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Sportverletz Sportschaden 2018; 32(02): 103-110
DOI: 10.1055/a-0583-3850
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Standards in der Nachbehandlung nach vorderem Kreuzbandersatz im deutschsprachigen Raum

Standards in rehabilitation following anterior cruciate ligament reconstruction in the German-speaking world
Christina Valle
1   Medical Park Chiemsee, Bernau-Felden
,
Anja Hirschmüller
2   Universitätsklinikum Freiburg, Freiburg
8   ALTIUS Swiss Sportmedizin Center, Rheinfelden, Schweiz
,
Marcus Schmitt-Sody
1   Medical Park Chiemsee, Bernau-Felden
,
Bernhard Haller
3   Klinikum rechts der Isar der Technischen Universität München, München
,
Matthias Keller
4   OSINSTITUT Bewegung für Orthopädie und Sportmedizin, München
,
Wolfgang Schoch
5   PULZ im Riesenfeld, Freiburg
,
Helmut Hoffman
6   Eden Reha Privatklinik für Unfall- und Sportverletzungen, Donaustauf
,
Philipp Minzlaff
3   Klinikum rechts der Isar der Technischen Universität München, München
7   Chirurgisches Klinikum München Süd, München
› Author Affiliations
Further Information

Publication History

Publication Date:
05 June 2018 (online)

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Zusammenfassung

Einleitung Die Nachbehandlung nach Rekonstruktion des vorderen Kreuzbandes (VKB) ist nach wie vor ein kontrovers diskutiertes Thema. Die existierenden Nachbehandlungsschemata unterscheiden sich teils erheblich, unter anderem da bei einigen Aspekten noch kein Nachweis einer optimalen Vorgehensweise existiert. Das Ziel dieser Befragung war es zu untersuchen, wie die Nachbehandlung nach VKB-Ersatz

im deutschsprachigen Raum von Ausbildern für arthroskopische Kniegelenksoperationen mit besonderer Expertise empfohlen wird und dies mit der aktuellen Literatur zu vergleichen.

Material und Methoden Es wurde eine strukturierte anonyme Online-Umfrage an Instruktoren der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA) zur Nachbehandlung nach operativer Versorgung der isolierten Ruptur des vorderen Kreuzbandes durchgeführt. Der Fragebogen enthielt 23 geschlossene Fragen mit teils mehrfacher Antwortmöglichkeit.

Ergebnisse Bei 218 befragten Operateuren konnten 117 vollständig beantwortete Fragebögen analysiert werden. 96,5 % der Operateure geben die Vollbelastung nach spätestens 4 Wochen frei, 52,6 % limitieren die Beugung und 9,7 % die Streckung des Kniegelenks nach der Operation. Eine Orthese wird von 82,8 % verordnet, überwiegend mit einem harten Rahmen. In den ersten 6 Wochen werden v. a. isometrisches Training und Übungen in geschlossener Kette empfohlen. Fahrradfahren wird von 78,5 % und Autofahren von 86,2 % der Befragten spätestens nach 6 Wochen wieder erlaubt.

Die Mehrheit der befragten Operateure erlaubt Joggen (65,5 %) und Sprungsportarten (67,0 %) nach 3 Monaten, Alpinskifahren (53,0 %) sowie Kontakt- und Mannschaftssport wird oftmals nach 12 Monaten freigegeben (55,2 % und 46,2 %). 82,6 % der Befragten wünschen sich eine praxistaugliche Return-to-sport-Testbatterie.

Schlussfolgerung Auch bei erfahrenen Kreuzbandoperateuren kommen nach wie vor viele unterschiedliche postoperative Nachbehandlungschemata und -empfehlungen zur Anwendung. Oft entspricht die gängige Praxis dabei nicht den Empfehlungen der aktuellen Literatur. Obwohl der Einsatz von Orthesen keinen nachweislichen Vorteil bringt, schützen die Mehrzahl der Operateure das von ihnen operierte Gelenk mittels Hartrahmenschiene und die Trainingsempfehlungen entsprechen oft nicht der Evidenz.

