Knee Joint In Children Research Articles

Modern technologies for medical rehabilitation of children with knee joint injuries

Pathology of the knee joint in children is a pressing problem in pediatric traumatology, orthopedics and pediatrics. The frequency of injuries to the knee joint is determined by the complexity of its structure, biomechanical features with a high probability of overload. At the same time, intra-articular injuries in children and adolescents, accounting for up to 7 % in the structure of inpatient pathology, are the cause of pronounced functional disorders of the lower limb and the risk of developing post-traumatic osteoarthritis Currently, physical factors are widely used at various stages of medical rehabilitation of children with damage to the capsular-ligamentous apparatus of the knee joint. The conducted studies have established the effectiveness of using local air cryotherapy in the early postoperative period, characterized by a pronounced anti-edematous, analgesic effect. Early regression of pain and elimination of microcirculatory disorders in the area of injury as a result of a course of pulsed low-frequency magnetic therapy at various stages of medical rehabilitation of children with damage to the capsular-ligamentous apparatus of the knee joint have been recorded. The beneficial effect of a pulsed low-frequency electrostatic field on indicators of orthopedic status, and thermography indicators in the area of injury in children with knee joint injuries has been established. Data were obtained on more pronounced regression of pain, earlier restoration of range of motion in the damaged joint and relief of signs of post-traumatic synovitis with the complex use of a pulsed low-frequency electrostatic field and robotic mechanotherapy in children with damage to the capsular ligamentous apparatus of the knee joint. The obtained clinical and functional results are of great importance for injuries of the knee joint with the risk of contractures in the postoperative period.

The Influence of Temporary Epiphysiodesis of the Proximal End of the Tibia on the Shape of the Knee Joint in Children Treated for Leg Length Discrepancy.

Background: Leg length discrepancy (LLD) is a common problem in the daily clinical practice of pediatric orthopedists. Surgical treatment using LLD temporary epiphysiodesis with eight-plate implants is a minimally invasive, safe, and well-tolerated procedure that provides good treatment effects with a relatively low percentage of complications. The main aim of this retrospective study was to determine the effect of epiphysiodesis on the shape of the proximal tibia. Methods: The retrospective study was based on medical records from 2010 to 2019. Radiographs taken before the epiphysiodesis and at 6-month intervals until the end of the treatment were investigated. A total of 60 patients treated for LLD were included in the study (24 girls, 36 boys). They were divided into three groups depending on the duration of the LLD treatment: group I (18 months), group II (30 months), and group III (42 months of treatment). Radiological parameters were assessed, including the roof angle (D), the slope angles (α and β), and the specific parameters of the tibial epiphysis, namely LTH (lateral tubercle height), MTH (medial tubercle height), and TW (tibial width). Results: The roof angle decreased in all the groups, which was accompanied by an increase in the β or α angle. LTH, MTH and TW also increased, and the differences before and after the treatment for the treated legs were statistically significant in all the studied groups. The greatest change in the shape of the articular surface of the proximal tibia occurred after 42 months of treatment. Conclusions: The study showed that epiphysiodesis affects the proximal tibial articular surface over prolonged treatment. Thus, there is a need for future long-term follow-up studies to elucidate the potential effects of LLD egalization.

Physical factors in medical rehabilitation of children with damage to the capsulal-ligating apparatus of the knee joint

Pathology of the knee joint in children is a pressing problem in pediatric traumatology, orthopedics and pediatrics. The frequency of injuries to the knee joint is determined by the complexity of its structure, biomechanical features with a high probability of overload. At the same time, intra-articular injuries in children and adolescents, accounting for up to 7% in the structure of inpatient pathology, are the cause of pronounced functional disorders of the lower limb and the risk of developing post-traumatic osteoarthritis.
 Currently, physical factors are widely used at various stages of medical rehabilitation of children with damage to the capsular-ligamentous apparatus of the knee joint. The conducted studies have established the effectiveness of using local air cryotherapy in the early postoperative period, characterized by a pronounced anti-edematous, analgesic effect. Early regression of pain and elimination of microcirculatory disorders in the area of injury as a result of a course of pulsed low-frequency magnetic therapy at various stages of medical rehabilitation of children with damage to the capsular-ligamentous apparatus of the knee joint have been recorded. The beneficial effect of a pulsed low-frequency electrostatic field on indicators of orthopedic status, and thermography indicators in the area of injury in children with knee joint injuries has been established. Data were obtained on more pronounced regression of pain, earlier restoration of range of motion in the damaged joint and relief of signs of post-traumatic synovitis with the complex use of a pulsed low-frequency electrostatic field and robotic mechanotherapy in children with damage to the capsular ligamentous apparatus of the knee joint. The obtained clinical and functional results are of great importance for injuries of the knee joint with the risk of contractures in the postoperative period.

