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Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Syndesmotic sprains are uncommon injuries that require prolonged recovery. The influence of ultrasound-guided injections of platelet-rich plasma (PRP) into the injured antero-inferior tibio-fibular ligaments (AITFL) in athletes on return to play (RTP) and dynamic stability was studied.

Methods

Sixteen elite athletes with AITFL tears were randomized to a treatment group receiving injections of PRP or to a control group. All patients followed an identical rehabilitation protocol and RTP criteria. Patients were prospectively evaluated for clinical ability to return to full activity and residual pain. Dynamic ultrasound examinations were performed at initial examination and at 6 weeks post-injury to demonstrate re-stabilization of the syndesmosis joint and correlation with subjective outcome.

Results

All patients presented with a tear to the AITFL with dynamic syndesmosis instability in dorsiflexion–external rotation, and larger neutral tibia–fibula distance on ultrasound. Early diagnosis and treatment lead to shorter RTP, with 40.8 (±8.9) and 59.6 (±12.0) days for the PRP and control groups, respectively (p = 0.006). Significantly less residual pain upon return to activity was found in the PRP group; five patients (62.5 %) in the control group returned to play with minor discomfort versus one patient in the treatment group (12.5 %). One patient in the control group had continuous pain and disability and subsequently underwent syndesmosis reconstruction.

Conclusions

Athletes suffering from high ankle sprains benefit from ultrasound-guided PRP injections with a shorter RTP, re-stabilization of the syndesmosis joint and less long-term residual pain.

Level of evidence

II.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Sports Medicine Unit, “Meir” Medical Center, The Sackler School of Medicine (Tel-Aviv University), Kfar-Saba, Israel

    Lior Laver, Ezequiel Palmanovich, Eyal Yaacobi, Gideon Mann & Meir Nyska

  2. Division of Sports Medicine, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA

    Lior Laver

  3. Department of Trauma and Orthopaedic Surgery, Princess Royal Hospital, Telford, Shropshire, UK

    Michael R. Carmont

  4. Pacific Orthopaedics and Sports Medicine, North Vancouver, BC, Canada

    Mark O. McConkey

  5. Ribstein Center for Sport Medicine Sciences and Research, Wingate Institute, Netanya, Israel

    Gideon Mann

  6. Department of Radiology, Sports Medicine Unit, “Meir” Medical Center, Kfar-Saba, Israel

    Eugene Kots

  7. Department of Sports Medicine, University of Colorado Hospitals, Boulder, CO, USA

    Omer Mei-Dan

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  1. Lior Laver
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  2. Michael R. Carmont
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  3. Mark O. McConkey
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  4. Ezequiel Palmanovich
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  6. Gideon Mann
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  8. Eugene Kots
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  9. Omer Mei-Dan
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Correspondence to Lior Laver.

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Laver, L., Carmont, M.R., McConkey, M.O. et al. Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial. Knee Surg Sports Traumatol Arthrosc 23, 3383–3392 (2015). https://doi.org/10.1007/s00167-014-3119-x

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