Ruptúra LCA (ACL)= roztrhnutie predného skríženého väzu kolena

            Pomerne časté poranenie kolena, najmä pri bočnom násilí v kombinácií s rotáciou predkolenia (často pri kontaktných športoch, lyžiarske pády). Poranenie môže byť kombinované s poškodením menisku, postranného väzu tzv."unhappy trias" alebo chrupavky.

            LCA (ligamentum cruciatum anterius)= predný skrížený väz patrí medzi stabilizačné štruktúry kolena, jeho úloha je najmä zabezpečenie anteromediálnej (predo-vnútornej) stability, čiže jeho poškodenie môže viesť k anteromediálnej in(ne)stabilite. Instabilita vedie u väčšiny pacientov k pocitu preskakovania kolena, najmä pri záťaži- napr. športe. Pacienti na začiatku nemusia mať potiaže s kolenom, ale postupné poškodzovanie meniskov a chrupaviek môže viesť k nenapraviteľnému poškodeniu kĺbu s rozvojom až včasných artrotických zmien.
            Mechanizmus poranenia predného skríženého väzu je názorne zobrazený v animácii, v nižšie uvedenom videu.

 Anatómia, vyšetrenie 

Normálna anatómia hlavných väzov kolena je znázornená na obrázku č.1., LCA alebo v anglosasky hovoriacich krajinách ACL je predný skrížený väz. Prebieha z prednej vnútornej časti holennej kosti na zadnú vonkajšiu časť stehnovej kosti. Postranné väzu sú znázornené po stranách.

 

Obr. 1. anatómia kolena, zobrazené sú hlavné väzy kolena

            Najčastejším vyšetrením, ktoré nám umožňuje odhaliť poškodenie LCA je MRI= magnetická rezonancia, je to neinvazívne vyšetrenie, bez známej biologickej záťaže na organizmus, využíva na zobrazenie silné magnetické pole a výhodou je takmer presné zobrazenie mäkkých štruktúr kolena. 

Na obr.č. 2 je zobrazený roztrhnutý predný zkrížený väz v MRI obraze.

  

Obr. 2. MRI nález pri roztrhnutí LCA

            Po takto závažnom poranení následuje artroskopická operácia kolena, artroskopia je mininvazívna operácia, pri ktorej sa využíva špeciálna optika a nástroje umožňujúce ošetrenie kolenného kĺbu z malých 5mm rezov. Na obr.č.3 je artroskopický obraz miesta, kde chýba poškodené LCA.   

   

Obr.3. Artroskopický nález pri roztrhnutom LCA, sonda sa nachádza v oblasti predného dolného úponu LCA

 

V športe

Ani vrcholoví športovci sa často tomuto typu zranenia nevyhnú. Vznikne často aj po nevinne vyzerajúcom páde: Michael Owen si roztrhol LCA počas Majstrovstiev sveta v zápase proti Švédsku, 2006- 1. video 

Mary Pierce si poranila LCA počas WTA tour v Linzi, v zápase proti Vere Zvonarevovej- 2. video

Diskusná téma: Ruptúra LCA (ACL)= roztrhnutie predného skríženého väzu kolena

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