Sprunggelenkarthrometrie zur Diagnostik der mechanischen Komponente der chronischen Sprunggelenkinstabilität

Zusammenfassung

Hintergrund: Obwohl der Begriff „chronische Sprunggelenkinstabilität“ in der Literatur häufig verwendet wird, ist er bis heute nicht eindeutig definiert. Häufig wird er synonym mit funktioneller Sprunggelenkinstabilität gebraucht und der relative Anteil der mechanischen Komponente ist noch nicht klar verstanden.

Patienten/Material und Methoden: Bei 15 Patienten mit chronischer Sprunggelenkinstabilität wurde die mechanische Instabilität mittels gehaltener Röntgenaufnahmen und mit einem neuartigen Sprunggelenkarthrometer quantifiziert. Das Ausmaß der funktionellen Behinderung wurde mit dem FAAM-G-Fragebogen erfasst. Die Ergebnisse wurden mit einer Gruppe von 17 asymptomatischen und nicht vorverletzten Probanden verglichen.

Ergebnisse: Sowohl in mechanischer Hinsicht (40 – 60 N Stiffness in der Kraft-Weg-Kurve und Quotient der Stiffness zwischen 125 – 175 N und 40 – 60 N) als auch unter funktionellen Aspekten unterschieden sich die Patienten signifikant von der Kontrollgruppe (p < 0,001 – 0,040).

Schlussfolgerung: Patienten, deren chronische Sprunggelenkinstabilität sowohl eine mechanische als auch eine funktionelle Komponente aufweisen, unterscheiden sich im FAAM-G-Fragebogen-Resultat und hinsichtlich spezifischer Auswertungsparameter auf dem Sprunggelenkarthrometer eindeutig von einer gesunden Kontrollgruppe. Diese Untersuchungsmethoden können für die abgrenzende Diagnostik, aber auch bei weiterführenden wissenschaftlichen Untersuchungen eingesetzt werden. Funktionelle und mechanische Komponenten der chronischen Sprunggelenkinstabilität können so quantifiziert und differenziert werden.

Abstract

Background: Chronic ankle instability (CAI) is a term that is not well defined until now in spite of a large body of respective literature. Most frequently this umbrella term is used synonymously for functional ankle instability and the role of the mechanical component is not fully understood.

Patients/Material and Methods: In a cohort consisting of 15 patients suffering from CAI we preoperatively investigated the mechanical component using both stress radiographs and ankle arthrometry. The functional impact was measured with the FAAM-G (foot and ankle ability measure, German version). The results were compared with a respective group of 17 uninjured subjects.

Results: Relevant differences were found between the patients and the uninjured groups in the mechanical (stiffness in the 40 – 60 N region of the load deformation curves and the ratio between stiffness in the 125 – 175 N and 40 – 60 N region) and functional analyses (FAAM-G), respectively (p < 0.001 – 0.040). There was no difference found between groups in the upper (125 – 175 N) region of the load deformation curves.

Conclusions: This article helps to clarify the role of the mechanical component in CAI. Patients suffering from both functional and mechanical ankle instability can be detected with the FAAM-G questionnaire and with different ankle stiffness parameters from ankle arthrometer stress testing. These measures differentiate CAI patients from uninjured persons with functionally and mechanically stable ankles. Therefore, these instruments can be recommended to diagnose and quantify the mechanical component in CAI.

Schlüsselwörter

chronische Sprunggelenkinstabilität - Sprunggelenkarthrometer - FAAM-G - mechanische Sprunggelenkinstabilität - funktionelle Sprunggelenkinstabilität

Key words

chronic ankle instability - ankle arthrometer - FAAM-G - functional ankle Instability - mechanical ankle Instability

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