thealthЗдравоохранение ТаджикистанаHealth care of Tajikistan0514-2415Редакция журнала «Здравоохранение Таджикистана»10.52888/0514-2515-2026-369-2-134-140thealth-748Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEW ARTICLESОптимизация хирургического лечения повреждения передней крестообразной связкиOptimization of surgical treatment of anterior cruciate ligament injurieshttps://orcid.org/0009-0006-5492-4462ГафорзодаС. С.GaforzodaS. S.

Синои Саидюсуфи Гафорзода - аспирант кафедры травматологии, ортопедии и ВПХ

тел.: +99233033333

г. Душанбе 

Sinoi Saidyusufi Gaforzoda - postgraduate student at the Department of Traumatology, Orthopedics and Military Field Surgery

tel.: +99233033333

Dushanbe 

sinoi_s@mail.ruТГМУ имени Абуали ибни СиноТаджикистанSEI Avicenna Tajik State Medical UniversityTajikistan20260207202602134140Copyright © Гафорзода С.С., 20262026Гафорзода С.С.Gaforzoda S.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.zdrav.tj/jour/article/view/748

Травмы передней крестообразной связки (ПКС) считаются одними из наиболее распространённых повреждений структуры коленного сустава, особенно среди лиц, регулярно занимающихся физической активностью. В клинической практике эта патология отмечается преимущественно у пациентов, которые подвергают свои колени значительным нагрузкам вследствие занятий спортом и других активных видов деятельности. Современная хирургия предлагает широкий спектр методик реконструкции ПКС, включая аутотрансплантацию, использование аллотрансплантатов, «всё-внутри» технологии и латеральные дополнительные процедуры. В данной обзорной статье обобщены современные подходы к выбору метода хирургического вмешательства, сравнивается эффективность различных видов трансплантатов, способы фиксации, проанализированы факторы, влияющие на исходы лечения, включая ревизионные вмешательства и послеоперационные осложнения. Особое внимание уделено восстановлению биомеханической стабильности, реабилитации и профилактике повторных разрывов. В статье представлены данные метаанализов, систематических обзоров и клинических рекомендаций, опубликованных за 2020–2024 гг. Работа предназначена для травматологов-ортопедов, спортивных врачей и хирургов, специализирующихся на хирургии коленного сустава.

Anterior cruciate ligament (ACL) injuries are one of the most common injuries to the knee joint structure, especially among individuals who regularly engage in physical activity. In clinical practice, this pathology is observed mainly in patients who subject their knees to significant stress due to sports and other high-intensity activities. Contemporary surgical approaches offers a wide range of reconstruction techniques, including autografts, allografts, all-inside procedures, and lateral extra-articular augmentations. This review summarizes current strategies in ACL surgical treatment, compares graft types and fixation methods, and analyzes factors influencing clinical outcomes, including revision surgeries and postoperative complications. Special attention is given to biomechanical stabilization, rehabilitation protocols, and prevention of graft failure. The article includes evidence from meta-analyses, systematic reviews, and clinical guidelines published between 2020 and 2024. It is intended for orthopedic surgeons, sports medicine specialists, and clinicians involved in knee joint surgery.

