Christian Nührenbörger

Extracorporeal shock wave therapy for tendinopathies

Shock waves, as applied in urology and gastroenterology, were introduced in the middle of the last decade in Germany to treat different pathologies of the musculoskeletal system, including epicondylitis of the elbow, plantar fasciitis, and calcifying and noncalcifying tendinitis of the rotator cuff. With the noninvasive nature of these waves and their seemingly low complication rate, extracorporeal shock wave therapy (ESWT) seemed a promising alternative to the established conservative and surgical options in the treatment of patients with chronically painful conditions. However, the apparent advantages of the method led to a rapid diffusion and even inflationary use of ESWT; prospective, randomized studies on the mechanisms and effects of shock waves on musculoskeletal tissues were urgently needed to define more accurate indications and optimize therapeutic outcome. This review covers recent international research in the field and presents actual indications and results in therapy of musculoskeletal conditions with ESWT.

Static rotational knee laxity in anterior cruciate ligament injuries.

PurposeThe purpose was to provide an overview of the non-invasive devices measuring static rotational knee laxity in order to formulate recommendations for the future.ResultsEarly cadaver studies provided evidence that sectioning the anterior cruciate ligament (ACL) led to an increase of static rotational knee laxity of approximately 10–20% between full extension and 30° of knee flexion. Sections of the menisci or of the peripheral structures induced a much higher increase in rotation. This supported the hypothesis that static rotation measurements might be useful for the diagnosis of ACL or associated injuries. In vivo evaluations with measurement devices are relatively new. Several articles were published during the last decade with many different devices and important differences were seen in absolute rotational knee laxity between them. This was due to the varying precision of the devices, the variability in patient positioning, the different methods of measurement, examination protocols and data analysis. As a consequence, comparison of the available results should be performed with caution. Nevertheless, it has been established that rotational knee laxity was greater in females as compared to males and that the inter-subject variability was high. For this reason, it will probably be difficult to categorise injured patients preoperatively, and the interpretation of the results should probably be limited to side-to-side differences.ConclusionFuture studies will show whether rotational laxity measurements alone will be sufficient to provide clinically relevant data or if they should be combined to static sagittal laxity measurements.

Noninjured Knees of Patients With Noncontact ACL Injuries Display Higher Average Anterior and Internal Rotational Knee Laxity Compared With Healthy Knees of a Noninjured Population

Background: Excessive physiological anterior and rotational knee laxity is thought to be a risk factor for noncontact anterior cruciate ligament (ACL) injuries and inferior reconstruction outcomes, but no thresholds have been established to identify patients with increased laxity. Purpose: (1) To determine if the healthy contralateral knees of ACL-injured patients have greater anterior and rotational knee laxity, leading to different laxity profiles (combination of laxities), compared with healthy control knees and (2) to set a threshold to help discriminate anterior and rotational knee laxity between these groups. Study Design: Case-sectional study; Level of evidence, 3. Methods: A total of 171 healthy contralateral knees of noncontact ACL-injured patients (ACL-H group) and 104 healthy knees of control participants (CTL group) were tested for anterior and rotational laxity. Laxity scores (measurements corrected for sex and body mass) were used to classify knees as hypolax (score <–1), normolax (between −1 and 1), or hyperlax (>1). Proportions of patients in each group were compared using χ2 tests. Receiver operating characteristic curves were computed to discriminate laxity between the groups. Odds ratios were calculated to determine the probability of being in the ACL-H group. Results: The ACL-H group displayed greater laxity scores for anterior displacement and internal rotation in their uninjured knee compared with the CTL group (P < .05). Laxity profiles were different between the groups for the following associations: normolax in anterior displacement/hypolax in internal rotation (6% [ACL-H] vs 15% [CTL]; P = .02) and hyperlax in anterior displacement/normolax in internal rotation (27% [ACL-H] vs 10% [CTL]; P < .01). The laxity score thresholds were 0.75 for anterior laxity and −0.55 for internal rotation. With both scores above these thresholds, a patient was 3.18-fold more likely to be in the ACL-H group (95% CI, 1.74-5.83). Conclusion: The healthy contralateral knees of patients with noncontact ACL injuries display different laxity values both for internal rotation and anterior displacement compared with healthy control knees. The identification of knee laxity profiles may be of relevance for primary and secondary prevention programs of noncontact ACL injuries.

