Sensomotorische Kontrolle des Kniegelenks - BFH · Sensomotorische Kontrolle des Kniegelenks Heiner Baur 1, Leonore Bösch1, Angela Blasimann 1, Patric Eichelberger , Irene König

Berner Fachhochschule | Haute école spécialisée bernoise | Bern University of Applied Sciences

Sensomotorische Kontrolle des Kniegelenks

Heiner Baur1, Leonore Bösch

1, Angela Blasimann

1, Patric Eichelberger

1, Irene König

1, Helena Luginbühl

1, Lorenz Radlinger

1, Philipp Henle

2

1Berner Fachhochschule, Fachbereich Gesundheit, Physiotherapie

2Sonnenhofspital Bern, Kniechirurgie und Sportverletzungen


▶ Das vordere Kreuzband wird häufig geschädigt

Hootman et al., J Athlet Train., 2007

▶ Inzidenz Rate: 0.15 per 1000 Athleten

Hootman et al., J Athlet Train., 2007; Quisquater et al., Acta Orthop Belg., 2013.

▶ 80% sind sogenannte „Non-contact“-Verletzungen

http://sportskneetherapy.com www.kneealert.com

Epidemiologie


▶ Folgen: Instabilitätsgefühl

Folgeverletzungen wie Meniskusschäden

Arthrose (degenerative Knorpelschädigung)

Friel et al., Clin Sports Med., 2013

▶ Mechanismus: abruptes Abbremsen

Drehung/ Landung

17-50ms nach Bodenkontakt

körpereigenes Feedback reicht nicht für Schutz

passiert häufig unter Ermüdung ->Spielende

Brown et al., J Sci Med Sport, 2014, Price et al., J Sports Med 2004

Verletzungsmechanismus


▶ Beeinflussbarkeit der neuromuskulären Kontrolle?

▶ Prävention

▶ Therapie

▶ Können wir die neuromuskuläre Kontrolle erfassen?

▶ Zum richtigen Zeitpunkt?

▶ Unter nahezu realen Bedingungen ->“Verletzungssituation“?

Forschungsfrage

Bruhn et al., Hum Mov Sci 2011


▶ Neuromuskuläre Kontrolle vor und kurz nach Perturbation

Outcome

Behrens et al., plos one, 2013.


Experimentelles Setup


▶ Prüfung Messsetup

▶ Reliabilität

▶ Validität

▶ Vergleich intakt vs defekt -> „gesund“ vs. Krank“

▶ 2015-16

▶ Reflexgeschehen der Muskulatur

▶ Verhalten in funktionellen Situationen ->Treppensteigen

▶ Verlauf der neuromuskulären Kontrolle nach

▶ Konservativer Therapie

▶ Operativer Therapie

Forschungslinie


▶ Prüfung von Präventionsstrategien

▶ Trainingsmassnahmen

▶ Technikschulung

▶ Prüfung unterschiedlicher Nachbehandlungsschemen

▶ Konservativ

▶ Operativ

▶ Outcome unterschiedlicher OP-Strategien

▶ Evaluation orthopädischer Hilfsmittel

▶ mechanik vs. sensomotorische Effekte

Ausblick


▶ Sonnenhofspital Bern, Kniechirurgie

▶ Dr. Philipp Henle

▶ Förderung durch die Lindenhofstiftung

▶ Institut für Sportwissenschaft, Universität Rostock

▶ Prof. Dr. Sven Bruhn

▶ Dr. Michael Behrens

------

▶ Industriepartner: Ortho-Team AG, Bern

▶ Andreas Reinhard

Kooperationspartner



▶ Andriacchi T.P. & Dyrby C.O. (2005). Interactions between kinematics and loading during walking for the

normal and ACL deficient knee. Jornal of Biomechanics, 38, 293-298.

▶ Behrens M., Mau-Moeller A., Wassermann F. & Bruhn S.(2013).Effect of fatigue on hamstring reflex

responses and posterior-anterior tibial translation in men and women. PLoS One, 8(2):e56988.

doi:10.1371/journal.pone.0056988. Epub 2013 Feb 27.

▶ Beynnon B. D., Vacek P. M., Newell M. K., Tourville T. W., Smith H. C., Shultz S. J., Slauterbeck J. R. &

Johnson R. J. (2014). The Effects of Level of Competition, Sport, and Sex on the Incidence of First-Time

Noncontact Anterior Cruciate Ligament Injury. American Journal of Sports Medecine, 42, 1806-1812.

▶ Blackburn J.T. & Padua D.A. (2009) Sagittal-plane trunk position, landing forces and quadriceps

electromyogrphic activity. Journal of Athletic Training, 44, 174-179.

▶ Blackburn J.T, Norcross M.F. & Padua D.A. (2011). Influences of hamstring stiffness and strenghts on

anterior knee koint stability. Clinical Biomechanics, 26, 278-283.

▶ Blackburn J.T, Norcross M.F. Cannon L.N. & Zinder S.M. (2013). Hamstring stiffness and landing

biomechanics linked to anterior cruciate ligament loading. Journal of Athletic Training, 48, 764-772.

▶ Brown T.N., McLean S.G. & Palmier-Smith R.M. (2014). Associations between lower limb muscle activation

strategies and resultant multi-plantar knee kinematics during single leg landings. Journal of Science and

Medicine in Sport, 17, 408-413.

▶ Bruhn S.,Leukel C. & Gollhofer A.(2011). Differntial effects of stimulus characteristics during knee joint

pertubation on hamstring and quadriceps reflex responses. Human Movement Science, 30, 1079-1091.

