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Introduction Surgical treatment of stiff elbow caused by ossification often result in poor outcomes due to anatomical and physiological characteristics, significant functional load and higher patient requirements for the elbow functionality. The purpose was to determine ways of improved surgical treatment for patients with elbow contractures caused by ossification, based on an analysis of literature reporting surgical strategy and outcomes. Material and methods An internet search of PubMed, Medline, Elibrary.ru, CyberLeninka, Google Scholar, International Clinical Trials Registry of the US National Institutes of Health, ISRCTN Registry of International Standard Randomized Clinical Trial Numbers, German Clinical Trials Registry DRKS, WHO Registry was performed. Search words and phrases included elbow contracture, ossification, surgical treatment, stiff, elbow, surgical treatment, ossification. The search depth was 10 years. Results and discussion Some important parameters (recurrence of stiffness, pain, decreased quality of life, etc.) are reported as “very unassertive” in patients with stiff elbow due to ossification at mid and long terms (12–24 months or greater). Poor outcomes are reported in approximately 50 % of the cases due to the range of motion decreased to the preoperative level or less. Many patients (more than 90 % according to some authors) need a repeated surgery and are at risk for the stiff joint. Conclusion A critical analysis of the literature indicates lack of preoperative instrumentation examination of patients with use of new visualization methods (3D modeling). Preoperative examination and surgical planning based on additive technologies are essential for surgically treated patients with stiff elbow caused by ossification.

Background. Despite the anterior cruciate ligament reconstruction (ACL-R) is considered to be routine and successful procedure the burden of patients who needs revision surgery is growing worldwide. Purpose to describe the gender and social-demographic characteristics of this cohort of patients, analyze the reasons leading to revision ACL-R (re-ACL-R), estimate survival-ship of primary procedure as well as highlight clinically relative aspects of revision surgery. Methods. The database of Vreden Orthopaedic Center for the period from 01.01.2011 to 31.12.2021 searched for patients admitted for re-ACL-R. 234 patients (257 knees) agreed to take part in the study. Patient records with surgery reports, clinical exams and PROMs were analyzed. Results. There was a tendency to annual increase of re-ACL-R while the time between primary and revision procedures was just 4.0 years in average. Young males dominated among re-ACL-R cohort (75.2%, 31.0 years). The acute trauma prevailed over other reasons of ACL-R failure however, it was absent in 39.1% of cases. Patients who injured performing sports were significantly younger than the rest of the cohort (p = 0.005). Allografts were the most popular choice both for first re-ACL-R (53.0%) and re-revision ACL-R (60.9%). Interestingly that majority of re-ACL-R were performed in one stage while two-staged approach implemented only in 4.3% of cases. Conclusion. The main cause for re-ACL-R is repeated injury but significant percentage of patients develops recurrence of instability without trauma in middle-term period after ACL-R. Therefore to reduce the numbers of re-ACL-R both the proper post-op sport injury prevention program and improvement of surgical technique are of the same importance.

Introduction Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures around the knee. Despite good long-term outcomes in general, thousands of revisions after ACL reconstruction are performed annually in the world due to graft failures, repeated injuries, technical errors, disorders in ligamentization process or inadequate rehabilitation. The aim of the study was to evaluate the current evidence and describe the relevant clinical features of planning and performing revision ACL reconstruction. Materials and methods A search was conducted for English- and Russian-language publications in the electronic databases PubMed and e-LIBRARY for the period from 2000 to 2020 using the keywords: anterior cruciate ligament, ACL, revision, re-reconstruction, re-rupture. Among 572 publications, 107 corresponded to the study topic. Based on the inclusion criteria (more than 50 reported cases; follow-up more than 2 years; homogeneous groups of patients; assessment with knee function scores; application of various imaging options), 31 articles were included in this review. There were no Russian studies that met the above-mentioned criteria. Results and discussion The analysis of the literature identified four clinically relevant features in the treatment of patients with failures of ACL reconstruction: criteria and principles for the implementation of a one- or two-stage approach; additional features of the revision ACL reconstruction; determination of the optimal graft type. Conclusion Most of the revision ACL reconstructions can be performed at one stage, combined with bone grafting if needed. For a successful treatment outcome, in some cases, correction of frontal and sagittal deformity of the lower limb, management of the injury to other knee joint stabilizers, to cartilage or menisci is required. Surgeons’ preferences in the choice of plastic material has shifted to autografts with bone blocks, or allografts, especially if reconstruction of several stabilizers is necessary.