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Konservative Behandlung der Achillestendinopathie

Conservative treatment of Achilles tendinopathy

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Zusammenfassung

Tendinopathien des Rückfußes betreffen vornehmlich die Achillessehne. Die Farb- und Powerdopplersonographie visualisieren Neogefäße im Bereich des Achillessehnenschmerzes, die mit schmerzleitenden Nervenfasern assoziiert sind. Moderne Therapien fokussieren auf eine Reduktion dieses erhöhten kapillären Blutflusses. Das schmerzhafte exzentrische Krafttraining an einer Treppenstufe kann Schmerzen signifikant senken und die Funktion nach 12 Wochen nachhaltig verbessern (Evidenzlevel Ib). Die radiale Stoßwellentherapie ist in Kombination mit einem exzentrischen Krafttraining dem alleinigen exzentrischen Krafttraining überlegen (Evidenzlevel Ib). Langzeitergebnisse suggerieren eine Kollageninduktion mit Schmerzreduktion durch die topische Nitroglyzerinanwendung (Evidenzlevel Ib). Die Farb- oder Powerdoppler-gesteuerte gezielte Sklerosierung von Neogefäßen mit Polidocanol kann nachhaltig Schmerzen reduzieren und ein Sehnenremodelling induzieren (Evidenzlevel Ib). Begleitender Sport kann während der Therapie schmerzlimitiert bis Grad 5/10 auf der visuellen Analogskala (VAS) erfolgen (Evidenzlevel Ib). Auch die Kühlung über 3-mal 10 min reduziert nachhaltig den Schmerz und die pathologisch gesteigerte Durchblutung bei Tendinopathien (Evidenzlevel Ib). Der Stellenwert eines propriozeptiven Trainings zur Behandlung von Achillestendinopathien über einen alternativen Mechanismus sollte weiter geprüft werden (Evidenzlevel II). Insgesamt ist in den letzten Jahren auch im Feld der Tendinopathie die anekdotische Evidenz der evidenzbasierten Medizin gewichen.

Abstract

Hind foot tendinopathies mainly involve the Achilles tendon. Color and Power-Doppler ultrasound visualizes pathological neovessels in painful tendons, which are associated with pain mediating nerve fibres. These neovessels are characterized by an increased capillary blood flow at the point of pain. Painful eccentric training can significantly reduce pain and improve function in Achilles tendinopathy (evidence level Ib). Shock wave therapy in combination with eccentric training is superior to eccentric training alone (evidence level Ib). Long-term results suggest a collagen induction and reduced pain following topical application of glyceryl trinitrate (NO) (evidence level Ib). Color and Power-Doppler-guided sclerosing therapy using polidocanol reduces pain, improves function and may lead to tendon remodeling (evidence level Ib). Pain-restricted sport up to a visual analogue scale (VAS) score 5/10 during therapy is recommended (evidence level Ib). Cryotherapy sessions of 3-times 10 min of reduce pain and capillary blood flow (evidence level Ib). The role of proprioceptive training in tendinopathy has to be determined in future trials (evidence level II). Anecdotical treatment of hindfoot tendinopathies has been replaced by evidence-based recommendations.

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  1. Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    K. Knobloch & T. Hüfner

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  2. T. Hüfner
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Correspondence to K. Knobloch.

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Knobloch, K., Hüfner, T. Konservative Behandlung der Achillestendinopathie. Unfallchirurg 113, 705–711 (2010). https://doi.org/10.1007/s00113-010-1808-6

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