Diagnostic Accuracy Study of the Pediatric-Specific Ultrasound Scoring System for the Knee Joint in Children With Juvenile Idiopathic Arthritis.

We undertook this study to validate the Pediatric Arthritis Ultrasound Scoring System for the knee joint (PAUSS-knee) in children with juvenile idiopathic arthritis (JIA). Children with JIA were enrolled to prospectively receive a musculoskeletal ultrasound (MSUS) examination of the knee and a physical examination to determine presence/absence of clinical arthritis. MSUS images were scored using the PAUSS-knee, a semiquantitative MSUS scoring system (0-3, normal to severe) for B-mode and power Doppler mode. In addition to MSUS, a subset of participants also received magnetic resonance imaging (MRI) of the knee, which was scored according to the combined Juvenile Arthritis MRI Scoring (JAMRIS) system. Spearman's correlations (rs ) were used to calculate associations between variables. Test characteristics of the PAUSS-knee were calculated with MRI as the reference standard. Inflammatory biomarkers were assessed in synovial fluid from involved knees. Eighty children with JIA contributed 112 MSUSs and 25 MRIs of the knee. Of the knees, 41% (n=46) had clinical evidence of arthritis. The B-mode PAUSS-knee score moderately correlated with clinically determined arthritis (rs = 0.54, P < 0.001) and strongly correlated with the JAMRIS score (rs = 0.75, P < 0.001). Compared with MRI, the area under the curve for the B-mode PAUSS-knee was 0.92. For a cutoff of >1, the B-mode PAUSS-knee had a sensitivity of 83% and specificity of 82%. Biomarker analysis indicates that interleukin-2R levels correlate with PAUSS score. Our data indicate that the PAUSS-knee has excellent accuracy for the diagnosis of arthritis when compared with MRI. The PAUSS-knee has the potential to effectively inform JIA medical decision-making in real time.

CircRNA-CIRH1A Promotes the Development of Osteosarcoma by Regulating PI3K/AKT and JAK2/STAT3 Signaling Pathways.

Osteogenic sarcoma (OS), one of the mesenchymal tumors with a high degree of malignancy, mainly occurs in the metaphysis of the long bones and around the knee joints in children and adolescents. The poor diagnosis in patients with OS can be attributed to the lack of early clinical symptoms, although the growth of tumor mass gradually results in severe pain and systemic symptoms. The mechanisms underlying the pathogenesis of OS are not fully understood. Thus, identifying early diagnostic biomarkers and novel targets involved in the progression of OS is of critical significance in the management of OS. CircRNA is a class of non-coding RNAs characterized by the close-loop structure and increased stability, which are implicated in the regulation of cell proliferation, differentiation, migration, and apoptosis. Moreover, circRNAs also play significant roles in aging and chronic disorders, such as cancer and cardiovascular diseases. Accordingly, we reported the upregulation of circRNA-CIRH1A in OS tissues and cell lines. Silencing circRNA-CIRH1A in OS cell lines (U2OS, HOS, Saos-2, and MG-63) could inhibit the cell proliferation, invasion, migration, and apoptosis, which was also validated in xenograft tumorigenesis mouse model. We further demonstrated that circRNA-CIRH1A sponged miR-1276, which subsequently disrupted the effect of miR-1276 on PI3K/AKT and JAK2/STAT3 signaling pathways. Together, our study revealed the oncogenic role of circRNA-CIRH1A in OS, and identified miR-1276/ PI3K-AKT and JAK2-STAT3 signaling axis as the key downstream mediators of circRNA-CIRH1A.

