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Unterschenkel-Muskelatrophie bei Arthrose des oberen Sprunggelenks und deren Rehabilitation nach Implantation einer Sprunggelenksprothese

Lower leg muscle atrophy in ankle osteoarthritis and its rehabilitation after implantation of a total ankle arthroplasty

Fuß & Sprunggelenk volume 5, Article number: 33 (2007) Cite this article

Abstract

The aim of this orthopaedic-biomechanical study was to evaluate lower leg muscle function in ankle osteoarthritis (OA) patients and muscle rehabilitation after the implantation of a total ankle replacement (TAR).

Patients with a severe unilateral ankle OA were assessed with an orthopaedic and biomechanical examination before and one year after TAR surgery. Visual analogue pain score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, ankle range of motion for dorsi- and plantar flexion (ROM DF/PF), and calf circumference difference between affected and contralateral healthy leg were measured. Isometric maximal voluntary torque for ankle dorsiflexion and plantar flexion were measured simultaneously with surface electromyography (EMG; mean frequency and intensity) of the anterior tibial, medial gastrocnemius, soleus, and peroneus longus muscle. Data were compared to a group of age- and gender-matched normal subjects.

The mean calf circumference difference between legs did not significantly decrease from preoperative to one year follow-up. The mean dorsiflexion torque and plantar flexion torque of the affected ankle increased significantly. The atrophic muscles were characterized by a reduction of the mean EMG intensity and mean EMG frequency. In the rehabilitation process, the mean EMG intensity recovered and was not significantly different for all muscles, however, not for EMG frequency, which remained low and unchanged.

This study reports for the first time in the literature the clinical and biomechanical facts of lower leg muscle atrophy in ankle OA as well as the amount of the muscle rehabilitation after a total ankle replacement. Patients with a symptomatic ankle OA achieve better function with a total ankle replacement; however, one year after the operation neuromuscular and biomechanical deficits may still be present.

Zusammenfassung

Das Ziel dieser orthopädisch-biomechanischen Studie war die Evaluation der Muskelfunktion von Patienten mit einer schweren Arthrose des oberen Sprunggelenks (OSG) sowie deren Rehabilitation nach Implantation einer OSG-Prothese.

Patienten mit einer schweren OSG-Arthrose wurden einer orthopädischen und biomechanischen Untersuchung vor und 12 Monate nach Implantation einer OSG-Prothese unterzogen. Dabei wurden der Schmerz-Score, der American Orthopaedic Foot and Ankle Society (AOFAS)-Ankle-Score, der Bewegungsumfang (ROM) des Sprunggelenks und der Unterschenkel-Umfang des betroffenen und des kontralateralen, gesunden Beins gemessen. Die biomechanische Beurteilung bestand aus einer simultanen Messung des maximal-willkürlichen, isometrischen Drehmoments bei Plantarflexion und Dorsalextension des OSG sowie von Oberflächen-Elektromyogrammen (EMG; mittlere Frequenz und Intensität) von vier bilateralen Unterschenkelmuskeln: M. tibialis anterior (TA), M. gastrocnemius medialis (GM), M. soleus (SO) und M. peronaeus longus (PL). Die erhobenen Daten wurden mit einer alters- und geschlechtsangepassten Gruppe von Normalprobanden verglichen.

Die mittlere Differenz des Unterschenkel-Umfangs zwischen den beiden Beinen nahm vom arthrotischen Stadium zur Einjahresnachkontrolle nicht signifikant ab. Das mittlere Drehmoment des betroffenen Sprunggelenks verbessert sich für die Dorsalextension und Plantarflexion. Die atrophische Unterschenkelmuskulatur war im arthrotischen Stadium im Vergleich zu den gesunden Muskeln der kontralateralen Seite durch eine signifikante Reduktion der mittleren EMG-Frequenz und EMG-Intensität gekennzeichnet. Im Rehabilitationsprozess konnte nach einem Jahr zwar eine Erholung der EMG-Intensität aller vier Muskeln nachgewiesen werden, nicht jedoch der mittleren EMG-Frequenz. Letztere blieb auf Niveau des präoperativen arthrotischen Stadiums reduziert.

Diese Studie liefert zum ersten Mal in der Literatur objektive und orthopädisch-biomechanische Daten zur Atrophie der Unterschenkelmuskulatur bei der Arthrose des OSG und deren Rehabilitation nach Implantation einer OSG-Prothese. Patienten mit einer symptomatischen OSG-Arthrose erlangen mit einer OSG-Prothese zwar eine bessere klinische Funktion, ein Jahr nach der Operation können jedoch noch immer muskulär-biomechanische Defizite nachgewiesen werden.

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Authors and Affiliations

  1. Human Performance Laboratory & Orthopaedic Department, University of Calgary, 2500 University Drive N.W., Calgary, Alberta, Canada T2N 1N4

    V. Valderrabano,  V. von Tscharner,  B. M. Nigg &  C. B. Frank

  2. Orthopädische Universitätsklinik, Behandlungszentrum Bewegungsapparat, Universitätsspital Basel, Spitalstraße 21, 4031, Basel, Switzerland

    V. Valderrabano &  B. Hintermann

  3. Labor für Orthopädische Biomechanik, Universität Basel, 4055, Basel, Switzerland

    B. Goepfert

  4. Orthopädische Universitätsklinik, Behandlungszentrum Bewegungsapparat, Universitätsspital Basel, Spitalstraße 21, 4031, Basel, Switzerland

    V. Valderrabano

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  1. V. Valderrabano
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  2. V. von Tscharner
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  3. B. M. Nigg
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  4. B. Goepfert
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Correspondence to V. Valderrabano.

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Valderrabano, V., von Tscharner, V., Nigg, B.M. et al. Unterschenkel-Muskelatrophie bei Arthrose des oberen Sprunggelenks und deren Rehabilitation nach Implantation einer Sprunggelenksprothese. Fuss 5, 33 (2007). https://doi.org/10.1007/s10302-006-0242-0

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  • DOI: https://doi.org/10.1007/s10302-006-0242-0

Key words

  • ankle
  • osteoarthritis
  • total ankle replacement
  • muscle
  • atrophy

Schlüsselwörter

  • Sprunggelenk
  • Arthrose
  • Sprunggelenksprothese
  • Muskel
  • Atrophie