Ispitivanje spoljašnjih i unutrašnjih faktora značajnih za povredu prednje ukrštene veze zgloba kolena u sportski aktivnoj populaciji

Abstract

Anatomski faktori koji dovode do povredivanja prednje ukrštene veze mogu se svrstati u dve grupe: unutrašnji faktori i saktori spoljašnje sredine. Unutrašnji faktori mogu biti anatomski, neuromuskularni i hormonalni. Uska medukondilarna jama, velik ugao zadnjeg tibijalnog nagiba, vertikalna LCA u frontalnoj ravni, povecana labavost zglobova i loše oslanjanje prilikom doskoka samo su neki od faktora koji mogu uticati na rupturu prednje ukrštene veze. Uzimajuci u obzir podatke iz literature ne može se doneti jedinstven stav o ulozi ovih faktora u povredivanju, jer rezultati istraživanja cesto ne potvrduju njihov uticaj na povredivanje prednje ukrštene veze. Ciljevi ove doktorske disertacije su: odredivanje faktora rizika koji dovode do povredivanja prednje ukrštene veze kolena, njihovo stepenovanje i odredivanje statisticke verovatnoce povredivanja prednje ukrštene veze kolena. U ovoj studiji su formirane dve grupe pacijenata sa po 41 pacijentom (29 muškaraca i 12 žena unutar svake grupe). Ispitivanu grupu su cinili pacijenti sa rupturom LCA. Kontrolnu grupu su cinili pacijenti sa distorzijom zgloba kolena ali bez rupture LCA. Ovi pacijenti su upareni prema profesionalitetu i vrsti sporta, polu, godinama i strani tela. Pratili smo 77 faktora za koje smo pretpostavili da mogu uticati na rupturu LCA. Merenja pojedinih parametara su vršena direktno na donjem ekstremitetu ispitanika, zatim na Rendgenskim i snimcima magnetne rezonance. Informacije o mehanizmu povrede i spoljašnjim faktorima rizika dobijali smo uz pomoc ankete, informacije o nacinu oslanjanja tokom doskoka dobijali smo analizom video snimaka a koncentracije polnih hormona u pljuvacci smo odredivali uz pomoc „Salivametrics“ testa. Od svih pracenih parametara za povredivanje prednje ukrštene veze kod muškaraca znacajnost je pokazalo 20 a kod žena 21. Najveci uticaj na rupturu LCA kod muškaraca imali su: povecan zadnji tibijalni nagib spoljašnjeg kondila, veci LESS kao i povecana razlika u nagibu izmedu spoljašnjeg i unutrašnjeg kondila golenjace. Najveci uticaj na rupturu LCA kod žena imali su: smanjen nivo testosterona u pljuvacci, veca snaga odmicaca natkolenice i promena frontalne angulacije zgloba kolena u pravcu varusa tokom perioda od pripreme za skok u visinu do dodirivanja tla. Na osnovu svih znacajnih faktora moguce je prognozirati rupturu prednje ukrštene veze kod muške, sportski aktivne populacije sa verovatnocom od 77 %, odnosno kod ženske sa verovatnocom od 96 %....

The anatomical factors leading to anterior cruciate ligament injury can be divided into two categories: internal factors and factors of the external environment. The internal factors can be anatomical, neuromuscular and hormonal. A narrow intercondylar fossa, a wide angle of the posterior tibial slope, a vertical LCA in the frontal plane, increased looseness of joints and improper contact with the surface when landing after a jump are only some of the factors that my influence the rupture of the anterior cruciate ligament. Taking into consideration the data from relevant literature a uniform conclusion cannot be made regarding the role of these factors in LCA injury, since the results of different studies often do not confirm their influence on anterior cruciate ligament injury. The goals of this doctoral thesis were: determining the risk factors leading to anterior cruciate ligament injury of the knee, grading these factors, and determining the statistical probability of injury to the anterior cruciate ligament of the knee. Two groups of patients were formed for the purpose of this study, with 41 patients in each group (29 men and 12 women per group). The examined group consisted of patients with a ruptured LCA. The control group was made up of patients with a knee joint distortion, but without LCA rupture. These patients were paired off according to the level of professional sports engagement, the type of sports activity, gender, age and side of the body. We monitored 77 factors which we assumed may influence the rupture of LCA. The measurement of individual parameters was performed directly on the lower limb of the examinees, followed by measurement on Xray and MR images. Data related to the mechanism of the injury and the external risk factors were obtained by a questionnaire, the information related to the mode of leaning onto the surface during landing after a jump was obtained by the analysis of video footage, while the concentrations of hormones in saliva were determined via the “Salivametrics” test. Of all the monitored parameters for anterior cruciate ligament injury, 20 proved to be statistically significant in men and 21 proved to be statistically significant in women. The following parameters had the greatest influence on LCA rupture in men: increased posterior tibial slope of the lateral condyle, a greater LESS as well as an increased difference in the slope between the lateral and the medial condyle of the tibia. The following parameters had the greatest influence on ACL rupture in women: decreased level of testosterone in the saliva, greater strength of the abductor of the upper leg, and the change of angulation of the knee joint in the direction of the varus in the interval between preparation for a jump upwards and landing. Based on these significant factors it is possible to make a prognosis of anterior cruciate ligament rupture in male athletes with a probability of 77% and in female athletes with a probability of 96%....