Validation of Pedi-IKDC scale and intercultural adaptation to Ukrainian language

There are no questionnaires available in Ukrainian that can be used to objectify the results of treatment of orthopaedic and traumatological pathology of the knee joint in children. In world practice, subjective Pedi-IKDC and KOOS-Child scales are used for this purpose. Objective. Validation, intercultural adaptation and translation of the Pedi-IKDS scale in English (original) into Ukrainian for paediatric patients. Methods. Translation and adap­tation agreed with the copyright holder of the AOSSM test and performed according to the requirements of the Recommendations for the Cross-Cultural Adaptation of Health Status Measures of the American Academy of Orthopaedic Surgeons Institute for Work &amp; Health. The translated and adapted questionnaire has been tested on a heterogeneous group of 10 children treated for knee pathology. The questionnaire has been adjusted. The participants (both sexes, aged 10–18 years) have been divided into two groups for validation: I — without knee pathology, tested once; II — with knee injuries and physical limitations, tested before and after treatment. Results. We obtained 50 questionnaires in group I (50 child­ren). Student's t-test has been chosen for the analysis of results. To compare the accuracy of the translation, a comparison has been made with the results of A.Y. Nasreddine's study (unpaired Student's t-test). The resulting differences between the original questionnaire and its translation have not been statistically significant (p = 0.966). Group II received 200 questionnaires. A paired Student's t-test has been chosen for analysis. Test results before and after treatment have been significantly different (t2 &gt; tcrit, p &lt; 0.001). The appropriateness and objectivity of the Pedi-IKDC questionnaire have been confirmed. Conclusions. The Pedi-IKDC test has been successfully translated into Ukrainian and adapted for use. The quality of adaptation has been confirmed and no statistically significant difference has been found compared to the results of the world stu­dies. Pedi-IKDC is recommended to be used in children with knee pathology for clinical and scientific purposes.

Combined application of pulsed low-frequency electrostatic field and robotic mechanotherapy for damage to capsular ligamentous apparatus of the knee joint in children (Methodological recommendations, SAHI MSPC MRRSM MHD. 2022. - 19 p.).

Pathology of the knee joint in children is an urgent problem in pediatric traumatology, orthopedics and pediatrics. Features of the anatomical structure of the knee joint, its functioning, high static and dynamic loads determine the frequency of injuries of this localization (up to 25% among all injuries of the musculoskeletal system).

Physical factors in traumatic arthropathy in children

The relevance and the urgent character of the problem of traumatic arthropathy of the knee joint in children is due to the high frequency of injuries of this localization, comprising from 5 to 25% of all injuries of the musculoskeletal system.&#x0D; Nowadays, physical factors are commonly used at different stages of medical rehabilitation of children with traumatic injuries of the knee joint. At the same time, scientifically substantiated recommendations for medical rehabilitation of children with nonspecific posttraumatic knee pain syndrome are insufficient.&#x0D; Studies conducted have ascertained the effectiveness of local air cryotherapy, which is characterized by an explicit anti-edema, analgesic effect. An early regression of pain has been registered, the elimination of microcirculatory disorders in the area of damage as a result of the course effects of pulsed low-frequency magnetic therapy at various stages of medical rehabilitation. The beneficial effect of a pulsed low-frequency electrostatic field on the indicators of orthopedic status, the state of microcirculation, thermography in the area of damage has been established in children with traumatic arthropathy of the knee joint.&#x0D; The possibility of using polychromatic polarized light in traumatic arthropathy of the knee joint in children, characterized by pain reduction due to muscle relaxation, activation of microcirculation in the injury area, restoration of the volume of movements, has been proved.

Diagnostic Utility of Synovial Fluid Cell Counts and CRP in Pediatric Knee Arthritis: A 10-Year Monocentric, Retrospective Study.

