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Neuromuskuläres Defizit bei chronischer Sprunggelenkinstabilität

Häufigkeit und Wertigkeit – Multicenterstudie

Neuromuscular deficits in chronic ankle instability

Frequency and significance – multicenter study

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Zusammenfassung

Die peroneale Reaktionszeit (PRT) dient zur Beurteilung eines neuromuskulären Defizits bei der chronisch funktionellen Sprunggelenkinstabilität. Ziel dieser Studie ist es, die PRT an einem großen Patientenkollektiv mit chronischer Sprunggelenkinstabilität zu bestimmen, da unklar ist, ob bei diesen Patienten dieser Parameter als Ausdruck eines neuromuskulären Defizits grundsätzlich erhöht ist. 186 Patienten durchliefen einen diagnostischen Algorithmus aus Anamnese, klinischer Untersuchung, Röntgendiagnostik und Bestimmung der PRT auf einer Kippplattform. Eine verlängerte PRT ließ sich bei der überwiegenden Mehrzahl der Patienten (n = 143; 77 %) nachweisen. Bei 41 % (n = 77) zeigte sich im Rahmen der radiologischen Stressdiagnostik ein signifikanter Seitenunterschied zwischen betroffenem und gesundem Bein bei der Taluskippung (p = 0,002) und beim Talusvorschub (p = 0,04). Von diesen 77 Patienten hatten nur 15 Patienten (8 %) ein radiologisch nachgewiesenes rein mechanisches Problem. Als eine Folge von rezidivierenden Umknicktraumen der Sprunggelenke ist in den meisten Fällen von einem posttraumatischen Defizit der Propriozeptivität auszugehen. Als Konsequenz ergibt sich ein konservativer Therapieansatz mit gezieltem Training zur Schulung der neuromuskulären und propriozeptiven Defizite.

Abstract

The peroneal reaction time (PRT) is used in the assessment of neuromuscular deficits in chronic functional ankle instability. Powered by the Editorial Manager® and Preprint Manager® from Aries Systems Corporation the present study was conducted to determine the PRT in a large collective of patients with chronic ankle instability because it is unclear if this parameter of neuromuscular deficit is prolonged. In this study 186 patients underwent a diagnostic algorithm consisting of anamnesis, clinical examination, X-ray and determination of the PRT on a tilting platform. A prolonged PRT as a manifestation of a neuromuscular deficit could be detected in the majority of the patients (n = 143, 77 %). Comparing the affected and healthy legs 77 patients (41 %) showed a significant difference in talar shift (p = 0.002) and talar tilt (p = 0.04) in the radiological stress views. Of these 77 patients only 15 (8 %) showed radiological evidence of a mechanical problem. As a consequence of recurring ankle sprains a post-traumatic deficit in proprioception has to be expected in most cases. In general a conservative therapy approach should be followed including specific training to improve neuromuscular and proprioceptive deficits.

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Authors and Affiliations

  1. Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland

    R. Schmidt &  M. Tannheimer

  2. Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland

    H.P. Becker

  3. Bundeswehrkrankenhaus Berlin, Berlin, Deutschland

    F. Rauhut

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  1. R. Schmidt
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  2. H.P. Becker
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  3. F. Rauhut
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  4. M. Tannheimer
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Correspondence to M. Tannheimer.

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Schmidt, R., Becker, H., Rauhut, F. et al. Neuromuskuläres Defizit bei chronischer Sprunggelenkinstabilität. Unfallchirurg 117, 710–715 (2014). https://doi.org/10.1007/s00113-013-2392-3

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