Jumper’s knee - eine Übersicht

Zusammenfassung

Das so genannte „jumper’s knee” ist definiert als Schmerz im Bereich des Kniestreckapparats, der auf eine chronische Überlastung zurückzuführen ist. Die Erkrankung hat eine erhöhte Inzidenz in Sprungsportarten und ist abhängig von Trainingsfrequenz und Leistungsniveau. Der natürliche Verlauf ist protrahiert, rezidivierend und häufig bilateral auftretend. Die zugrunde liegende Ätiologie ist eine chronische Überlastung des Kniestreckapparats, die durch Sprungsportarten (Volleyball, Basketball u. ä.) sowie verschiedene intrinsische (Bandlaxität, Q-Winkel, Patellahöhenstand, Muskeldehnbarkeit, Art der Kraftentwicklung) und extrinsische Dispositionen (Trainingsfrequenz und -niveau, Bodenhärte) ausgelöst wird. Der Ort der Pathologie ist am häufigsten die osteo-tendinöse Übergangszone der proximalen Patellasehne. Histologische Untersuchungen der Sehne zeigten, dass es sich nicht um eine Entzündung, sondern um eine Degeneration handelt. In der Diagnostik stehen die typische Sportanamnese, der Untersuchungsbefund und die Sonografie im Vordergrund. Die MRT ist zur OP-Planung hilfreich. Nativröntgen, CT und Szintigrafie dienen eher der Ausschlussdiagnostik. Die Therapie ist stadienorientiert und sollte zunächst mit einem konservativen Ansatz beginnen. Dies beinhaltet zunächst eine Sportpause, Immobilisation, NSAR, paratendinöse Steroidinfiltrationen, Querfriktionsmassage, Elektrotherapie, Ultraschall und Stoßwellen. Anschließend kann mit dem Belastungsaufbau begonnen werden (moderates Training, adäquates Warm-up, Eiskühlung nach Aktivität, Muskeldehnung, exzentrische Quadrizepsstärkung). Zur Prävention werden die Patellasehnenbandage und weiche Einlagen eingesetzt. Bei Therapieresistenz kann bei bis zu 42 % der Patienten auch die chirurgische Therapie notwendig werden, die sowohl offen als auch arthroskopisch durchgeführt wird. Die chirurgischen Prinzipien beinhalten die Exzision des Paratenons und des Degenerationsherds, Resektion des unteren Patellapols sowie longitudinale Inzisionen der Sehne. Die überwiegende Anzahl der Patienten ist nach chirurgischer Therapie schmerzfrei, aber eine Rückkehr zum Sport ist meist nur auf niedrigerem Niveau möglich.

Abstract

Jumper’s knee has been defined as painful chronic overuse injury of the extensor mechanism of the knee joint. The disease has a high incidence in jumping sports and depends on training frequency and level of performance. Its natural course is protracted, repetitive, and often bilaterally occurring. Its etiology is a chronic overload of the knee extensor mechanism which is triggered by jumping sports (volleyball, basketball etc.) as well as different intrinsic (ligamentous laxity, Q-angle, patella height, tenderness, pattern of force development) and extrinsic dispositions (frequency of training, level of performance, hardness of underground). The place of pathology most often is the osteo-tendinous transition zone of the proximal patellar tendon. Histologic evalutation of the tendon showed that the disease is rather degenerative than inflammational. The diagnosis is primarily based on the typical sports history, physical examination, and ultrasound. MRI is helpful in operation planning. Plain radiography, CT, and bone scans are used to rule out differential diagnoses. Therapy should be chosen according to the stage of the disease and usually starts with a non-surgical approach. This includes rest from sports activities, immobilisation, non-steroid antiphlogistics, paratendinous cortisone injections, massage, electric therapy, ultrasound and extracorporal shock waves. Afterwards an increase of activities is begun (moderate training, adequate warm-up, ice cooling after activity, muscle stretching, eccentric strengthening of the quadriceps). Patella straps and soft insoles are used as prevention. Up to 42 % of patients need surgical therapy after failure of long-lasting non-surgical measures, carried out either open or arthroscopically. Surgical principles include excision of the paratenon, excision of the degenerative tissue, resection of the lower patella pole, and longitudinal incisions into the tendon. Most patients are pain-free after surgery but return to sports only at a lower level.

Knie - Patellasehne - Patellaspitzensyndrom - Übersicht - jumper’s knee patellar tendinitis - patellar tendonitis - patellar tendinosis

Knee - patellar tendon - review - jumper’s knee - patellar tendinitis - patellar tendonitis - patellar tendinosis - patellar apicitis

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