Background: Orthopedic surgeons often use the intra-articular white blood counts (WBCs) and the percentage of polymorphonuclear cells (PMN) in the diagnosis of an acute swollen and painful knee joint in children. Today, there is no established threshold for the synovial WBC, and their differentiation, as indicative of native joint knee bacterial arthritis. We determine the sensitivity and specificity of synovial WBCs and PMN percentages in the prediction of a community-acquired, acute bacterial native joint septic arthritis (SA) in the pediatric population. Methods: A retrospective study on healthy children 0–16 years of age who underwent knee joint aspiration for a community-acquired, acute irritable knee effusion in our tertiary-care children’s hospital between May 2009 and April 2019 was conducted. We divided the study population into two groups according to the detection of bacterial arthritis in the synovial fluid (bacterial arthritis versus its absence) and compared the intra-articular leukocyte and C-reactive protein (CRP) levels. Results: Overall, we found a statistically significant difference regarding the total CRP (p = 0.017), leukocyte or PMN counts (p ≤ 0.001 in favor of a bacterial arthritis). In contrast, the percentage of the neutrophils was not determinant for the later confirmation of bacterial pathogens, and we were unable to establish diagnostically determining minimal thresholds of the intra-articular CRP and leukocyte levels. Conclusions: This pilot study suggests that either the leukocyte or PMN counts may be associated with a bacterial origin of knee arthritis in children. We plan a larger prospective interventional study in the future to confirm these findings including the investigation of other joint aspirate biomarkers.

Pulse Low-Frequency Electrostatic Field Application for Injuries of Knee Joint Capsular Ligament Apparatus in Children: a Prospective Randomized Comparative Study

INTRODUCTION. Rehabilitation of children with knee joint injuries is very relevant due to a high prevalence of such a localization of injuries leading to loss of limb function and often requiring surgical treatment and intensive rehabilitation. AIM. To establish scientifically the isolated use of low-frequency pulsed electrostatic field and in combination with robotic mechanotherapy in treatment of the knee joint capsular ligamentous apparatus injuries in children. MATERIAL AND METHODS. 60 children aged 13 to 18 years with damage to the capsular ligamentous apparatus of the knee joint were included in the clinical study. The study group was represented by 30 children receiving a combined effect of the low-frequency pulsed electrostatic field and robotic mechanotherapy. A comparison group of 30 children was exposed to the low-frequency pulsed electrostatic field. Medical rehabilitation was prescribed in the early post-immobilization period after arthroscopic operations. To determine the effectiveness of medical rehabilitation techniques, we used orthopedic status assessment, a subjacent determination of the severity of pain syndrome according to the VAS, clinical assessment of motor deficit, laser Doppler flowmetry, ultrasound examination of knee joints, infrared thermography, and psychological testing using the Spielberg-Hanin scale. RESULTS AND DISCUSSION. A prospective open randomized comparative study revealed a more pronounced regression of pain syndrome, earlier restoration of the motions in the injured joint, and relief of posttraumatic synovitis signs when using two physical factors in children with damage to the capsule-ligament apparatus of the knee joint in combination. The clinical and functional results obtained are of great importance in injuries of the knee joint with the risk of contracture formation in the postoperative period. CONCLUSION. High therapeutic efficacy, good tolerability of procedures, and the absence of adverse reactions substantiate expediency of the low frequency pulsed electrostatic field introduction in combination with robotic mechanotherapy for injuries of the capsular ligamentous apparatus of the knee joint in children into the practice of children’s medical and preventive medical organizations.

A comparative analysis of outcomes of surgical treatment of meniscus injuries in the knee joint in children after meniscectomy and meniscus suture repair

