Liječenje ozljeda hrskavice koljenskog zgloba

master's thesis

• Title (english): Treatment of knee joint cartilage injuries
• Author: Ivan Milobara
• Mentor: Mislav Jelić (mentor)
• Committee member: Domagoj Delimar (predsjednik povjerenstva)
• Committee member: Tomislav Đapić (član povjerenstva)
• Committee member: Mislav Jelić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Orthopedics); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Orthopedics

Abstract

Zglobna hrskavica koljena je vrsta hijaline hrskavice koja je građena od hondrocita i izvanstaničnog matriksa. Većina hrskavice, otprilike 98% njenog volumena pada na izvanstanični matriks, dok ostalih 2% čine hondrociti. Izvanstanični matriks je pretežno građen od vode, kolagena tipa II i glikozaminoglikana. Hrskavica je siromašna krvnim i limfnim žilama pa se prehranjuje difuzijom iz sinovije, što pridonosi njenoj slaboj regeneraciji. Degeneracija hrskavice se smatra jedan od ključnih rizičnih čimbenika za razvoj osteoartritisa koljena. Defekti hrskavice koljena se klasificiraju prema Outerbridge i ICRS (International Cartilage Repair Society). Terapija ozljeda se primarno mogu podijeliti na konzervativne i kirurške metode. Konzervativne metode se koriste kao prva metoda liječenje prije nekih većih, invazivnijih tehnika. Kirurške metode se mogu podijeliti u simptomatske, reparacijske i restauracijske. Simptomatske metode se koriste radi smanjena boli i poboljšanja funckije zglobe. U ove metode spadaju tehnike poput debridmana i intraartrikularne lavaže zgloba. Reparacijske metode su bazirane na korištenju mezenhimalnih stanice koje se otpuštaju u hrskavicu s ciljem njenog oporavka. Tu spadaju tehnike poput mikrofraktura, subhondralne abrazije i MACI (matrix-induced autologous chondrocyte implantation). Restauracijskim metodama je cilj defekt hrskavice upotpuniti istom tom hrskavicom radi njenih svojstava poput otpornosti na mehanički stres. Presadci, implantati, matične stanice, genska terapija i mnoge druge su obećavajuće u restauraciji zglobne hrskavice koljena, ali su potrebna daljnja i duža studija za potvrđenje njihovih korisnosti, ali isto tako i nedostataka. Još uvijek ne postoji univerzalna terapija ozljedi zglobne hrskavice koljena, već se liječenje zasniva na željama, stilu života pacijenta, ali isto tako i prijašnjeg iskustva ortopeda.

Abstract (english)

Articular cartilage of the knee is a type of hyaline cartilage that is made of chondrocytes and extracellular matrix. Most of the cartilage, approximately 98% of its volume consists of extracellular matricex, while the remaining 2% is made up of chondrocytes. The extracellular matrix is mainly composed of water, collagen type II and glycosaminoglycans. Cartilage is poor in blood and lymphatic vessels, so it is nourished by diffusion from the synovium, which contributes to its poor regeneration. Cartilage degeneration is considered one of the key risk factors for the development of knee osteoarthritis. Knee cartilage defects are classified according to Outerbridge and ICRS (International Cartilage Repair Society). Treatment can primarily be divided into conservative and surgical methods. Conservative methods are used as the first method of treatment before some larger, more invasive techniques. Surgical methods can be divided into symptomatic, reparative and restorative. Symptomatic methods are used to reduce pain and improve joint function. These methods include techniques such as debridement and intra-articular joint lavage. Reparation methods are based on the use of mesenchymal cells that are released into the cartilage with the aim of its recovery. These include techniques such as microfracture, subchondral abrasion and MACI (matrix-induced autologous chondrocyte implantation). The goal of restoration methods is to complete the cartilage defect with the same cartilage due to its properties such as resistance to mechanical stress. Grafts, implants, stem cells, gene therapy and many others are promising in the restoration of articular cartilage of the knee, but further and due studies are needed to confirm their usefulness and consistency, but also their disadvantages. There is still no universal therapy for injuries to the articular cartilage of the knee. Furthermore, the treatment is based on the wishes, lifestyle of the patient and also on the previous experience of the orthopaedic surgeon.

• Keywords: zglobna hrskavica; terapija; metode
• Keywords (english): articular cartilage; treatment; method
• Language: croatian
• URN:NBN: urn:nbn:hr:105:468227
• 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: 2023-10-26 12:14:10