70 Jahre Jubiläumsausgabe
EDITORIAL

70 Years of Sports Orthopedic

70 Jahre Sportorthopädie

Zum 70. Geburtstag der Deutschen Zeitschrift für Sportmedizin.

The roots of orthopedic-surgical sports medicine reach back to the 1920s. Famous surgeons like August Bier, Ferdinand Sauerbruch and W. Baetzner come to mind in this connection. After World War II, the Sports Clinic Lüdenscheid-Hellersen was founded in 1946 in Nordrhein-Westfalen. In 1954, the Hospital for Sports Injuries in Bad Cannstadt was founded at the initiative of the orthopedics specialist F. Heiss, the first President of the newly reinstituted Deutschen Sportärztebundes. New buildings housed both of these hospitals in the 1960s.

At that time, Orthopedics/Traumatology became part of the curriculum for specialist licensing in sports medicine. Even though orthopedic/traumatological treatment of athletes was already being provided in university hospitals, sports-orthopedic outpatient departments dedicated particularly to this topic were first formed in the late 1960s in these hospitals. The first examination sites for the care of high-performance athletes were set up at the orthopedic university hospitals in Berlin (West), Freiburg, Frankfurt, Heidelberg, Homburg/Saar and Munich. In the early 1980s, a sports/trauma-tological C3 department was set up for the first time at the TU in Munich under the direction of Paul Bernett and a short while later in Heidelberg at the initiative of Horst Cotta (5).

Following the example of international leagues and suggestions particularly from the USA, seven orthopedic specialist friends interested in sports medicine founded the Society of Orthopedic-Traumatological Sports medicine (GOTS), which as a German-language Society includes doctors, physiotherapists, biomechanics specialists and sports scientists from Germany, Austria and Switzerland. With now ca. 1600 members, it has become the second-largest sports-orthopedic society in the world. The good and close cooperation with the German Society of Sports Medicine and Prevention led to a joint annual congress of the two societies in 2018 in Munich, which is viewed as the basis for further cooperative activities.

Looking at the care of sports participants 70 years ago and today, there are a considerable number of differences reflected in ever-improving care of athletes. Both in conservative treatment and in surgical procedures, there are now fundamentally different therapeutic approaches which enable athletes to regain their sports capacity relatively early. Several weeks of immobilization, often by means of plaster casts, are hardly ever used nowadays.  Long immobilization led in many cases to marked limitations in movement. Moreover, there was atrophy of the affected muscles, which in many cases could not be trained sufficiently to attain the earlier level and marked the end of the sports career for many athletes. Operating on the principle of early functional treatment, these problems can now be avoided in many cases by use of increasingly function-enhancing means in orthopedic techniques. Stabilizing and mobilizing effects can be attained in various joint regions with bandages, ortheses or other means and can support optimal rehabilitation. Principles of early functional treatment are also in the foreground among measures in physiotherapy and physical therapy.

The surgical treatment of sports injuries has developed to a particularly great measure. With an eye to keeping the trauma of the required surgery to a minimum, the last 30 years have seen the development of a number of minimally-invasive techniques which, in addition to the lower traumatization of the patient, also enable more rapid regeneration in many cases. Using arthroscopic instruments, it is now possible to evaluate the extent of injury in all large and even some small joints and thus undertake therapeutic steps with as little burdens possible. Implants or stabilizers produced by the industry are also being continuously further developed and now enable optimal care in almost all possible situations. Arthroscopic cruciate ligament operations as well as revisions, for example, are now performed exclusively arthroscopically. Likewise, the implants needed for stabilization of ligament and bone structures are becoming smaller and more reliable so that a large incision is rarely necessary. Today, artificial joints offering suitability even for sports with a high risk of falling, like alpine skiing, are demanded by patients and in many cases make renewed participation possible – which was unthinkable in the past (3). There have also been great advances in the treatment of cartilage damage, but there is still room for improvement. Even if creating strain-resistant cover for circumscribed cartilage defects is now quite successful, the procedures are limited for larger defects. Among others, stem-cell treatment techniques will offer further options in such cases.

Of course, rapid development of imaging procedures has contributed to the better visualization of sports injuries and especially overload damage, such as stress reactions and stress fractures or damage to the inner joint, enabling adequate treatment. Nuclear magnetic resonance warrants 
special mention here (2).

Movement analysis is also important for optimization of treatment of athletes in the various types of sports. It is now offered in numerous exercise laboratories and applied increasingly in sport-specific situations, thus useful to athletes and their sports environment (4). Many sport-scientific and sport-medical departments have such laboratories available.

The “new” types of sports bring a special challenge for treating physicians. These “new” sports have had influence not only on the leisure activities of the population, but have also become important by being sometimes included in Olympic Games competitions. The different requirements in the various types of sports demand that the doctors are knowledgeable in the recognition of danger, estimating loads and, in addition to treatment athletes during rehabilitation after injury and overload damage, influencing the back to sports question, especially with regard to prevention of injuries.

What will the coming years bring? The prevention of sports injuries will have increasing importance in sports-orthopedic departments. Even though prevention programs have been developed which can be scientifically demonstrated to reduce the rate of injury in individual types of sports, more knowledge must be gained and the results brought most strongly to the attention of the broad public. Operative measures which preserve the body’s own structures will be further developed. The area of stem-cell therapy, both conservative and in conjunction with surgical procedures, will further promote the body’s own healing processes (1). In this respect, it is important to have strong, established university sports orthopedics and traumatology at various sites. One of the most important tasks of the professional societies will be to defend this standpoint in university medicine, which is increasingly economically oriented.

Literatur

  1. NIEMEYER P, HIRSCHMANN MT. Zukunftsperspektive“Stammzelltherapie” in Deutschland. Knorpeltherapie zwischenRegulation, wissenschaftlicher Evidenz und Marketing.Arthroskopie. 2019; 32: 205-211.
    doi:10.1007/s00142-019-0279-1
  2. ROEMER F. Arthrose am Kniegelenk. Welche neuen Erkenntnissehat die MRT gebracht? Arthroskopie. 2019; 32: 95-104.
    doi:10.1007/s00142-018-0237-3
  3. SIEBERT CH. Hip replacement and return to sports. Dtsch ZSportmed. 2017; 68: 111-115.
    doi:10.5960/dzsm.2017.268
  4. SCHNEIDER J, WIEGAND Y, BRAUMANN K-M, WOLLESEN B. Functionaland motor deficits in youth soccer athletes – an explorative,quais-experimental study. Dtsch Z Sportmed. 2019; 70: 14-20.
    doi:10.5960/dzsm.2018.358
  5. STEINBRÜCK K. Säule der Sportmedizin in Arendt, Löllgen, Schnell:100 Jahre Deutsche Sportmedizin. Druckhaus Verlag Gera. 2012:172-176.
Prof. Dr. med. Holger Schmitt
Hüft- und Kniechirurgie, Sporttraumatologie
Deutsches Gelenkzentrum Heidelberg
Bismarckstraße 9-15
69115 Heidelberg
holger.schmitt@atos.de