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Konservativ-funktionelle Behandlung der Achillessehnenruptur

Conservative functional treatment of Achilles tendon ruptures

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Zusammenfassung

Die konservativ-funktionelle Therapie der Achillessehnenruptur hat sich in den letzten 20 Jahren weiter entwickelt und ist grundsätzlich für 60–80% der Patienten durchführbar. Die Therapie führt zum Erfolg, wenn die Indikation aufgrund der dynamischen Sonographie korrekt gestellt wird (Adaptation der Sehnenenden bis 20° Plantarflexion), die Patienten eine ausreichende Compliance aufweisen und die Physiotherapie abhängig von der Sehnenheilung zunehmend intensiviert wird. Moderne Orthesen erlauben eine vermehrte Spitzfußstellung und damit eine verbesserte Protektion der heilenden Sehne. Sind diese Faktoren gegeben, kann eine relativ niedrige Rerupturrate von 7% erreicht werden.

Der entscheidende Vorteil der konservativ-funktionellen Therapie ist das Vermeiden spezifischer operativer Risiken, wie einer Infektion und der N.-suralis-Verletzung. Nach Abnahme der Orthese sollte die Sehne noch durch Einlagen und Absatzerhöhung modelliert werden.

Abstract

The conservative functional treatment of Achilles tendon ruptures has developed further over the last 20 years and is basically possible for 60–80% of patients. The treatment leads to success if the indications obtained by dynamic sonography are correctly interpreted (adaptation of the tendon ends up to 20° plantar flexion), if the patient presents sufficient compliance and the physiotherapy is increasingly intensified depending on tendon healing. Modern ortheses allow an increased equinus position and therefore improved protection of the healing tendon. If these factors are present a relatively low re-rupture rate of only 7% can be achieved. The decisive advantage of conservative functional therapy is the avoidance of specific operative risks, such as infection and injury to the sural nerve. After removal of the orthesis the tendon should continue to be modeled using shoe insoles and raised heels.

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  1. Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    T. Hüfner, R. Gaulke, J. Imrecke, C. Krettek & T. Stübig

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  1. T. Hüfner
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  2. R. Gaulke
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  3. J. Imrecke
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  4. C. Krettek
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  5. T. Stübig
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Correspondence to T. Hüfner.

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Hüfner, T., Gaulke, R., Imrecke, J. et al. Konservativ-funktionelle Behandlung der Achillessehnenruptur. Unfallchirurg 113, 699–704 (2010). https://doi.org/10.1007/s00113-010-1833-5

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  • DOI: https://doi.org/10.1007/s00113-010-1833-5

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