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Einlagen, Knie- und Unterschenkelorthesen in der Behandlung der medialen Gonarthrose

Eine aktuelle Literaturübersicht
  • M. SchwarzeEmail author
  • L. P. Bartsch
  • J. Block
  • S. I. Wolf
  • M. Alimusaj
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Zusammenfassung

Hintergrund

Die Arthrose ist die häufigste Gelenkerkrankung weltweit und manifestiert sich am häufigsten in Form der Gonarthrose. In den Behandlungsalgorithmen haben orthopädietechnische Hilfsmittel in Form von Einlagen mit Außenranderhöhung, valgisierende Knieorthesen und Unterschenkelorthesen in der medial betonten Form der Gonarthrose einen Stellenwert. Nationale und internationale Leitlinien unterscheiden sich jedoch relevant in ihren Empfehlungen.

Einlagen

Unter Berücksichtigung einer Vielzahl wissenschaftlicher Arbeiten erscheint der messbare Effekt von Einlagen mit Außenranderhöhung gering zu sein, sodass eine rechtfertigende Indikation nur bei niedrigen Arthrosegraden besteht.

Knieorthesen

Valgisierende Knieorthesen konnten stärkere biomechanische und klinische Effekte nachweisen, bei jedoch etwas erhöhtem Komplikationspotenzial und geringer Compliance. Leicht- bis mittelgradige Arthrosen können behandelt werden.

Unterschenkelorthesen

Noch nicht abschließend untersucht sind Unterschenkelorthesen. Erste Arbeiten deuten eine biomechanische und klinische Wirksamkeit an. Gesamteffekt und Indikationsfeld erscheinen vergleichbar zu Knieorthesen, bei wohl geringerem Komplikationspotenzial.

Schlüsselwörter

Hilfsmittel Arthrose Fußorthese Kniegelenk Kniegelenksarthrose 

Abkürzungen

AAOS

American Academy of Orthopaedic Surgeons

ADL

Aktivitäten des täglichen Lebens

AFO

Agilium Freestep Orthese

DGOOC

Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie

KAAI

„Knee adduction angular impulse“

KAM

Knieadduktionsmoment

KFM

„Knee flexion moment“

KOOS

Knee Injury and Osteoarthritis Outcome Score

KSS

Knee Society Score

LWI

„Laterally wedged insoles“

NICE

National Institute for Health and Care Excellence

NSAID

„Non-steroidal anti-inflammatory drugs“

OARSI

Osteoarthritis Research Society International

RACGP

Royal Australian College of General Practitioners

VAS

Visuelle Analogskala

WOMAC

Western Ontario and McMaster Universities Osteoarthritis Index

Insoles, knee braces and ankle-foot orthoses in the treatment of medial gonarthrosis

A literature review

Abstract

Background

Osteoarthritis is the most common joint disease worldwide and mostly affects the knee joint (gonarthrosis). In treatment algorithms, technical aids in the form of laterally wedged insoles, valgizing knee braces and ankle-foot orthoses have an importance in the treatment of medial unicompartmental knee joint disease. However, national and international guidelines differ in their recommendations.

Insoles

Taking into account a great amount of scientific work, the measurable effect of laterally wedged insoles appears to be low, so that a justifying indication only exists at low gonarthrosis levels.

Knee braces

Valgizing knee braces have shown stronger biomechanical and clinical effects, but with a slightly increased complication potential and low compliance. Low to medium-grade arthrosis can be treated.

Ankle-foot orthoses

Ankle-foot arthroses have not yet been conclusively examined. Initial work indicates biomechanical and clinical efficacy. The overall effects and indications appear comparable to knee braces, probably with less complication potential.

Keywords

Aids Arthrosis Foot orthosis Knee joint Osteoarthritis of knee 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Schwarze, L.P. Bartsch, J. Block, S.I. Wolf und M. Alimusaj geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • M. Schwarze
    • 1
    Email author
  • L. P. Bartsch
    • 1
  • J. Block
    • 1
  • S. I. Wolf
    • 1
  • M. Alimusaj
    • 1
  1. 1.Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und ParaplegiologieUniversitätsklinikum HeidelbergHeidelbergDeutschland

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