Drokin A. Treatment Tactics for Isolated Injury of the Anterior Cruciate Ligament of the Knee Joint in Patients Injured Against the Background of Excess Body Weight

Injury of the anterior cruciate ligament of the knee joint (ACLKJ) is one of the most common and clinically significant injuries of the musculoskeletal system, especially among young and working-age individuals who lead an active lifestyle. Such injuries are accompanied not only by impaired mechanical stability of the knee joint (KJ), but also by long-term functional limitations, difficulties in returning to the previous level of physical activity, an increased risk of recurrent injury, and the development of post-traumatic osteoarthritis. This problem becomes particularly relevant in the context of the increasing prevalence of excess body weight, since increased body mass is associated with changes in gait biomechanics, increased axial and rotational load on the KJ, impaired proprioception, and disturbed muscle control. Despite the development of arthroscopic surgery and rehabilitation technologies, the results of ACLKJ reconstruction are not always optimal, while the frequency of functionally unsatisfactory outcomes and postoperative complications remains a clinically significant problem. In this regard, the search for diagnostic and prognostic markers that allow personalization of treatment, timely identification of high-risk patients regarding the possible development of complications after arthroscopic ACLKJ reconstruction, prediction of the postoperative course, and improvement of surgical treatment outcomes is relevant. In accordance with the main aim and objectives of the study, 90 patients aged 19–67 years were examined, including 38 patients with IACLIKJ against the background of obesity and 52 patients with IACLIKJ against the background of excess body weight. Scientific novelty of the dissertation. The dissertation for the first time comprehensively substantiates that IACLIKJ in overweight patients is not only a local orthopedic and traumatological injury, but a clinically multicomponent condition. For the first time, the diagnostic and prognostic value of the complex of clinical and anamnestic, laboratory and clinical and instrumental characteristics in patients with IACLIKJ against the background of overweight has been established. For the first time, the nature of the relationships between anthropometric, metabolic, hemostatic and functional indicators in patients with IACLIKJ has been determined. For the first time, the most informative markers and predictors of an unfavorable course after arthroscopic reconstruction of IACLIKJ in overweight patients have been identified. For the first time, a prognostic approach to assessing the risk of adverse outcomes of surgical treatment of IACLIKJ against the background of overweight has been developed and scientifically substantiated using clinically available indicators and VAS and Lysholm scales. Scientific ideas about the role of overweight as an independent factor have been improved. The practical significance of the results of the work lies in the possibility of direct use of the results in clinical practice of orthopedics and traumatology to increase the effectiveness of surgical treatment of patients with IACLIKJ against the background of overweight. A clinically oriented approach to a comprehensive preoperative assessment of patients with IACLIKJ has been proposed and diagnostic and prognostic markers have been identified that can be used by orthopedic traumatologists for early identification of patients at high risk. The developed prognostic approach using the VAS and Lysholm scales makes it possible to objectify the assessment of pain syndrome and functional status of the knee in the dynamics of treatment. The need for individualization of perioperative management of patients with IACLIKJ against the background of overweight has been substantiated and the possibilities of their use for personalization of preoperative assessment and postoperative management of patients with IACLIKJ against the background of overweight have been identified. The obtained results may be implemented in the work of orthopedic-traumatological departments, rehabilitation units, and consultative-diagnostic services, and may also be used in the educational process of higher medical education institutions during the teaching of orthopedics, traumatology, rehabilitation, and related clinical disciplines.