Evidenzlage zur konservativen Therapie bei akuter Syndesmosenverletzung am oberen Sprunggelenk im Sport

Marvin Reiter; Ute Vogt; Sven Reuter

doi:10.1055/a-0815-9989

manuelletherapie 2019; 23(01): 31-39
DOI: 10.1055/a-0815-9989

Literaturstudie

Evidenzlage zur konservativen Therapie bei akuter Syndesmosenverletzung am oberen Sprunggelenk im Sport

Darstellung eines auf dem aktuellen Stand der Wissenschaft basierenden physiotherapeutischen BehandlungsalgorithmusEvidence Level for Conservative Therapy in Acute Syndesmosis Injury of the Talocrural Joint in SportsPresentation of a Physiotherapeutic Treatment Algorithm Based on the Current Research

Authors

Marvin Reiter

¹SRH Hochschule für Gesundheit Gera, Campus Stuttgart

²Praxis Pro Physio, Ludwigsburg
Ute Vogt

¹SRH Hochschule für Gesundheit Gera, Campus Stuttgart
Sven Reuter

¹SRH Hochschule für Gesundheit Gera, Campus Stuttgart

Abstract

Zusammenfassung

In 1–18 % der Fälle wird die Syndesmosenverletzung von einer Bandverletzung am Sprunggelenk begleitet oder tritt isoliert auf. Zu den Risikogruppen gehören vor allem Sportarten mit schnellen Richtungswechseln und Gegnerkontakt wie Fußball oder American Football. Aktuell gibt es im Bereich der Physiotherapie keine Evidenz für die konservative Therapie der akuten Syndesmosenverletzung am oberen Sprunggelenk.

Die in den Fachdatenbanken PubMed, Cochrane und PEDro gefundenen und in die vorliegende Arbeit eingeschlossenen 11 Studien zeigten bezüglich der konservativen Therapie einen Konsens in verschiedenen aufgestellten Parametern. Basierend auf der aktuell vorhandenen Literatur ließ sich ein physiotherapeutischer Behandlungsalgorithmus zur ausschließlich konservativen Therapie der akuten Syndesmosenverletzung am oberen Sprunggelenk erstellen.

Abstract

Syndesmosis injury is accompanied by a ligament injury of the ankle or occurs isolated in 1–18 per cent of all cases. High-risk groups are predominantly sports with fast directional changes and contact sport such as soccer or American football. Currently there exists no physiotherapeutic evidence for conservative therapy in syndesmosis injury of the talocrural joint.

The 11 studies found in the databases PubMed, Cochrane and PEDro and included in this article showed agreement in the different parameters within the scope of the conservative treatment. Based on the current literature a physiotherapeutic treatment algorithm for an exclusively conservative therapy of the syndesmosis injury at the talocrural joint has been developed.

