Haben Patienten mit einer langwierigen Kreuzbandverletzung eine Veränderung der Neurodynamik des N. tibialis?

Zusammenfassung

Kreuzbandrisse (Rupturen des vorderen Kreuzbands, VKB) ziehen oft eine langwierige Rehabilitation und Wiedereingliederung nach sich. Die physiotherapeutische Nachbehandlung beinhaltet aktive und passive Maßnahmen. Bislang existieren keine Studien zu neurodynamischen Aspekten der Rehabilitation von Kreuzbandrissen. Das Ziel der vorliegenden Studie bestand darin, die Veränderung der Bewegung des N. tibialis des betroffenen und nicht betroffenen Beins bei Probanden nach einer VKB-Ruptur zu untersuchen.

Bestandteil der verblindeten Untersuchung der 19 Probanden waren der Knee Outcome Survey für alltägliche Aktivitäten (KOS) und verschiedene Funktionsuntersuchungen (Slump-Test mit passiver Knieextension, Long Sitting Slump Test mit passiver Dorsalextension des oberen Sprunggelenks, Straight Leg Raise Test, belastete Dorsalextension im Stand). Die longitudinale Nervenexkursion des N. tibialis wurde mit bildgebendem Ultraschall in sitzender Slump-Position untersucht. Die Auswertung der Ultraschallvideos erfolgte mit einer Frame-by-frame Cross Correlation Software.

Die Ergebnisse zeigten eine signifikant geringere Nervenexkursion des N. tibialis am betroffenen Knie. Allerdings fand sich kein klinisch signifikanter Zusammenhang zu den Funktionsuntersuchungen.

Abstract

Anterior cruciate ligament ruptures (ACL) often lead to lengthy rehabilitation and reintegration. Physiotherapeutic postoperative treatment includes active and passive interventions. To date there are no studies concerning neurodynamic aspects of rehabilitation following ACL rupture. The aim of this study was to determine changes in tibial nerve movement of the affected and non-affected leg in subjects with ACL rupture.

Components of the blinded examination of 19 subjects were the Knee Outcome Survey for Daily Activities (KOS) and multiple functional assessments (slump test with passive knee extension, long sitting slump test with passive dorsiflexion of the ankle, straight leg raise test, weight-bearing standing dorsiflexion). The longitudinal nerve excursion of the tibial nerve was examined using ultrasound in sitting slump position. The ultrasound videos were evaluated using a frame-to-frame cross correlation software.

The results showed a significant nerve excursion of the tibial nerve of the affected knee. There was, however, no clinically significant correlation with the functional examination.

Schlüsselwörter

vorderes Kreuzband - N. tibialis - Sonografie - diagnostischer Ultraschall - bildgebender Ultraschall - Neurodynamik

Keywords

anterior cruciate ligament - tibial nerve - sonography - diagnostic ultrasound - imaging ultrasound - neurodynamics

