Zusammenfassung
Die Tendopathie der Achillessehne ist ein multifaktorielles Krankheitsbild, bei dem völlig unterschiedliche Patientengruppen betroffen sind. Die Problematik wird immer noch von vielen Patienten als Entzündung begriffen. Die Behandlungsdauer wird dabei unterschätzt, viele Behandlungsmaßnahmen bleiben ineffektiv. Sehnenprobleme sind degenerative Erkrankungen, die realistische Behandlungszeit beträgt Wochen bzw. Monate. Für die konservative Therapie wird ein multimodales, auf den Patienten zugeschnittenes Behandlungskonzept angeregt, das idealerweise mit einem multiprofessionellen Team umgesetzt werden sollte. Eine operative Therapie ist bei der Mid-portion-Tendopathie der Achillessehne selten notwendig, bei den insertionsnahen Tendopathien jedoch, vor allem bei hohem Leistungsanspruch der Betroffenen, fast unumgänglich. Teilrupturen der Achillessehne werden abhängig vom Umfang des betroffenen Sehnenquerschnitts, der mit dem Funktionsverlust korreliert, konservativ oder operativ behandelt. Komplette Sehnenrupturen werden unter Berücksichtigung des Leistungsanspruchs des betroffenen Patienten unter Beachtung individueller Risikofaktoren behandelt. Um die Funktion der Achillessehne bestmöglich herzustellen, ist die operative Therapie mittels Triple-Bündel-Technik Mittel der Wahl.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsLiteratur
Abate M, Sibernagel KG, Siljeholm C, Di Iorio A, De Amicis D, Salini V, Werner S, Paganelli R (2009) Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Research & Therapy 11:235
Alfredson H, Pietilä T, Jonsson P, Lorentzon R (1998) Heavy–load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 26:360–366
Aström M (1998) Partial rupture in chronic Achilles tendinopathy. A retrospective analysis of 342 cases. Acta Orthop Scand 69(4):404–407
Bleakney RR, White LM (2005) Imaging of the Achilles tendon. Foot Ankle Clin 10(2):239–254
Bohnsack M, Rühmann O, Kirsch L, Wirth CJ (2000) Surgical shortening of the achilles tendon for correction of elongation following healed conservatively treated Achilles tendon rupture. Z Orthop Ihre Grenzgeb 138(6):501–505
Bussey MR, Emanuele MA, Lomasney LM, Tehrani R (2014) Sitagliptin-induced bilateral Achilles tendinitis. Rheumatology 53(4):630
Chan O, O’Dowd D, Padhiar N, Morrissey D, King J, Jalan R, Maffulli N, Crisp T (2008) High volume image guided injections in chronic Achilles tendinopathy. Disability and Rehabilitation 30(20–22):1697–1708
Cook JL (2009) In search of the tendon holy grail: predictable clinical outcomes. Br J Sports Med 43(4):235
Cook JL, Purdam CR (2009) Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med 43:409–416
Cook JL, Purdam CR (2014) The challenge of managing tendinopathy in competing athletes. Br J Sports Med 48:506–509
Cook JL, Karlsson, Khan KM (2007) A clinical perspective to tendinopathy. Br J Sports Med 41(4):187
Coombes BK, Bisset L, Vicenzino B (2010) Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 376:1751–1767
Couppé C, Hansen P, Kongsgaard M, Kovanen V, Suetta C, Aagaard P, Kjaer M, Magnusson SP (2009) Mechanical properties and collagen cross-linking of the patellar tendon in old and young men. J Appl Physiol 107(3):880–886
Deans VM, Miller A, Ramos J (2012) A prospective series of patients with chronic achilles tendinopathy treated with autologous-conditioned plasma injections combined with exercise and therapeutic ultrasonography. J Foot Ankle Surg 51(6):706–710
De Jonge S, Warnaars JLF, de Vos RJ, Weir A, van Schie HTM, Bierma-Zeinstra SMA, Tol JL (2014) Relationship between neovascularisation and clinical severity in Achilles tendinopathy in 556 paired measurements. Scand J Med Sci Sports 24(5):773–778
