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Der vordere Knieschmerz

Anterior knee pain

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Zusammenfassung

Hintergrund

In sportmedizinischen Schwerpunktpraxen gehören Symptome in der vorderen Knieregion zu den am häufigsten angeführten Beschwerden. Die betroffenen Sportler berichten nicht selten über rezidivierende Schmerzen, die regelmäßig zu langen Unterbrechungen ihrer sportlichen Aktivität führen. Es existiert weder eine allgemeingültige Definition noch besteht Einigkeit über die Ätiologie des Geschehens oder einen allgemein akzeptierten diagnostischen Algorhythmus. Therapeutische Konzepte werden uneinheitlich und vielfach ohne Evidenzabsicherung propagiert.

Methoden

Auf der Grundlage einer differenzierten Anamnese und Befunderhebung werden die Weichen für eine individuelle Behandlung gestellt. Das Ziel ist, so früh wie möglich die strukturelle Pathologie von (überwiegend) funktionellen Ursachen abzugrenzen. Dies ermöglicht ein nachhaltig strategisches Vorgehen, bei dem dann auch sinnvolle operative Maßnahmen rechtzeitig Berücksichtigung finden.

Ergebnisse

Bei den konservativen Therapieverfahren erzielen multimodale Ansätze die besten Ergebnisse. Neben den gängigen Therapieformen, wie nichtsteroidale Antirheumatika (NSAR), Infiltrationen, Tape, Bandagen etc., scheint eine Kombination aus manuellen Techniken (z. B. Kompression, Mobilisation), Edukation und funktionellen („sensomotorischen“) Krafttrainingsreizen (in der geschlossenen Kette) erfolgversprechend zu sein.

Abstract

Background

In sports clinics and specialists private practice, symptoms in the anterior knee region are amongst the most commonly occurring complaints. Affected athletes frequently complain about recurrent symptoms which regularly lead to long interruptions in sports activities. There is neither a generally agreed definition nor is there consensus on the etiology of the mechanisms or a generally accepted diagnostic algorithm. Therapeutic concepts are propagated nonuniformly and frequently with no evidential basis.

Methods

The plan for an individual treatment is established based on a differentiated patient history and findings. The aim is to differentiate the structural pathology from (essentially) functional causes as early as possible. This allows a sustainable strategic approach by which timely consideration can be given to meaningful operative measures.

Results

Under conservative forms of therapy the best results can be achieved by multimodal approaches. In addition to the usual forms of therapy, such as non-steroidal anti-inflammatory drugs (NSAIDs), infiltration anesthesia, tapes and bandages, a combination of manual techniques (e.g. compression and mobilization), education and functional (sensorimotor) power training stimuli (in a closed chain) seems to be promising.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Biesenbach gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb dieses Beitrags zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigen oder des gesetzlich bestellten Betreuers vor.

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  1. Praxisklinik Remscheid, Freiheitstr. 203, 42853, Remscheid, Deutschland

    S. Biesenbach

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Biesenbach, S. Der vordere Knieschmerz. Manuelle Medizin 52, 111–122 (2014). https://doi.org/10.1007/s00337-014-1097-1

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