Optimizing surgical treatment of anterior cruciate ligament injuries

1. STATE EDUCATIONAL INSTITUTION "TAJIK STATE MEDICAL UNIVERSITY NAMED AFTER ABUALI IBNI SINO" DEPARTMENT OF TRAUMATOLOGY AND

2. RELEVANCE This topic is as follows ACCORDING TO THE LITERATURE, INJURIES TO THE ANTERIOR CRUCIATE LIGAMENT (ACL) ACCOUNT FOR

27-67.9% OF ALL INJURIES AND 33-92% OF INJURIES
TO THE KNEE JOINT LIGAMENTS
(Michael A., 2011; Lind M., 2009; Orlyansky V., 2016)

3. PURPOSE OF THE STUDY • To improve the efficiency of ACL reconstruction. • To accelerate regeneration and improve functional

outcomes.
• To study the role of SVF and PRP.

4. RESEARCH MATERIALS The paper analyzes the results of arthroscopic anterior cruciate ligament reconstruction surgery in 224

patients treated in the traumatology and
orthopedics department of the state institution
"ISTIKLOL HEALTH COMPLEX" for the period
2021-2025.

5. Category patients

1. Gender
A. Men - 221
B. Women - 3
2. Age
A. 17 to 30 years - 90
B. 30 to 45 years - 131

6. - Clinical symptoms - Ultrasound - Magnetic resonance imaging - Diagnostic arthroscopy

DIAGNOSTIC METHODS

7.

Stages of patient
preparation for
surgery

8.

Diagnostic arthroscopy is performed to determine
the extent of damage
.

9.

ANTERIOR CRUCIATE LIGAMENT
INJURY DETECTED

10.

Harvesting of the
semitendinosus,
gracilis and
peroneus longus
tendons for graft
preparation.

11.

We insert the
arthroscope and clean
the intercondylar
notch, trying, if
possible, to preserve
the periligamentous
tissues and the base of
the ACL.

12.

Stages of transplant preparation:
muscle tissue is removed; tendons
are folded in half, sutured together
and fixed under tension.

13.

Through the
frame, using a
sharp trocar, we
drill a channel
into the femur.

14.

From the anteromedial
port through the tibial
guide, we drill a guide
pin so that it comes out
beyond the place where
the old ACL was
attached.

15.

After ensuring that
the pin is positioned
in the correct
direction, we drill
the tibial tunnel
using a 7 mm flute
reamer.

16.

We determine the location of
the femoral tunnel through the
tibial tunnel and drill a guide
pin through the femoral guide
with offset. Then, using a head
reamer, we drill the femoral
tunnel to a depth of 30 mm.
The diameter of the tunnel
corresponds to the diameter of
the transplant.

17.

We install the femoral guide frame into
the femoral canal so that the free arm of
the frame is on the outside of the knee
joint.

18.

We insert a pin with an
eye into the tunnel,
which will be used to
insert the transplant.

19.

Under arthroscope
control, we introduce
the transplant into the
tunnel.

20.

We fix the transplant in
the hip with transverse
biodegradable screws, a
button

21. Fixation

Fixation on the thigh and lower leg:
Titanium screw
Absorbable screws
Strength – 300-700 N

22.

The condition of the installed ACL graft is
checked

23. Application of PRP and SVF therapy for ACL injury

1. PRP: contains growth factors (PDGF, TGF-b, VEGF),
which stimulate chondrocytes to recover. Injections are
made in courses of 2-4 procedures.
2. SVF (stromal-vascular fraction):
Obtained by lipoaspiration and then processed and
injected directly into the transplant and joint. These cells
have anti-inflammatory, angiogenic and
chondroprotective effects.

24. POSTOPERATIVE NTRODUCTION - the lower limb is immobilized by direct knee arthesis - analgesics and antibiotic therapy -

prevention of thromboembolic complications

25. ASSESSMENT OF RESULTS USING THE LYSHALM SCALE

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
double-literal
non-double-literal
good

26. TREATMENT RESULTS - long-term results of surgical treatment from 6 months to one year were studied in all operated patients -

good functional results were obtained in
218 patients
- satisfactory treatment results were in 12
patients

27. Remote result after ACL plastic surgery:

28. CONCLUSION - AUTOGRAFTS FROM THE HOMOPLASTIC FLEXOR TENDONS AND THE LONG PERONEAL TENDON WITH THE USE OF PRP AND SVF THERAPY

CAN BE SUCCESSFULLY USED AS A
PLASTIC MATERIAL FOR ACL RECONSTRUCTION AND
ENHANCED REGENERATION
- THE USE OF THE GRAFT WILL PROVIDE A GOOD COSMETIC
MATERIAL AND DOES NOT INTERFERE WITH MOVEMENT IN
THE KNEE JOINT
- THE STRENGTH OF PRIMARY FIXATION AND THE
STRENGTH OF THE GRAFT ALLOWS TO START EARLY
REHABILITATION IN THE KNEE JOINT

29.

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