▶ Button K., Roos P.E. & van Deursen R.W.M. (2014). Activity progression for anterior cruciate ligament

injured individuals. Clinical Biomechanics, 29, 206-212.

▶ Fiel N.A. & Chu C.R.(2013). The role of ACL injury in the development of posttraumatic knee

osteoarthritis. Clin Sports Med, 32, 1-12.

Literaturverzeichnis


▶ Gardinier E.S., Manal K., Buchanan T.S. & Snyder-Mackler L. (2012). Gait and neuromuscular asymmetries

after acute ACL rupture. Med Sci Sports Exerc, 44, 1490-1496.

▶ Gao B. & Zheng N.N. (2010). Alterations in three-dimensional joint kinemtaics of anterior cruciate

ligamnet-deficient and –reconstructed knees during walking. Clinical Biomachanics, 25, 222-229.

▶ Gao B., Cordova M.L. & Zheng N.N. (2012). Three-dimensional joint kinematics of ACL-deficient and ACL-

reconstructed knees during stair ascent and descent. Human Movement Schience, 31,222-235.

▶ Gehring D., Melnyk M. & Gollhofer A. (2009). Gender and fatigue have influence on knee joint control

strategies during landing. Clinical Biomechanics, 24, 82-87.

▶ Hootmann J.M., Dick R., Agel J.(2007). Epidemiology of collegiate injuries for 15 sports: summary and

recommendations for injury prevention initiatives. Journal of Athletic Training, 42, 311-319.

▶ Hughes G. and Watkins J.(2006). A risk-factor model for anterior cruciate ligamnet injury. Sports

Med,36,411-428.

▶ Hurd J.W. & Snyder-Mackler L. (2007). Knee instability after acute ACL rupture affects movement patterns

during the mid-stance phase of gait. Journal of orthopaedic research,25,1369-1377.

▶ Knoll Z. Kiss R.M & Kocsis L. (2004). Gait adaptation in ACL deficient patients before and after anterior

cruciate ligament reconstruction surgery. Journal of Electromyography and Kinesiology,14,287-294.

▶ Kulas A. S., Hortobagyi T. & Devita P. (2010). The interaction of trunk-load and trunk-position adaptations

on knee anterior shear and hamstrings muscle forces during landing. Journal of Athletic Training, 45, 5-

15.

▶ Kutzner I., Heinlein B, Graichen F., Bender A., Rohlmann A., Halder A., Beier A. & Bergmann G. (2010).

Loading of the knee joint during activities of daily living measured in vivo in five subjects. Journal of

Biomechanics, 43, 2164–2173.



▶ Melnyk M. & Gollhofer A. (2007). Submaximal fatigue of the hamstrings impairs specific reflex

components and knee stability. Knee Surg Sports Traumatol Arthrosc, 15, 525-532.Melnyk M., Faist M.,

Gothner M., Claes L. & Friemert B. (2007). Changes in stretch reflex excitability are related to „giving way”

symptoms in patinets with anterior cruciate ligament rupture. Journal of Neurophysology, 97, 474-480.

▶ Negahban H., Salavati M., Mazaheri M., Sanjari M.A., Hadian M. R. & Parnianpour M. (2010). Non-linear

dynamical features of center of pressure extracted by recurrence quantification analysis in people with

unilateral anterior cruciate ligamnet injury. Gait & Posture, 31, 450-455.

▶ Oberländer K.D., Brüggemann G., Höher J. & Karamanidis K. (2012). Reduced knee joint moment in ACL

deficient patients at a cost of dynamic stability during landing. Journal of Biomechanics, 45, 1387-1392.

▶ Orishimo K. F., Liederbach M., Kremenic I. J., Hagins M. & Pappas E. (2014). Comparison of landing

biomechanics between male and female dancers and athletes, part 1: Influence of sex on risk of anterior

cruciate ligament injury. American Journal of Sports Medecine, 42, 1082-8.

▶ Quisquater L., Bollars P., Vanlommel P., Claes S., Corten K. & Bellemanns J. (2013). The incidence of knee

and anterior cruciate ligament injuries over one decade in the Belgian soccer league. Acta Orthopædica

Belgica, 79, 541-546.

▶ Roos P.E., Button K., Sparkes V. & van Deursen R.W.M. (2014). Altered biomechanical strategies and

medio-lateral control of the knee represent incomplete recovery of individuals with injury during single

leg hop. Journal of Biomechanics,47,675-680.

▶ Rudolph K.S., Axe M.J., Buchanan T.S., Scholz J.P. & Snyder-Mackler L. (2001). Dynamic stability in the

anterior cruciate ligament deficient knee. Knee Surg Sports Traumatol Arthrosc, 9, 62-71.

▶ Zebis M.K., Andersen L.L., Bencke J.,Kjær M. & Aagaard P. (2009). Identification of Athletes at Future Risk

of Anterior Cruciate Ligament Ruptures by Neuromuscular Screening. The American Journal of Sports

Medecine, 37. doi:10.1177/0363546509335000.



▶ Zebis M.K., Andersen L.L., Bencke J.,Kjær M. & Aagaard P. (2009). Identification of Athletes at Future Risk

of Anterior Cruciate Ligament Ruptures by Neuromuscular Screening. The American Journal of Sports

Medecine, 37. doi:10.1177/0363546509335000.


Documents

Sensomotorische Kontrolle des Kniegelenks - BFH · Sensomotorische Kontrolle des Kniegelenks Heiner Baur 1, Leonore Bösch1, Angela Blasimann 1, Patric Eichelberger , Irene König