Pathomorphological features of the bone-tendon-capsule enthesis complex of the lateral ankle joint

The article presents the pathomorphological features of the clinic, the diagnosis and treatment of a patient with signs of enthesopathy of the bone-tendon-capsule (CSC) complex of the lateral ankle joint. Enthesopathy is one of the forms of damage to paraarticular tissues that has not been studied to date, it can be characterized as a degenerative-dystrophic inflammatory process that occurs at the sites of attachment of tendons, ligaments, joint capsules and fascia to the bone (CSC-complex - enthesis), in the presence of common clinical, x-ray, ultrasound, magnetic resonance and other characteristic signs, and the absence of rheumatoid and similar factors in the blood plasma. A feature of the clinical observation was the absence of characteristic complaints and prior stress illnesses in the patient. The tumor-like deformation of the lateral part of the ankle joint, accidentally discovered by the patient in everyday life, did not cause any concern, which is also not characteristic of this pathology. The patient was forced to consult a doctor with a feeling of discomfort in the ankle joint with dorsal flexion of the foot while walking in shoes. Outpatient surgeon performed a standard amount of diagnostic research - general clinical, biochemical blood tests, x-ray - diagnosed with ankle bursitis and conducted a course of conservative treatment with non-steroidal anti-inflammatory drugs in combination with perifocal injections of a group of glucocorticosteroids (Diprospan) in the area of pathological changes. Despite the ongoing treatment, a lasting positive effect was not achieved. The patient was sent and hospitalized in a Central Military Clinical Hospital. P.V. Mandryka. According to the developed protocol, a thorough analysis of complaints, medical history, clinical and manual examination was carried out, an expanded scope of studies was performed: general clinical, biochemical, microbiological, cytological, x-ray, ultrasound, magnetic resonance. Consulted by an oncologist - no signs of malignancy were detected. Based on the analysis and research results, the diagnosis was established - enthesitis of the bone-tendon-capsule (CSC) complex of the lateral part of the left ankle joint. In the process of complex treatment of the patient, according to the developed standardized scheme, in the proliferation phase, the technology of perifocal implantation, platelet-enriched mass, in the region of the CSC-complex was used. The applied technique made it possible to level out manifestations of enthesopathy of the lateral external ankle CSC-complex of the left ankle joint as soon as possible, to create conditions for the restoration of degeneratively altered tissues, among which were the distal end of the short tendon of the fibula head of the metatarsal bone, the long and short tendon of the fibula , astragalocalcanean tendon structures, capsule of the ankle joint. As a result of the treatment, a persistent positive clinical effect was obtained in the form of leveling the feeling of discomfort in the ankle joint, restoring the physiological contours and the full range of movements in it, the physiological biomechanics of walking was normalized - the result was estimated to be good.