Traktion im Kniegelenk bewirkt eine geringe Gelenkflächenseparation ^[1]

Zusammenfassung

Traktion ist eine klassische Behandlung für Kniegelenkkontrakturen in der Orthopädie und Physiotherapie, um Schmerz und Beweglichkeit zu verbessern. Unklar ist, ob die positive Wirkung auf neurophysiologischem Weg oder durch lokale mechanische Effekte wie eine Dehnung der Gelenkkapsel entsteht. Für Letztere müssen sich während der Traktion die Gelenkflächen voneinander entfernen.

Die vorliegende Arbeit untersuchte die Kniegelenke von 5 gesunden Probanden ohne und während der Anwendung von 11,5 kg Traktionskraft in der Magnetresonanztomografie. Unabhängig voneinander analysierten 2 Radiologen die Veränderung des Gelenkspalts. Das Ergebnis zeigt eine signifikante Vergrößerung des medialen Gelenkspalts um 0,36 ± 0,15 mm (p < 0,05), während sich der laterale Gelenkspalt nur bei 1 Probanden um 0,6 mm vergrößerte. Die Messungen beider Radiologen stimmten mit einem Pearson-Korrelationskoeffizienten von 0,654 (p < 0,05) hoch überein. Beim 1. Radiologen korrelierte das Gesamtausmaß der Kniebeweglichkeit und -flexion mit seinen Traktionsmessungen, nicht aber beim zweiten. Aufgrund der geringen Unterschiede in den Messungen beider Radiologen und dem normalen Bewegungsausmaß aller Probanden fehlt diesem Befund die klinische Relevanz.

Abstract

In orthopaedics and in physiotherapy traction is a classical treatment for knee joint contracture which is used to improve pain and mobility. It is unclear whether the positive effect is due to neurophysiological mechanisms or due to mechanical effects such as joint capsule elongation. Gapping of the articular surfaces during traction is necessary for the latter to occur.

This study examined the knee joints of 5 healthy subjects without and during the application of 11.5 kg traction force using magnetic resonance imaging. Two radiologists independently analysed changes in the joint space. The result showed a significant enlargement of the medial joint space of 0.36 ± 0.15 mm (p < 0.05), whereas the lateral joint space increased only in 1 subject by 0.6 mm. Both radiologists’ measurements showed a high level of agreement using Pearson’s correlation coefficient of 0.654 (p < 0.05). The first radiologist’s measurement of total knee range and flexion correlated with his traction measurements, but the second radiologist’s measurement did not correlate. However, this result has no clinical relevance due to the small differences in both the radiologists’ measurements and normal range of motion in all of the subjects.

Schlüsselwörter

Traktion - Kniegelenk - Magnetresonanztomografie - Manuelle Therapie - Gelenkflächenseparation

Keywords

traction - knee joint - magnetic resonance imaging - manual therapy - articular surface gapping

1 Thesis von D. Rietzschel zum Erwerb des Master of Science in muskuloskeletaler Physiotheraie an der Donau-Universität Krems, Österreich.

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