OP-Journal 2016; 32(01): 44-54
DOI: 10.1055/s-0042-111250
Artikel zum Leitthema
Georg Thieme Verlag KG Stuttgart · New York

Tendinopathien der unteren Extremität im Sport – Diagnostik und Therapie

Tendinopathies of the Lower Extremities in Sport – Diagnostics and Therapy
Michael Cassel
Hochschulambulanz der Universität Potsdam, Zentrum für Freizeit-, Gesundheits- und Leistungssport
,
Josefine Stoll
Hochschulambulanz der Universität Potsdam, Zentrum für Freizeit-, Gesundheits- und Leistungssport
,
Frank Mayer
Hochschulambulanz der Universität Potsdam, Zentrum für Freizeit-, Gesundheits- und Leistungssport
› Author Affiliations
Further Information

Publication History

Publication Date:
20 September 2016 (online)

Zusammenfassung

Tendinopathien sind häufig Ursache chronischer, belastungsabhängiger Beschwerden an der unteren Extremität. Zumeist sind die großen Sehnen an Sprung- und Kniegelenk, insbesondere die Achillessehne und die Patellarsehne, betroffen. Ätiologisch wird eine repetitive Überbeanspruchung in Sport und/oder Alltag angenommen. Neben der klinischen Untersuchung und der ausführlichen Schmerz- und Belastungsanamnese hat die Sonografie als bildgebendes Verfahren einen hohen Stellenwert in der Diagnostik von Sehnenpathologien der unteren Extremität. Als Mittel der Wahl in der Behandlung sind trainingstherapeutische Konzepte anzusehen, die mit physiotherapeutischen Maßnahmen kombiniert werden können. Bei höhergradiger Pathologie und länger bestehenden Beschwerden sollten multimodale Therapieansätze genutzt werden. Erst bei Versagen der konservativen Behandlung über zumindest mehrere Monate sollte der Einsatz eines Operationsverfahrens erwogen werden.

Abstract

Tendinopathies are frequently the cause of chronic, load-dependent complaints of the lower extremity. Commonly, the large tendons of the ankle and knee joints are affected, especially the Achilles and patellar tendons. Repeated overuse in sports and/or daily activities is assumed as the aetiology. Besides the clinical examination including a comprehensive anamnesis of pain and training/loading, sonographic imaging has a high training/loading relevance for the diagnosis of tendon pathologies of the lower extremity. Training concepts are considered in first line as the treatment of choice. A combination with physical therapy interventions can be useful. In cases of a more severe pathology and long-standing complaints multimodal therapeutic options should be employed. The use of surgical treatment procedures should only be taken into account in case of failed response to conservative treatment.