передняя крестообразная связкаартроскопияреконструкциятрансплантатхирургическое лечениеanterior cruciate ligamentarthroscopyreconstructiongraftsurgical treatmentReferencesMigliorini F, Lucenti L, Mok YR, Bardazzi T, D’Ambrosi R, De Carli A, Paolicelli D, Maffulli N. Anterior Cruciate Ligament Reconstruction Using Lateral Extra-Articular Procedures: A Systematic Review. Medicina (Kaunas). 2025;61(2):294. doi: 10.3390/medicina61020294.Migliorini F, Lucenti L, Mok YR, Bardazzi T, D’Ambrosi R, De Carli A, Paolicelli D, Maffulli N. Anterior Cruciate Ligament Reconstruction Using Lateral Extra-Articular Procedures: A Systematic Review. Medicina (Kaunas). 2025;61(2):294. doi: 10.3390/medicina61020294.Migliorini F, Maffulli N, Jeyaraman M, Schäfer L, Rath B, Huber T. Minimal clinically important difference (MCID), patient-acceptable symptom state (PASS), and substantial clinical benefit (SCB) following surgical knee ligament reconstruction: a systematic review. Eur J Trauma Emerg Surg. 2025;51(1):32. doi: 10.1007/s00068-024-02708-3.Migliorini F, Maffulli N, Jeyaraman M, Schäfer L, Rath B, Huber T. Minimal clinically important difference (MCID), patient-acceptable symptom state (PASS), and substantial clinical benefit (SCB) following surgical knee ligament reconstruction: a systematic review. Eur J Trauma Emerg Surg. 2025;51(1):32. doi: 10.1007/s00068-024-02708-3.Wolterink TD, Gaudiani MA, Beydoun RS, Kasto JK, Sanii RY, Moutzouros V, Muh S. Anterior Cruciate Ligament Reconstruction Surgery Outcomes: A Comparison Between Patients Who Underwent the Procedure During the COVID-19 Pandemic and a Cohort Treated Prior to the Pandemic. Cureus. 2024;16(4):e57840. doi: 10.7759/cureus.57840.Wolterink TD, Gaudiani MA, Beydoun RS, Kasto JK, Sanii RY, Moutzouros V, Muh S. Anterior Cruciate Ligament Reconstruction Surgery Outcomes: A Comparison Between Patients Who Underwent the Procedure During the COVID-19 Pandemic and a Cohort Treated Prior to the Pandemic. Cureus. 2024;16(4):e57840. doi: 10.7759/cureus.57840.Phillips T, et al. After 40 days intra-articular injury, risk profile increases linearly with time to surgery in adolescent patients undergoing primary anterior cruciate ligament reconstruction. Knee Surg Sports TraumatolArthrosc. 2025;33(4):1192-1201. doi: 10.1002/ksa.12423.Phillips T, et al. After 40 days intra-articular injury, risk profile increases linearly with time to surgery in adolescent patients undergoing primary anterior cruciate ligament reconstruction. Knee Surg Sports TraumatolArthrosc. 2025;33(4):1192-1201. doi: 10.1002/ksa.12423.Papaleontiou T, et al. Conservative vs Surgical Treatment of Anterior Cruciate Ligament Injuries: A Systematic Review. J Orthop Surg Res. 2024;19(1):123. doi: 10.1186/s13018-024-07525-8.Papaleontiou T, et al. Conservative vs Surgical Treatment of Anterior Cruciate Ligament Injuries: A Systematic Review. J Orthop Surg Res. 2024;19(1):123. doi: 10.1186/s13018-024-07525-8.Buerba RA, et al. ACL Reconstruction in the Professional or Elite Athlete: State of the Art. J ISAKOS. 2021;6(4):226-236. doi: 10.1136/jisakos-2020-000456.Buerba RA, et al. ACL Reconstruction in the Professional or Elite Athlete: State of the Art. J ISAKOS. 2021;6(4):226-236. doi: 10.1136/jisakos-2020-000456.Gopinatth V, et al. Consistent Indications and Good Outcomes Despite High Variability in Techniques for Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy. 2023;39(9):2098-2111. doi: 10.1016/j.arthro.2023.02.009.Gopinatth V, et al. Consistent Indications and Good Outcomes Despite High Variability in Techniques for Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy. 2023;39(9):2098-2111. doi: 10.1016/j.arthro.2023.02.009.Getgood AMJ, et al. Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft ACL Reconstruction: 2-Year Outcomes From the STABILITY Study. Am J Sports Med. 2020;48(2):285–297. doi:10.1177/0363546519896333.Getgood AMJ, et al. Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft ACL Reconstruction: 2-Year Outcomes From the STABILITY Study. Am J Sports Med. 2020;48(2):285–297. doi:10.1177/0363546519896333.Schwartzberg R. Editorial Commentary: All-Inside Anterior Cruciate Ligament Reconstruction Produces Excellent Results: Adjustable Cortical Suspensory Fixation Provides Rigid Tibial Fixation for All Ages. Arthroscopy. 2024;40(8):2289-2291. doi: 10.1016/j.arthro.2024.03.011.Schwartzberg R. Editorial Commentary: All-Inside Anterior Cruciate Ligament Reconstruction Produces Excellent Results: Adjustable Cortical Suspensory Fixation Provides Rigid Tibial Fixation for All Ages. Arthroscopy. 2024;40(8):2289-2291. doi: 10.1016/j.arthro.2024.03.011.Beckers L, Vivacqua T, Firth AD, Getgood AMJ. Clinical outcomes of contemporary lateral augmentation techniques in primary ACL reconstruction: a systematic review and meta-analysis. J Exp Orthop. 2021;8(1):59. doi: 10.1186/s40634-021-00368-5.Beckers L, Vivacqua T, Firth AD, Getgood AMJ. Clinical outcomes of contemporary lateral augmentation techniques in primary ACL reconstruction: a systematic review and meta-analysis. J Exp Orthop. 2021;8(1):59. doi: 10.1186/s40634-021-00368-5.Wright RW, Johnson L, Brophy RH, Bogunovic L, Matava MJ, Smith MV. Revision Anterior Cruciate Ligament Reconstruction Outcomes at a Minimum of 5-Year Follow-Up: A Systematic Review. J Knee Surg. 2019;32(3):218-221. doi:10.1055/s-0038-1641137.Wright RW, Johnson L, Brophy RH, Bogunovic L, Matava MJ, Smith MV. Revision Anterior Cruciate Ligament Reconstruction Outcomes at a Minimum of 5-Year Follow-Up: A Systematic Review. J Knee Surg. 2019;32(3):218-221. doi:10.1055/s-0038-1641137.Grassi A, Kim C, Marcheggiani Muccioli GM, Zaffagnini S, Amendola A. What Is the Mid-term Failure Rate of Revision ACL Reconstruction? A Systematic Review. Clin Orthop Relat Res. 2017;475(10):2484-2499. doi:10.1007/s11999-017-5379-5.Grassi A, Kim C, Marcheggiani Muccioli GM, Zaffagnini S, Amendola A. What Is the Mid-term Failure Rate of Revision ACL Reconstruction? A Systematic Review. Clin Orthop Relat Res. 2017;475(10):2484-2499. doi:10.1007/s11999-017-5379-5.Mohan R, Webster KE, Johnson NR, Stuart MJ, Hewett TE, Krych AJ. Clinical Outcomes in Revision Anterior Cruciate Ligament Reconstruction: A Meta-analysis. Arthroscopy. 2018;34(1):289-300. doi:10.1016/j.arthro.2017.06.029.Mohan R, Webster KE, Johnson NR, Stuart MJ, Hewett TE, Krych AJ. Clinical Outcomes in Revision Anterior Cruciate Ligament Reconstruction: A Meta-analysis. Arthroscopy. 2018;34(1):289-300. doi:10.1016/j.arthro.2017.06.029.Nukuto K, Hoshino Y, Kataoka K, Kuroda R. Current development in surgical techniques, graft selection and additional procedures for anterior cruciate ligament injury: a path towards anatomic restoration and improved clinical outcomes—a narrative review. Ann Joint. 2023;8:16. doi:10.21037/aoj-22-59.Nukuto K, Hoshino Y, Kataoka K, Kuroda R. Current development in surgical techniques, graft selection and additional procedures for anterior cruciate ligament injury: a path towards anatomic restoration and improved clinical outcomes—a narrative review. Ann Joint. 