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Biomechanische Aspekte in der Rehabilitation des Patellofemoralgelenks

Biomechanical issues in patellofemoral joint rehabilitation

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Zusammenfassung

Spezifische Kenntnisse über die Biomechanik des patellofemoralen Gelenks sind für eine erfolgreiche konservative oder postoperative Rehabilitation unentbehrlich. Die biomechanischen Aspekte in verschiedenen Situationen müssen in der Übungsauswahl berücksichtigt werden. Gelenkreaktionskräfte, Kontaktflächen, und der Gelenkdruck sind im patellofemoralen Gelenk je nach Winkelstellung und Übungssituation unterschiedlich. Belastende Aktivitäten in Flexion beeinflussen über die Muskelkraft des Quadrizeps die patellofemoralen Gelenkreaktionskräfte. Übungen in der offenen und geschlossenen Kette sollten in schonenden Bewegungsamplituden ausgeführt werden, indem sie eine Quadrizepsaktivierung mit möglichst geringen patellofemoralen Gelenkreaktionskräften gewährleisten. Die isolierte Extensionsbewegung in der offenen Kette (90–40°), die Kniebeuge (0–30–60°) und die Beinpresse (0–30–60°) stellen die 3 Hauptübungssituationen in der Frührehabilitation des patellofemoralen Gelenk dar, wobei stets auf eine kontrollierte Körperstellung zu achten ist. Schmerzen und Symptome sollten auf ein Minimum reduziert werden, um eine optimale funktionelle Progression in der neuromuskulären Kontrolle zu erlauben.

Abstract

Specific knowledge of the biomechanics of the patellofemoral joint is crucial for successful nonoperative or postsurgical rehabilitation. The biomechanical aspects of different situations should be considered when designing an exercise program. Joint reaction forces, contact area, and contact stress are dependent on flexion angle and exercise situations. In weight-bearing activities, the amount of knee flexion directly influences the magnitude of quadriceps muscle force, which affects the magnitude of patellofemoral joint reaction forces. Open and closed chain exercises should be performed within a safe range of motion to allow quadriceps activation while minimizing patellofemoral joint reaction forces. The isolated knee extension (90°–40°), the squat (0°–30°–60°), and the leg press (0°–30°–60°) are the three main exercise situations in the acute rehabilitation phase. Controlled body positions and low levels of pain and symptoms should also be emphasized to achieve a functional progression, focusing on neuromuscular control.

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Literatur

  1. Amis A (2004) Patellofemoral joint biomechanics. In: Biedert R (Hrsg) Patellofemoral disorders. Diagnosis and treatment. Wiley, Chichester, UK

  2. Bandi W (1972) Chondromalacia patellae and femoro-patellar arthrosis, etiology, clinical aspects and therapy. Helv Chir Acta 39(Suppl 11): 1–70

    PubMed  Google Scholar 

  3. Biedert RM, Sanchis-Alfonso V (2002) Sources of anterior knee pain. Clin Sports Med 21(3): 335–347

    Article  PubMed  Google Scholar 

  4. Bizzini M (2000)Sensomotorische Rehabilitation nach Beinverletzungen. Thieme, Stuttgart

  5. Bizzini M, Childs JD, Piva SR, Delitto A (2003) Systematic review of the quality of randomized controlled trials for patellofemoral pain syndrome. J Orthop Sports Phys Ther 33(1): 4–20

    PubMed  Google Scholar 

  6. Cohen ZA, Roglic H, Grelsamer RP et al. (2001) Patellofemoral stresses during open and closed kinetic chain exercises. An analysis using computer simulation. Am J Sports Med 29(4): 480–487

    PubMed  CAS  Google Scholar 

  7. Dye SF (1996) The knee as a biologic transmission with an envelope of function: a theory. Clin Orthop Relat Res (325): 10–18

    Article  Google Scholar 

  8. Eng JJ, Pierrynowski MR (1993) Evaluation of soft foot orthotics in the treatment of patellofemoral pain syndrome. Phys Ther 73(2): 62–70

    PubMed  CAS  Google Scholar 

  9. Escamilla RF, Fleisig GS, Zheng N et al. (1998) Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises. Med Sci Sports Exerc 30(4): 556–569

    PubMed  CAS  Google Scholar 

  10. Escamilla RF, Fleisig GS, Lowry TM et al. (2001) Effects of technique variations on knee biomechanics during the squat and leg press. Med Sci Sports Exerc 33(9): 1552–1566

    Article  PubMed  CAS  Google Scholar 

  11. Goymann V, Haasters J, Heller W (1974) Proceedings: Current studies on the biomechanics of the patella. Z Orthop Ihre Grenzgeb 112(4): 623–625