Abstract

Introduction Rehabilitation protocols following anterior cruciate ligament (ACL) reconstruction often differ among orthopaedic surgeons. The primary aim of this study was to investigate which follow-up treatment is recommended by “AGA instructors” certified by the German-speaking Association for Arthroscopic and Open Joint Surgery (AGA). The secondary aim was to compare these findings with the current literature.

Material and Methods A structured anonymous online survey was performed with “AGA instructors” specialised in knee or ACL surgery. All participants were asked about their recommendations for rehabilitation following isolated ACL reconstruction using a questionnaire containing 23 items.

Results 117 out of 218 mail questionnaires were fully completed and analysed. 96.5 % of all surgeons allowed full weight-bearing after 4 weeks or earlier, 52.6 % put a limit on knee flexion, 9.7 % on knee extension after the operation. A brace was prescribed by 82.8 % of all participants. During the first six weeks, isometric training and closed-chain exercises were recommended by the majority of surgeons. Riding a bicycle or driving a car after 6 weeks or earlier was permitted by 78.5 % and 86.2 %, respectively. Jogging (65.5 %) or jumping activities (67.0 %) were allowed after 3 months or earlier. Skiing (53.0 %) or contact/team sport (55.2 % / 46.2 %) was often permitted after 12 months. 82.6 % of all surgeons would like to use return-to-sport test protocols.

Conclusion Rehabilitation protocols differ significantly even among experienced knee surgeons working as instructors. Their recommendations are often not evidence-based considering the current literature.

