Kreuzbandrehabilitation in der offenen Kette – Fakten und Mythen[1]

Zusammenfassung

In der Rehabilitation nach einer vorderen Kreuzbandruptur besteht Uneinigkeit darüber, ob in der offenen Kette trainiert werden darf oder ausschließlich das Training in der geschlossenen Kette zu bevorzugen ist.

Dieser Review untersuchte die Evidenz, ob es in der offenen Kette über eine verstärkte anteriore Tibiatranslation zu einer größeren Laxität des Transplantats und schlechteren funktionellen Nachbehandlungsergebnissen kommt. Als Resultat fanden sich widersprüchliche Beweise für eine vergrößerte Laxität bzw. kein Beweis für schlechtere funktionelle Nachbehandlungseffekte.

Abstract

In rehabilitation after anterior cruciate ligament reconstruction there is continued disagreement concerning the advisability of exercise in an open kinetic chain or whether exercise exclusively in the closed kinetic chain should be favoured.

This review examined the evidence concerning greater anterior tibia displacement during exercise in an open kinetic chain with resulting increase in the transplant’s laxity and poor functional rehabilitation outcome. The results were inconclusive concerning increased laxity and showed no evidence for poorer functional outcome.

vordere Kreuzbandruptur - offene Kette - geschlossene Kette - Laxität - funktionelle Nachbehandlungsergebnisse - Evidenz

anterior cruciate ligament rupture - open kinetic chain - closed kinetic chain - laxity - functional outcome - evidence

