The ortopedika.pl website uses cookies. By staying on our website, you consent to this. More information OK english Orthopedics | We treat sports injuries | Rehabilitation > Home > Symposium 2017 > About the clinic > Medical offer > Courses and training > News > Articles and information > Contact Contact: ORTOPEDIKA Specialist Surgery Center ul. Modlińska 310/312 03-152 Warsaw (in Fort Piontek) SEE THE DIRECTIONS tel. +48 (22) 510 26 60 mobile: +48 666 868 505 fax: +48 (22) 510 26 61 e-mail: ortopedika@ortopedika.pl ORTOPEDIKA Rehabilitation Bielany ul. Przybyszewskiego 69, office 1 01-824 Warszawa (Warszawa Bielany) SEE THE DIRECTIONS tel. +48 (22) 897 68 42 fax: +48 (22) 897 68 43 ORTOPEDIKA Rehabilitation Mokotów Al. Niepodległości 69 02-626 Warsaw (Warsaw Mokotów) Next to the entrance to the Wierzbno metro station SEE THE DIRECTIONS tel: +48 (22) 322 70 60 mobile: +48 882 667 487 fax: +48 (22) 322 76 60 Articles and information > Articles > Mini-invasive spine surgery > Meniscal allograft > Femoral - acetabular conflict > Treatment methods for articular cartilage defects > Treatment of bone union disorders with Exogen > HyProCure > Correction of hallux valgus > Correction of hallux valgus - FILM > Growth Factor Therapy > Basics of a good diet > Sprain of the ankle joint > Management of a knee injury > Supplementation during exercise > Treatment of meniscal tears > Two-bundle reconstruction of the anterior cruciate ligament > Information 1234 Principles of the two-bundle reconstruction of the anterior cruciate ligament Anterior cruciate ligament (ICL) injury is one of the more common consequences of knee torsion injuries. It is damaged in about 20% of knee injuries. In recent years, a significant increase in the number of LCI operations has been observed. It is estimated that from 200,000 to 300,000 such operations are performed annually in the world. In the United States alone, about 100,000 jobs are carried out. reconstruction of the Communist Party of Poland annually. An important factor contributing to the increase in the number of knee injuries is a social phenomenon popularly referred to as "sports fad". Damage to the LCI mainly occurs in people practicing alpine skiing, team games such as football, volleyball or basketball. Equally large trauma is a consequence of looking for strong sensations while practicing the so-called extreme sports. Individual anatomical conditions also play an important role in the epidemiology of knee joint damage to the knee. The consequences of damage to the LCI are well known and described and include knee instability, Anatomy The anterior cruciate ligament has a multi-bundle structure, thanks to which it is able to efficiently perform the complex task of maintaining the multidirectional stability of the knee. The ligament bundles begin at the medial surface of the lateral femoral condyle and extend forward and downward, ending at the tibia, at the front of the intercondylar elevation. Healthy anterior cruciate ligament Diagram of the two-bundle structure of the ligament The anterior-medial bundle is longer and thicker, up to 3.5 cm in length. It tightens with the bent knee, inhibiting the frontal extension of the tibia in relation to the femur. Posterior-lateral bundle it is slightly shorter, its average length is about 2 cm. It is most tense in extension, then it also stops the tibia from moving forward. Diagram of mutual arrangement of ligament bundles when bending the knee > Both bundles in a straightened knee are arranged parallel to each other, but when bent , they gradually cross each other, creating a locking mechanism that blocks the rotation of the tibia relative to the femur. Field bundles ligament attachment to the femur channels for graft bundles drilled in the femoral attachment of the box bundles ligament attachment to the tibia drilling positions for the channels of the graft bundles in the attachment to the tibia methods of anterior cruciate ligament reconstruction Rekonstrukcja jednopęczkowa At the beginning of the 90s, arthroscopic surgical technique became popular, allowing for precise location of bone canals. It became popular and for a long time was treated as a standard, a technique of single-bundle reconstruction, using the central strand of the patellar ligament, terminated with bone blocks. Frequently occurring, chronic pain after the removal of the patellar ligament caused the popularization of the technique using the tendons of the semi-tendinous and slender muscles. During the operation, a 7-8mm channel is drilled in the femur and tibia, through which the graft is introduced into the knee. Due to the fact that the ligament attachment area on both the femur and the tibia is more than twice as large, the single-bundle reconstruction of the LFM cannot be reconstructed, or even come close to the pre-injury anatomy of the knee. This affects the function of the knee after surgery. Two-bundle (anatomical) reconstruction In the 1990s, independently in the USA, Japan and Europe, surgeons began to perform multi-bundle anatomical reconstructions aimed at the best possible reconstruction of the knee anatomy. In this method, two channels with a diameter of 5-6 mm are drilled in both the tibia and the