Возможности туннелизации в лечении остеоартрита коленного сустава

Abstract

Introduction Surgical treatment of knee osteoarthritis is a controversial issue. Knee replacement is the treatment of choice in the orthopedic practice for patients with severe knee osteoarthritis. However, total knee arthroplasty (TKA) has not only beneficial results and implant survivorship is limited in time. In recent years, the number of publications devoted to the limitation of indications for TKA in patients with osteoarthritis has been increased. The use of drilled tunneling in its modern modifications enables to delay or, in some cases, avoid knee joint arthroplasty. Purpose To substantiate the safety, low invasiveness and effectiveness of the tunneling method as a minimally invasive organ-preserving treatment for knee joint osteoarthritis. Materials and methods The electronic Pub-Med/MEDLINE and eLibrary databases were searched for works published for the last 30 years. The search was carried out with keywords and phrases: knee joint osteoarthritis, articular cartilage, bone drilling, arthroscopy of the knee joint. Results The effectiveness of tunneling is based on the concept of simultaneous revascularization, drainage and decompression of the subchondral sections of the knee joint and the medullary cavity of the tubular bones. Up to 96 % of patients report a positive effect of tunneling immediately after surgery. Intraosseous pressure decreases for up to 2 years in 88 % of patients. Discussion The tunneling method in the treatment of knee osteoarthritis helps to reduce pain in the projection of the femur and tibia, including night pain, improves the functional parameters of the joint, inhibits the progress of cartilage destruction, improves the quality of life of patients and reduces the need for replacement of the affected joint. In addition, tunneling does not require serious economic costs. Due to the fact that this method is a minimally invasive surgical intervention, the risk of infection is noticeably lower than with TKA. Conclusion Thus, the tunneling of the articular ends is a simple, safe, low invasive and effective method of treating knee joint osteoarthritis.