 
  • Literatur

  • 1 Amlang MH, Maffuli N, Longo G et al. Operative Behandlung der Achillessehnenruptur. Unfallchirurg 2010; 113: 712-720
  • 2 Bashford GR, Tomsen N, Arya S et al. Tendinopathy Discrimination by Use of Spatial Frequency Parameters in Ultrasound B-Mode Images. IEEE Trans Med Imaging 2008; 27: 608-615
  • 3 Cacchio A, Borra F, Severini G et al. Reliability and validity of three pain provocation tests used for the diagnosis of chronic proximal hamstring tendinopathy. Br J Sports Med 2012; [Epub ahead of print]
  • 4 De Smet AA, Blankenbaker DG, Alsheik NH et al. MRI appearance of the proximal hamstring tendons in patients with and without symptomatic proximal hamstring tendinopathy. Am J Roentgenol 2012; 198: 418-422
  • 5 de Vos RJ, Weir A, Tol JL et al. No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy. Br J Sports Med 2011; 45: 387-392
  • 6 Hirschmüller A, Baur H, Müller S et al. Clinical effectiveness of customised sport shoe orthoses for overuse injuries in runners: a randomised controlled study. Br J Sports Med 2011; 45: 959-965
  • 7 Hoksrud A, Torgalsen T, Harstad H et al. Ultrasound-Guided Sclerosis of Neovessels in Patellar Tendinopathy: A Prospective Study of 101 Patients. Am J Sports Med 2012; 40: 542-547
  • 8 Larsson ME, Käll I, Nilsson-Helander K. Treatment of patellar tendinopathy – a systematic review of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 2011; [Epub ahead of print]
  • 9 League AC. Current concepts review: plantar fasciitis. Foot Ankle Int 2008; 29: 358-366
  • 10 Lempainen L, Sarimo J, Mattila K et al. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009; 37: 727-734
  • 11 Magnussen RA, Dunn WR, Thomson AB. Nonoperative Treatment of Midportion Achilles Tendinopathy: A Systematic Review. Clin J Sport Med 2009; 19: 54-64
  • 12 Mayer F, Hirschmüller A, Müller S et al. Effects of short-term treatment strategies over 4 weeks in Achilles tendinopathy. Br J Sports Med 2007; 41: e6
  • 13 Ohberg L, Alfredson H. Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis?. Knee Surg Sports Traumatol Arthrosc 2004; 12: 465-470
  • 14 Rist HJ, Mauch M. Quantifizierte TDI-Elastosonografie der Patellarsehne bei Sportlern. Sportverletz Sportschaden 2012; 26: 27-32
  • 15 Sengkerij PM, de Vos RJ, Weir A et al. Interobserver reliability of neovascularization score using power Doppler ultrasonography in midportion achilles tendinopathy. Am J Sports Med 2009; 37: 1627-1631
  • 16 Tenforde AS, Sayres LC, McCurdy ML et al. Overuse injuries in high school runners: lifetime prevalence and prevention strategies. PM R 2011; 3: 125-131 Quiz 131
  • 17 Cassel M, Baur H, Hirschmüller A et al. Prevalence of Achilles and patellar tendinopathy and their association to intratendinous changes in adolescent athletes. Scand J Med Sci Sports 2014; Sep 11. DOI: 10.1111/sms.12318. [Epub ahead of print]
  • 18 van der Worp H, Zwerver J, van den Akker-Scheek I et al. The TOPSHOCK study: effectiveness of radial shockwave therapy compared to focused shockwave therapy for treating patellar tendinopath – design of a randomised controlled trial. BMC Musculoskelet Disord 2011; 12: 229
  • 19 Cook JL, Purdam CR. Rehabilitation of lower limb tendinopathies. Clin Sports Med 2003; 22: 777-789
  • 20 Hart L. Corticosteroid and other injections in the management of tendinopathies: a review. Clin J Sport Med 2011; 21: 540-541
  • 21 Hirschmüller A, Frey V, Konstantinidis L et al. Prognostic Value of Achilles Tendon Doppler Sonography in Asymptomatic Runners. Med Sci Sports Exerc 2012; 44: 199-205
  • 22 de Jonge S, de Vos RJ, Weir A et al. One-year follow-up of platelet-rich plasma treatment in chronic Achilles tendinopathy: a double-blind randomized placebo-controlled trial. Am J Sports Med 2011; 39: 1623-1629
  • 23 Mayer F, Müller S, Hirschmüller A et al. Die Effizienz konservativer Therapiemaßnahmen bei Tendinopathien im Sport. Dtsch Z Sportmed 2008; 59: 251-254
  • 24 Hölmich P, Hölmich LR, Bjerg AM. Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study. Br J Sports Med 2004; 38: 446-451
  • 25 Hirschmuller A, Frey V, Deibert P et al. Achilles tendon power Doppler sonography in 953 long distance runners – a cross sectional study. Ultraschall Med 2010; 31: 387-393
  • 26 Arya S, Kulig K. Tendinopathy alters mechanical and material properties of the Achilles tendon. J Appl Physiol 2010; 108: 670-675
  • 27 Maffulli N, Wong J, Almekinders LC. Types and epidemiology of tendinopathy. Clin Sports Med 2003; 22: 675-692
  • 28 Alfredson H. Midportion Achilles tendinosis and the plantaris tendon. Br J Sports Med 2011; 45: 1023-1025
  • 29 van Dijk CN, van Sterkenburg MN, Wiegerinck JI et al. Terminology for Achilles tendon related disorders. Knee Surg Sports Traumatol Arthrosc 2011; 19: 835-841
  • 30 Andersson G, Backman LJ, Scott A et al. Substance P accelerates hypercellularity and angiogenesis in tendon tissue and enhances paratendinitis in response to Achilles tendon overuse in a tendinopathy model. Br J Sports Med 2011; 45: 1017-1022
  • 31 Tol JL, Spiezia F, Maffulli N. Neovascularization in Achilles tendinopathy: have we been chasing a red herring?. Knee Surg Sports Traumatol Arthrosc 2012; 20: 1891-1894
  • 32 Klauser AS, Faschingbauer R, Jaschke WR. Is sonoelastography of value in assessing tendons?. Semin Musculoskelet Radiol 2010; 14: 323-333
  • 33 Genovese E, Ronga M, Recaldini C et al. Analysis of achilles tendon vascularity with second-generation contrast-enhanced ultrasound. J Clin Ultrasound 2011; 39: 141-145
  • 34 Alfredson H, Cook J. A treatment algorithm for managing Achilles tendinopathy: new treatment options. Br J Sports Med 2007; 41: 211-216
  • 35 Ratamess NA, Alvar BA, Evetoch TK et al. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2009; 41: 687-708
  • 36 Rompe JD, Nafe D, Furia JP et al. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial. Am J Sports Med 2007; 35: 374-383
  • 37 Baur H, Hirschmüller A, Müller S et al. Neuromuscular Activity of the Peroneal Muscle after Foot Orthoses Therapy in Runners. Med Sci Sports Exerc 2011; 43: 1500-1506
  • 38 Maffulli N, Longo UG, Hüfner T et al. Surgical treatment for pain syndromes of the Achilles tendon. Unfallchirurg 2010; 113: 721-725