De Vos RJ, Weir A, Cobben LPJ, Tol JL (2007) The value of power Doppler ultrasonography in Achilles tendinopathy: a prospective study. Am J Sports Med 35(10):1696–1701
De Vos RJ, Weir A, Tol JL, Verhaar JAN, Weinans H, van Schie HTM (2011) No effect of PRP on untrasonographic tendon structure and neovascularisation in chronic Achilles tendinopathy. Br J Sports Med 45(5):387–392
Easley ME, Le ILD (2008) Noninsertional Achilles tendinopathy: an overview. In: Nunley JA (Hrsg) The Achilles tendon. Treatment and rehabilitation. Springer Science and Business Media, Heidelberg, S 145–167
Ekstrand J, Hägglund M, Kristenson K, Magnusson H, Waldén M (2013) Fewer ligament injuries but no preventive effect on muscle injuries and severe injuries: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med 47(12):732–737
Ferry ST, Dahners LE, Afshari HM et al (2007) The effects of common anti-inflammatory drugs on the healing rat patellar tendon. Am J Sports Med 35:1326–1333
Fallon K, Purdam C, Cook J, Lovell G (2008) A ″polypill″ for acute tendon pain in athletes with tendinopathy? Journal of Science and Medicine in Sport 11:235–238
Furia JP (2008) High-energy extracorporeal shock wave therapy as a treatment for chronic noninsertional Achilles tendinopathy. Am J Sports Med 36(3):502–508
Gajhede-Knudsen M, Ekstrand J, Magnusson H, Maffulli N (2013) Recurrence of Achilles tendon injuries in elite male football players is more common after early return to play: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med 47(12):763–768
Hootman JM, Macera CA, Ainsworth BE, Addy CL, Martin M, Blair SN (2002) Epidemiology of musculoskeletal injuries among sedentary and physically active adults. Medicine and Science in Sports and Exercise 34(5):838–844
Hufner TM, Brandes DB, Thermann H, Richter M, Knobloch K, Krettek C (2006) Long-term results after functional nonoperative treatment of achilles tendon rupture. Foot Ankle Int 27–3:167–171
Jiang N, Wang B, Chen A, Dong F, Yu B (2012) Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. International Orthopedics 36(4):765–773
Johnson KW, Charalampos Z, Thordarson DB (2006) Surgical management of insertional calcific Achilles tendinosis with a central tendon splitting approach. Foot Ankle Int 27(4):245–250
Kannus P, Jósza L (1991) Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am 73(10):1507–1525
Kayser R, Mahlfeld K, Heyde CE (2005) Partial rupture of the proximal Achilles tendon: a differential diagnostic problem in ultrasound imaging. Br J Sports Med 39:838–842
Khan KM, Scott A (2009) Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med 43:247–252
Khan KM, Cook JL, Kannus P, Maffulli N, Bonar SF (2002) Time to abandon the ″tendinitis″ myth – Painful, overuse tendon conditions have a non-inflammatory pathology. BMJ 324(7338):626–627
Khan RJ, Carey Smith RL (2010) Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev 9:CD003674
Kirchgesner T, Larbi A, Omoumi P, Malghem J, Zamali N, Manelfe J, Lecouvet F, Vande Berg B, Djebbar S, Dallaudière B (2014) Drug-induced tendinopathy: From physiology to clinical applications. Joint Bone Spine 81(6):485–492
Knobloch K, Weinert F (Hrsg) (2012) Mikronährstoffe in der Sportmedizin und Orthopädie. Uni-Med, S 93–100
Kujala UM, Sarna S, Kaprio J (2005) Cumulative incidence of Achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med 15(3):133–135
Langberg H, Ellingsgaard H, Madsen T et al (2007) Eccentric rehabilitation exercise increases peritendinous type I collagen synthesis in humans with Achilles tendinosis. Scand J Med Sci Sports 17:61–66
Malliaras P, Barton CJ, Reeves ND, Langberg H (2013) Achilles and Patellar tendinopathy loading programmes. Sport Med 43:267–286
