Die Trainierbarkeit von propriozeptiven und koordinativen Parametern bei der chronisch-funktionellen Sprunggelenkinstabilität

[Neuromuscular deficits in chronic ankle instability. Frequency and significance - multicenter study]

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.

The influence of playing level on functional ankle stability in soccer players

OBJECTIVE

The aim of this study was to compare the functional ankle stability between professional and amateur soccer players as well as controls.

MATERIALS AND METHODS

Thirty professional soccer players, 30 amateur soccer players and 30 controls were evaluated. All participants completed a questionnaire. Range of motion (ROM), peroneal reaction time (PRT) and ankle position sense were measured. Balance control was investigated with the Biodex Stability System, measuring the stable level 8 and the unstable level 2.

RESULTS

Professional soccer players cited significantly more frequent ankle sprains than all other groups (P = 0.002). They showed a significantly decreased dorsiflexion of the right foot (amateur: P = 0.017; controls: P = 0.004), an increased pronation of both feet (amateurs: right: P = 0.0048, left: P = 0.006; controls: right: P = 0.017, left: P = 0.007) and a decreased supination of the left foot in comparison to all other groups (amateurs: P = 0.003; controls: P = 0.004). Balance control showed no significant differences among all groups. Significant differences in angle reproduction were observed between professionals and amateurs for the left ankle joint at the positions of 105° (P = 0.0018) and 140° (P = 0.013). Professionals (P = 0.004) and amateurs (P = 0.001) showed a significantly delayed PRT of the right peroneus longus muscle compared to controls. In addition, the PRT of the right peroneus brevis muscle was significantly increased in professional soccer players in comparison to controls (P = 0.017).

CONCLUSIONS

Professional soccer players have shown more frequent ankle sprains, limited ROM, and delayed PRT of the right leg which reflects the higher risk of functional ankle instability due to intensified work-related use of feet. Therefore, proprioceptive exercises of the ankle in daily training programs are recommended in order to minimize the risk of ankle injuries and improve functional ankle stability.

EVALUATION OF THE PROPRIOCEPTIVE INFLUENCE OF THE CUTANEOUS AFFERENTS TO THE ANKLE IN PATIENTS AFTER SURAL NERVE HARVESTING

OBJECTIVE

Cutaneous afferent nerves contribute to joint proprioception. The aim of this study was to retrospectively analyze the proprioceptive influence of the cutaneous afferents to the ankle in patients after sural nerve harvesting in comparison to controls.

METHODS

The proprioception of the ankle in 24 patients after sural nerve harvesting was investigated. The sural nerve was harvested bilaterally in Group 1 (n = 10), in the right leg in Group 2 (n = 6), and in the left leg in Group 3 (n = 8). The proprioception of the ankle was also tested in controls (Group 4, n = 24). The peroneal reaction time (PRT) was measured on a tilting platform. The position sense test was performed. Balance control was investigated with the Biodex Stability System (Biodex Medical Systems, Shirley, NY) at the stable Level 8 and unstable Level 2.

RESULTS

No significant differences among the groups were seen in the position sense test, the PRT, and all scores of the Biodex Stability System. The PRT showed significant differences in comparison to the contralateral leg for the peroneus brevis muscle in Group 1 (P = 0.005) and Group 4 (P = 0.001) as well as for the peroneus longus muscle in Group 3 (P = 0.036) and Group 4 (P = 0.001).

CONCLUSION

The proprioception of the ankle in patients after sural nerve harvesting is not reduced in comparison to controls. Significant differences of the PRT between the left and right legs are attributable to leg dominance in most cases and not to a loss of innervation. Harvesting of the sural nerve does not result in ankle instability.