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Einfluss von Gangbildmodifikationen und Orthesen auf die Kniegelenkbelastung bei Kniearthrose

Influence of gait modifications and orthoses on the knee joint load in knee osteoarthritis

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Zusammenfassung

Die mediale Kniegelenkarthrose ist eine der häufigsten Erkrankungen bei Personen über 55 Jahren. Die eingeschränkte Mobilität und Schmerzsituation beeinträchtigen das tägliche Leben. Neben den operativen gibt es auch konservative Maßnahmen, die zu einer Schmerzreduktion und Belastungsnormalisierung führen können. Dazu zählen aktive Maßnahmen wie die Modifikation des Gangbilds und Muskelkräftigung. Durch die Modifikation des Gangbilds lässt sich die Belastungssituation im Gehen reduzieren. Nachgewiesen wird diese Belastungsreduktion mithilfe einer dreidimensionalen Ganganalyse. Der primäre Zielparameter ist dabei das externe Adduktionsmoment. Modifikationen, die die Belastungssituation positiv beeinflussen sind vermehrte Seitneigung zur Standbeinseite, vermehrte Fußaußenrotation oder vermehrte Oberschenkelinnenrotation. Passive Maßnahmen, wie Kniegelenksorthesen oder Schuhranderhöhungen, können ebenfalls zu einer Reduktion des externen Adduktionsmoments führen. In Studien wurde nachgewiesen, dass die Maßnahmen nicht nur das Adduktionsmoment, sondern auch subjektiv das Schmerzempfinden verringern. Konservative Maßnahmen können eine Belastungsreduktion im Kniegelenk bewirken und somit die Lebensqualität insgesamt etwas steigern.

Abstract

Medial knee osteoarthritis is one of the most common diseases in persons over 55 years of age. Limited mobility and pain impair the activities of daily life. In addition to surgical interventions there are also conservative treatment options that can lead to pain reduction and normalization of load distribution. These include active treatment options, such as modification of gait and muscle strengthening. Modification of the gait pattern can lead to a reduction in the load situation in the knee joint during walking. This reduction in load is detected by a three-dimensional gait analysis during which the load situation in the knee joint can be measured. The primary target parameter is the external adduction moment. Modifications, such as increased lateral trunk sway, increased foot progression angle or increased internal thigh rotation can positively influence the load situation. Passive treatment options, such as knee joint braces or lateral wedge insoles also result in reduction of the external adduction moment. Studies have demonstrated that these measures not only caused a reduction of the moment but also reduced the subjective feeling of pain. Conservative measures can result in a reduction of knee joint loading and thus increase the quality of life.

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Authors and Affiliations

  1. Labor für Gang- und Bewegungsanalyse, Orthopädisches Spital Speising, Speisinger Straße 109, 1130, Wien, Österreich

    A. Kranzl

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Interessenkonflikt

A. Kranzl gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Dieser Beitrag basiert auf einem Vortrag, gehalten auf dem Kongress „Knie- und Schulterschmerzen – ein häufiges Problem in der Praxis“ in Pörtschach am Wörthersee im Juli 2016.

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Kranzl, A. Einfluss von Gangbildmodifikationen und Orthesen auf die Kniegelenkbelastung bei Kniearthrose. Manuelle Medizin 55, 9–13 (2017). https://doi.org/10.1007/s00337-016-0220-x

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