Adaptation der muskulären Kraftfähigkeiten sowie der Gang- und Laufkinematik nach einer vorderen Kreuzbandrekonstruktion bzw. Kreuzbandverletzung

126 Abstract The regeneration of the muscular force generating capabilities and of the gait related motor tasks are crucial in the therapy and rehabilitation of the ACL injured patient. The aim of many rehabilitative procedures is to positively influence the regeneration of the musculoskeletal system in order to either ensure the success of the reconstruction or to avoid surgery after ACL injury. However, it is not always easy to identify from the literature (Bulgeroni et al., 1997; Wojitys et al., 2000; Busch-Joseph et al., 2001; Gokler et al., 2003), the point in time at which the changes occurring after an ACL injury in the force producing capability and in the gait kinematics return to the level of normal population. The influence of either a reconstruction using a Semitendinosus (ST) or a Patella (PT) graft (Rudroff et al., 2003; Knoll et al., 2004; Webster et al., 2005) or the choice of a conservative therapy on the force generating capabilities and the gait kinematics (Wexler et al., 1998; Boerboom et al., 2001; Rudolf et al., 2001; Knoll et al., 2004), remains unclear as well. The aim of the present work was to improve the understanding of the adaptation of the muscular and motor task specific capabilities after an ACL reconstruction or injury, in order to support therapeutic interventions. The results prove that the muscular force generating capabilities of the affected limb can be impaired even 12-24 months after the ACL reconstruction, showing force deficits in the knee extensors, knee flexors and hip flexors. During this period (12-24 months post surgery) the altered gait pattern of many patients returns to normality. This indicates that the adaptation of the muscular force capabilities and the adaptation of the gait kinematics follow different time courses. There is a threshold up to which the force deficits are tolerated during gait. However, when this threshold is surpassed, the biological system changes its strategy in order to accomplish the aimed motor task. During the periods 6-12 and 12-24 months post surgery, the traumatising of the Patella tendon, when using the PT graft has a bigger effect, especially in the development andThe regeneration of the muscular force generating capabilities and of the gait related motor tasks are crucial in the therapy and rehabilitation of the ACL injured patient. The aim of many rehabilitative procedures is to positively influence the regeneration of the musculoskeletal system in order to either ensure the success of the reconstruction or to avoid surgery after ACL injury. However, it is not always easy to identify from the literature (Bulgeroni et al., 1997; Wojitys et al., 2000; Busch-Joseph et al., 2001; Gokler et al., 2003), the point in time at which the changes occurring after an ACL injury in the force producing capability and in the gait kinematics return to the level of normal population. The influence of either a reconstruction using a Semitendinosus (ST) or a Patella (PT) graft (Rudroff et al., 2003; Knoll et al., 2004; Webster et al., 2005) or the choice of a conservative therapy on the force generating capabilities and the gait kinematics (Wexler et al., 1998; Boerboom et al., 2001; Rudolf et al., 2001; Knoll et al., 2004), remains unclear as well. The aim of the present work was to improve the understanding of the adaptation of the muscular and motor task specific capabilities after an ACL reconstruction or injury, in order to support therapeutic interventions. The results prove that the muscular force generating capabilities of the affected limb can be impaired even 12-24 months after the ACL reconstruction, showing force deficits in the knee extensors, knee flexors and hip flexors. During this period (12-24 months post surgery) the altered gait pattern of many patients returns to normality. This indicates that the adaptation of the muscular force capabilities and the adaptation of the gait kinematics follow different time courses. There is a threshold up to which the force deficits are tolerated during gait. However, when this threshold is surpassed, the biological system changes its strategy in order to accomplish the aimed motor task. During the periods 6-12 and 12-24 months post surgery, the traumatising of the Patella tendon, when using the PT graft has a bigger effect, especially in the development and