Sprunggelenk-Instabilität: Wie unterscheide ich mechanisch von funktionell?

Zusammenfassung

Die chronische Sprunggelenkinstabilität lässt sich grundlegend in 3 Komponenten unterteilen, die interagieren: die mechanische Instabilität, die funktionelle Instabilität und die subjektive Instabilität. Die bestmögliche Therapieempfehlung muss die dominierende Ätiologie sowie das Zusammenspiel zwischen mechanischer und funktioneller Komponente berücksichtigen. Hierzu bedarf es einer adäquaten Diagnostik, auch wenn die quantitative Diagnostik der mechanischen Instabilität weiterhin eine Herausforderung darstellt. Zu den diagnostischen Optionen zählen für die Mechanik die klinische Untersuchung, die jedoch keine Einteilung in Schweregrade erlaubt. Weiterhin bilden die Stress-Sonografie, das 3-D-Stress-MRT (3SAM), die Arthrometrie, je nach Fragestellung die markerbasierte Bewegungsanalyse und die diagnostische Sprunggelenkarthroskopie das Portfolio der diagnostischen Möglichkeiten. Letztere ist aktuell der anerkannte Goldstandard, auch wenn eine rein diagnostische Arthroskopie nicht indiziert ist, es sich um ein invasives Verfahren handelt und diese ebenso wenig wie die klinische Untersuchung eine Bemessung der Instabilität erlaubt. Zur funktionellen Diagnostik gehören der Star Excursion Balance Test, die Posturografie/Stabilometrie, die Gang-/Laufanalyse, die EMG-Analyse (EMG: Elektromyografie) in der dynamischen Untersuchung und die isokinetische Kraftmessung.

Die Standardtherapie ist die konservative Behandlung mithilfe von sensomotorischem Training, Kräftigung der gelenkumgreifenden Muskulatur sowie der unteren Extremität, Gleichgewichtstraining mit Gang- und Laufschule auf unterschiedlichen Untergründen. Jedoch wird zunehmend klar, dass ein gewisser Grad mechanischer Insuffizienz nicht durch funktionelles Training kompensiert werden kann. Es ist das Ziel der differenzierten Diagnostik, diese Patienten/-innen zu identifizieren und für diese die richtige mechanische Therapie zu indizieren bspw. Tapeverbände, Sprunggelenkorthesen oder operative Bandrekonstruktion.

Schlüsselwörter

Sprunggelenkinstabilität - funktionelle Instabilität - mechanische Instabilität - Sprunggelenkdistorsion

Publication History

Received: 06 September 2021

Accepted: 11 November 2021

Article published online:
14 February 2022

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