    PubMed  CAS  Google Scholar 

  12. Grood ES, WJ Suntay, FR Noyes et al. (1984) Biomechanics of the knee-extension exercise. Effect of cutting the anterior cruciate ligament. J Bone Joint Surg Am 66(5): 725–734

    PubMed  CAS  Google Scholar 

  13. Hehne HJ (1990) Biomechanics of the patellofemoral joint and its clinical relevance. Clin Orthop Relat Res (258): 73–85

    Google Scholar 

  14. Hubbard JK, Sampson HW, Elledge JR (1997) Prevalence and morphology of the vastus medialis oblique muscle in human cadavers. Anat Rec 249(1): 135–242

    Article  PubMed  CAS  Google Scholar 

  15. Huberti HH, Hayes WC (1984) Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am 66(5): 715–724

    PubMed  CAS  Google Scholar 

  16. Hungerford DS, Barry M (1979) Biomechanics of the patellofemoral joint. Clin Orthop Relat Res (144): 9–15

    Google Scholar 

  17. Lindahl O, Movin A (1967) The mechanics of extension of the knee-joint. Acta Orthop Scand 38(2): 226–234

    Article  PubMed  CAS  Google Scholar 

  18. Mascal CL, Landel R, Powers C (2003) Management of patellofemoral pain targeting hip, pelvis and trunk muscle function: 2 case reports. J Orthop Sports Phys Ther 33(11): 647–660

    PubMed  Google Scholar 

  19. McGinty G, Irrgang JJ, Pezzullo D (2000) Biomechanical considerations for rehabilitation of the knee. Clin Biomech 15(3): 160–166

    Article  CAS  Google Scholar 

  20. Müller W, Wirz D (2000) Anatomie, Biomechanik und Dynamik des Patellofemoralgelenks. In: Wirth C, Rudert M (Hrsg) Das patellofemorale Schmerzsyndrom. Steinkopff, Darmstadt

  21. Reilly DT, Martens M (1972) Experimental analysis of the quadriceps muscle force and patello-femoral joint reaction force for various activities. Acta Orthop Scand 43(2): 126–137

    PubMed  CAS  Google Scholar 

  22. Steindler A (1955) Kinesiology of the human body. Thomas, Springfield, IL

  23. Steinkamp LA, Dillingham MF, Markel MD et al. (1993) Biomechanical considerations in patellofemoral joint rehabilitation. Am J Sports Med 21(3): 438–444

    Article  PubMed  CAS  Google Scholar 

  24. Toumi H et al. (2007) New insights into the function of the vastus medialis with clinical implications. Med Sci Sports Exerc 39(7): 1153–1159

    Article  PubMed  Google Scholar 

  25. van Eijden TM, de Boer W, Weijs WA (1985) The orientation of the distal part of the quadriceps femoris muscle as a function of the knee flexion-extension angle. J Biomech 18(10): 803–809

    Article  Google Scholar 

  26. van Kampen, A. Huiskes R (1990) The three-dimensional tracking pattern of the human patella. J Orthop Res 8(3): 372–382

    Article  Google Scholar 

  27. Werner S et al. (1993) Electrical stimulation of vastus medialis and stretching of lateral thigh muscles in patients with patello-femoral symptoms. Knee Surg Sports Traumatol Arthrosc 1(2): 85–92

    Article  PubMed  CAS  Google Scholar 

  28. Wilk KE et al. (1996) A comparison of tibiofemoral joint forces and electromyographic activity during open and closed kinetic chain exercises. Am J Sports Med 24(4): 518–527

    Article  PubMed  CAS  Google Scholar 

  29. Wilk KE, MM R (2001) Principles of Patellofemoral Rehabilitation. Sports Med Arthrosc 9: 325–336

    Article  Google Scholar 

  30. Zhang LQ et al. (2003) In vivo load sharing among the quadriceps components. J Orthop Res 21(3): 565–571

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Neuromuscular Research Laboratory, Schulthess-Klinik, Lengghalde 2, CH-8008, Zürich, Schweiz

    M. Bizzini MSc, PT, N. Maffiuletti & F. Impellizzeri

  2. Sportclinic Villa Linde, Biel, Schweiz

    R. Biedert

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  1. M. Bizzini MSc, PT
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  2. R. Biedert
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  3. N. Maffiuletti
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  4. F. Impellizzeri
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Correspondence to M. Bizzini MSc, PT.

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Bizzini, M., Biedert, R., Maffiuletti, N. et al. Biomechanische Aspekte in der Rehabilitation des Patellofemoralgelenks. Orthopäde 37, 864–871 (2008). https://doi.org/10.1007/s00132-008-1293-6

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