• Literatur

• 1 Ardern CL, Webster KE, Taylor NF. et al. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. Am J Sports Med 2011; 39: 538-543
• 2 Arendt E, Dick R. Knee Injury Patterns among Men and Women in Collegiate Basketball and Soccer. NCAA Data and Review of Literature. The American Journal of Sports Medicine 1995; 23: 694-701
• 3 Bizzini M, Gorelick M. Development of a German version of the knee outcome survey for daily activities. Archives of Orthopaedic and Trauma Surgery 2007; 127: 781-789
• 4 Boyd BS, Gray AT, Dilley A. et al. The pattern of tibial nerve excursion with active ankle dorsiflexion is different in older people with diabetes mellitus. Clinical Biomechanics 2012; 27: 967-971
• 5 Butler DS. Mobilisation des Nervensystems. Berlin: Springer; 1995
• 6 Carroll M, Yau J, Rome K. et al. Measurement of tibial nerve excursion during ankle joint dorsiflexion in a weight-bearing position with ultrasound imaging. Journal of Foot and Ankle Research 2012; 5: 1-7
• 7 Castellote-Caballero Y, Valenza MC, Martín-Martín L. et al. Effects of a neurodynamic sliding technique on hamstring flexibility in healthy male soccer players. A pilot study. Physical Therapy in Sport 2013; 14: 156-162
• 8 Cohen J. A coefficient of agreement for nominal scales. Educational and Psychological Measurement 1960; 20: 37-46
• 9 Coppieters MW, Alshami AM, Babri AS. et al. Strain and excursion of the sciatic, tibial, and plantar nerves during a modified straight leg raising test. Journal of Orthopaedic Research 2006; 24: 1883-1889
• 10 Denti M, Tornese D, Melegati G. et al. Combined Chronic Anterior Cruciate Ligament and Posterior Cruciate Ligament Reconstruction: Functional and Clinical Results. Knee Surgery, Sports Traumatology, Arthroscopy 2015; 23: 2853-2858
• 11 Dilley A, Greening J, Lynn B. et al. The Use of Cross-Correlation Analysis between High-Frequency Ultrasound Images to Measure Longitudinal Median Nerve Movement. Ultrasound in Medicine & Biology 2001; 27: 1211-1218
• 12 Duthon VB, Barea C, Abrassart S. et al. Anatomy of the anterior cruciate ligament. Knee Surgery, Sports Traumatology, Arthroscopy 2006; 14: 204-213
• 13 Ellis R, Hing W, Dilley A. et al. Reliability of measuring sciatic and tibial nerve movement with diagnostic ultrasound during a neural mobilisation technique. Ultrasound in Medicine & Biology 2008; 34: 1209-1216
• 14 Farmer JC, Wisneski RJ. Cervical Spine Nerve Root Compression. An Analysis of Neuroforaminal Pressures with Varying Head and Arm Positions. Spine 1994; 19: 1850-1855
• 15 Gianotti. Simon M, Marshall SW. et al. Incidence of Anterior Cruciate Ligament Injury and Other Knee Ligament Injuries: A National Population-Based Study. Journal of Science and Medicine in Sport 2009; 12: 622-627
• 16 Hauser M, Maitland GD, Hengeveld E. et al. Manipulation der Wirbelsäule. Heidelberg: Springer; 2005
• 17 Herrington L, Bendix K, Cornwell C. et al. What is the normal response to structural differentiation within the slump and straight leg raise tests?. Manual Therapy 2008; 13: 289-294
• 18 Hewett TE, Ford KR, Hoogenboom BJ. et al. Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations – update 2010. North American Journal of Sports Physical Therapy 2010; 5: 234-251
• 19 Hirose CB, McGarvey WC. Peripheral Nerve Entrapments. Foot and Ankle Clinics 2004; 9: 255-269
• 20 Impellizzeri FM, Mannion AF, Leunig M. et al. Comparison of the reliability, responsiveness, and construct validity of 4 different questionnaires for evaluating outcomes after total knee arthroplasty. The Journal of Arthroplasty 2011; 26: 861-869
• 21 Johnson LB, Sumner S, Duong T. et al. Validity and reliability of smartphone magnetometer-based goniometer evaluation of shoulder abduction – A pilot study. Manual Therapy 2015; 20: 777-782
• 22 Joseph AM, Collins CL, Henke NM. et al. A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics. J Athl Train 2013; 48: 810-817
• 23 Kiapour AM, Murray MM. Basic science of anterior cruciate ligament injury and repair. Bone and Joint Research 2014; 3: 20-31
• 24 Klau K. Einfluss einer vorderen Kreuzbandruptur auf die longitudinale Beweglichkeit des N. tibialis – Eine Querschnitt-Studie [Bachelor-Arbeit]. Osnabrück: HS Osnabrück; 2013
• 25 Maitland GD. Movement of pain sensitive structures in the vertebral canal in a group of physiotherapy students. Proceedings, Inaugural Congress of Manipulative Therapists Association of Australia; Sydney: 1978
• 26 Majewski M, Susanne H, Klaus S. Epidemiology of athletic knee injuries: A 10-year study. Knee 2006; 13: 184-188
