Alterated ligamento-muscular reflex pattern after stimulation of the anterior talofibular ligament in functional ankle i
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Alterated ligamento‑muscular reflex pattern after stimulation of the anterior talofibular ligament in functional ankle instability Susanne Rein1,2 · Elisabet Hagert3,4 · Thorben Sterling‑Hauf5 Received: 10 June 2020 / Accepted: 10 August 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
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. Keywords Ankle joint · Electromyography · Ligament · Proprioception Abbreviations ATFL Anterior talofibular ligament CFL Calcaneofibular ligament EMG Electromyography FAI Functional ankle instability PL Peroneus longus muscle
* Susanne Rein [email protected] 1
Department of Plastic and Hand Surgery, Burn Unit, Klinikum Sankt Georg, Delitzscher Straße 141, 04129 Leipzig, Germany
2
Martin-Luther-University of Halle-Wittenberg, Halle, Germany
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
TA Tibialis anterior muscle TP Tibialis posterior muscle
Introduction Ligaments have three main functions: (1) to provide passive mechanical stability of joints; (2) viscoelasticity, and (3) sensory function, where ligaments are recognized as sensory organs capable of monitoring and supplying afferent kinesthetic and proprioceptive data [41]. Proprioceptive information transmitted from mechanoreceptors in ligaments and joint capsule, reacting to changes in joint angle or velocity, influence the muscular stability of a joint. Recent investigations h
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