Maffulli N, Binfield PM, Moore D, King JB (1999) Surgical decompression of chronic central core lesions of the Achilles tendon. Am J Sports Med 27(8):747–752
Maffulli N, Sharma P, Luscombe KL (2004) Achilles tendinopathy: aetiology and management. J R Soc Med 97(10):472–476
Maffulli N, Spiezia F, Longo UG et al (2013) High volume image guided injections for the management of chronic tendinopathy of the main body of the Achilles tendon. Physical Therapy in Sport 14(3):163–167
Marie I, Delafenêtre H, Massy N et al (2008) Tendinous disorders attributed to statins: A study on ninety-six spontaneous reports in the period 1990–2005 and review of the literature. Arthritis Care Res 59:367–372
Movin T, Kristoffersen-Wiberg M, Rolf C et al (1998) MR imaging in chronic Achilles tendon disorders. Acta Radiol 39:126–132
Nehrer S, Breitenfeuer M, Brodner W, Kainberger F, Fellinger EJ, Engel A, Imhof F (1997) Clinical and sonographic evaluation of the risk of rupture in the Achilles tendon. Arch Orthop Trauma Surg 116(1–2):14–18
Neumayer F, Mouhsine E, Arlettaz Y, Gremion G, Wettstein M, Crevoisier X (2010) A new conservative-dynamic treatment for the acute ruptured Achilles tendon. Arch Orthop Trauma Surg 130(3):363–368
Nilsson-Helander K, Silbernagel KG, Thomeé R, Olsson N, Eriksson BI, Karlsson J (2010) Acute Achilles tendon rupture. A randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med 38(11):2186–2193
Notarnicola A, Pesce V, Vicenti G, Tafuri S, Forcignanò M, Moretti B (2012) SWAAT Study: Extracorporeal Shock Wave Therapy and arginine supplementation and other nutraceuticals for insertional achilles tendinopathy. Adv Ther 29:799–814
Ohberg L, Alfredson H (2002) Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med 36:173–177
Osadnik R, Redeker J, Kraemer R, Vogt PM, Knobloch K (2010) Microcirculatory effects of topical glyceryl trinitrate on the Achilles tendon microcirculation in patients with previous Achilles tendon rupture. Knee Surgery, Sports Traumatology, Arthroscopy 18(7):977–981
Paolini JA, Murrell GA (2007) Three-year follow up study of topical glyceryl trinitrate treatment of chronic non insertional Achilles tendinopathy. Foot Ankle Int 28:1064–1068
Rasmussen S, Christensen M, Mathiesen I, Simonson O (2008) Shockwave therapy for chronic Achilles tendinopathy: a double-blind, randomized clinical trial of efficacy. Acta Orthop 79(2):249–256
Rees JD, Stride M, Scott A (2014) Tendons: time to revisit inflammation? Br J Sports Med 48(21):1553–1557
Renstrom PAHF, Woo SL-Y (2008) Tendinopathy: a major medical problem in sport. In: Woo S, Renström P, Arnoczky S (Hrsg) Tendinopathy in athletes. Wiley-Blackwell, New York, S 1–9
Resteghini P, Yeoh J (2012) High-volume injection in the management of recalcitrant mid-body Achilles tendinopathy: a prospective case series assessing the influence of neovascularity and outcome. International Musculoskeletal Medicine 34(3):92–100
Rio E, Kidgell D, Moseley L, Pearce A, Gaida J, Cook J (2013) Exercise to reduce tendon pain: A comparison of isometric and isotonic muscle contractions and effects on pain, cortical inhibition and muscle strength. J Sci Med Sport 16(Suppl 1):e28
Rio E, Kidgell D, Cook J (2014) Exercise reduces pain immediately and affects cortical inhibition in patellar tendinopathy. Br J Sports Med 48:A57–A58
Robinson JM, Cook JL, Purdam C, Visentini PJ, Ross J, Maffulli N, Taunton JE, Khan KM (2001) The VISA-A questionnaire. A valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 35:335–341
Rompe JD, Furia J, Maffulli N (2009) Eccentric loading versus eccentric loading plus shock-wave treatment for midportion Achilles tendinopathy: a randomized controlled trial. Am J Sports Med 37:463–470
Segesser B, Brüggemann GP, Weisskopf L (2006) Die Achillessehne im Sport. Therapiewoche 7/8:144–150
Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J (2007a) Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy. Br J Sports Med 41:276–280
Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J (2007b) Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med 35:897–906
Silbernagel KG, Brorsson A, Lundberg M (2011) The majority of patients with achilles tendinopathy recover fully when treated with exercise alone. Am J Sports Med 38:607–613
Stäudle B, Kälin X, Heinrich K, Segesser B, Brüggemann G-P (2010) Therapieschuh für Achillessehnenverletzungen: Eine biomechanische Untersuchung von Entlastungsstrategien. Orthopädieschuhtechnik 82:24–29
Stevens M, Tan CW (2014) Effectiveness of the Alfredson Protocol compared with a lower repetition-volume protocol for midportion Achilles tendinopathy: a randomized controlled trial. JOSPT 44(2):59–67
Trattnig S, Zbýň Š, Schmitt B, Friedrich K, Juras V, Szomolanyi P, Bogner W (2012) Advanced MR methods at ultra-high field (7 Tesla) for clinical musculoskeletal applications. European Radiology 22(11):2338–2346
Van Schie HTM, de Vos RJ, de Jonge S, Bakker EM, Heijboer MP, Verhaar JAN, Tol JL, Weinans H (2010) Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach. Br J Sports Med 44(16):1153–1159
Wallace RG, Traynor IE, Kernohan WG, Eames MH (2004) Combined conservative and orthotic management of acute ruptures of the Achilles tendon. J Bone Joint Surg Am 86(6):1198–1202
Wallace RG, Heyes GJ, Michael AL (2011) The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture. J Bone Joint Surg Br 93(10):1362–1366
Weinert F (2012) Mikronährstoffe bei Tendinopathien. In: Knobloch K, Weinert F (Hrsg) Mikronährstoffe in der Sportmedizin und Orthopädie. Uni-Med, Jena, S 93–100
Weinert F, Authorsen S (2010) Klinische Wirksamkeit einer supportiven Ernährungstherapie bei Patienten mit Tendopathien – Ergebnisse einer multizentrischen kontrollierten Beobachtungsstudie. Ernährung und Medizin 25:172–177
Weisskopf L, Segesser B, Ulrich M, Rosso C, Rist H-J, Brüggemann P (2010a) Akute und chronische Achillessehnenrupturen: die offene Achillessehnenrekonstruktion. http://orthopaedie-unfallchirurgie.universimed.com/artikel/akute-und-chronische-achillessehnenrupturen-die-offene-achilles
Weisskopf L, Segesser B, Ulrich M, Rosso C, Rist H-J, Brüggemann P (2010b) Ätiologie, Diagnostik und Rekonstruktion: Teilrupturen der Achillessehne. http://orthopaedie-unfallchirurgie.universimed.com/artikel/ Ätiologie-diagnostik-und-rekonstruktion-teilrupturen-der-achill
Wiegerinck JI, Kerkhoffs GM, van Sterkenburg MN, Sierevelt IN, van Dijk CN (2013) Treatment for insertional Achilles tendinopathy: a systematic review. Knee Surgery Sports Traumatology Arthroscopy 21(6):1345–1355
Wheeler PC (2014) The use of high-volume image guided injections (HVIGI) for Achilles tendinopathy – A case series and pilot study. International Musculoskeletal Medicine 36(3):96–103
Woo SL-Y, Renström P, Arnotzky SP (2008) Tendinopathy in athletes. Blackwell Publishing, New York
Yelland MJ, Sweeting KR, Lyftogt JA, Ng SK, Scuffham PA, Evans KA (2011) Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomized trial. Br J Sports Med 45(5):421–428
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Weinert, F., Weisskopf, L. (2016). Sehnenmanagement in Praxis und Klinik am Beispiel der Achillessehnentendopathie. In: Jerosch, J., Linke, C. (eds) Patientenzentrierte Medizin in Orthopädie und Unfallchirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48081-6_36
Download citation
DOI: https://doi.org/10.1007/978-3-662-48081-6_36
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-48080-9
Online ISBN: 978-3-662-48081-6
eBook Packages: Medicine (German Language)