| Abstract | Uvod. Dugo vremensko razdoblje rehabilitacije nakon rekonstrukcije prednje ukrižene sveze (LCA) koljenskog zgloba jest velik problem za pacijente, a napose za aktivne športaše. Razlog je u sporim procesima uraštanja presatka u koštanim tunelima i ligamentizacije intraartikularnog dijela presatka.
Cilj. Cilj istraživanja bio je ustanoviti da li tombocitni gel (TG) utječe na rane fiziološke procese nakon operacije, kao što je neovaskularizacija i da li to ima bilo kakvu morfološku i kliničku relevantnost za ishod operacije.
Metode. Trombocitni gel smo pripremili separatorom trombocita iz autologne plazme bogate trombocitima (PBT). Gel smo aplicirali lokalno u područje koštanog tunela tibije. Uključili smo 50 pacijenata koje smo podijelili u dvije skupine, ispitivanu (25) i kontrolnu (25). U pacijenata u ispitivanoj skupini lokalno smo aplicirali trombocitni gel. Kvantitativno smo analizirali proces neovaskularizacije presatka u intraartikularnom dijelu te u zoni između presatka i koštanog tunela. Analizirali smo i tvorbu koštanog tkiva oko presatka, dilataciju koštanih tunela, stabilnost koljena te funkcionalne rezultate nakon završene rehabilitacije. Upotrijebili smo magnetsku rezonanciju s paramagnetnim kontrastnim sredstvom, KT-2000 te funkcionalne koljenske upitnike Tagner, Lysholm i IKDC.
Rezultati. Kod 1. kontrole 4 - 6 tjedana nakon operacije u pacijenata koji su primili TG došlo je do statistički signifikantnog ekstenzivnijeg nivoa revaskularizacije u odnosu na kontrolnu skupinu (0.33±0.09 : 0.16±0.09; p<0.01). U intraartikularnom dijelu presatka nismo našli razlike između skupina glede nivoa vaskularizacije. Kod druge kontrole 10 – 12 tjedana nakon operativnog zahvata nivo vaskularizacije smanjio se u ispitivanoj skupini (0.20±0.13) i narastao u kontrolnoj skupini (0.17±0.10). U intraartikularnom dijelu presatka u obje smo skupine našli minimalne nivoe vaskularizacije. Kod treće kontrole 25 – 27 tjedana nakon operacije nivo vaskularizacije opao je u obje skupine. Kod ispitivane skupine došlo je i do ekstenzivnije tvorbe koštanog obruča oko presatka u tibijalnom dijelu (68.57±14.2), negoli u kontrolnoj skupini (54.50±16.6), p<0.0062 te do manje dilatacije femoralnog tunela koja nije statistički signifikantna. Premda razlike u rezultatima funkcionalnih upitnika između skupina nisu statistički signifikantne, koljena u ispitivanoj skupini su bila stabilnija (4.7±1.9 mm) od onih u kontrolnoj skupini (6.7±2.1 mm), p<0.003.
Zaključak. Trombocitni gel, lokalno apliciran stimulira neovaskularizaciju presatka u prvim tjednima nakon rekonstrukcije prednje ukrižene sveze. Daljnje manifestacije postoperativnih bioloških procesa sastoje se u kstenzivnijaj tvorbi sklerotičkog koštanog obruča oko presatka, manja dilatacija koštanih tunela i stabilnije koljeno.
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| Abstract (english) | Background. Long rehabilitation after arthroscopic anterior cruciate ligament (LCA) reconstruction still represents big problems for patients, especially in professional športsmen. The reason is slow graft healing in bone tunnels and a slow graft ligamentization process.
Purpose: The purpose of this study was to determine if the use of platelet gel (PG) accelerates graft revascularisation after anterior cruciate ligament (LCA) reconstruction, and does it have any morphological and clinical relevance for outcome of the operation.
Methods. Platelet gel was produced from the platelet rich plasma (PRP), prepared from a unit of whole blood in an Autologous Platelet Separator. PG was applied locally. Fifty patients were included, 25 in the platelet and 25 in a control group. We quantitatively evaluated the process of revascularization in the zone of the osteoligamentous interface in the bone tunnels and in the intraarticular part of the graft. Contrast enhanced magnetic resonance imaging (MRI) studies were carried out at 4-6, 10-12 and 25-27 weeks post surgery. We also evaluated extension of new sclerotic bone formation around tunnels and tunnels dilatation with MRI, knee stability with KT-2000 and functional outcomes of rehabilitation with functional scores.
Results. At the first control (4-6 weeks), patients treated with PG demonstrated a significantly higher level of vascularization in the osteoligamentous interface (0.33±0.09), compared with the control group (0.16±0.09), p<0.001. In the intra-articular part of the graft we found no evidence of revascularization in either group. At the second control (10-12 W), the level of vascularisation decreased in the platelet group (0.20±0.13) and increased in the control group (0.17±0.10). In the intra-articular part of the graft we found minimal levels of revascularization but no differences among the groups. At third control (25-27 W) the level of vascularisation decreased in both group. The amount of new sclerotic bone formarion, was significantly higher in platelet group (68.57±14.2) in comparation with control group (54.50±16.6), p<0.0062, 6 months after surgery. The anteroposterior knee stability, was also significanty better in platelet (4.7±1.9) than in control (6.7±2.1) group, six months after sugery (p<0.003).
Conclusion. The PG, applied locally, enhance early revascularization of the graft in the zone of the osteoligamentous interface in the bone tunnel, after anterior cruciate ligament reconstruction. Enhancement of this early postoperative biological process, is demonstrated in late morphological and clinical manifestations, as extensive new bone formation around bone tunnels, smaller enlargement of bone tunnels and more stable knee joint.
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