Beeinträchtigungen der sensomotorischen Kontrolle bei funktioneller Sprunggelenkinstabilität

Zusammenfassung

Distorsionen des oberen Sprunggelenks stellen mit einer Prävalenz von 25–30 % aller Sportunfälle neben dem Kniegelenk die am häufigsten betroffene Körperregion dar. Mindestens ein Drittel aller Betroffenen entwickelt eine chronische Gelenkinstabilität mit anhaltenden Beschwerden, die jedoch in vielen Fällen nicht auf eine mechanische Insuffizienz des Kapsel-Band-Apparats zurückzuführen ist. Hierfür wurde der Begriff der funktionellen Sprunggelenkinstabilität geprägt. Als Ursache werden Störungen des sensomotorischen Systems vermutet. Dazu zählen u. a. Beeinträchtigungen der Propriozeption, der posturalen Kontrolle sowie der Kraft und Reflexaktivität der gelenkumgebenden Muskulatur. Im vorliegenden Übersichtsbeitrag wird die aktuelle Studienlage hinsichtlich sensomotorischer Defizite bei funktioneller Sprunggelenkinstabilität aufgearbeitet. Die Ergebnisse werden vor dem Hintergrund neuerer neurophysiologischer Modelle zur Entstehung von Gelenkinstabilitäten diskutiert.

Abstract

Lateral ankle sprains are among the most common sports injuries, with a prevalence of 25 to 30 % of all injuries. At least one-third of individuals develop long-term complaints and chronic instabilities at the ankle, which in many cases cannot be attributed to mechanical insufficiencies of the joint. This condition is referred to as functional ankle instability (FAI). Impairments of the sensorimotor control system, such as disturbed proprioception and postural control, as well as reduced muscle strength and reflex activity, have been suggested to contribute to the aetiology of FAI. This review summarises the current body of literature regarding sensorimotor control in individuals with FAI. We discuss the results in the context of current neurophysiological models of the development of functional joint instabilities.

Schlüsselwörter

chronische Sprunggelenkinstabilität - neuromuskuläre Kontrolle - Propriozeption - posturale Kontrolle - Sportverletzungen

Key words

chronic ankle instability - neuromuscular control - proprioception - postural control - sports injuries