Schlüsselwörter

Vordere Kreuzbandruptur - Nachbehandlung - Reruptur

Key words

anterior cruciate ligament - rehabilitation - rerupture
 

  • Literatur

  • 1 Makhni EC, Crump EK, Steinhaus ME. et al. Quality and Variability of Online Available Physical Therapy Protocols From Academic Orthopaedic Surgery Programs for Anterior Cruciate Ligament Reconstruction. Arthroscopy 2016; 32: 1612-1621
    CrossrefPubMedGoogle Scholar
  • 2 Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy 2011; 27: 1697-1705
    CrossrefPubMedGoogle Scholar
  • 3 Beynnon B, Howe JG, Pope MH. et al. The measurement of anterior cruciate ligament strain in vivo. Int Orthop 1992; 16: 1-12
    PubMedGoogle Scholar
  • 4 Beynnon BD, Fleming BC. Anterior cruciate ligament strain in-vivo: a review of previous work. J Biomechanics 1998; 31: 519-525
    CrossrefPubMedGoogle Scholar
  • 5 Bordes P, Laboute E, Bertolotti A. et al. No beneficial effect of bracing after anterior cruciate ligament reconstruction in a cohort of 969 athletes followed in rehabilitation. Ann Phys Rehabil Med 2017; 60: 230-236
    CrossrefPubMedGoogle Scholar
  • 6 Budny J, Fox J, Rauh M. Emerging Trends in Anterior Cruciate Ligament Reconstruction. J Knee Surg 2017; 30: 63-69
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Cipolla M, Scala A, Gianni E. et al. Different patterns of meniscal tears in acute anterior cruciate ligament (ACL) ruptures and in chronic ACL-deficient knees. Classification, staging and timing of treatment.. Knee Surg Sports Traumatol Arthrosc 1995; 3: 130-134
    CrossrefPubMedGoogle Scholar
  • 8 Claes S, Verdonk P, Forsyth R. et al. The “Ligamentization” Process in Anterior Cruciate Ligament Reconstruction: What Happens to the Human Graft? A Systematic Review of the Literature. Am J Sports Med 2011; 39: 2476-2483
    CrossrefPubMedGoogle Scholar
  • 9 Cohen M, Amaro JT, Ejnisman B. et al. Anterior Cruciate Ligament Reconstruction After 10 to 15 Years: Association Between Meniscectomy and Osteoarthrosis. Arthroscopy 2007; 23: 629-634
    CrossrefPubMedGoogle Scholar
  • 10 Pauzenberger L, Syre S, Schurz M. “Ligamentization” in Hamstring Tendon Grafts After Anterior Cruciate Ligament Reconstruction: A Systematic Review of the Literature and a Glimpse Into the Future. Arthroscopy 2013; 29: 1712-1721
    CrossrefPubMedGoogle Scholar
  • 11 Engström B, Sperber A, Wredmark T. Continuous passive motion in rehabilitation after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 1995; 3: 18-20
    CrossrefPubMedGoogle Scholar
  • 12 Escamilla RF, MacLeod TD, Wilk KE. et al. ACL Strain and Tensile Forces for Weight Bearing and Non—Weight-Bearing Exercises After ACL Reconstruction: A Guide to Exercise Selection. J Orthop Sports Phys Ther 2012; 42: 208-220
    CrossrefPubMedGoogle Scholar
  • 13 Giotis D, Paschos NK, Zampeli F. et al. Bracing can partially limit tibial rotation during stressful activities after anterior crucial ligament reconstruction with a hamstring graft. Orthop Traumatol Surg Res 2016; 102: 601-606
    CrossrefPubMedGoogle Scholar
  • 14 Gokeler A, Bisschop M, Benjaminse A. et al. Quadriceps function following ACL reconstruction and rehabilitation: implications for optimisation of current practices. Knee Surg Sports Traumatol Arthrosc 2013; 22: 1163-1174
    PubMedGoogle Scholar
  • 15 Hartigan EH, Axe MJ, Snyder-Mackler L. Time line for noncopers to pass return-to-sports criteria after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2010; 40: 141-154
    CrossrefPubMedGoogle Scholar
  • 16 Hewett TE, Di Stasi SL, Myer GD. Current Concepts for Injury Prevention in Athletes After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2012; 41: 216-224
    PubMedGoogle Scholar
  • 17 Janssen RPA, Scheffler SU. Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2014; 22 (09) 2102-8
    CrossrefPubMedGoogle Scholar
  • 18 Kline PW, Burnham J, Yonz M. et al. Hip external rotation strength predicts hop performance after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26: 1137-1144
    PubMedGoogle Scholar
  • 19 Kvist J. Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sports Med 2004; 34: 269-280
    CrossrefPubMedGoogle Scholar
  • 20 Lohmander LS, Englund PM, Dahl LL. et al. The Long-term Consequence of Anterior Cruciate Ligament and Meniscus Injuries: Osteoarthritis. Am J Sports Med 2007; 35: 1756-1769
    CrossrefPubMedGoogle Scholar
  • 21 Lowe WR, Warth RJ, Davis EP. et al. Functional Bracing After Anterior Cruciate Ligament Reconstruction: A Systematic Review. J Am Acad Orthop Surg 2017; 25: 239-249