Introduction. The most common modalities of surgical treatment of meniscus injuries in children are meniscectomy and meniscal suture repair. However, indications and contraindications for both approaches in the pediatric practice is one of the most discussed problems. To more precisely define indications and contraindications for resection and meniscus suture repair will optimize management of meniscus injuries in children, thus improving outcomes and preventing early osteoarthritis of the knee joint.Purpose. To analyze outcomes after meniscectomy and meniscus suture repair in children after meniscus injuries.Material and methods. From 2015 till 2020, 120 children were treated in the department of traumatology and orthopedics (Morozovskaya Children's Clinical Hospital) for meniscus injuries. 88 patients (73.3%) from Group 1 had arthroscopic meniscus suture repair. 32 children (26.7%) from the comparison group had meniscectomy. All removed menisci were subjected to histological examination. Outcomes were assessed in 6 and 12 months after the surgery: clinical examination, MRI, radiography, and questionnaires with KOOS-Child and Pedi-IKDC scales.Results. In 6 months after the surgery, the following complaints were registered: after total meniscectomy pain was in 100% of patients; after partial resection of the meniscus pain was in 3.1% of patients. The basic complaint after meniscus suture repair was flexion restriction (10.2%). In 12 months after surgery, complaints were registered in 7 children after total meniscus resection (100% of all total meniscectomies), in 15 children after partial meniscus resection (60% of all partial meniscectomies), and in 14 children after meniscus suture repair (19.4% of all meniscus suture repairs). The assessment of clinical findings before and after meniscus suture repair in 6 and 12 months after the surgery has shown a statistically significant decrease in pain (p0.001), in swelling of the knee joint (p0.001) and relief of flexion restriction (p0.021), if to compare with partial meniscectomy.Conclusion. Unsatisfactory outcomes after total meniscectomy urge to exclude this type of intervention in the pediatric practice. Partial meniscectomy should be performed only if it is a case of multiple and multiplanar, multidirectional complex injury when meniscus repair is technically impossible. Marked cicatricial changes in the meniscus tissue which deform it and do not allow to make an anatomical reconstruction of the joint is also an indication for partial resection. If there are no marked degenerative changes and meniscus suture repair is technically possible, the damaged meniscus should be restored, regardless of the time of its injury and rupture location.

Imaging of Knee Swelling in Children

The knee joint is the largest joint in the body and comprises the tibiofemoral (medial and lateral) and the patellofemoral compartments. The knee joint is a modified hinge joint and relies on several associated muscles, tendons, and ligaments to provide strength and stability during movement and at rest. A limping child with a swollen knee is a common presentation encountered by pediatricians. Although trauma is the most common cause of pediatric knee swelling, a wide variety of pathologies can manifest as a swollen and/or painful knee joint in children, reflecting underlying abnormalities of soft tissue or osseous components of the knee.1 , 2 In the absence of a recent or remote history of knee trauma, other pathologic causes of knee swelling include infections and inflammatory conditions, congenital/developmental causes, vascular abnormalities, and neoplastic disorders.

Management status of anterior cruciate ligament injury in children and adolescents

To summarize the current management of anterior cruciate ligament (ACL) injury in children and adolescents, in order to provide reference for the management of ACL injury in children and adolescents. The relevant literature at home and abroad in recent years was extensively accessed to summarize the management status of ACL injury in children and adolescent. The number of ACL injury in children and adolescents is increasing every year. The diagnosis of ACL mainly depends on symptoms and signs. Rehabilitation, physeal-sparing techniques, partial transphyseal techniques, all-epiphyseal techniques, and transphyseal techniques are used to treat ACL injury in children and adolescents. Dynamic monitoring of knee joint in children and adolescents should be strengthened. The best treatment for ACL injury in children and adolescents is selected according to the patients' actual age, bone age, Tanner stage, and physiological conditions such as menstruation, body growth speed, and other characteristics.

Influence of the growth of children on the features of injuries arising during a car injury

Was to establish the features of injuries that occur from a car impact and from an injury in the car cab in children of different heights. A retrospective study of archival material was carried out, including forensic conclusions of the corpses of children under 18 who died as a result of car injuries. We analyzed the frequency of damage to various parts of the body as a percentage in children of different heights. As a result, it was found that in children who died as a result of an accident, both from a car impact and from an injury in the car cab, with an increase in height, death occurs more often from a combined injury, less often from an isolated injury of any one part of the body. In children-pedestrians who died from a car impact, with an increase in height, the localization of fractures of the bones of the upper and lower limbs «moves» to more distal regions. The frequency of fractures of the ribs, blades, and pelvic bones increases with increasing height. Ruptures of the liver and spleen are several times more likely to occur in children below 160 cm. In children-passengers with an injury in the car cab, the main features of damage caused by height were identified in the trunk region, which are manifested by a significant predominance of massiveness and the proportion of damage to the bones and internal organs of the chest, the abdomen and pelvis in children above 140 cm and, especially, above 160 cm. Of the injuries of the lower limbs, a feature of the injury in the car cab is the prevalence of injuries to the knee joints in children above 140 cm. A direct dependence of injuries of all parts of the upper limbs on height was revealed, fractures of the forearm bones has been revealed occurred only in children above 160 cm.

