Susanne Rein1,2, Elisabet Hagert3,4, Thorben Sterling-Hauf5. 1. Department of Plastic and Hand Surgery, Burn Unit, Klinikum Sankt Georg, Delitzscher Straße 141, 04129, Leipzig, Germany. susanne.rein@web.de. 2. Martin-Luther-University of Halle-Wittenberg, Halle, Germany. susanne.rein@web.de. 3. Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden. 4. Arcademy, H.M Queen Sophia Hospital, Stockholm, Sweden. 5. Department of Otolaryngology, University Hospital, Franz-Joseph-Strauß-Allee 11, 93053, Regensburg, Germany.
Abstract
PURPOSE: Ligamento-muscular reflex pattern following stimulation of the anterior talofibular ligament (ATFL) was examined. METHODS: The peroneus longus (PL), the tibialis anterior (TA), and tibialis posterior (TP) muscles were investigated in sixteen patients with functional ankle instability (FAI) and 16 age- and gender-matched controls. The ATFL was stimulated with a fine wire electrode while electromyographic (EMG) activities were recorded during isometric foot contraction of 20% maximal force in plantarflexion, dorsiflexion, supination and pronation. The complete measurement was repeated after a peroneal block anesthesia. RESULTS: Statistically significant changes in post-stimulus EMG activity were observed in all three muscles and all four tested foot positions. In supination, the PL showed no reactions in both groups before and after anesthesia. The post-stimulus inhibition of the TA seen after 80 and 180 ms disappeared in controls after anesthesia. The TP had similar inhibitory responses in both groups. CONCLUSION: Ligamento-muscular reflex pattern is alterated in FAI. While early reactions are essential in protecting the ankle joint in sudden movements, the later responses indicate a supraspinal control of neuromuscular stability of the ankle joint. Proprioceptive rehabilitation of the PL, TA, and TP is crucial in FAI to compensate for post-traumatic ligamentomuscular reflex deficiencies. LEVEL OF EVIDENCE: II.
PURPOSE: Ligamento-muscular reflex pattern following stimulation of the anterior talofibular ligament (ATFL) was examined. METHODS: The peroneus longus (PL), the tibialis anterior (TA), and tibialis posterior (TP) muscles were investigated in sixteen patients with functional ankle instability (FAI) and 16 age- and gender-matched controls. The ATFL was stimulated with a fine wire electrode while electromyographic (EMG) activities were recorded during isometric foot contraction of 20% maximal force in plantarflexion, dorsiflexion, supination and pronation. The complete measurement was repeated after a peroneal block anesthesia. RESULTS: Statistically significant changes in post-stimulus EMG activity were observed in all three muscles and all four tested foot positions. In supination, the PL showed no reactions in both groups before and after anesthesia. The post-stimulus inhibition of the TA seen after 80 and 180 ms disappeared in controls after anesthesia. The TP had similar inhibitory responses in both groups. CONCLUSION: Ligamento-muscular reflex pattern is alterated in FAI. While early reactions are essential in protecting the ankle joint in sudden movements, the later responses indicate a supraspinal control of neuromuscular stability of the ankle joint. Proprioceptive rehabilitation of the PL, TA, and TP is crucial in FAI to compensate for post-traumatic ligamentomuscular reflex deficiencies. LEVEL OF EVIDENCE: II.