The dissertation is dedicated to solving the urgent scientific problem of modern traumatology and orthopedics – increasing the efficiency of restorative treatment of patients who develop tendinopathy of the patellar ligament (TN) after arthroscopic resection of the knee meniscus. Despite the minimally invasive nature of arthroscopic interventions, some patients develop persistent pain syndrome in the anterior knee in the postoperative period, which is accompanied by functional limitations, decreased muscle strength and deterioration of the quality of life. The issues of clinical course, functional consequences and optimal tactics of physical therapy in this pathology remain insufficiently studied.
The purpose of the study is to improve the results of rehabilitation treatment of patients with tendinopathy of the patellar ligament after arthroscopic resection of the meniscus of the knee joint through a comprehensive clinical and functional assessment of the pathology and the development of a physical therapy program as a component of rehabilitation, using a robotic orthosis (RO).
The object of the study is structural and functional changes in the state of the knee joint in patients with tendinopathy of the patellar ligament after arthroscopic resection of the meniscus.
The subject of the study is clinical manifestations, functional state of the knee joint, ultrasound characteristics of the patellar ligament tissue, features of autonomic nervous regulation, changes in the strength of the lower limb muscles and the effectiveness of comprehensive rehabilitation treatment with the use of a robotic orthosis.
The study was carried out on the basis of the Department of Joint Diseases in Adults of the State Institution "National Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine". The study included 120 patients (76 men, 44 women; mean age 38.1 ± 7.8 years; mean BMI 28.5 ± 5.9 kg/m²), selected from 524 examined after arthroscopic meniscus resection when early manifestations of TN were detected on the 14th day after surgery. Patients were divided into two groups of 60 people. The main group received standard physical therapy with an additional course of Locomat RO; the control group - treatment according to the EU-US Meniscus Rehabilitation 2024 Consensus protocol. Clinical, ultrasound, functional (VAS, AKPS, Lysholm scale), dynamometric, autonomic and biomechanical research methods were applied; statistical processing was performed using Mann–Whitney, Friedman, χ², Fisher's exact test and Spearman's correlation.
The use of RO provided significantly better results of rehabilitation treatment compared to the standard program. After 12 weeks, the median VAS in the main group was 1 (0–1) points versus 2 (2–3) points in the control group;
AKPS – 89.5 (89–90) versus 76 (76–76) points; Lysholm scale – 90 (84–91) versus 84 (76–85) points. The increase in AKPS from the 14th day to the 12th week was 171.2% in the main group and 137.5% in the control group. The strength of the extensor muscles in the main group after 3 months recovered to the preoperative level (76.0 N m), while in the control group it remained 6.5% lower (72.0 N m). Normalization of vegetative balance (eutonia, class I rhythmogram) after 12 weeks was recorded in 90.0% of patients in the main group compared to 63.3% of the control group. The age of the patients was more associated with functional indicators, while BMI was associated with the intensity of the pain syndrome; however, in all subgroups, the main group demonstrated better dynamics, which confirms the independent clinical effect of the proposed program. The developed rehabilitation treatment program using a robotic orthosis is pathogenetically justified and clinically effective. Its implementation provides a faster reduction in pain syndrome, a more complete restoration of knee joint function, normalization of extensor muscle strength and vegetative regulation. The program is recommended for wider use in the practice of postoperative physical therapy of patients after arthroscopic interventions on the knee joint.
