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DOI: 10.1055/a-2210-0401
Aktuelles Vorgehen in der Nachbehandlung gelenkerhaltender Operationen am Kniegelenk im deutschsprachigen Raum
Current approach in the follow-up treatment of joint-preserving operations on the knee joint in German-speaking countriesZusammenfassung
Einleitung Die postoperative Nachbehandlung nach gelenkerhaltenden Kniegelenkoperationen beinhaltet neben klassischer Physiotherapie weitere Ansätze und Hilfsmittel wie CPM- und CAM-Schienen, TENS-Geräte, BFR-Training, Prähabilitation und digitale Gesundheitsanwendungen. Ziel der vorliegenden Umfrage war es, aktuelle Standards, Trends und Steuerungsmöglichkeiten in der Nachbehandlung zu untersuchen, Problemfelder zu identifizieren und mit der aktuellen Literatur zu vergleichen.
Material und Methoden Es erfolgte eine strukturierte anonyme Online-Befragung gelisteter Fachärzte für Orthopädie und Unfallchirurgie der deutschsprachigen Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA). Der Fragebogen umfasste 36 geschlossene Fragen zur Nachbehandlung gelenkerhaltender Operationen am Kniegelenk.
Ergebnisse Es konnten die Fragebogen von 528 Teilnehmenden mit langjähriger Berufserfahrung (86,6% mehr als 10 Jahre) analysiert werden. Standardisierte Nachbehandlungsschemata werden von 97,2% verwendet und deren Evidenz als hoch (59,1%) /sehr hoch (14,8%) eingeschätzt. Probleme der Rehabilitation werden in 10–20% der Fälle von 87,3% (persistierende Muskelatrophie 30,9%) gesehen. Nach rekonstruktiven Eingriffen werden CPM-Schienen (70,1%), CAM-Schienen (42,1%), Orthesen (85,0%) und TENS-Geräte (40,0%) verschrieben. Potentere Ansätze zur Behandlung des postoperativen Muskeldefizits werden von 89,4% gewünscht. BFR-Training ist bei 41,7% bekannt und wird von 8% regelmäßig angewendet. Es erfolgt nur ein unregelmäßiger Austausch mit behandelnden Physiotherapeuten (schriftlich: 27,5%). Eine digitale Rehabilitationssteuerung würde von 83,3% unterstützt werden, 22,7% kennen digitale Gesundheitsanwendungen nicht. 87,9% der Teilnehmenden gehen davon aus, dass Prähabilitation das postoperative Ergebnis beeinflussen kann.
Schlussfolgerung Die Nachbehandlung kniegelenkerhaltender Operationen erfolgt in der Regel standardisiert und wird regelmäßig auf Aktualität überprüft. Die Evidenz für ausgesprochene Empfehlungen wird dabei als hoch eingeschätzt. In der Regel werden Orthesen nach rekonstruktiven Eingriffen verwendet, persistierende Muskelatrophien sind ein zentrales Problemfeld, das BFR-Training ist nur begrenzt bekannt, standardisierte Trainingsprotokolle fehlen hierfür aktuell. Die Kommunikation mit Physiotherapeuten ist verbesserungswürdig. Eine digitale Rehabilitationssteuerung wird selten verwendet, würde aber von der Mehrzahl der Chirurgen unterstützt werden.
Abstract
Introduction Postoperative follow-up after joint-preserving knee surgery involves conventional physiotherapy as well as other approaches and devices such as CPM and CAM splints, TENS devices, BFR exercise, prehabilitation, and digital health applications. The aim of this survey was to investigate current standards, trends and control methods in postoperative care to identify fields of concern and to compare them with the current literature.
Material and Methods We conducted a structured anonymous online survey of specialists in orthopaedics and trauma surgery listed by the German-speaking Society for Arthroscopy and Joint Surgery (AGA). The questionnaire included 36 closed-ended questions on the follow-up of joint-preserving surgery of the knee joint.
Results Questionnaires from 528 participants with long-term professional experience (86.6% with more than 10 years) were analysed. Standardised post-treatment schemes are used by 97.2% and their evidence is estimated to be high (59.1%) / very high (14.8%). Problems of rehabilitation are seen in 10–20% of cases by 87.3% (persistent muscular atrophy 30.9%). After reconstructive surgery, CPM splints (70.1%), CAM splints (42.1%), orthoses (85.0%) and TENS devices (40.0%) are prescribed. More potent approaches for the treatment of postoperative muscle deficits are desired by 89.4%. BFR exercise is known by 41.7% and is used regularly by 8%. Communication with treating physiotherapists is infrequent (written: 27.5%). Digital rehabilitation management would be supported by 83.3%; 22.7% are not aware of digital health applications. 87.9% of participants believe that prehabilitation can affect postoperative outcomes.
Conclusion Follow-up of knee joint-preserving surgeries is usually standardised and regularly reviewed for up-to-date evidence. The evidence for recommendations made is considered high. Orthoses are usually used after reconstructive surgery, persistent muscle atrophy is a major problem, BFR training is only known to a limited extent, and there is currently a lack of standardised training protocols. Communication with physiotherapists needs to be improved. Digital rehabilitation management is rarely used but would be supported by the majority of surgeons.
Schlüsselwörter
Arthroskopie - gelenkerhaltende Operation - Kniegelenk - Nachbehandlung - RehabilitationPublikationsverlauf
Eingereicht: 18. Oktober 2023
Angenommen nach Revision: 13. November 2023
Artikel online veröffentlicht:
01. Februar 2024
© 2024. Thieme. All rights reserved.
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