    CrossrefPubMedGoogle Scholar
  • 22 Luque-Seron JA, Medina-Porqueres I. Anterior Cruciate Ligament Strain In Vivo: A Systematic Review. Sports Health 2016; 8: 451-455
    CrossrefPubMedGoogle Scholar
  • 23 Mall NA, Chalmers PN, Moric M. et al. Incidence and Trends of Anterior Cruciate Ligament Reconstruction in the United States. Am J Sports Med 2014; 42 (10) 2363-2370
    Google Scholar
  • 24 Mayr HO, Stüeken P, Münch E-O. et al. Brace or no-brace after ACL graft?. Four-year results of a prospective clinical trial. Knee Surg Sports Traumatol Arthrosc 2013; 22: 1156-1162
    PubMedGoogle Scholar
  • 25 Minzlaff P, Heidt T, Feucht MJ. et al. Patient satisfaction with health is substantially improved following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26: 582-588
    CrossrefPubMedGoogle Scholar
  • 26 Nikolić DK. Lateral meniscal tears and their evolution in acute injuries of the anterior cruciate ligament of the knee. Arthroscopic analysis. Knee Surg Sports Traumatol Arthrosc 1998; 6: 26-30
    PubMedGoogle Scholar
  • 27 Norouzi S, Esfandiarpour F, Shakourirad A. et al. Rehabilitation after ACL injury: a fluoroscopic study on the effects of type of exercise on the knee sagittal plane arthrokinematics. Biomed Res Int 2013; 248525 DOI: 10.1155/2013/248525. . Epub 2013 Aug 26
    CrossrefPubMedGoogle Scholar
  • 28 Nyland J, Mattocks A, Kibbe S. et al. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update. OAJSM 2016; 7: 21-32
    PubMedGoogle Scholar
  • 29 Paterno MV, Schmitt LC, Ford KR. et al. Biomechanical Measures During Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury After Anterior Cruciate Ligament Reconstruction and Return to Sport. Am J Sports Med 2010; 38: 1968-1978
    CrossrefPubMedGoogle Scholar
  • 30 Petersen W, Stöhr A, Ellermann A. et al. Wiederkehr zum Sport nach VKB-Rekonstruktion. OUP 2016; 5 (03) 166-167
    PubMedGoogle Scholar
  • 31 Petersen W, Zantop T. Return to play following ACL reconstruction: survey among experienced arthroscopic surgeons (AGA instructors). Arch Orthop Trauma Surg 2013; 133: 969-977
    CrossrefPubMedGoogle Scholar
  • 32 Rodeo SA, Arnoczky SP, Torzilli PA. et al. Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am 1993; 75: 1795-1803
    PubMedGoogle Scholar
  • 33 Rodriguez-Merchan EC. Knee Bracing After Anterior Cruciate Ligament Reconstruction. Orthopedics 2016; 39: e602-e609
    CrossrefPubMedGoogle Scholar
  • 34 Saka T. Principles of postoperative anterior cruciate ligament rehabilitation. World J Orthop 2014; 5: 450-459
    CrossrefPubMedGoogle Scholar
  • 35 Scheffler SU, Unterhauser FN, Weiler A. Graft remodeling and ligamentization after cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2008; 16: 834-842
    CrossrefPubMedGoogle Scholar
  • 36 Schmidt J, Simmel S, Bork H. Vorderes Kreuzband, operativ. DGOU Nachbehandlungsempfehlungen 2016; 2: 51-52
    PubMedGoogle Scholar
  • 37 Shafizadeh S, Jaecker V, Otchwemah R. et al. Current status of ACL reconstruction in Germany. Arch Orthop Trauma Surg 2016; 136: 593-603
    CrossrefPubMedGoogle Scholar
  • 38 Thomeé R, Kaplan Y, Kvist J. et al. Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2011; 19: 1798-1805
    CrossrefPubMedGoogle Scholar
  • 39 VBG. Return-to-Competition – Testmanual zur Beurteilung der Spielfähigkeit nach Ruptur des vorderen Kreuzbands. 2017: 1-44
    PubMedGoogle Scholar
  • 40 Weiler A, Peine R, Pashminehazar A. et al. Tendon healing in a bone tunnel. Part 1. Arthroscopy 2002; 8: 113-123
    PubMedGoogle Scholar
  • 41 Wright RW, Haas AK, Anderson J. et al. Anterior Cruciate Ligament Reconstruction Rehabilitation: MOON Guidelines. Sports Health: A Multidisciplinary Approach 2015; 7: 239-243
    PubMedGoogle Scholar
  • 42 Wright RW, Magnussen RA, Dunn WR. et al. Ipsilateral Graft and Contralateral ACL Rupture at Five Years or More Following ACL Reconstruction. J Bone Joint Surg Am 2011; 93: 1159-1165
    CrossrefPubMedGoogle Scholar
  • 43 Keller M, Kurz E, Schmidtlein O. et al. Interdisziplinäre Beurteilungskriterien für die Rehabilitation nach Verletzungen an der unteren Extremität: Ein funktionsbasierter Return to Activity Algorithmus. Sportverletz Sportschaden 2016; 30 (01) 38-49
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Herbst E, Hoser C, Hildebrandt C. et al. Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part II: clinical application of a new test battery. Knee Surg Sports Traumatol Arthrosc 2015; 23 (05) 1283-1291
    CrossrefPubMedGoogle Scholar