Literatur

• 1 Beynnon B, Johnson R J, Fleming B C. et al . The strain behaviour of the anterior cruciate ligament during squatting and active flexion-extension.  Am J Sports Med. 1997;  25 823-829
• 2 Beynnon B. et al . Rehabilitation after anterior cruciate ligament reconstruction.  Am J Sports Med. 2005;  33 347-359
• 3 Bynum E B, Barrack R L, Alexander A H. Open versus closed chain kinetic exercises after anterior cruciate ligament reconstruction. A prospective randomized trial.  Am J Sports Med. 1995;  23 401-406
• 4 Draganich L F, Jaeger R J, Kralj A R. Coactivation of the hamstrings and quadriceps during extension of the knee.  J Bone Joint Surg. 1989;  71A 1075-1081
• 5 Eastlack M E, Axe M J, Snyder-Mackler L. Laxitiy, instability, and functional outcome after ACL injury: copers versus noncopers.  Med Sci Sports Exerc. 1999;  31 210-215
• 6 Engelhardt M, Freiwald J, Rittmeister M. Rehabilitation nach vorderer Kreuzbandplastik.  Der Orthopäde. 2002;  31 791-798
• 7 Fitzgerald G K. Open versus closed kinetic chain exercise: Issues in rehabilitation after anterior cruciate ligament reconstructive surgery.  Physical Therapy. 1997;  77 1747-1754
• 8 Fleming B C, Oksendahl H, Beynnon B. Open- or Closed-kinetic Chain Exercises after Anterior Cruciate Ligament Reconstruction.  Exercise and Sport Sciences Review. 2005;  33 134-140
• 9 Heijne A, Werner S. Early versus Late Start of Open Kinetic Chain Quadriceps Exercise after ACL Reconstruction with Patellar Tendon or Hamstring Grafts: A Prospective Randomized Outcome Trial.  Knee Surg Sports Traumtol Arthrosc. 2007;  15 402-414
• 10 Hooper D M, Morrissey M C, Drechsler W I. et al . Open and closed kinetic chain exercises in the early period after ACL reconstruction: improvements in level walking, stairs ascent and descent.  Am J Sports Med. 2001;  29 167-174
• 11 Hsieh H H, Walker P S. Stabilizing mechanisms of the loaded and unloaded knee joint.  J Bone Joint Surg. 1976;  58 A 87-93
• 12 Jonsson H, Kärrholm J, Elmquist L G. Kinematics of active knee extension after tear of the anterior cruciate ligament.  Am J Sports Med. 1989;  17 796-802
• 13 Jonsson H, Kärrholm J, Elmquist L G. Laxity after cruciate ligament injury in 94 knees. The KT-1000 arthrometer versus roentgen stereophotogrammetry.  Acta Orthop Scand. 1993;  64 567-570
• 14 Küpper J C, Loitz-Ramage B, Corr D T. et al . Measuring knee joint laxitiy: A review of applicable models and the need for new approaches to minimize variability.  Clin Biomechanics. 2007;  22 1-13
• 15 Kvist J, Gillquist J. Sagittal plane knee translation and elctromyographic activity during closed and open kinetic chain exercises in anterior cruciate ligament – deficient patients and control subjects.  Am J Sports Med. 2001;  29 72-82
• 16 Lutz G E, Palmiter R A, An K N. Comparison of tibiofemoral joint forces during open-kinetic-chain and closed-kinetic-chain exercises.  J Bone Joint Surg. 1993;  75 A 732-739
• 17 Mikkelsen C, Werner S, Eriksson E. Closed kinetic chain alone compared to combined open and closed kinetic chain exercise for quadriceps strengthening after anterior cruciate ligament reconstruction with respect to return to sports: a prospective matched follow-up.  Knee Surg Sports Trauma Arthrosc. 2000;  8 330-342
• 18 Morrissey M, Hudson Z L, Drechsler W J. et al . Effects of open versus closed kinetic chain training on knee laxity in the early period after anterior cruciate ligament reconstruction.  Knee Surg Sports Trauma Arthrosc. 2000;  8 343-348
• 19 Ohkoshi Y, Yasuda K, Kaneda K. Biomechanical analysis of rehabilitation in the standing position.  Am J Sports Med. 1991;  19 605-611
• 20 Pässler H H, Shelbourne K D. Biologische, biomechanische und klinische Konzepte zur Nachbehandlung nach Bandeingriffen am Knie.  Der Orthopäde. 1993;  22 421-435
• 21 Perry C, Morrissey M C, King J B. et al . Effects of closed versus open kinetic chain knee extensor resistance training on knee laxity and leg function in patients during the 8- to 14-week post-operative period after anterior cruciate ligament reconstruction.  Knee Surg Sports Trauma Arthrosc. 2005;  13 357-369
• 22 Pollet V. et al . The role of the Rolimeter in Quantifying Knee Instability Compared to the Functional Outcome of ACL-Reconstructed versus Conservatively Treated Knees.  Knee Surg sports Traumatol Arthrosc. 2005;  13 12-18
• 23 Roberts D. et al . Clinical Measurement of Propioception, Muscle Strength and Laxity in Relation to Function in the ACL-Injured Knee.  Knee Surg Sports Traumatol Arthrosc. 2007;  15 9-16
• 24 Roi G S. et al . Return to Official Italian First Division Soccer Games within 90 Days after Anterior Ligament Reconstruction: A Case Report.  J Orthop Sports Phys Ther. 2005;  35 52-61
• 25 Ross M D, Dengar C R, Winzenried J A. Implementation of open and closed kinetic chain quadriceps strengthening exercises after anterior cruciate ligament reconstruction.  J Strength Cond Res. 2001;  15 466-473
• 26 Shaw T, Williams M T, Chipchase L C. Do early exercises affect the outcome of ACL reconstruction? A randomized controlled trial.  Australian Journal of Physiotherapy. 2005;  51 9-17
• 27 Synder-Macker L. Reflex inhibition of the quadriceps femoris muscle after injury or reconstruction of the anterior cruciate ligament.  J Bone and Joint Surgery (Am). 1994;  76 555-560
• 28 Trees A H, Howe T E, Dixon J. et al . Exercise for treating isolated anterior cruciate ligament injuries in adults.  The Cochrane Library. 2006;  Issue 3
• 29 Yack H J, Collins C E, Whieldon T J. Comparison of closed and open kinetic chain exercise in the anterior cruciate ligament-deficient knee.  Am J Sorts Med. 1993;  21 49-54
• 30 www.pedro.fhs.usyd.edu.au/scale_item.html

1 Die Arbeit wurde im Rahmen des Master-of-Science-Studiengangs Muskuloskelettale Physiotherapie an der Donau-Universität Krems erstellt.