Knee Trauma.

Knee Trauma.

Is magnetic resonance imaging reliable for assessing osteosarcoma of the knee joint in children?

IntroductionThe study of tumor extension in knee osteosarcomas is an essential diagnostic tool that helps determine the surgical approach. Magnetic resonance imaging (MRI) is the key component in this decision-making process, but the interpretation of signals can be difficult because peritumoral edema and inflammation may be mistaken for the tumor. HypothesisThere is a discrepancy between MRI and histopathology findings in the assessment of joint involvement in pediatric osteosarcomas of the knee. Materials and methodsAll children who underwent an extra-articular resection for an osteosarcoma of the knee between 2007 and 2016 were included. This was indicated if there was at least one of the following MRI signs: presence of articular effusion, involvement of either the peripheral capsuloligamentous structures, central pivot or patella, or lesion abutting the articular cartilage. ResultsNine patients were operated on with a mean age of 13±2.7 years. There were at least two of the described signs, mainly the involvement of the peripheral capsuloligamentous structures (78%) and central pivot (56%). The histopathology confirmed that the resection margins were healthy in all cases, but the indication for extra-articular resection could have been avoided in 89% of them. DiscussionMRI is the current gold standard for assessing tumor extension, but the signs contraindicating the transarticular approach remain poorly defined. Joint effusion detected by clinical or radiological assessment is the least reliable one. It seems that the tumor's proximity to the articular cartilage, as long as there is no loss of continuity in the latter, or its extension into the central pivot should no longer be considered as relevant signs. The involvement of the peripheral capsuloligamentous structure remains an indication criterion because oncologic resection is otherwise impossible, and the risk of false-negative histopathologic diagnoses is higher. Other MRI sequences could better assess the true extension into the joint space. Level of evidenceIV, retrospective study.

Effect of Screw Configuration on the Rate of Correction for Guided Growth Using the Tension-band Plate.

This study investigated the effect of screw configuration on the rate of correction of coronal angular deformity of the knee joint in children who underwent guided growth using the tension-band plate. Consecutive patients (76 patients with 154 physes; mean age: 11.8±2.2 y) who underwent guided growth using the tension-band plate for coronal angular deformity (genu varum or genu valgum) were included. The mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, and screw angle were measured from the teleroentgenograms of preoperative and postoperative periodic follow-up visits. The mean initial screw angle and the mean rate of correction were 16.7±10.5 degrees and 6.5±5.3 degrees per year, respectively. The rate of correction was significantly affected by age at surgery, sex, physis treated, severity of deformity, and rate of change in screw angle (all P<0.001). However, the initial screw angle and type of deformity did not affect the rate of correction. The rate of correction per year was 3.6 degrees higher in boys than in girls and 2.8 degrees higher in the distal femur than in the proximal tibia. A 1 degree increase in the rate of change in screw angle was associated with a 0.5 degree increase in the correction rate. Screw angle significantly increased with follow-up duration (P<0.001) and the change in screw angle was significantly affected by age, sex, and physis treated (all P<0.001). This study demonstrated that screw configuration did not affect the correction rate of coronal angular deformity for guided growth using the tension-band plate. Therefore, surgeons only need to insert the screws according to anatomic restriction, not considering the screw configuration when using the tension-band plate for guided growth in children. Prognostic level III.

The Role of Arthroscopy in the Diagnosis and Treatment of Capsular-ligamentous and Intraarticular Lesions of the Knee Joint in Children