Schlüsselwörter

Syndesmosenverletzung - oberes Sprunggelenk - konservative Therapie - Sport

Key words

syndesmosis injury - talocrural joint - conservative therapy - sports

Full Text

References

Literatur
1 Williams G, Jones M, Amendola A. Syndesmotic Ankle Sprains in Athletes. Am J Sports Med 2007; 1: 1197-1207 doi: 10.1177/0363546 507302545
2 Williams G, Allen E. Rehabilitation of Syndesmotic (High) Ankle Sprains. Sports Health 2010; 2: 460-470 doi: 10.1177/1941738110384573
3 Thermann H, Nitsche L, Feil S. et al. Verletzungen des vorderen Syndesmosenbandes (AITFL). Was, wann, wie behandeln?. Sports Orthop Traumatol 2011; 27: 99-107 doi: 10.1016/j.orthtr.2011.04.002
4 Schmidmaier G, Ferbert T, Meenen N. et al. Leitlinien Unfallchirurgie – überarbeitete Leitlinie S2–e: Sprunggelenkfraktur. 2015 www.awmf.org/uploads/tx_szleitlinien/012–003l_S2e_Sprunggelenkfraktur_2016–02.pdf (15.06.2018)
5 Deutsche Gesellschaft für Orthopädie und orthopädische Chirurgie. (Hrsg). Leitlinien der Orthopädie: Frische Außenbandruptur oberes Sprunggelenks. Köln: Dt. Ärzte-Verlag; 2002
6 Schepers T. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair. Int Orthop 2012; 36: 1199-1206 doi: 10.1007/s00264–012–1500–2
7 Amendola A, Williams G, Foster D. Evidence-based approach to treament of acute traumatic syndesmosis (high ankle sprains). Sports Med and Arthrosc Rev 2006; 14: 232-236 doi: 10.1097/01.jsa.0000212329.32969.b8
8 Rammelt S, Richter M, Walther M. Leitlinien Unfallchirurgie – neu erarbeitete Leitlinie – AWMF-Nr. 012–022: Frische Außenbandruptur am Oberen Sprunggelenk. 2017 www.awmf.org/uploads/tx_szleitlinien/012–022l_S1_Aussenbandruptur_oberes_Sprunggelenk_2017–08.pdf (15.06.2018)
9 Gerber J, Williams G, Scoville S. et al. Persistent Dissability Associated with Ankle Sprains: A Prospektive Examination of an Athletic Population. Foot Ankle Int 1998; 19: 653-660 doi: 10.1177/107110 079 80 1901002
10 Schünke M, Schulte E, Schumacher U. Prometheus. LernAtlas der Anatomie. Allgemeine Anatomie und Bewegungssystem. Illustrationen von M. Voll und K. Wesker. 3. überarb. u. erw. Aufl.. Stuttgart: Thieme; 2011
11 Taylor DC, Englehardt DL, Bassett FH. Syndesmosis sprains of the ankle. The influence of heterotopic ossification. Am J Sports Med 1992; 20: 146-150 doi: 10.1177/036354659202000209
12 Brosky T, Nyland J, Nitz A. et al. The Ankle Ligaments: Consideration of Syndesmotic injury and Implications for Rehabilitation. J Orthop Sports Phys Ther 1995; 21: 197-205 doi: 10.2519/jospt.1995. 21.4.197
13 Nussbaum E, Hosea T, Sieler S. Prospective Evaluation of Syndesmotic Ankle Sprains Without Diastasis. Am J Sports Med 2001; 29: 31-35 doi: 10.1177/03635465010290011001
14 Lin C, Gross M, Weinhold P. Ankle Syndesmosis Injuries: Anatomy, Biomechanics, Mechanism of Injury, and Clinical Guidelines for Diagnosis and Intervention. J Orthop Sports Phys Ther 2006; 36: 372-284 doi: 10.2519/jospt.2006.2195
15 Pajaczkowski J. Rehabilitation of distal syndesmosis sprains: a case report. J Can Chiropr Assoc 2007; 51: 42-49
16 Miller B, Downie B, Johnson P. et al. Time to Return to Play After High Ankle Sprains in Collegiate Football Players: A Prediction Model. Sports Health: 2012; 11: 504-509 doi: 10.1177/1941738111434916
17 Tiemstra J. Update on acute ankle sprains. Am Fam Physician 2012; 85 12: 1170-1176
18 Morgan C, Konopinski M, Dunn A. Conservative Management of Syndesmosis Injuries in Elite Football. 2014 www.aspetar.com/journal/viewarticle.aspx?id=204 (15.06.2018)