2023;8:16. doi:10.21037/aoj-22-59.Wright RW, Johnson L, Brophy RH, Bogunovic L, Matava MJ, Smith MV. Revision Anterior Cruciate Ligament Reconstruction Outcomes at a Minimum of 5-Year Follow-Up: A Systematic Review. J Knee Surg. 2019;32(3):218-221. doi:10.1055/s-0038-1641137.Wright RW, Johnson L, Brophy RH, Bogunovic L, Matava MJ, Smith MV. Revision Anterior Cruciate Ligament Reconstruction Outcomes at a Minimum of 5-Year Follow-Up: A Systematic Review. J Knee Surg. 2019;32(3):218-221. doi:10.1055/s-0038-1641137.Jackson GR, Mameri ES, Tuthill T, Wessels M, Asif S, Sugrañes J. et al. Adverse Events and Complications After Primary ACL Reconstruction With Quadriceps Tendon Autograft: A Systematic Review. Orthop J Sports Med. 2023;11(12):23259671231199728. doi: 10.1177/23259671231199728.Jackson GR, Mameri ES, Tuthill T, Wessels M, Asif S, Sugrañes J. et al. Adverse Events and Complications After Primary ACL Reconstruction With Quadriceps Tendon Autograft: A Systematic Review. Orthop J Sports Med. 2023;11(12):23259671231199728. doi: 10.1177/23259671231199728.Glattke KE, Tummala SV, Chhabra A. Anterior Cruciate Ligament Reconstruction Recovery and Rehabilitation: A Systematic Review. J Bone Joint Surg Am. 2022;104(8):739-754. doi: 10.2106/JBJS.21.00688.Glattke KE, Tummala SV, Chhabra A. Anterior Cruciate Ligament Reconstruction Recovery and Rehabilitation: A Systematic Review. J Bone Joint Surg Am. 2022;104(8):739-754. doi: 10.2106/JBJS.21.00688.Bohu Y, Klouche S, Sezer HB, Herman S, Grimaud O, Gerometta A, Meyer A, Lefevre N. Vancomycin-soaked autografts during ACL reconstruction reduce the risk of post-operative infection without affecting return to sport or knee function. Knee Surg Sports TraumatolArthrosc. 2020;28(8):2578-2585. doi: 10.1007/s00167-020-05879-9.Bohu Y, Klouche S, Sezer HB, Herman S, Grimaud O, Gerometta A, Meyer A, Lefevre N. Vancomycin-soaked autografts during ACL reconstruction reduce the risk of post-operative infection without affecting return to sport or knee function. Knee Surg Sports TraumatolArthrosc. 2020;28(8):2578-2585. doi: 10.1007/s00167-020-05879-9.Коструб А.А., Поляченко Ю.В., Герасименко М.А., Котюк В.В., Блонский Р.И., Мазевич В.Б., Вадзюк Н.С. Антеролатеральная связка как ротационный стабилизатор коленного сустава. роль МРТ и УЗИ в понимании ее анатомии и в выборе тактики хирургического лечения ее повреждений. Новости хирургии. 2021;29(5):581-589. doi: 10.18484/2305-0047.2021.5.581.Kostrub A.A., Polyachenko Yu.V., Gerasimenko M.A., Kotyuk V.V., Blonsky R.I., Mazevich V.B., Vadzyuk N.S. Anterolateral ligament as a rotational stabilizer of the knee joint. The role of MRI and ultrasound in understanding its anatomy and in choosing tactics for surgical treatment of its injuries. Surgical news. 2021;29(5):581-589.doi: 10.18484/2305-0047.2021.5.581. (In Russ.).Бальжинимаев Д.Б., Михайлов И.Н., Пусева М.Э., Тишков Н.В. Сравнительный анализ результатов реконструкции передней крестообразной связки коленного сустава с подготовкой аутотрансплантата по известной и новой методикам. Actabiomedicascientifica. 2022; 7(6): 229-238. doi: 10.29413/ABS.2022-7.6.23Balzhinimaev D.B., Mikhailov I.N., Puseva M.E., Tishkov N.V. Comparative analysis of the results of reconstruction of the anterior cruciate ligament of the knee joint with the preparation of an autograft using known and new techniques. Actabiomedicascientifica. 2022; 7(6): 229-238. doi: 10.29413/ABS.2022-7.6.23. (In Russ.).

The authors declare that there are no conflicts of interest present.