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Neue Therapieverfahren im Wettkampfsport

Was können wir aus der Betreuung von Spitzensportlern lernen?

New treatment methods in competitive sports

What can we learn from the medical care of top athletes?

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Zusammenfassung

Hintergrund

Im Zuge der Professionalisierung des Spitzensports ist die medizinisch-psychologische Betreuung der Athleten ein wichtiger Faktor, um diese bestmöglich zu unterstützen und so ihre Leistungen zu optimieren. Die Erfahrungen auf den Gebieten der Prävention, der konservativen und operativen Therapie sowie der Rehabilitation liefern darüber hinaus wertvolle Erkenntnisse für die Therapie unserer Patienten in der täglichen Praxis.

Prävention

Das Verletzungspräventionsprogramm FIFA 11+ dient der statischen und dynamischen Verbesserung von Muskelkraft, kinästhetischer Sensibilität und neuromuskulärer Kontrolle und ist als dreigliedriges Aufwärmprogramm konzipiert, welches mittlerweile sowohl bei der Trainerausbildung als auch im Freizeitsport breite Anwendung findet.

Konservative Therapie

Thrombozytenreiches Plasma (PRP) ist die mutmaßlich am weitesten verbreitete orthobiologische Behandlungsmethode zur konservativen Behandlung von Sehnen‑, Muskel- und Knorpelverletzungen. Die Wirksamkeit der Therapie hängt dabei von der zugrundeliegenden Pathologie und der betroffenen Körperregion ab. Die beste Evidenz gibt es für die Behandlung von Ansatztendinitiden der Patellasehne („jumpers knee“) und der Epicondylitis humeri radialis („Tennisellenbogen“).

Operative Therapie

Die Behandlung von VKB-Verletzungen bei Leistungssportlern stellt aufgrund des hohen körperlichen Anspruchs eine Herausforderung dar. Die zeitnahe chirurgische Intervention, die anatomische Rekonstruktion sowie die zusätzliche extraartikuläre Stabilisierung sind mit einem verbesserten operativen Ergebnis assoziiert. Die Transplantatwahl muss individuell, an die Anforderungen des Sportlers und unserer Patienten angepasst, erfolgen.

Rehabilitation

Die Elektromyographie (EMG) ist in der Rehabilitation ein diagnostisches Tool zur Identifikation von muskulären Dysbalancen und hilft durch Biofeedback-Training gleichzeitig diese zu verringern.

Kognitives Training

Training zur Schulung basaler kognitiver Fähigkeiten, dient – durch seinen potenziell positiven Einfluss auf die exekutiven Funktionen der Athleten – der Optimierung der Leistungsfähigkeit.

Abstract

Background

As elite sport becomes more professional, the medical-psychological care of athletes is an important factor in providing them with the best possible support and thus optimising their performance. Our experience in the fields of prevention, conservative and surgical treatment, and rehabilitation also provides valuable insights for the treatment of our patients in daily practice.

Prevention

Designed to improve static and dynamic muscle strength, kinaesthetic sensitivity, and neuromuscular control, the FIFA 11+ injury prevention programme is a three-part warm-up programme that is widely used in coaching and recreational sports.

Conservative treatment

Platelet-rich plasma (PRP) is probably the most widely used orthobiologic treatment modality for the conservative management of tendon, muscle and cartilage injuries. Its effectiveness depends on the underlying pathology and the affected body region. The best evidence exists for the treatment of patellar tendinitis (“jumper’s knee”) and epicondylitis humeri radialis (“tennis elbow”).

Surgical treatment

The treatment of ACL injuries in competitive athletes is challenging due to the high physical demands. Prompt surgical intervention, anatomical reconstruction and additional extra-articular stabilisation are associated with improved surgical outcomes. Graft selection must be individualised, adapted to the needs of the athletes and our patients.

Rehabilitation

Electromyography (EMG) is a diagnostic tool to identify muscular imbalances in rehabilitation and, at the same time, to help reduce them through biofeedback training.

