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manuelletherapie 2019; 23(01): 31-39
DOI: 10.1055/a-0815-9989
Literaturstudie
© Georg Thieme Verlag KG Stuttgart · New York

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
Marvin Reiter
1   SRH Hochschule für Gesundheit Gera, Campus Stuttgart
2   Praxis Pro Physio, Ludwigsburg
,
Ute Vogt
1   SRH Hochschule für Gesundheit Gera, Campus Stuttgart
,
Sven Reuter
1   SRH Hochschule für Gesundheit Gera, Campus Stuttgart
› Author Affiliations
Further Information

Publication History

05/14/2018

06/21/2018

Publication Date:
15 February 2019 (online)

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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
 

  • 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
    PubMedGoogle Scholar
  • 2 Williams G, Allen E. Rehabilitation of Syndesmotic (High) Ankle Sprains. Sports Health 2010; 2: 460-470 doi: 10.1177/1941738110384573
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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)
    PubMedGoogle Scholar
  • 5 Deutsche Gesellschaft für Orthopädie und orthopädische Chirurgie. (Hrsg). Leitlinien der Orthopädie: Frische Außenbandruptur oberes Sprunggelenks. Köln: Dt. Ärzte-Verlag; 2002
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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)
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 15 Pajaczkowski J. Rehabilitation of distal syndesmosis sprains: a case report. J Can Chiropr Assoc 2007; 51: 42-49
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 17 Tiemstra J. Update on acute ankle sprains. Am Fam Physician 2012; 85 12: 1170-1176
    PubMedGoogle Scholar
  • 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)
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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)
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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)
    PubMedGoogle Scholar
  • 30 Zemková E. Sport-Specific Balance. Sports Med 2013; 44: 579-590 doi: 10.1007/s40279–013–0130–1
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 33 Bonnaire F, Lein T, Moritz F. Syndesmosenverletzungen. OP-Journal 2007; 23: 90-97 doi: 10.1055/s-2007–991915
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar