Spieler kommen meist mit Sprungelenkverletzungen in die Ambulanz, Torwarte oft mit Knochenbrüchen
Mittwochabends und am Wochenende nachmittags herrscht Hochbetrieb in der orthopädisch-unfallchirurgischen Ambulanz -es ist Trainings- und Wettkampfzeit in “Fußball-Deutschland”. Mehr als 6,2 Millionen Mitglieder hat der Deutsche Fußball-Bund. Diese spielen in rund 166.000 Mannschaften in über 26.000 Vereinen Woche für Woche Fußball. Hinzu kommen noch unzählige begeisterte Fußballer, die nicht in Vereinen und Mannschaften organisiert sind. Die Verletzungen beim Fußball stellen – wie bereits seit vielen Jahren – den größten prozentualen Anteil der Sportverletzungen dar. Meist handelt sich jedoch um leichte Verletzungen, die durch ein direktes Trauma verursacht werden. Schwere Verletzungen, die oft nach indirekten Traumen entstehen, sind glücklicherweise selten. In der Invaliditätsstatistik rangiert Fußball an vierter Stelle.
Im Zweikampf, beim “Hineingrätschen” und beim “Fußaufsetzen”, entstehen äußerst schmerzhafte Verletzungen an Unterschenkel und Fuß, der direkte Anprall am Oberschenkel führt zum “Pferdekuss”. Die scharfkantigen Stollen verursachen Schürfwunden und Schwellungen, die Wucht des Anpralles Prellungen im Vorfuß- und Knöchelbereich. Wichtig ist hier die Erstbehandlung nach der PECH-Regel: Pause, Eis/Kühlung, Compression und Hochlagerung. Nach sorgfältiger Abklärung des Verletzungsausmaßes kann meist mit frühzeitigen Übungsbehandlungen begonnen werden, um Verklebungen zu reduzieren.
Die häufigste Verletzung ist die Distorsion (Verstauchung) des oberen Sprunggelenkes. Neben den relativ einfachen Verletzungen der Kapsel – die mit rasch auftretenden Schwellungen und Hämatomen einhergehen können – sind Verletzungen des Bandapparates und der knöchernen Strukturen anzutreffen. Die Diagnose ist am Spielfeldrand nicht immer sicher zu stellen, so dass diese Distorsionsverletzungen des oberen Sprunggelenkes zum Besuch der Ambulanzen und der orthopädischen Praxen führen. Nach der ausführlichen Darstellung des “Unfallherganges” folgt die Untersuchung des Sportarztes auf die Festigkeit des Bandapparates. Aufgrund starker
Schwellungen und Schmerzsymptomatik ist diese Untersuchung manchmal nur eingeschränkt möglich, so dass zusätzlich die Sonographie eingesetzt wird. Das Röntgenbild ist zum Ausschluss einer knöchernen Verletzung unerlässlich. Nach Zusammenschau der erhobenen Befunde wird die Diagnose gestellt und eine entsprechende Therapie in die Wege geleitet. Neben abschwellenden Maßnahmen kommen stabilisierende Verbände und nachfolgend stabilisierende Orthesen und Bandagen zum Einsatz. Diese erlauben oftmals die volle Belastung und schränken nur ganz bestimmte Bewegungen ein. Sollte eine Verletzung des Knochens oder eine Zerreißung mehrerer Bandstrukturen vorliegen, so ist auch die Möglichkeit einer Operation zu erwägen.
Selten sind direkte Verletzungen der Achillessehne durch einen Tritt. Sie machen in der Diagnostik und nachfolgenden Behandlung keine größeren Probleme. Die meisten Verletzungen der Achillessehne finden sich auf dem Boden von degenerativen Veränderungen und chronischer Sportschäden. Die häufigen Belastungsbeschwerden der Achillessehne werden nur ungenügend ausbehandelt – vielfach werden die Sportler kurzfristig “fit gespritzt”. Einer vorgeschädigten Achillessehne reicht schon ein “Bagatelltrauma” oder ein kräftiger “Antritt” zum definiten Riss – und das bedeutet Operation und lange Verletzungspause.
Nach den Verletzungen des Sprunggelenkes sind die Knieverletzungen im Fußball die zweithäufigsten. Prellungen in dieser Region verheilen meist folgenlos. Schwerwiegender sind die indirekten Verletzungen, die durch eine Verdrehung bei leichter Kniebeugung entstehen. Egal, ob der Sturz durch Gegnerbehinderung erfolgte, den feststehenden Stollen auf dem Rasen oder einem Pressschlag an der Innenseite des Fußes, die Folge ist meist eine Kombinationsverletzung der Kapsel-Band-Strukturen. In leichten Fällen sind “nur” die Kapsel, der Meniskusansatz und das Seitenband beteiligt, oftmals wird dann weitergespielt und am nächsten Morgen dem Orthopäden ein “dickes” Knie präsentiert. Meist wird sofort eine intensive konservative Therapie in die Wege geleitet. Bei kombinierten Knieverletzungen – Meniskuseinriss, Kreuzbandruptur und Seitenbandläsion – ist eine Operation nötig, die dann auch kurzfristig in die Wege geleitet werden sollte. Bei der Arthroskopie stellt sich eventuell auch ein Knorpelschaden dar, der oftmals entscheidend für den späteren Heilungsverlauf und die weitere sportliche Aktivität ist. Nach der Operation folgt eine langfristige “Rehabilitationsphase”, in der dem Knie wieder die volle Funktionstüchtigkeit und Stabilität antrainiert wird.
Fast jeder Fußballer kennt Leistenbeschwerden – die Adduktoren ziehen, der Leistenkanal “drückt” bei zunehmender Belastung. Die Untersuchung zeigt Verhärtungen der Adduktoren und Verkürzungen der ischiokruralen Muskulatur, die der intensiven Behandlung durch die Sportphysiotherapeuten zugeführt werden sollten. Diese “Schwachstelle” muss zu verstärkten Dehn- und Lockerungsübungen beim Fußballer führen. Die Untersuchung der Leiste offenbart selten einen echten Leistenbruch; meist liegt eine “weiche Leiste” vor. Hier ist nach Ausschluss anderer Ursachen die operative “Verstärkung” der Bauchwand angezeigt, die heute meist arthroskopisch und damit ohne langfristige Verletzungspause durchgeführt wird.
Mit Knochenbrüchen kommen am häufigsten die Torwarte in die Ambulanzen. Durch die gewaltigen Kräfte der Torschüsse, die “Festigkeit” des Gehäuses und direkte Anpralltraumen brechen Knochen der Mittelhand oder einzelne Finger. Mit einer stabilen Frakturverschraubung ist oftmals frühzeitig der Spielbetrieb wieder aufzunehmen.
Der aktive und leidenschaftliche Sportler ist verletzungsgefährdet, doch in sinnvoller Zusammenarbeit mit seinem medizinischen Team und seinen Trainern ist das Verletzungsrisiko zu minimieren und die notwendige Verletzungspause optimal zu gestalten. Ungenügend diagnostizierte oder verkannte Verletzungen führen zu einer falschen oder ungenügenden Behandlung. Eine ungenügende Heilungs- und Regenerationszeit bedeutet langfristigen Raubbau an der Gesundheit. Gerade im Profisport ist der Druck immens, “schnell wieder fit zu sein”. Doch auch im Freizeitbereich will der Fußballer “schnell wieder fit sein” – fit für den Alltag und die Arbeit. Hier ist der erfahrene Orthopäde und Sportmediziner gefragt.
Dr. Christian Schneider
Leiter Ambulanz
Orthopädische Klinik München-Harlaching
28. Mai 2003
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