The objective: to carry out arthroscopic verification of intrarticular lesions of the knee joint in children, in order to develop optimal treatment tactics.Materials and methods. The results of preoperative examination and arthroscopic treatment of 105 patients with intra-articular lesions of the knee joint, who have been treated in pediatric orthopedic and trauma departmertments for the last three years, were retrospectively analyzed. The average age of patients was 15.5 years (10 to 17 years), boys – 69 (61,7 %), girls – 35 (34,3 %). Radiography was performed on all patients, ultrasound was performed on 81 children, MRI was performed on 67 patients, CT scan – 14 patients.Results. After arthroscopy, it was found: injurie of the anterior cruciate ligament in 19 (18 %) patients; meniscus injurie in 26 (25 %) children; pelvic instability in 19 (18 %) patients; fat body hypertrophy and mediopatellar fold syndrome in 17 (16 %) patients; free bone-cartilage body in 15 (14 %) children; dissecting osteochondritis in 6 (6 %) patients; osteochondral cartilage injurie in 3 (3 %) patients. In case of the meniscus break, which was close to the free edge, we performed a marginal resection, but if it is a radial break or a small break in the red zone, then the suture gives a greater chance of fusion of the meniscus. In case of the complete rupture of the anterior cruciate ligament in 9 patients, we restored it completely. In 7 cases, the plastic of the anterior cruciate ligament was performed, in 2 cases the refixation of the bone fragment with the ligament to the tibia was performed. The plastic of the anterior cruciate ligament was performed with STG autografts with fixation by interference biodegradable screws. In case of instability of the patellar 3 patients with recurrent dislocations plastic with the use of STG tendons was performed. For 10 patients with primary dislocation of the patella we made a lateral release and suture on Yamamoto, 6 patients with a clinic of instability of the patella and a subluxation of it on Kohn ≤2 c. only a lateral release was performed. In other cases, arthroscopic removal of free fragments and formations was done. In the postoperative period, all the sick children had good and excellent results.Conclusions. 1. Arthroscopic interventions can solve diagnostic and therapeutic problems in capsular-ligamentous and intraarticular lesions of the knee joint in children.2. Indications for surgery are made on the basis of a carefully collected medical history, comprehensive clinical and convincing MRI diagnosis with a determination of the degree of damage to the elements of the knee joint.3. Inconnection with the elasticity of the capsular-ligamentous apparatus in children, incomplete (partial) damage to ligaments and menisci is more common.4. Hypertrophy of the Hoff body and the mediopatellar fold in children often simulates meniscus damage, which leads to the need for arthroscopic surgery.

Application of pulsed low-frequency electrostatic field and physical medicine in rehabilitation of children with post-traumatic arthralgia

Damage to the knee joints in children is up to 25% of all injuries of the musculoskeletal system. Currently, physical factors used in medical rehabilitation of children with traumatic injuries of the knee joint are primarily aimed at stopping the inflammatory process, and physiotherapy technologies with a pronounced analgesic, lymphatic drainage effect are not sufficiently developed. For the first time, a new pathogenetically substantiated technology for medical rehabilitation of children with traumatic arthropathy of the knee joint using a pulsed low-frequency electrostatic field was developed. The beneficial effect of a pulsed low-frequency electrostatic field on the indicators of orthopedic status, psychological processes, the state of microcirculation and thermography in the area of damage has been established.

Joint position sense of lower extremities is impaired and correlated with balance function in children with developmental coordination disorder.

To determine the joint position sense of the lower extremities and its relationship with motor function in children with developmental coordination disorder (DCD) and typically developing (TD) children. A total of 56 participants were recruited; 28 children with DCD (age 10.86±1.07 years; 13 females, 15 males) and 28 TD children (age 10.96±1.18 years; 12 females, 16 males). Knee and ankle joint position sense were assessed using a Biodex isokinetic dynamometer. Joint position acuity was measured by position error (PE) and position error variability (PEV). Motor function was examined using the 2nd edition of Movement Assessment Battery for children (MABC-2) and quantified via sub-scores from 3 MABC-2 domains. Both PE and PEV at knee and ankle joints were significantly greater in children with DCD compared with TD children. In addition, both PE and PEV were significantly greater at the ankle joints than the knee joints in children with DCD. For children with DCD only, joint position acuity in the lower extremities significantly and negatively correlated with MABC-2 balance sub-score. This study verifies that lower limb proprioception is impaired in children with DCD. Also, children with DCD displayed greater proprioceptive deficits at the ankle compared with the knee joint. Children with DCD who had poorer joint position acuity, i.e. greater PE and PEV, in the lower extremities tended to perform less well in balance function.