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„Return to sports“ nach femoroazetabulärer Impingement-Operation

Return to sports after femoroacetabular impingement surgery

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Zusammenfassung

Die schmerzhafte Hüfte und deren Begleitpathologien stellen eine verstärkt erkannte Problematik bei Sportlern dar. Das femoroazetabuläre Impingement (FAI) wurde in den letzten Jahren als wichtige Ursache für Hüft- und Leistenschmerzen bei jungen Sportlern und als eine mögliche Ursache für die verfrühte Entstehung der Koxarthrose identifiziert. Gefährdende Sportarten sind v. a. solche mit schnellen Richtungswechseln (z. B. Fußball, Basketball), mit einer starken Beugung des Hüftgelenks (z. B. Kampfsportarten, [Eis-]Hockey, Eisschnelllauf) und mit supraphysiologischem Bewegungsausmaß (z. B. Tanzen). Neben der Reduktion der Schmerzen und dem Abwenden einer weiteren Schädigung des Gelenks sind die Verbesserung der körperlichen Aktivität und die Rückkehr zum Sport häufige Motivationen des Sportlers, sich einer Operation zu unterziehen, und besitzen daher einen hohen Stellenwert für die Patientenzufriedenheit. Bei rechtzeitiger Diagnosestellung kann mit einem guten klinischen Outcome und einer hohen Rate der Rückkehr zum Sport auf gleichem Niveau gerechnet werden. Die Evidenz für die postoperative Rehabilitation ist schwach; sie verläuft i. Allg. in 4 Phasen. Während die erste Phase zeitbasiert ist und der Protektion der biologischen Heilung dient, verlaufen die weiteren Phasen vornehmlich kriterienbasiert. Der Athlet sollte nach Abschluss der letzten Phase uneingeschränkt zu seiner Sportart zurückkehren. Erste Kriterien für einen „return to sports“ sind beschrieben worden; diese bilden die Grundlage unterschiedlicher Testbatterien, die das Leistungsniveau des Sportlers überprüfen. Maßgeblich für den erfolgreichen „return to sports“ scheint neben der Motivation des Patienten das Ausmaß der Knorpelschädigung zu sein.

Abstract

The painful hip and the associated lesions represent an increasingly recognized issue in athletes. In recent years femoroacetabular impingement (FAI) has been identified as one of the most important causes of hip and groin pain in young athletes as well as a possible cause of an early onset of osteoarthritis of the hip. Athletes participating in pivotal sports (e. g. soccer and basketball), in sports with high hip flexion (e. g. martial arts, hockey and speed skating) as well as sports that involve an extraordinary range of joint motion (e. g. dancing) are particularly at risk. Apart from relief of pain and prevention of further damage to the hip, returning to sports is one of the main reasons for patients to undergo surgery. Thus, return to sports plays an important role in a successful outcome. For patients with a timely diagnosis, the clinical outcome and return to sports after surgically treated FAI is very good and athletes can expect a postoperative recovery of the previous sports level. The evidence for postoperative rehabilitation schemes is weak but in general, four stages are distinguished. Whereas the first stage is time constrained and is important to protect tissue healing, the further stages are mainly criteria-based and necessitate sport-specific loading. After completion of the last stage athletes should be able to make an unrestricted resumption of sports activities. Preliminary criteria for return to sports after FAI surgery have been described but are still under development; however, patient motivation and the degree of cartilage damage seem to be the most important factors for return to sports and a successful outcome.

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Correspondence to J. H. Schröder.

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J. H. Schröder, M. Bizzini, S. Fickert, P. Hölmich, J. Krüger und S. Kopf geben an, dass kein Interessenkonflikt besteht.

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Schröder, J.H., Bizzini, M., Fickert, S. et al. „Return to sports“ nach femoroazetabulärer Impingement-Operation. Arthroskopie 29, 22–31 (2016). https://doi.org/10.1007/s00142-015-0060-z

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Schlüsselwörter

  • Hüftgelenk
  • Schmerz
  • Arthroskopie
  • Patientenzufriedenheit
  • Rehabilitation

Keywords

  • Hip joint
  • Pain
  • Arthroscopy
  • Patient satisfaction
  • Rehabilitation