• Literaturverzeichnis

• 1 Fong D, Hong Y, Chan L et al. A systematic review on ankle injury and ankle sprain in sports. Sports Med 2007; 37: 73-94
• 2 Steinbrück K. Epidemiologie von Sportverletzungen – 25-Jahres-Analyse einer sportorthopädisch-traumatologischen Ambulanz. Sportverletz Sportschaden 1999; 13: 38-52
• 3 McKay GD, Goldie PA, Payne WR et al. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med 2001; 35: 103-108
• 4 Nelson AJ, Collins CL, Yard EE et al. Ankle injuries among United States high school sports athletes, 2005–2006. J Athl Train 2007; 42: 381-387
• 5 Lohrer H, Alt W, Gollhofer A et al. Verletzungen am lateralen Kapselbandapparat des Sprunggelenks – eine Übersicht. Dtsch Z Sportmed 2000; 51: 196-203
• 6 Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train 2002; 37: 364-375
• 7 van Rijn RM, van Os AG, Bernsen RMD et al. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med 2008; 121: 324-331
• 8 Anandacoomarasamy A, Barnsley L. Long term outcomes of inversion ankle injuries. Br J Sports Med 2005; 39: e14
• 9 Valderrabano V, Leumann A, Pagenstert G et al. Chronische Instabilität des oberen Sprunggelenks im Sport: Ein Review für Sportärzte. Sportverletz Sportschaden 2006; 20: 177-183
• 10 Hiller CE, Kilbreath SL, Refshauge KM. Chronic ankle instability: evolution of the model. J Athl Train 2011; 46: 133-141
• 11 Delahunt E, Coughlan GF, Caulfield B et al. Inclusion criteria when investigating insufficiencies in chronic ankle instability. Med Sci Sports Exerc 2010; 42: 2106-2121
• 12 Hertel J. Sensorimotor deficits with ankle sprains and chronic ankle instability. Clin Sports Med 2008; 27: 353-370
• 13 McKeon JMM, McKeon PO. Evaluation of joint position recognition measurement variables associated with chronic ankle instability: a meta-analysis. J Athl Train 2012; 47: 444-456
• 14 Hiller CE, Nightingale EJ, Lin CC et al. Characteristics of people with recurrent ankle sprains: a systematic review with meta-analysis. Br J Sports Med 2011; 45: 660-672
• 15 Refshauge KM, Kilbreath SL, Raymond J. Deficits in detection of inversion and eversion movements among subjects with recurrent ankle sprains. J Orthop Sports Phys Ther 2003; 33: 166-173
• 16 de Noronha M, Refshauge KM, Kilbreath SL et al. Loss of proprioception or motor control is not related to functional ankle instability: an observational study. Aust J Physiother 2007; 53: 193-198
• 17 Refshauge KM, Kilbreath SL, Raymond J. The effect of recurrent ankle inversion sprain and taping on proprioception at the ankle. Med Sci Sports Exerc 2000; 32: 10-15
• 18 Forkin DM, Koczur C, Battle R et al. Evaluation of kinesthetic deficits indicative of balance control in gymnasts with unilateral chronic ankle sprains. J Orthop Sports Phys Ther 1996; 23: 245-250
• 19 Lentell G, Baas B, Lopez D et al. The contributions of proprioceptive deficits, muscle function, and anatomic laxity to functional instability of the ankle. J Orthop Sports Phys Ther 1995; 21: 206-215
• 20 Hubbard TJ, Kaminski TW. Kinesthesia is not affected by functional ankle instability status. J Athl Train 2002; 37: 481-486
• 21 Arnold BL, Docherty CL. Low-load eversion force sense, self-reported ankle instability, and frequency of giving way. J Athl Train 2006; 41: 233-238
• 22 Docherty CL, Arnold BL, Hurwitz S. Contralateral force sense deficits are related to the presence of functional ankle instability. J Orthop Res 2006; 24: 1412-1419
• 23 Docherty CL, Arnold BL. Force sense deficits in functionally unstable ankles. J Orthop Res 2008; 26: 1489-1493
• 24 Wright CJ, Arnold BL. Fatigueʼs effect on eversion force sense in individuals with and without functional ankle instability. J Sport Rehabil 2012; 21: 127-136
• 25 Arnold BL, de la Motte S, Linens S et al. Ankle instability is associated with balance impairments: a meta-analysis. Med Sci Sports Exerc 2009; 41: 1048-1062
• 26 Munn J, Sullivan SJ, Schneiders AG. Evidence of sensorimotor deficits in functional ankle instability: a systematic review with meta-analysis. J Sci Med Sport 2010; 13: 2-12
• 27 Wikstrom EA, Naik S, Lodha N et al. Bilateral balance impairments after lateral ankle trauma: a systematic review and meta-analysis. Gait Posture 2010; 31: 407-414
• 28 Ross SE, Guskiewicz KM, Gross MT et al. Balance measures for discriminating between functionally unstable and stable ankles. Med Sci Sports Exerc 2009; 41: 399-407
• 29 Wikstrom EA, Fournier KA, McKeon PO. Postural control differs between those with and without chronic ankle instability. Gait Posture 2010; 32: 82-86
• 30 McVey ED, Palmieri RM, Docherty CL et al. Arthrogenic muscle inhibition in the leg muscles of subjects exhibiting functional ankle instability. Foot Ankle Int 2005; 26: 1055-1061
• 31 Palmieri-Smith RM, Hopkins JT, Brown TN. Peroneal activation deficits in persons with functional ankle instability. Am J Sports Med 2009; 37: 982-988
• 32 Sedory EJ, McVey ED, Cross KM et al. Arthrogenic muscle response of the quadriceps and hamstrings with chronic ankle instability. J Athl Train 2007; 42: 355-360
• 33 Arnold BL, Linens SW, de la Motte SJ et al. Concentric evertor strength differences and functional ankle instability: a meta-analysis. J Athl Train 2009; 44: 653-662
• 34 Fox J, Docherty CL, Schrader J et al. Eccentric plantar-flexor torque deficits in participants with functional ankle instability. J Athl Train 2008; 43: 51-54
• 35 Gribble PA, Robinson RH. An examination of ankle, knee, and hip torque production in individuals with chronic ankle instability. J Strength Cond Res 2009; 23: 395-400
• 36 Spaulding SJ, Livingston LA, Hartsell HD. The influence of external orthotic support on the adaptive gait characteristics of individuals with chronically unstable ankles. Gait Posture 2003; 17: 152-158
• 37 Delahunt E, Monaghan K, Caulfield B. Altered neuromuscular control and ankle joint kinematics during walking in subjects with functional instability of the ankle joint. Am J Sports Med 2006; 34: 1970-1976
• 38 Monaghan K, Delahunt E, Caulfield B. Ankle function during gait in patients with chronic ankle instability compared to controls. Clin Biomech (Bristol, Avon) 2006; 21: 168-174
• 39 Delahunt E, Monaghan K, Caulfield B. Changes in lower limb kinematics, kinetics, and muscle activity in subjects with functional instability of the ankle joint during a single leg drop jump. J Orthop Res 2006; 24: 1991-2000
• 40 Caulfield BM, Garrett M. Functional instability of the ankle: differences in patterns of ankle and knee movement prior to and post landing in a single leg jump. Int J Sports Med 2002; 23: 64-68
• 41 Freeman MA, Dean MR, Hanham IW. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br 1965; 47: 678-685
• 42 Hogervorst T, Brand RA. Mechanoreceptors in joint function. J Bone Joint Surg Am 1998; 80: 1365-1378
• 43 Konradsen L, Ravn JB, Sørensen AI. Proprioception at the ankle: the effect of anaesthetic blockade of ligament receptors. J Bone Joint Surg Br 1993; 75: 433-436
• 44 Riemann BL, Myers JB, Stone DA et al. Effect of lateral ankle ligament anesthesia on single-leg stance stability. Med Sci Sports Exerc 2004; 36: 388-396
• 45 Sefton JM, Hicks-Little CA, Hubbard TJ et al. Segmental spinal reflex adaptations associated with chronic ankle instability. Arch Phys Med Rehabil 2008; 89: 1991-1995
• 46 Delahunt E, Monaghan K, Caulfield B. Ankle function during hopping in subjects with functional instability of the ankle joint. Scand J Med Sci Sports 2007; 17: 641-648
• 47 McKeon PO, Hertel J. Systematic review of postural control and lateral ankle instability, Part I: Can deficits be detected with instrumented testing?. J Athl Train 2008; 43: 293-304
• 48 Kapreli E, Athanasopoulos S, Gliatis J et al. Anterior cruciate ligament deficiency causes brain plasticity: a functional MRI study. Am J Sports Med 2009; 37: 2419-2426
• 49 Kapreli E, Athanasopoulos S. The anterior cruciate ligament deficiency as a model of brain plasticity. Med Hypotheses 2006; 67: 645-650
• 50 Zech A, Hübscher M, Vogt L et al. Neuromuscular training for rehabilitation of sports injuries: a systematic review. Med Sci Sports Exerc 2009; 41: 1831-1841