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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
Berner Fachhochschule | Haute école spécialisée bernoise | Bern University of Applied Sciences
▶ 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
Berner Fachhochschule | Haute école spécialisée bernoise | Bern University of Applied Sciences
▶ 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
Berner Fachhochschule | Haute école spécialisée bernoise | Bern University of Applied Sciences
▶ 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
Berner Fachhochschule | Haute école spécialisée bernoise | Bern University of Applied Sciences
▶ Neuromuskuläre Kontrolle vor und kurz nach Perturbation
Outcome
Behrens et al., plos one, 2013.
Berner Fachhochschule | Haute école spécialisée bernoise | Bern University of Applied Sciences
Experimentelles Setup
Berner Fachhochschule | Haute école spécialisée bernoise | Bern University of Applied Sciences
▶ 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
Berner Fachhochschule | Haute école spécialisée bernoise | Bern University of Applied Sciences
▶ Prüfung von Präventionsstrategien
▶ Trainingsmassnahmen
▶ Technikschulung
▶ Prüfung unterschiedlicher Nachbehandlungsschemen
▶ Konservativ
▶ Operativ
▶ Outcome unterschiedlicher OP-Strategien
▶ Evaluation orthopädischer Hilfsmittel
▶ mechanik vs. sensomotorische Effekte
Ausblick
Berner Fachhochschule | Haute école spécialisée bernoise | Bern University of Applied Sciences
▶ 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
Berner Fachhochschule | Haute école spécialisée bernoise | Bern University of Applied Sciences
Berner Fachhochschule | Haute école spécialisée bernoise | Bern University of Applied Sciences
▶ 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
Berner Fachhochschule | Haute école spécialisée bernoise | Bern University of Applied Sciences
▶ 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.
Literaturverzeichnis
Berner Fachhochschule | Haute école spécialisée bernoise | Bern University of Applied Sciences
▶ 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.
Literaturverzeichnis
Berner Fachhochschule | Haute école spécialisée bernoise | Bern University of Applied Sciences
▶ 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.
Literaturverzeichnis