Ozljeda unutarnje i vanjske pobočne sveze koljenskog zgloba

master's thesis

• Title (english): Medial and lateral collateral injury of the knee joint
• Author: Katarina Jelić
• Mentor: Esmat Elabjer (mentor)
• Committee member: Ivan Dobrić (predsjednik povjerenstva)
• Committee member: Ivan Bojanić (član povjerenstva)
• Committee member: Esmat Elabjer (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Unutarnja i vanjska pobočna sveza pripadaju vanjskim svezama koljenskog zgloba i sudjeluju u njegovoj stabilizaciji. Razumijevanjem anatomije i biomehanike struktura olakšavamo klinički pregled, ali i povećavamo efektivnost i uspješnost u liječenju ozljeda i funkcionalnom ishodu. Ozljede pobočnih sveza česte su ozljede koljenskog zgloba. Mehanizam nastanka ozljede unutarnje pobočne sveze je prekomjerna abdukcija pri ekstendiranom koljenu ili pri rotaciji u koljenu gdje potkoljenica ostaje u laganoj fleksiji i abdukciji. Ozljede vanjske pobočne sveze nisu tako učestale u rotaciji koljenskog zgloba zbog svog anatomskog položaja. Sveza najčešće puca na distalnom dijelu hvatišta na lisnoj kosti gdje se uz ozljedu često odlomi i koštani dio hvatišta sveze. Za uspješno zbrinjavanje ovih ozljeda potrebno je postaviti ispravnu dijagnozu, a to postižemo detaljnom anamnezom, fizikalnim pregledom te kliničkim ortopedskim testovima koji uključuju varus i valgus stres testove pri fleksiji koljena od 0 i 30 stupnjeva. Klasifikacija ozljeda pobočnih sveza podijeljena je u stupnjeve I, II i III. Ozljede unutarnje pobočne sveze prvog i drugog stupnja te izolirane ozljede trećeg stupnja liječe se konzervativnim putem uz ranu rehabilitaciju i vježbe snage i povećanja opsega pokreta. Udružene ozljede i teške ozljede unutarnje pobočne sveze zahtijevaju kirurški zahvat i rekonstrukciju sveze. Ozljede vanjske pobočne sveze prvog i drugog stupnja liječe se konzervativno uz rehabilitaciju, dok se ozljede trećeg stupnja s nestabilnošću koljena moraju kirurški zbrinuti rekonstrukcijom sveze. Kriterij za povratak aktivnostima uključuje bezbolni puni opseg pokreta, izostanak nestabilnosti tijekom kliničkog pregleda i mišićna snaga usporediva sa suprotnom neozlijeđenom stranom.

Abstract (english)

The medial and lateral collateral ligaments in part comprise the outer capsule of the knee joint and contribute to its functional stability. By apprehension of the anatomy and biomechanical structure, we develop a better clinical assessment, which benefits the efficacy and outcome in treatment in terms of injury and functionality. The collateral ligaments of the knee are frequently damaged when injuries of the knee are present. The mechanism of injury of the medial collateral ligament entails over abduction at the knee joint while the leg is extended or by way of external rotation of the knee joint with slight
flexion and abduction. The lateral collateral ligaments are not so commonly injured during rotations of the knee due to their anatomical location. Most commonly, the ligament tears at its distal point of insertion on the fibula, where the mechanics of injury may lead to the breaking off this bony insertion point. To successfully manage such injuries, it is imperative to correctly diagnose these patients. This is achieved by obtaining a detailed patient history, and physical examination using orthopedic tests which include the Varus and Valgus stress tests during flexion of the kne e at a range of 0 to 30 degrees.
The extent of injury in the aforemention ed ligaments is graded as first, second or third degree. Medial collateral ligament injuries of the first, second and isolated third degree are managed by the early rehabilitation therapy and focus on strength and functional motion range optimization. Multiple and more severe injuries require surgical reconstruction of the ligament and surrounding tissues. Injuries of the lateral collateral ligament of the first and second degree are managed conservatively with rehabilitation, while injuries of the third degree with loss of stability are surgically reconstructed. The
criteria for return to activity includes no pain on completion of full range of motion, absence of any instability during clinical examination and recovery of muscle strength comparable to that of the uninjured contralateral leg.

• Keywords: pobočne sveze; ozljeda; liječenje; konzervativno; kirurško
• Keywords (english): collateral ligaments; injury; treatment; management; conservatively; surgery
• Language: croatian
• URN:NBN: urn:nbn:hr:105:994802
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-02-23 08:49:44