Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 23, Issue 11, pp 3383–3392 | Cite as

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

  • Lior LaverEmail author
  • Michael R. Carmont
  • Mark O. McConkey
  • Ezequiel Palmanovich
  • Eyal Yaacobi
  • Gideon Mann
  • Meir Nyska
  • Eugene Kots
  • Omer Mei-Dan



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.


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.


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.


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



Syndesmosis Injections Platelet-rich plasma Ultrasound Return to play 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Lior Laver
    • 1
    • 2
    Email author
  • Michael R. Carmont
    • 3
  • Mark O. McConkey
    • 4
  • Ezequiel Palmanovich
    • 1
  • Eyal Yaacobi
    • 1
  • Gideon Mann
    • 1
    • 5
  • Meir Nyska
    • 1
  • Eugene Kots
    • 6
  • Omer Mei-Dan
    • 7
  1. 1.Department of Orthopaedic Surgery, Sports Medicine Unit, “Meir” Medical CenterThe Sackler School of Medicine (Tel-Aviv University)Kfar-SabaIsrael
  2. 2.Division of Sports Medicine, Department of Orthopaedic SurgeryDuke UniversityDurhamUSA
  3. 3.Department of Trauma and Orthopaedic SurgeryPrincess Royal HospitalTelford, ShropshireUK
  4. 4.Pacific Orthopaedics and Sports MedicineNorth VancouverCanada
  5. 5.Ribstein Center for Sport Medicine Sciences and ResearchWingate InstituteNetanyaIsrael
  6. 6.Department of Radiology, Sports Medicine Unit“Meir” Medical CenterKfar-SabaIsrael
  7. 7.Department of Sports MedicineUniversity of Colorado HospitalsBoulderUSA

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