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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">smjournal</journal-id><journal-title-group><journal-title xml:lang="ru">Спортивная медицина: наука и практика</journal-title><trans-title-group xml:lang="en"><trans-title>Sports medicine: research and practice</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2223-2524</issn><issn pub-type="epub">2587-9014</issn><publisher><publisher-name>NEICON</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.47529/2223-2524.2025.3.4</article-id><article-id custom-type="elpub" pub-id-type="custom">smjournal-712</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>СПОРТИВНАЯ ТРАВМАТОЛОГИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>SPORTS TRAUMATOLOGY</subject></subj-group></article-categories><title-group><article-title>Сравнительная оценка одноэтапной и двухэтапной реконструкции при мультилигаментарных повреждениях коленного сустава: данные ретроспективного сравнительного исследования</article-title><trans-title-group xml:lang="en"><trans-title>Comparative evaluation of single-stage and two-stage reconstruction in multiligament knee injuries: A retrospective comparative study</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9809-7637</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Гончаров</surname><given-names>Е. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Goncharov</surname><given-names>E. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Гончаров Евгений Николаевич, к.м.н., врач — травматолог‑ортопед, доцент кафедры травматологии и ортопедии хирургического факультета; заведующий отделением травматологии и ортопедии</p><p>119435, Москва, Абрикосовский пер., 2;</p><p>125993, Москва, ул. Баррикадная, 2/1, стр. 1</p></bio><bio xml:lang="en"><p>Evgeniy N. Goncharov, PhD (Medicine), Traumatologist‑Orthopedist, Associate Professor, Department of Traumatology and Orthopedics, Surgical Faculty; Head of the Department of Traumatology and Orthopedics</p><p>2 Abrikosovskiy per., Moscow, 119435;</p><p>2/1 Barrikadnaya str., bldg. 1, Moscow, 125993</p></bio><email xlink:type="simple">goncharoven@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3258-2220</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ветошкин</surname><given-names>А. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Vetoshkin</surname><given-names>A. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Ветошкин Александр Александрович, к.м.н., доцент, руководитель Центра травматологии и ортопедии АО «Европейский Медицинский Центр»; доцент кафедры травматологии и ортопедии</p><p>129110, Москва, Орловский пер. 7;</p><p>125993, Москва, ул. Баррикадная, 2/1, стр. 1</p></bio><bio xml:lang="en"><p>Aleksandr A. Vetoshkin, PhD (Med.), Associate Professor, Head of the Traumatology and Orthopedics Center, European Medical Center (EMC); Associate Professor, Department of Traumatology and Orthopedics</p><p>7 Orlovskiy per., Moscow, 129110;</p><p>2/1 Barrikadnaya str., bldg. 1, Moscow, 125993</p></bio><email xlink:type="simple">totoalex5@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4193-4972</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Коваль</surname><given-names>О. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Koval</surname><given-names>O. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Коваль Олег Александрович, к.м.н., врач — травматолог‑ортопед отделения травматологии и ортопедии; старший лаборант кафедры травматологии и ортопедии хирургического факультета</p><p>119435, Москва, Абрикосовский пер., 2;</p><p>125993, Москва, ул. Баррикадная, 2/1, стр. 1</p></bio><bio xml:lang="en"><p>Oleg A. Koval, PhD (Med.), Traumatologist‑Orthopedist, Department of Traumatology and Orthopedics; Senior Laboratory Assistant, Department of Traumatology and Orthopedics, Surgical Faculty</p><p>2 Abrikosovskiy per., Moscow, 119435;</p><p>2/1 Barrikadnaya str., bldg. 1, Moscow, 125993</p></bio><email xlink:type="simple">drkovaloa@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0006-3090-4280</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Арутюнов</surname><given-names>Г. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Arutyunov</surname><given-names>G. G.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Арутюнов Гурген Гурамиевич, врач спортивной медицины и лечебной физкультуры; старший врач отдела сопровождения спортивных сборных команд и соревнований</p><p>121059, Москва, ул. Б. Дорогомиловская, 5</p></bio><bio xml:lang="en"><p>Gurgen G. Arutyunov, Sports Medicine and Rehabilitation Physician; Senior Physician, Department of Support for National Teams and Competitions</p><p>5 B. Dorogomilovskaya str., Moscow, 121059</p></bio><email xlink:type="simple">g.arutyunov@volley.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0002-3680-1443</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Семенова</surname><given-names>М. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Semenova</surname><given-names>M. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Семенова Мария Павловна, врач спортивной медицины отдела медицинского обеспечения федеральных учебно‑тренировочных баз ФМБА России</p><p>121059, Москва, ул. Б. Дорогомиловская, 5</p></bio><bio xml:lang="en"><p>Maria P. Semenova, Sports Medicine Physician, Department of Medical Support for Federal Training Bases of the FMBA of Russia</p><p>5 B. Dorogomilovskaya str., Moscow, 121059</p></bio><email xlink:type="simple">marya.semen2017@yandex.ru</email><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Научно-клинический центр № 2 ФГБНУ «Российской научный центр хирургии им. акад. Б.В. Петровского»; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Petrovsky National Research Centre of Surgery; Russian Medical Academy of Continuous Professional Education (RMANPO)</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России; Центр травматологии и ортопедии АО «Европейский Медицинский Центр»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Russian Medical Academy of Continuous Professional Education (RMANPO); European Medical Center (EMC)</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>ФГБУ «Национальный центр спортивной медицины Федерального медико-биологического агентства»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>National Center for Sports Medicine of the Federal Medical-Biological Agency (FMBA)</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>30</day><month>12</month><year>2025</year></pub-date><volume>15</volume><issue>3</issue><fpage>5</fpage><lpage>12</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Гончаров Е.