| Abstract | Prednji križni ligament važan je ligament koljena, često ozlijeđen kod sportaša, najčešće zbog beskontaktne rotirajuće ozljede. Pristup varira ovisno o težini ozljede, aktivnosti bolesnika te dostupnim resursima. Čimbenici koji predviđaju uspješan povratak sportu su simetrično izvedeni test skakanja, mlađa dob, muški spol, profesionalno bavljenje sportom te pozitivni psihološki pogled. Nekompletna ruptura ACL-a se može tretirati neoperativno rehabilitacijom. Odabir grafta kod operativnog pristupa je debatirana tema, gdje čimbenici poput anamneze bolesnika, resursi te edukacija kirurga igraju ulogu. Autograftovi imaju prednost brže integracije, manji rizik ponovne ozljede te nemaju rizik infekcije, dok alograftovi imaju prednost kraćeg trajanja operacije, nemaju problema donorskog mjesta te je moguć pristup raznim veličinama tetiva. Najbolji trenutak za rekonstrukciju ACL-a ovisi o čimbenicima stanja ozlijeđenog koljena poput potpuni opseg kretnji, bez oteknuća i adekvatna snaga. Prerehabilitacija je preporučena, no značajno odgođena rekonstrukcija može povećati rizik za daljnju ozljedu koljena. Kratkoročne komplikacije operativnog pristupa su infekcije i duboka venska tromboza, dok dugoročne komplikacije su OA koljena, artrofibroza, propadanje grafta te ponovna ozljeda. Principi rehabilitacije su dostizanje ciljeva poput potpunog opsega pokreta i adekvatne snage i propriocepcije koji se dostižu vježbama zatvorenog lanca te vježbama specifičnim za sport. Rizik za nastanak OA je multifaktorijalan, po utjecajem čimbenika poput težine primarne traume, konkominantna ozljeda meniskusa, kvaliteta kirurške rekonstrukcije te starost, aktivnost i biomehanika koljena samog bolesnika. |
| Abstract (english) | The anterior cruciate ligament is an important ligament of the knee, often injured in athletes, most often due to a non-contact pivoting injury. The approach varies depending on the severity of the injury, the activity of the patient, and the available resources. Factors that predict a successful return to sports are a symmetric performance of unilateral hopping exercises, younger age, male gender, playing sports at an elite level, and a positive psychological outlook. Incomplete rupture of the ACL can be treated non-operatively. The choice of graft in the operative approach is a debated topic, where factors such as the patient's history, resources, and the surgeon's education play a role. Autografts have the advantage of faster integration, lower risk of re-injury, and no risk of infection, while allografts have the advantage of a shorter duration of surgery, no donor site problems, and access to various tendon sizes. The best time for ACL reconstruction depends on factors of the condition of the injured knee, like full range of motion, no swelling, and adequate strength. Pre-rehabilitation is recommended, but significantly delayed reconstruction may increase the risk of further knee injury. Short-term complications of the operative approach are infections and deep vein thrombosis, while long-term complications are knee OA, arthrofibrosis, graft failure and re-injury. The principles of rehabilitation are to achieve goals such as full range of motion and adequate strength and proprioception, which are achieved through closed-chain exercises and sport-specific exercises. The risk of OA is multifactorial influenced by factors such as the severity of the primary trauma, concomitant meniscus injury, the quality of the surgical repair, and the age, activity and biomechanics of the patient's own knee. |
