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Einlagen, Knie- und Unterschenkelorthesen in der Behandlung der medialen Gonarthrose

Eine aktuelle Literaturübersicht

Insoles, knee braces and ankle-foot orthoses in the treatment of medial gonarthrosis

A literature review

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Zusammenfassung

Hintergrund

Die Arthrose ist die häufigste Gelenkerkrankung weltweit und manifestiert sich am häufigsten in Form der Gonarthrose. In den Behandlungsalgorithmen haben orthopädietechnische Hilfsmittel in Form von Einlagen mit Außenranderhöhung, valgisierende Knieorthesen und Unterschenkelorthesen in der medial betonten Form der Gonarthrose einen Stellenwert. Nationale und internationale Leitlinien unterscheiden sich jedoch relevant in ihren Empfehlungen.

Einlagen

Unter Berücksichtigung einer Vielzahl wissenschaftlicher Arbeiten erscheint der messbare Effekt von Einlagen mit Außenranderhöhung gering zu sein, sodass eine rechtfertigende Indikation nur bei niedrigen Arthrosegraden besteht.

Knieorthesen

Valgisierende Knieorthesen konnten stärkere biomechanische und klinische Effekte nachweisen, bei jedoch etwas erhöhtem Komplikationspotenzial und geringer Compliance. Leicht- bis mittelgradige Arthrosen können behandelt werden.

Unterschenkelorthesen

Noch nicht abschließend untersucht sind Unterschenkelorthesen. Erste Arbeiten deuten eine biomechanische und klinische Wirksamkeit an. Gesamteffekt und Indikationsfeld erscheinen vergleichbar zu Knieorthesen, bei wohl geringerem Komplikationspotenzial.

Abstract

Background

Osteoarthritis is the most common joint disease worldwide and mostly affects the knee joint (gonarthrosis). In treatment algorithms, technical aids in the form of laterally wedged insoles, valgizing knee braces and ankle-foot orthoses have an importance in the treatment of medial unicompartmental knee joint disease. However, national and international guidelines differ in their recommendations.

Insoles

Taking into account a great amount of scientific work, the measurable effect of laterally wedged insoles appears to be low, so that a justifying indication only exists at low gonarthrosis levels.

Knee braces

Valgizing knee braces have shown stronger biomechanical and clinical effects, but with a slightly increased complication potential and low compliance. Low to medium-grade arthrosis can be treated.

Ankle-foot orthoses

Ankle-foot arthroses have not yet been conclusively examined. Initial work indicates biomechanical and clinical efficacy. The overall effects and indications appear comparable to knee braces, probably with less complication potential.

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Abbreviations

AAOS:

American Academy of Orthopaedic Surgeons

ADL :

Aktivitäten des täglichen Lebens

AFO :

Agilium Freestep Orthese

DGOOC :

Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie

KAAI :

„Knee adduction angular impulse“

KAM :

Knieadduktionsmoment

KFM :

„Knee flexion moment“

KOOS :

Knee Injury and Osteoarthritis Outcome Score

KSS :

Knee Society Score

LWI :

„Laterally wedged insoles“

NICE :

National Institute for Health and Care Excellence

NSAID :

„Non-steroidal anti-inflammatory drugs“

OARSI :

Osteoarthritis Research Society International

RACGP :

Royal Australian College of General Practitioners

VAS :

Visuelle Analogskala

WOMAC :

Western Ontario and McMaster Universities Osteoarthritis Index

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  1. Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland

    M. Schwarze, L. P. Bartsch, J. Block, S. I. Wolf & M. Alimusaj

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Correspondence to M. Schwarze.

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M. Schwarze, L.P. Bartsch, J. Block, S.I. Wolf und M. Alimusaj geben an, dass kein Interessenkonflikt besteht.

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Schwarze, M., Bartsch, L.P., Block, J. et al. Einlagen, Knie- und Unterschenkelorthesen in der Behandlung der medialen Gonarthrose. Orthopäde 49, 449–459 (2020). https://doi.org/10.1007/s00132-019-03802-w

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