Zusammenfassung
Die Rehabilitation nach operativem Ersatz des vorderen Kreuzbandes trägt wesentlich zum Erfolg der Operation bei, da negative Folgen wie die Entwicklung einer Arthrofibrose verhindert werden können und die Zeit bis zur Wiederherstellung der Muskelkraft und der Rückkehr zur sportlichen Belastbarkeit verkürzt wird. Die Rehabilitation kann in 4 Phasen unterteilt werden, bei denen unterschiedliche Ziele im Vordergrund stehen:
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Phase 1, präoperativ: Abbau der Schwellung und Wiederherstellen der Beweglichkeit,
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Phase 2, 1.–2. Woche postoperativ: Wundheilung, freie Streckung, Abbau der Schwellung,
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Phase 3, 3.–6. Woche postoperativ: zunehmende Beugung, normales Gangbild,
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Phase 4, ab der 7. Woche: Wiedererlangung der Kraft, Rückkehr zu sportlicher Belastung.
Die Inhalte der Rehabilitation umfassen physikalische Maßnahmen, krankengymnastische und manualtherapeutische Techniken und trainingstherapeutische Methoden. Der Einsatz zusätzlicher Maßnahmen wie Funktionsorthesen, Muskelstimulationsgeräten und Bewegungsschienen erscheint von fraglichem Erfolg. Grundsätzlich müssen Rehabilitationsmaßnahmen auf die individuelle Situation des Patienten abgestimmt werden und erfolgen nach einem Stufenplan. Die Rehabilitation muss in Abstimmung mit dem Operateur erfolgen und sollte von ärztlicher Seite bis zum Abschluss kontrolliert werden. Mit den aktuellen Methoden ist eine Wiederaufnahme kniebelastender Sportarten nach Kreuzbandersatz nach etwa 6–9 Monaten möglich.
Abstract
Rehabilitation after anterior cruciate ligament (ACL) reconstruction largely contributes to the success of this procedure since negative events such as the development of arthrofibrosis can be prevented and the time to regain muscle strength and the return to sports can be diminished.
Rehabilitation can be divided into four distinct phases that are characterized by different goals of treatment:
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phase 1, preoperative: reduction of swelling and regaining range of motion,
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phase 2, 2 weeks postoperative: wound healing, full extension, reduction of swelling,
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phase 3, 3–6 weeks postoperative: increasing flexion, normal gait pattern,
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phase 4, after 7 weeks: regaining muscle strength, return to sports.
Rehabilitation measures include various forms of physical therapy and systematic exercise training. Additional activities such as the use of functional bracing, electrical muscle stimulation, and motorized range-of-motion machines remain controversial. In all cases rehabilitation measures have to be adapted to the individual situation of the patient and should follow the goals of treatment according to the phases described above. Specific restrictions imposed by the surgeon must always be considered and regular visits to a physician are recommended throughout the rehabilitation phase. By adhering to current rehabilitation programs, full recovery and return to sports after ACL reconstruction can be achieved in most cases within 6–9 months after surgery.
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Danksagung:
Der Autor dankt Hrn. Uwe Schmidt, Physiosport Köln für technische Unterstützung bei der Erstellung der Abbildungen.
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Höher, J. Rehabilitation nach operativem Ersatz des vorderen Kreuzbandes. Arthroskopie 18, 41–47 (2005). https://doi.org/10.1007/s00142-004-0286-7
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DOI: https://doi.org/10.1007/s00142-004-0286-7