Н., Ветошкин А.А., Коваль О.А., Арутюнов Г.Г., Семенова М.П., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Гончаров Е.Н., Ветошкин А.А., Коваль О.А., Арутюнов Г.Г., Семенова М.П.</copyright-holder><copyright-holder xml:lang="en">Goncharov E.N., Vetoshkin A.A., Koval O.A., Arutyunov G.G., Semenova M.P.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.smjournal.ru/jour/article/view/712">https://www.smjournal.ru/jour/article/view/712</self-uri><abstract><sec><title>Цель исследования</title><p>Цель исследования: оценить клинические и функциональные исходы различных хирургических подходов у пациентов с мультилигаментарными повреждениями коленного сустава (МПКС) типов III–L и III–M по классификации Schenck.</p></sec><sec><title>Материалы и методы</title><p>Материалы и методы. В ретроспективное сравнительное исследование включены 43 пациента с хронической нестабильностью коленного сустава после МПКС типа III по Schenck, которые на основании объема хирургического вмешательства были разделены на три группы: группу одномоментной реконструкции передней и задней крестообразных связок (ПКС + ЗКС) без восстановления структур заднелатерального угла (ЗЛУ), группу одномоментной реконструкции ПКС + ЗКС с восстановлением ЗЛУ и группу двухэтапной реконструкции, в которой пациентам на первом этапе выполнялась реконструкция ЗКС и восстановление структур ЗЛУ, а на втором этапе через 6 месяцев — реконструкция ПКС. Оценку исходов проводили с использованием шкал IKDC и Lysholm, а также результатов стресс‑рентгенографии.</p></sec><sec><title>Результаты</title><p>Результаты. Исходы лечения среди пациентов из группы двухэтапной реконструкции были статистически значимо лучше, чем у пациентов из других групп, как по показателям функциональных шкал IKDC и Lysholm (p &lt; 0,01), так и показателям стресс‑рентгенографии коленных суставов. Необходимо отметить, что часть пациентов в группе двухэтапной реконструкции после первого этапа отказались от продолжения лечения, сообщив о восстановлении удовлетворяющей их функции коленного сустава.</p></sec><sec><title>Заключение</title><p>Заключение. Результаты исследования демонстрируют, что при хронических мультилигаментарных повреждениях коленного сустава (тип III по Schenck) двухэтапная тактика хирургического лечения обладает преимуществами перед одномоментными вмешательствами. Разделение этапов реконструкции позволяет не только улучшить функциональные показатели и стабильность сустава, но и избежать избыточного хирургического травматизма: у части пациентов восстановление функции достигается уже после первого этапа (реконструкции ЗКС и ЗЛУ), что делает второй этап необязательным. Таким образом, персонализированный двухэтапный подход является предпочтительной стратегией, обеспечивающей высокие клинические результаты и удовлетворенность пациентов.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Objective</title><p>Objective: to evaluate clinical and functional outcomes of different surgical approaches in patients with multiligamentous knee injuries (MLKI) classified as Schenck type III (III‑L and III‑M).</p></sec><sec><title>Materials and methods</title><p>Materials and methods. A retrospective comparative study included 43 patients with chronic knee instability following Schenck type III MLKI. Based on the surgical intervention performed, patients were divided into three groups: single‑stage reconstruction of the anterior and posterior cruciate ligaments (ACL + PCL) without posterolateral corner (PLC) repair; single‑stage reconstruction of the ACL + PCL with PLC repair; and a two‑stage reconstruction group, where the first stage involved PCL and PLC reconstruction, followed by ACL reconstruction 6 months later. Outcomes were evaluated using IKDC and Lysholm scores, as well as stress radiography results.</p></sec><sec><title>Results</title><p>Results. The two‑stage approach (Group 3) demonstrated significantly better outcomes according to IKDC and Lysholm scores (p &lt; 0.01), improved stability on stress radiographs, and lower complication rates. Notably, 4 patients from Group 3 declined ACL reconstruction due to satisfactory functional recovery after the first stage.</p></sec><sec><title>Conclusion</title><p>Conclusion: The study findings demonstrate that for chronic multiligament knee injuries (Schenck type III), a two‑stage surgical strategy offers superior outcomes compared to single‑stage interventions. Staging the reconstruction of posterior and anterior structures not only improves functional scores and joint stability but also prevents excessive surgical trauma. Notably, satisfactory functional restoration is achieved in some patients after the first stage (PCL and PLC reconstruction) alone, rendering the second stage unnecessary. Therefore, a personalized two‑stage approach is the preferred strategy, ensuring optimal clinical results and high patient satisfaction.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>мультилигаментарные повреждения коленного сустава</kwd><kwd>одномоментная операция</kwd><kwd>поэтапная (двухэтапная) реконструкция</kwd><kwd>нестабильность коленного сустава</kwd><kwd>функциональные исходы</kwd><kwd>стресс‑рентгенография</kwd><kwd>классификация Schenck</kwd></kwd-group><kwd-group xml:lang="en"><kwd>multiligament knee injuries</kwd><kwd>single‑stage surgery</kwd><kwd>staged reconstruction</kwd><kwd>knee instability</kwd><kwd>functional outcomes</kwd><kwd>stress radiography</kwd><kwd>Schenck classification</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Bagherifard A., Jabalameli M., Ghaffari S., Rezazadeh J., Abedi M., Mirkazemi M., Aghamohamadi J., Hesabi A., Mohammadpour M. 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