METHOD OF MOSAIC AUTOCHONDROPLASTY OF FULL-THICKNESS OSTEOCHONDRAL DEFECTS OF THE ARTICULAR SURFACE OF THE TALUS IN PATIENTS WITH CHONDROPATHY AND ASEPTIC NECROSIS Russian patent published in 2023 - IPC A61B17/56 A61K35/16 A61P19/02 

FIELD: medicine, traumatology and orthopedics.

SUBSTANCE: invention can be used in mosaic autochondroplasty of full-thickness osteochondral defects of the articular surface of the talus. In the preoperative period, magnetic resonance imaging is performed and localization, the area of the articular surface lesion and the depth of the subchondral bone lesion are determined, then the patient's venous blood is taken for the manufacture of fibrin gel. The medial malleolus is accessed and a chevron osteotomy of the medial malleolus is performed, followed by visualization of the articular surface of the talus. Then surgical sanitation of the defect is perform, debridement is carried out. The depth of its insertion into the talus is determined on the bone picker and, under the control of an image intensifier tube, the sclerosed, aseptically altered tissue is removed within the healthy bone and articular surface. On the medial surface of the calcaneus, access is made to the unloaded pre-Achilles region of the calcaneus. Using a bone harvester, a bone tissue column is taken from the unloaded pre-Achilles region of the calcaneus, which is placed vertically in the formed bed of the talus bone defect using the press-fit method and fixed with a wire. After filling the bed of the bone defect of the talus with bone columns, the previously installed wires are removed and a fibrin gel with adhesive ability is applied to the surface of the mosaic bone osteochondral autograft. Modeling of the collagen membrane is carried out according to the size of the cartilage defect, on the surface of which a fibrin gel with adhesive ability is applied. Osteosynthesis of osteotomy of the medial malleolus is performed with 2 cannulated screws.

EFFECT: method ensures the restoration of the structure and architectonics of the talus with the formation of a durable bone auto-transplant with the simultaneous restoration of the cartilaginous tissue above the autotransplant zone, the reliable fixation of the bone autotransplant in the prepared bed when filling out the talus defect, a significant reduction in the risk of bone resorption with the simultaneous filling of the osteochonderal defect, accurate reposition of the osteotomy zone of the medial malleolus, the absence of postoperative pain at the donor site of bone autograft sampling, as well as improving the quality of life of the patient due to the combination of techniques of the claimed invention.

3 cl, 3 ex