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die finanziellen Aufwendungen für die medizinische Versorgung steigen und sind nicht nur in Zeiten des politischen Wahlkampfes ein kontrovers diskutiertes Thema. Prävention gewinnt bei zunehmendem Kostendruck an Relevanz. Vor knapp zehn Jahren gaben die gesetzlichen Krankenkassen 340 Millionen Euro für Prpphylaxe-Maßnahmen aus. Doch allein die schlechte Ernährung und fehlende Bewegung verursachten im Jahr 2008 geschätzte Kosten von mehr als 70 Milliarden Euro.
Angesichts des weiter zunehmenden Bewegungsmangels und teilweise erheblichen Übergewichts schon im Kindes- und Jugendalter kommt auch dem Sport eine wichtige Aufgabe zu. Dass in diesem Zusammenhang auch die Bedeutung der Sportorthopädie für die Gesellschaft wächst, haben wird zum Anlass dieses Essays von Prof. Dr. med. Martin Engelhardt genommen.
Mit freundlichen Grüßen,
Ihr Andreas Bellinger, GOTS-Pressesprecher presse@gots.org
Hamburg ist vom 24. bis 26. Mai 2018 Schauplatz des ersten Deutschen Olympischen Sportärztekongresses, der von der Gesellschaft für Orthopädisch-Traumatologische Sportmedizin (GOTS) in Zusammenarbeit mit der Deutschen Gesellschaft für Sportmedizin und Prävention (DGSP) veranstaltet wird. Titel der dreitägigen Veranstaltung an der Universität Hamburg, zu der mehr als 1.000 Teilnehmer aus dem In- und Ausland erwartet werden, ist: “Gemeinsam für einen gesunden Sport”. Bis zum 1. November können Sie ihr Abstract einreichen. Die Themen entnehmen Sie bitte dem Flyer im Anhang dieses Newsletters oder der Kongress-Website www.deutscher-olympischer-sportaerztekongress.de.
Wir möchten Sie zudem auf folgende Veranstaltungen hinweisen:
13. Oktober 2017 in Wien: 3. Sportmedizinisches Symposium der ÖMGGT, Infos ab Mitte September unter: www.oemggt.org
14. Oktober 2017 in München: 9. Münchner Gelenktag: Das Sprunggelenk (www.sport-ortho.de). Anmeldung unter: anmeldung@vfos.info
06.-09. Dezember 2017 in Nürnberg: 33. Nürnberger Arthroskopiekurs und Gelenksymposium (www.nuernberger-arthroskopiekurs.de)
Sportorthopädie: Bedeutung wächst – Prävention immer wichtiger
Obwohl der Sparzwang allgegenwärtig ist und sich der Wandel in der Medizin vom rein sozial-karitativen hin zu einem ökonomisch kalkulierenden Selbstverständnis vollzogen hat, sind die Kosten gestiegen: In den Krankenhäusern von 46,5 Milliarden Euro im Jahr 1996 auf 63,1 Milliarden Euro im Jahr 2008. Dabei hat sich die Zahl der Krankenhäuser zwischen 1980 und 2010 von 3.783 auf 2.064 reduziert. Die Verweildauer in den Kliniken halbierte sich in dieser Zeit – darüberhinaus fielen 50.000 Stellen dem Rotstift zum Opfer.
In Deutschland treiben mehr als 20 Millionen Menschen Sport. Ob nun aus Spaß an der Freude, zur Gesunderhaltung und im Rahmen der Rehabilitation oder auch als Hochleistungssportler und leistungsorientierte Freizeitsportler. Aber Sport birgt auch das Risiko von Fehl- und Überbelastung sowie Verletzungen in sich. Der Berliner Sportmediziner Harald Mellerowicz schätzte schon 1974 die jährlichen Kosten für die Krankenversicherungen auf knapp zwei Milliarden D-Mark; was einen Anteil an den Gesamtausgaben der Krankenkassen von einem Prozent bedeutete. Inzwischen dürften die Kosten weitaus höher liegen.
Die Zahl der jährlichen Sportunfälle, die eine ärztliche Versorgung zur Folge haben, wurde Mitte der 1970er-Jahre auf 1,5 Millionen (20% der Gesamtunfälle) geschätzt. Tödliche Sportunfälle machten zwei Prozent aller tödlichen Unfälle aus. Mellerowicz, der eine der ersten Herzsportgruppen Deutschlands gegründet hat (1965), forderte immer wieder politische Maßnahmen gegen den Bewegungsmangel. Schon 1984 wies er darauf hin, dass die Schäden durch zivilisationsbedingten Bewegungsmangel in Deutschland bei über 50 Milliarden D-Mark liegen würden. Seither hat sich die Problematik weiter verschärft: 2007 hatten in Deutschland 58,9% der Frauen und 75,4% der Männer einen BMI >25 und 22,5% der Männer sowie 23,3% der Frauen einen BMI >30. Der Body-Mass-Index (BMI) errechnet sich aus “Körpergewicht in Kilogramm durch Körpergröße in Meter zum Quadrat”. Ein BMI zwischen 18,5 und 25 gilt als normal – 25 bis 30 bedeuten Übergewicht.
