Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics235510.17816/2311-2905-2355ReviewsОбзорыReviewsReview ArticleCurrent Concepts in Diagnostics and Treatment of Patellar Instability: ReviewСовременные подходы к диагностике и лечению нестабильности надколенника: обзор литературыhttps://orcid.org/0000-0001-9391-331665046186175174-4433KhominetsVladimir V.ХоминецВладимир ВасильевичKhominetsVladimir V.
Russian Federation

Dr. Sci. (Med.), Professor

доктор медицинских наук, профессор, начальник кафедры клиники военной травматологии и ортопедии

Dr. Sci. (Med.), Professor

khominets_62@mail.ruhttps://orcid.org/0000-0003-3100-03211625-0543KonokotinDmitry A.КонокотинДмитрий АлександровичKonokotinDmitry A.
Russian Federation

адъюнкт кафедры военной травматологии и ортопедии

konokotin.dmitry@yandex.ruhttps://orcid.org/0000-0002-2027-89967508-2541RikunOleg V.РикунОлег ВладимировичRikunOleg V.

Cand. Sci. (Med.)

кандидат медицинских наук, врач-травматолог ортопед

Cand. Sci. (Med.)

rikoleg@yandex.ruhttps://orcid.org/0000-0002-9953-93853639-4352FedotovAlexey O.ФедотовАлексей ОлеговичFedotovAlexey O.
Russian Federation

Cand. Sci. (Med.)

кандидат медицинских наук, преподаватель кафедры военной травматологии и ортопедии

Cand. Sci. (Med.)

alexfedot83@gmail.comhttps://orcid.org/0000-0002-4565-90661122-8388GrankinAlexey S.ГранкинАлексей СергеевичGrankinAlexey S.
Russian Federation

Cand. Sci. (Med.)

кандидат медицинских наук, начальник отделения клиники военной травматологии и ортопедии

Cand. Sci. (Med.)

aleksey-grankin@yandex.ruhttps://orcid.org/0009-0006-8878-0145VorobievAleksandr S.ВоробьевАлександр СергеевичVorobievAleksandr S.
Russian Federation

cadet

курсант факультета подготовки врачей

aleks.vorobev2000@mail.ruKirov Military Medical AcademyФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны РоссииKirov Military Medical Academy230620232921301432001202312052023Copyright ©; 2023, Eco-VectorCopyright ©; 2023, Эко-ВекторCopyright ©; 2023,2023Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://journal.rniito.org/jour/article/view/2355

Background. Patellar instability is one of the most common pathologies of the musculoskeletal system, predominantly observed in physically active young individuals. It ranks third in the structure of knee joint injuries after anterior cruciate ligament and meniscal injuries.

The aim of this review — to present modern perspectives on the diagnosis, principles, and surgical treatment techniques for patients with patellar instability based on an analysis of the literature.

Methods. Publications were searched in the PubMed/MedLine and eLIBRARY databases. A total of 112 foreign articles published between 1984 and 2023 and 12 domestic publications from 2011 to 2022 were found. During the analysis, 68 articles were selected, which had full texts or abstracts containing sufficient information on diagnostic methods, commonly used standard and modified surgical correction methods for patellar instability, and treatment protocols considering patient age structure, instability characteristics, and functional demands.

Results. A qualitatively new stage in the reconstructive and restorative surgery of patellar instability is the in-depth examination of patients to determine the extent of damage to the medial retinaculum and the presence of dysplastic changes in anatomical structures that provide normal biomechanics of the knee extensor apparatus. A strictly individual approach to the selection of surgical treatment methods considering risk factors contributing to the development of chronic patellar instability becomes of particular importance.

Conclusion. Precise restoration of the medial patellofemoral ligament, supplemented by the correction of identified dysplastic changes in anatomical formations of the knee joint area, allows for better functional outcomes in patients with acute and chronic patellar instability.

Актуальность. Нестабильность надколенника — одна из наиболее часто встречающихся патологий опорно-двигательного аппарата, наблюдающаяся преимущественно у физически активных молодых людей, которая занимает третье место в структуре повреждений области коленного сустава после травм передней крестообразной связки и менисков.

Цель обзора — на основании анализа данных литературы представить современные взгляды на диагностику, принципы и методики хирургического лечения пациентов с нестабильностью надколенника.

Материал и методы. Поиск публикаций осуществлялся в базах данных PubMed/MedLine и eLIBRARY. Всего было найдено 112 иностранных статей, опубликованных в период с 1984 по 2023 г., и 12 отечественных публикаций за 2011–2022 гВ ходе анализа публикаций было отобрано 68 статей, для которых были доступны полные тексты или рефераты, содержащие достаточную информацию по методам диагностики и наиболее часто применяемым стандартным и модифицированным способам хирургической коррекции нестабильности надколенника, а также протоколы лечения рассматриваемой патологии с учетом характера нестабильности, возрастной структуры и функциональных запросов пациентов.

Результаты. Качественно новым этапом развития реконструктивно-восстановительной хирургии нестабильности надколенника является углубленное обследование пострадавших с определением степени повреждений медиального ретинакулюма и диспластических изменений анатомических структур, обеспечивающих нормальную биомеханику разгибательного аппарата коленного сустава. Особое значение приобретает строго индивидуальный подход к выбору метода хирургического лечения с учетом факторов риска, способствующих развитию хронической нестабильности надколенника.

Заключение. Прецизионное восстановление медиальной пателло-феморальной связки, дополненное по показаниям коррекцией выявленных диспластических изменений анатомических образований области коленного сустава, позволяет получить лучшие функциональные результаты у больных с острой и хронической нестабильностью надколенника.

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