• 27 Majlesi J, Togay H, Ünalan H. et al. The sensitivity and specificity of the Slump and the Straight Leg Raising tests in patients with lumbar disc herniation. Journal of Clinical Rheumatology 2008; 14: 87-91
• 28 Marx RG, Jones EC, Allen AA. et al. Reliability, Validity, and Responsiveness of Four Knee Outcome Scales for Athletic Patients. The Journal of Bone and Joint Surgery America 2001; 83-A: 1459-1469
• 29 Meyer J, Kulig K, Landel R. Differential diagnosis and treatment of subcalcaneal heel pain: A case report. Journal of Orthopaedic and Sports Physical Therapy 2002; 32: 114-124
• 30 Murray JR, Lindh AM, Hogan NA. et al. Does Anterior Cruciate Ligament Reconstruction Lead to Degenerative Disease? Thirteen-Year Results after Bone-Patellar Tendon-Bone Autograft. Am J Sports Med 2012; 40: 404-413
• 31 Nee RJ, Butler D. Management of peripheral neuropathic pain: Integrating neurobiology, neurodynamics, and clinical evidence. Physical Therapy in Sport 2006; 7: 36-49
• 32 Oesch P, Hilfiker R, Keller S. et al. Assessments in der Rehabilitation. Bd. 2: Bewegungsapparat. Bern: Huber; 2011
• 33 Pahor S, Toppenberg R. An investigation of neural tissue involvement in ankle inversion sprains. Manual Therapy 1996; 1: 192-197
• 34 Petersen W, Rosenbaum D, Raschke M. Rupturen des vorderen Kreuzbandes bei weiblichen Athleten. Teil 1: Epidemiologie, Verletzungsmechanismen und Ursachen. Deutsche Zeitschrift für Sportmedizin 2005; 56: 150-156
• 35 Petersen W, Zantop T. Das vordere Kreuzband: Grundlagen und aktuelle Praxis der operativen Therapie. Köln: Deutscher Ärzte-Verlag; 2009
• 36 Philip K, Lew P, Matyas TA. The inter-therapist reliability of the slump test. Australian Journal of Physiotherapy 1989; 35: 89-94
• 37 Von Piekartz HJM, Schouten S. Neurodynamic responses in children with migraine or cervicogenic headache versus a control group. A comparative study. Manual Therapy 2007; 12: 153-160
• 38 Rabin A, Gerszten PC, Karausky P. et al. The sensitivity of the seated straight-leg raise test compared with the supine straight-leg raise test in patients presenting with magnetic resonance imaging evidence of lumbar nerve root compression. Archives of Physical Medicine and Rehabilitation 2007; 88: 840-843
• 39 Rasch B, Friese M, Hofmann WJ. et al. Quantitative Methoden. 2. Einführung in die Statistik für Psychologen und Sozialwissenschaftler. Berlin: Springer; 2009
• 40 Roos H, Adalberth T, Dahlberg L. et al. Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age. Osteoarthritis and Cartilage 1995; 3: 261-267
• 41 Ross MD, Irrgang JJ, Denegar CR. et al. The relationship between participation restrictions and selected clinical measures following anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2002; 10: 10-19
• 42 Schwieder H. Effektivität aktiver versus passiver physiotherapeutischer Behandlungstechniken zur Verbesserung der Knieextension nach vorderer Kreuzbandersatzplastik. manuelletherapie 2015; 19: 127-34
• 43 Silva A, Manso A, Andrade R. et al. Quantitative in vivo longitudinal nerve excursion and strain in response to joint movement: A systematic literature review. Clinical Biomechanics 2014; 29: 839-847
• 44 Silvers HJ, Mandelbaum BR. Prevention of anterior cruciate ligament injury in the female athlete. Br J Sports Med 2007; 41: 52-59
• 45 Statistisches Bundesamt. Diagnosedaten der Patienten und Patientinnen in Krankenhäusern (einschl. Sterbe- und Stundenfälle). 2015 www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Krankenhaeuser/DiagnosedatenKrankenhaus2120621157004.pdf?__blob=publicationFile
• 46 Tucker N, Reid D, McNair P. Reliability and Measurement Error of Active Knee Extension Range of Motion in a Modified Slump Test Position: A Pilot Study. The Journal of Manual & Manipulative Therapy 2007; 15: E85-E91
• 47 Wahlstedt C, Rasmussen-Barr E. Anterior cruciate ligament injury and ankle dorsiflexion. Knee Surgery, Sports Traumatology, Arthroscopy Knee Surg Sports Traumatol Arthrosc 2015; 23: 3202-3207
• 48 Walker FO, Cartwright MS, Wiesler ER. et al. Ultrasound of nerve and muscle. Clinical Neurophysiology 2004; 115: 495-507
• 49 Westerhuis P, Wiesner R. Klinische Muster in der Manuellen Therapie: IMTA Kurshandbuch Level 2a u. b.. Stuttgart: Thieme; 2014
• 50 World Medical Association (WMA). WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human subjects. Bulletin of the World Health Organization 2001; 79: 373
• 51 World Health Organization (WHO). International Classification of Functioning, Disability and Health: ICF. Geneva: WHO; 2001
• 52 Yaxley G, Jull G. Adverse tension in the neural system: A preliminary study of tennis elbow. Australian Journal of Physiotherapy 1993; 39: 15-22