDT the synovial membrane possessed noticeable villous structure, and no cells of inflammatory nature were observed.Conclusion: Fluorescent diagnostics in knee joint tissues can be used in clinical practice of gonarthritis before, during and after PDT for monitoring the Ce6 accumulation and for treatment control. Optimal radiation energy density was determined to be 150 j/cm(2). In the studied time intervals (5-25 min) no dependency of PDT effect on irradiation time at the same energy density was observed. The analysis of results of clinical and morphological research shows that PDT is a low-invasive method of gonarthritis treatment with a high degree of efficiency and selectivity. (C) 2016 Elsevier B.V. All rights reserved.

Possibility of hyaline cartilage integrity restoration using multipotent mesenchymal stromal cells (MMSC) was studied on the rabbit model of partial thickness articular hyaline cartilage defect without subchondral plate damage. Size of defect made up 0.5 cm in diameter and 1.5 mm deep. Autologous bone marrow was harvested from the resected upper flaring portion of the ilium, single cell suspension was prepared and cultured in matrasses. Grown MMSC were centrifuged and the sediment was transferred into the cartilage defect. The cells were covered with either vicryl or gelatin sponge, or vicryl mesh. Histologic examination was performed in 4 months. It was shown that the most active regeneration of hyaline cartilage tissue, that substituted the largest part of a defect, was noted when MMSC were covered with vicryl mesh. One of the advantages of vicryl mesh use was that it neither protruded above the cartilaginous plate nor compressed the cells, and slowly resolved.

Integrate criterion for the evaluation of pathological gait based on the distinction of the pattern dynamograms of vertical components of weight bearing reaction at walking in norm and in injured lower extremities is suggested. In patients with different pathology of lower extremities the application of this criterion in clinical practice allows to perform the integral evaluation of gait using the minimum of informative biomechanical parameters. Suggested criterion could serve as an universal index for the evaluations of treatment and rehabilitaion results and may be used in research and clinical practice.