Izhodišča: Ruptura sprednje križne vezi (ACL) je ena pogostejših poškodb kolena. Pri zdravljenju igra ključno vlogo uspešna rekonstrukcija ACL z vstavitvijo presadka. Uspešnost operativnega postopka je 73-95 %, vrnitev na predoperatvno stopnjo dejavnosti pa 37-75 %. Glavna težava po rekonstrukciji je zelo dolga rehabilitacija. Bolniki ne smejo polno obremeniti kolena najmanj 6 mesecev po poškodbi. Uspešnost rekonstrukcije ACL je odvisna od vraščanja presadka v kostnem tunelu in od ligamentizacije, t.j. procesa, pri katerem pridobi lastnosti nativnega ACL. Pri tem igrajo pomembno vlogo biomehanski dejavniki (pravilni položaj kostnih tunelov -anatomska lega presadka, pričvrstitev in ustreznost presadka ter pooperativna rehabilitacija) in biološki odziv presadka po rekonstrukciji (stopnja revaskularizacije in nastajanje kolagenskih vlaken), ki ga lahko pospešimo z dodajanjem rastnih faktorjev (RF), periosta in uporabo mezenhimskih zarodnih celic. Ti pristopi so novost v rekonstrukciji ligamentnih struktur, saj posegajo v biologijo celjenja med kostjo in presadkom. Danes uporabljamo tehniko za pridobivanje s trombociti bogate plazme (PRP) iz avtologne krvi, ki jo damo na mesto vstavitve presadka in tako pospešimo vraščanje in proces ligamentizacije presadka.
Zaključki: Pregledni članek obravnava dejavnike, ki vplivajo na uspešnost zdravljenja po rekonstrukciji ACL. Poznavanje in modulacija biološkega odziva presadka je nov pristop k zdravljenju pretrgane ACL, bolnikom in športnikom pa omogoča hitrejšo vrnitev k vsakodnevnim in drugim telesnim dejavnostim.Background: Anterior cruciate ligament (ACL) rupture is one of the most common knee injuries. The operative reconstruction is usually performed as the standard treatment. The success of the operative technique is between 73-95 %, and 37-75 % of patients return to the preoperative physical activity. The main problem after surgical reconstruction is the long rehabilitation period. Patients are not allowed to perform sports activities for 6 months after surgery. The outcome after ACL reconstruction depends upon the healing of the graft in the bone tunnel and upon the ligamentization of the intraarticular part of the graftthis is a process during which the graft attains the features of a native ACL. The biomechanical factors (anatomical tunnel position, fixation, adequacy of the graft and postoperative rehabilitation) and biological response (revascularization and the number of collagen fibers) seem to play a crucial role after surgery. The biological response can be accelerated with the use of growth factors (GF), periosteum and mesenchymal stem cells (MSCs). Nowadays platelet-rich plasma (PRP) from autologous blood is applied at the graft insertion site to promote healing and ligamentization of the graft.
Conclusion: The review focuses on the factors that influence the outcome of ACL reconstruction. A better understanding of the graft\u27s biological response and its modulation is the basis of new approach in the treatment of ACL rupture, which enables the patient and athlete to quicker resume their everyday and sports activities