femur, which almost completely cover the anatomical area of the ligament attachment. More and more publications from the professional literature confirm the fact that the two-bundle CMM reconstruction largely recreates the biomechanics of the knee before the injury, as opposed to the single-bundle reconstructions. The undoubted disadvantage of these procedures is the extension of the operation time, the involvement of more people and the need to use a double number of fixing implants. This affects the price of the procedure. Schemat dwupęczkowej rekonstrukcji więzadła krzyżowego przedniego z mocowaniem w kości udowej na implantach "endobutton" i w kości piszczelowej śrubami biowchłanialnymi Rekonstrukcja WKP w Ortopedice The surgical procedure should be performed using a technique that allows a reconstruction that is as close as possible to the anatomy of the original ligament. Before the procedure, the patient meets with an anesthesiologist who discusses how to perform and administer anesthesia. Usually, except in exceptional circumstances, the patient is anesthetized in the lumbar region, which is a very safe and comfortable method, which also allows, if the patient expresses interest, to follow the course of the operation. The procedure is performed arthroscopically, only a small incision is made in the shin, through which only the tendon of the semi-tendon is collected (in most centers, the slender tendon is also taken), from which we prepare the graft. In the case of revision surgeries, we use allogeneic grafts (tendons from human cadavers, from a tissue bank). However, each of the methods used carries certain risks. Taking your own tendon may cause chronic pain, limb weakness and limitation of mobility in the joint, while the use of the allograft is associated with the risk of viral infection transmission, immune response to foreign tissue, and the quality of the graft used is also questionable. The operation takes about 90 minutes, unless we are also repairing the damage to the cartilage or menisci. immune response to foreign tissue, the quality of the graft used is also questionable. The operation takes about 90 minutes, unless we are also repairing the damage to the cartilage or menisci. immune response to foreign tissue, the quality of the graft used is also questionable. The operation takes about 90 minutes, unless we are also repairing the damage to the cartilage or menisci. Przeszczepy pęczków przednio przyśrodkowego i tylno bocznego przygotowane ze ścięgna mięśnia półścięgnistego Rekonstrukcja pęczków więzadła - wewnątrz kolana jest już pęczek tylno - boczny,wprowadzany jest pęczek przednio - przyśrodkowy Gotowy przeszczep więzadła krzyżowego przedniego - widoczny przede wszystkim pęczek przednio - przyśrodkowy Implanty We use the so-called hybrid attachment to fix the graft. In the femur, the graft is mounted on two extra-cortical endobutton implants. In the tibia, depending on the conditions, we use either bioabsorbable screws and an additional, strengthening suture on the bone bridge or, similarly to the thigh, endobutton implants. Such fastening allows the use of short grafts and has high mechanical strength, while ensuring good healing of the graft in the bone canals. Until recently, the use of biosabsorbable, interference screws alone has been widespread, but it has been shown that such screws lose some of their mechanical strength within 8 weeks of implantation, resulting in loosening of the grafts. The most common problems Nieprawidłowa lokalizacja kanałów po której przebieg przeszczepu nie daje stabilności (np.: przy zbyt pionowym jego przebiegu). Brak integracji przeszczepu z otaczającą kością. Może to prowadzić do wysunięcia przeszczepu, co prowadzi do wtórnej niestabilności kolana. Wtórny uraz, prowadzący do zerwania przeszczepu. Najczęstszym błędem jest zbyt wczesny i odważny powrót do aktywności fizycznej w ciągu pierwszego roku po zabiegu, gdy więzadło jest jeszcze w okresie przebudowy i gojenia. Rehabilitation An anterior cruciate ligament reconstruction operation is not only an operation. The operation is only one of the stages that the patient goes through when recovering from health under the care of the rehabilitation team. Due to the long-lasting process of reconstruction and healing of the ligament transplant, lasting at least 8-10 months, return to dynamic sports such as skiing, windsurfing, football, tennis or martial arts, it is recommended after about 9-12 months after the reconstruction surgery. Home Symposium 2017 About the clinic Medical offer Courses and training News Articles and information contact Specialists doctors Physiotherapists Andrzej Mioduszewski, MD, PhD Robert Świerczyński, MD, PhD bow. Mikołaj Wróbel bow. Jacek Mazek Paula Śliwińska-Stańczyk, MD, PhD Mariusz Głowacki, MD, PhD bow. Juliusz Sroczyński Bartłomiej Kordasiewicz, MD, PhD bow. Grzegorz Kłos bow. Agnieszka Maksymiuk - Kłos the drug . Sławomir Mihułka Artur Pasierbiński Renata Jopek Jacek Mańka Aneta Jarząbek Karolina Barańska Agata Miros Katarzyna Mordyl Iza Oryniak Krzysztof Ruszkiewicz Edyta Łukasik Jacek Klimek All rights reserved | All Rights Reserved | Copyright 2011 © ORTOPEDIKA Specialist Surgery Center Graphic design and CMS : TION