Kamin Konrad, Mäder Marcel, Marx Christine, Rammelt Stefan
UniversitätsCentrum für Orthopädie und Unfall- und Plastische Chirurgie, Am Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
Unfallchirurgie (Heidelb). 2025 Jan;128(1):47-58. doi: 10.1007/s00113-024-01503-4. Epub 2024 Dec 10.
Acute sprains and ruptures of the lateral ankle ligaments are the most common injuries of the ankle joint. They are often related to sporting activity and predominantly affect individuals under 40 years old. Lateral ligament injuries occur due to supination trauma. The anterior talofibular ligament is most commonly affected often in combination with the calcaneofibular ligament. In contrast, ruptures of all three lateral ankle ligaments (luxatio pedis supinatoria) or complete ruptures of the medial and lateral ligaments (luxatio pedis cum talo) are extremely rare. The clinical diagnostics have a high sensitivity and specificity and X-ray images are used to exclude fractures and other accompanying injuries. In cases of acute injuries conservative treatment in an orthosis for 5-6 weeks to prevent supination is the method of choice. Surgical treatment is reserved for exceptional indications. For both operative and conservative forms of treatment the functional treatment with initial movement exercises in a semi-rigid orthosis and the following proprioceptive training are crucial for the success of treatment and show superior results compared to immobilization in a surgical cast.
外侧踝关节韧带的急性扭伤和断裂是踝关节最常见的损伤。它们通常与体育活动有关,主要影响40岁以下的人群。外侧韧带损伤是由于旋后创伤引起的。距腓前韧带最常受累,通常与跟腓韧带同时损伤。相比之下,外侧踝关节三条韧带全部断裂(旋后型足脱位)或内外侧韧带完全断裂(距骨型足脱位)极为罕见。临床诊断具有较高的敏感性和特异性,X线片用于排除骨折和其他伴随损伤。对于急性损伤,采用矫形器保守治疗5-6周以防止旋后是首选方法。手术治疗仅适用于特殊指征。对于手术和保守治疗方式,在半刚性矫形器中进行初始运动锻炼以及随后的本体感觉训练这种功能治疗对于治疗成功至关重要,并且与手术石膏固定相比显示出更好的效果。