19 Knapik D, Trem A, Sheehan J. et al. Conservative Management for Stable High Ankle Injuries in Professional Football Players. Sports Health 2018; 10: 80-84 doi: 10.1177/1941738117720639
20 Kaminski T, Hertel J, Amendola N. et al. National Athletics Trainers‘ Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes. J Athl Train 2013; 48: 528-545 doi: 10.4085/1062–6050–48.4.02
21 Farshad A, Kazemi M, Shahmir A. et al. Diagnosis of syndesmosis sprain (Comparing radiography and physical examination). Poster No. 1940. 55th Annual Meeting of the Orthopaedic Research Society. www.ors.org/Transactions/55/1940.pdf (15.06.2018)
22 De César P, Avilla E, De Abreu M. Comparison of magnetic resonance imaging to physical examination for syndesmotic injury after lateral ankle sprain. Foot Ankle Int 2011; 32: 1110-1114 doi: 10.3113/FAI.2011.1110
23 Beumer A, Swierstra BA, Mulder P. Cliniqual diagnosis of syndesmosis ankle instability: evaluation of stress tests behind the curtains. Acta Orthop Scand 2002; 73: 667-669 doi: 10.1080/000164702321039642
24 Sman A, Hiller C, Refshauge K. Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review. Br J Sports Med 2016; 47: 620-628 doi:10.1136/bjsports-2012–091702
25 Hiller CE, Refshauge KM, Bundy AC. et al. The Cumberland Ankle Instability Tool: A report of validity and reliability testing. Arch Phys Med Rehabil 2006; 87: 1235-1241 doi:10.1016/j.apmr.2006.05.022
26 Jenkin M, Sitler M, Kelly J. Clinical Usefullness of the Ottawa Ankle Rules for Detecting Fractures of the Ankle and Midfoot. J Athl Train 2010; 45: 480-482 doi: 10.4085/1062–6050–45.5.480
27 Latham A, Goodwin P, Stirling B. et al. Ankle syndesmosis repair and rehabilitation in professional rugby league players: a case series report. BMJ Open Sport Exerc Med 2017; 3: 1-6 doi: 10.1136/bmjsem-2016–000175
28 Chinn L, Dicharry J, Hertel J. Ankle kinematics of individuals with chronic ankle instability while walking and jogging on a treadmill in shoes. Phys Ther Sport 2013; 14: 232-239 doi: 10.1016/j.ptsp.2012.10.001
29 FIFA Medical Assessment and Research Centre. (Hrsg). 11+ Manual: Ein komplettes Aufwärmprogramm zur Verletzungsprävention. 2007 www.dfb.de/fileadmin/_dfbdam/16988-Elf-Plus-Manual-Deutsch.pdf (15.06.2018)
30 Zemková E. Sport-Specific Balance. Sports Med 2013; 44: 579-590 doi: 10.1007/s40279–013–0130–1
31 Chun KY, Choi YS, Lee SH. et al. Deltoid Ligament and Tibiofibular syndesmosis Injury in Chronic Lateral Ankle Instability: Magnetic Resonance Imaging Evaluation at 3T and Comparison with Arthroscopy. Korean J Radiol 2015; 16: 1096-1103 doi: 10.3348/kjr.2015.16.5.1096
32 Best R, Brüggemann P, Petersen W. et al. Aktuelle und neue Konzepte in der Behandlung akuter Außenbandverletzungen des Sprunggelenkes. Deutsche Zeitschrift für Sportmedizin 2011; 62: 57-62
33 Bonnaire F, Lein T, Moritz F. Syndesmosenverletzungen. OP-Journal 2007; 23: 90-97 doi: 10.1055/s-2007–991915
34 Lubberts B, Vopat B, Wolf J. et al. Arthroscopically measured syndesmotic stability after screw vs. suture button fixation in cadaveric model. Injury 2017; 48: 2433-2437 doi: 10.1016/j.injury.2017.08.066
35 Van Dijk CN, Longo UG, Loppini M. et al. Conservative and surgical management of acute isolated syndesmotic injuries: ESSKAAFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc 2016; 24: 1217-1122 doi: 10.1007/s00167–016–4017–1
36 Teitz CC, Harrington RM. A biomechanical analysis of the squeeze test for sprains of the syndesmotic ligaments of the ankle. Foot Ankle Int 1998; 19: 489-492 doi: 10.1177/107110079801900713