Cognitive training

Training for the development of basic cognitive skills helps to optimise performance through its potentially positive influence on the executive functions of athletes.

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Abbreviations

AFC:

American Football Conference

BPTB :

„Bone patellar tendon bone“

EMG :

Elektromyographie

FIFA :

Fédération Internationale de Football Association

F‑MARC :

FIFA-Zentrum für medizinische Auswertung und Forschung

HS :

Hamstring

LP/P-PRP :

Leukozytenarmes/pures PRP

L‑PRP :

Leukozytenreiches PRP

NCAA :

National Collegiate Athletic Association

NFL :

National Football League

PRP :

Thrombozytenreiches Plasma

QS :

Quadrizepssehne

RCT :

„Randomized controlled trial“

VKB :

Vorderes Kreuzband

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Authors and Affiliations

  1. Orthopädische Universitätsklinik Heidelberg, Ruprecht-Karls-Universität, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland

    Johannes Weishorn, Tobias Renkawitz &  Yannic Bangert

  2. TSG ResearchLab gGmbH, Zuzenhausen, Deutschland

    Jan Spielmann & Jan Mayer

  3. Ethianum, Heidelberg, Deutschland

    Ralf Kern

  4. TSG 1899 Hoffenheim Fußball-Spielbetriebs GmbH, Zuzenhausen, Deutschland

    Ralf Kern &  Yannic Bangert

  5. Abteilung Innere Medizin VII, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    Birgit Friedmann-Bette

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  1. Johannes Weishorn
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Correspondence to Yannic Bangert.

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Interessenkonflikt

T. Renkawitz weist auf folgende finanzielle Interessen hin: Forschungsförderung zur persönlichen Verfügung: DePuy, Zimmer, Aesculap, Bundesministerium für Bildung und Forschung, Deutsche ArthroseHilfe, Otto-Bock-Stiftung, Bundesministerium für wirtschaftliche Zusammenarbeit und Entwicklung, Stiftung Oskar-Helene-Heim in Berlin, Vielberth-Stiftung Regensburg, Deutsche Forschungsgemeinschaft (DFG). Kostenerstattungen: DePuy, Zimmer, Aesculap, Bundesministerium für Bildung und Forschung, Deutsche Arthrose-Hilfe, Otto-Bock-Stiftung, Bundesministerium für wirtschaftliche Zusammenarbeit und Entwicklung, Stiftung Oskar-Helene-Heim in Berlin, Vielberth-Stiftung, DGOOC, BVOU, DGOU. Kostenerstattungen für Schulungen/Vorträge: DePuy, Zimmer, Aesculap, Deutsche Gesellschaft für Endoprothetik (AE), Bayerischer Hausärzteverband. Nichtfinanzielle Interessen: Lehrstuhlinhaber (W3) für Orthopädische Chirurgie, Ruprecht-Karls-Universität Heidelberg, Direktor der Orthopädischen Universitätsklinik Heidelberg. Mitgliedschaften: Vizepräsident des Berufsverband für Orthopädie und Unfallchirurgie (BVOU), Gesamtvorstand der DGOOC, Leiter der „Arbeitsgemeinschaft Evidenzbasierte Medizin“ der DGOU, Herausgeberboard von Die Orthopädie und Die Unfallchirurgie (SpringerMedizin), Schriftleitung der Orthopädie und Unfallchirurgie – Mitteilungen und Nachrichten (OUMN), International Advisory Board des Journal of the American Academy of Orthopaedic Surgeons (AAOS). J. Weishorn, J. Spielmann, R. Kern, J. Mayer, B. Friedmann-Bette und Y. Bangert geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Weishorn, J., Spielmann, J., Kern, R. et al. Neue Therapieverfahren im Wettkampfsport. Orthopädie 52, 897–906 (2023). https://doi.org/10.1007/s00132-023-04440-z

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