Sportverletzungen des Kniegelenks im Kindesalter

ZusammenfassungRegelmäßige sportliche Aktivität im Kindes- und Jugendalter sollte wegen verschiedener positiver gesundheitlicher Effekte gefördert werden, kann aber auch mit Knieverletzungen einhergehen, die zum Sportabbruch und zu gesundheitlichen Langzeitfolgen führen. Aufgrund der physiologischen Wachstumsprozesse im Rahmen der biologischen Reifung unterscheiden sich Knieverletzungen bei Kindern von denen bei Jugendlichen und Erwachsenen. Allgemein gesehen sind sie häufiger bei Jungen, wobei im Rahmen von sportlicher Aktivität Mädchen häufiger betroffen sind. Folgende unterschiedliche Risikofaktoren für Sportverletzungen konnten gefunden werden: Alter, Vorverletzung, Sportart und -kontext, Trainingsumfang, Koordination sowie psychologischer Zustand. Die beeinflussbaren Faktoren sollten dabei in die primäre und sekundäre Verletzungsprävention einbezogen werden.AbstractActive sport participation should be encouraged in children and adolescents because of a variety of beneficial effects on health. However, regular physical activity also generates a significant proportion of knee injuries, which will affect future involvement and may have detrimental long-term health consequences. Because of the physiological processes related to biological maturation, knee injuries in children have a different pattern compared to adolescents and adults. Knee lesions are generally more common in boys, but in a sport context girls are more frequently affected. A series of other risk factors for sports injuries have been identified, such as age, injury history, context and type of sport, training volume, coordination and psychological factors. Those factors which are modifiable should be targeted for primary and secondary injury prevention.

Orthopädische Checkliste: Rudern

316 A. Urhausen, C. Nuhrenborger · Rudern In der Antike dienten Ruderboote den Agyptern, Griechen und Romern lediglich als Fortbewegungsund Transportmittel. Die Wiege der Sportart Rudern stand wohl im viktorianischen England des 17. und fruhen 18. Jahrhunderts. Seit dem 19. Jahrhundert wurde Rudern in ganz Europa und schlieslich auch in Amerika popular. In Deutschland als mitgliederstarkste Rudernation liegt die Zahl der sportlich aktiven Vereinsmitglieder bei ca. 45.000, in Osterreich bei 3000 und in der Schweiz bei 6300. Der Deutsche Ruderverband ist der alteste Sportverband Deutschlands. Im Internationalen Ruderverband sind derzeit 118 Nationen organisiert. Zu den weltweit erfolgreichsten Rudernationen zahlen neben Deutschland, das in den letzten Jahren mehrfach die Nationenwertung im Weltcup und bei den Weltmeisterschaften gewinnen konnte, die USA, Australien, Rumanien, Italien, Grosbritannien und Kanada. In den angelsachsischen Landern ist (Riemen-)Rudern in Schulen und Universitaten etabliert, traditionelle Veranstaltungen wie das seit 1829 ausgetragene Boat-Race der Universitaten Oxford gegen Cambridge, die Henley-Regatta oder der Head-of-the-Charles in Boston/Cambridge oder seit 2000 der Canal-Cup der Achter uber 12,7 km in Rendsburg sind Medienereignisse und locken jahrlich Hunderttausende Zuschauer an die Strecke sowie Millionen vor die Fernseher. Seit Beginn der Spiele der Neuzeit 1896 ist Rudern olympisch. Die klassische Renndistanz betragt 2000 m. Neben den offenen Klassen gibt es auch (seit 1996 teilweise olympische) Leichtgewichtsruderklassen, in denen die obere Gewichtsgrenze fur Manner bei 70 kg (Bootsmittel) bzw. 72,5 kg (individuell) und fur Frauen bei 57 bzw. 59 kg liegt. Das Wiegen geschieht maximal 2 Stunden vor dem Rennen, eine intravenose Flussigkeitszufuhr zwischen Waage und Rennen fuhrt zur Disqualifikation. Ein Wechsel der Bootsbesatzung auf internationalen Regatten ist nur im Krankheitsfall erlaubt.