Besonders negativ ist der Trend bei Deutschlands Kindern. Mehr als 16% sind übergewichtig – allein 6% sogar adipös (fettleibig). Nur knapp ein Drittel der Jungen und ein Fünftel der Mädchen bewegt sich täglich eine Stunde. 1950 bewegte sich der Deutsche durchschnittlich noch zehn Kilometer pro Tag – inzwischen sind es im Schnitt unter 700 Meter. Zehnjährige können im Durchschnitt nicht mehr als 1.000 Meter am Stück rennen. Die gesetzlichen Krankenkassen gaben 2008 340 Millionen Euro für Prävention aus. Zum Vergleich verursachten schlechte Ernährung und Bewegungsmangel im selben Jahr mehr als 70 Milliarden Euro an Kosten.
Im Sportreport 2016 der Verwaltungs-Berufsgenossenschaft wurden erstmals umfangreiche Daten über Sportverletzungen von Bundesliga-Profis aus den Ligen im Fußball, Handball, Basketball und Eishockey veröffentlich. In der Saison 2014/15 wurden demnach 3.500 Spieler eingesetzt. Fast 80% dieser Spieler verletzte sich mindestens ein Mal in dieser Zeit. Mehr als 8.500 Verletzungen führten zu einem Arbeitsausfall von in der Summe mehr als 75.000 Tagen und 10 Millionen Euro Kosten für Heilbehandlungen und Entgeltersatzleistungen. Umfassende Daten zu Sportverletzungen und deren Versorgungskosten gibt es allerdings nach wie vor nicht. Das wird bei der Sichtung der Fachliteratur schnell deutlich.
Wichtiger noch als die Gesamtkosten für die Gesellschaft sind jedoch die Einzelschicksale der betroffenen Sportler. Alle im Sport tätigen Orthopäden und Unfallchirurgen kennen die individuellen Auswirkungen wie insbesondere frühzeitige Coxarthrose, Gonarthrose, Sprunggelenksarthrose nach initialen, potenziell vermeidbaren Sportverletzungen ihrer betroffenen Sportler.
Daraus resultieren folgende Forderungen:
- systematische Erfassung von Sportverletzungen und deren Behandlungskosten durch die Krankenversicherungen
- Langzeitstudien über die Auswirkungen von Sportverletzungen auf die betroffenen Sportler für alle häufigen Verletzungen (vordere Kreuzbandruptur, Meniskusruptur, Kapsel-Band-Verletzungen im Sprunggelenk, Muskelverletzungen etc.)
- systematische Etablierung von Präventionsprogrammen zur Vermeidung von Sportverletzungen.
- gesonderte wissenschaftliche Auswertung von Sportverletzungen im Kindes- und Jugendalter
Neben den skizzierten Problemen, die sich aus Bewegungsmangel, Fehlernährung sowie Sportverletzungen und Überlastungsschäden durch unsachgemäßes Sporttreiben ergeben, gilt es, die vielleicht mehr denn je relevanten positiven Aspekte des Sports zu berücksichtigen:
- positive Wertevermittlung / Sozialisation
- gesundheitsfördernde Wirkung
- mögliche Integration ausländischer Mitbürger
- Überwinden sozialer Schranken
- friedensstiftende und völkerverbindende Wirkung
Daraus ergibt sich die Notwendigkeit eines umfassenden und langfristig angelegten Sport- und Präventionsplanes der vom Bund initiiert in Zusammenarbeit mit den Ländern, den Fachgesellschaften, Sportverbänden und Vereinen abgestimmt sein sollte. Überdies sollten die Universitäten, Schulen und Kindergärten eingebunden sein. Die dafür notwendigen finanziellen Mittel müssen bereitgestellt werden.
Das benötigte Geld wäre im gesamtgesellschaftlichen Konsens gut investiert. Es könnten viele Milliarden Euro für sogenannte Reparaturkosten gespart werden, die durch mangelnde Gesundheit und gesellschaftliche Fehlentwicklung entstehen beziehungsweise entstanden sind.
Über den Autor:
Prof. Dr. med. Martin Engelhardt ist Chefarzt der Klinik für Orthopädie, Unfall- und Handchirurgie des Klinikums Osnabrück, Präsident der Deutschen Triathlon Union (DTU) und Mitglied in der medizinischen Expertenkommission des Deutschen Olympischen Sportbundes (DOSB). Seine sportliche Laufbahn begann Engelhardt als Bundesliga-Schwimmer des EOSC Offenbach; als Triathlet nahm er 1987 am Ironman auf Hawaii teil. Bei den Olympischen Spielen in Athen (2004) und Peking (2008) war der Spezialist für Orthopädie und Sporttraumatologie Leitender Orthopäde der deutschen Mannschaft sowie von 2000 bis 2006 Präsident der GOTS.
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