Treatment of lateral ankle sprain with platelet-rich plasma: A randomized clinical study (original) (raw)
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The Use of Platelet-Rich Plasma in the Management of Foot and Ankle Conditions
2011
Platelet-rich plasma (PRP) contains growth factors derived from venous blood. Bone marrow concentrate (BMC) is an analogous platelet-rich product that is generated from bone marrow aspirate and might have the added advantage of containing mesenchymal stem cells. The active growth factors are platelet-derived growth factor, transforming growth factor , vascular endothelial growth factor, hepatocyte growth factor, fibroblast growth factor, and epidermal growth factor. It is probable that a multitude of factors and cells play a role in inducing healing of hard or soft tissues that have been acutely or chronically injured or diseased. PRP can be used alone or in conjunction with surgical reconstruction to achieve better healing of tissues. Our group has treated 634 patients with PRP or BMC for nonunions, malunions, arthritis, malalignments, tendinopathies, tendon ruptures, plantar fasciitis, fractures, or ligament injuries that were performed in a variety of healthy and unhealthy patients. Overall, the results were favorable with very limited morbidity. In general, healing was more complete and rapid compared with historic norms, but failures can still occur. Condition-specific retrospective and prospective studies are underway to further establish the role of PRP in foot and ankle conditions and reconstructions. Oper Tech Sports Med 19:177-184
Platelet-rich plasma for foot and ankle pathologies: A systematic review
Foot and Ankle Surgery, 2014
Background: The aim of this article is to review systematically all the literature available on the clinical application of PRP for the treatment of foot and ankle pathologies, to understand its potential and best indications for clinical use. Methods: A systematic search of the PubMed database was performed. Research criteria were the following: (1) papers in the English language, (2) dealing with the clinical application of PRP for the treatment of orthopedic-related conditions affecting the foot and ankle district, (3) with I to IV level of evidence, and (4) reporting clinical results. Results: A total of 17 studies fulfilled the inclusion criteria. Nine papers dealt with Achilles tendon management, 2 articles with plantar fasciitis, 3 papers with talar osteochondral lesions, 2 with PRP application in total ankle replacement, and 1 article with PRP in foot and ankle fusions. The overall evaluation of the results reported does not clearly demonstrate the potential of PRP treatment in any of the specific fields of application. Conclusions: Considering the literature currently available, no clear indications for using PRP in the foot and ankle district emerged. Level of evidence: Level IV, systematic review of Level I, II, III and IV studies.
Indonesian Community Empowerment Journal
Growth factors are not only capable of triggering cell and tissue repair but also act as anti-inflammatory molecules, capable of inhibiting inflammatory processes triggered by trauma. However, currently, patients with ankle sprains are still reluctant to get this therapeutic modality, even though the potential for this new therapeutic modality is superior enough to accelerate trauma repair. This is because the patient is still not familiar with this therapeutic modality. This community service aims to increase the knowledge aspect of ankle sprain patients about the potential benefits and possible risks of using platelet growth factors through the counseling and education process for ankle sprain patients at YK Madira Hospital, Palembang, Indonesia. The implementation of community service is carried out through 3 stages of the implementation process, namely preparation, implementation, and evaluation. The target audience for this community service activity is outpatients at the ortho...
Knee Surgery, Sports Traumatology, Arthroscopy, 2014
Purpose Syndesmotic sprains are uncommon injuries that require prolonged recovery. The influence of ultrasoundguided 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.
Clinical Journal of Sport Medicine, 2011
Objective: To evaluate, through a systematic review of the current literature, the evidence-based outcomes of the use of platelet-rich plasma (PRP) for the treatment of tendon and ligament injuries. studies were excluded. Tissue engineering strategies, which included a combination of PRP with additional cell types (bone marrow), were also excluded. Articles with all levels of evidence were included. Thirteen of 32 retrieved articles respected the inclusion criteria.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2014
The aim of this study was to evaluate the effectiveness of platelet-rich plasma (PRP) in the nonoperative treatment of acute Achilles tendon rupture. Methods: This was a comparative study that included a prospective cohort and a historical control group. The control group was formed from a randomized trial in which one arm of the trial underwent nonoperative treatment, including accelerated functional rehabilitation after acute Achilles tendon rupture identical to that performed in the prospective treatment group. Patients in the prospective group were recruited consecutively and were administered 2 injections of PRP during the first 2 weeks after the injury. The primary outcome was isokinetic plantar flexion strength at 1 and 2 years after injury. Secondary outcomes included range of motion (ROM), calf circumference, and Leppilahti score. The ankle-hindfoot scale (American Orthopedic Functional Ankle Scale [AOFAS]) was administered to patients who received the PRP injection in the prospective group but was not measured for the historical group. Results: A total of 73 patients participated in the prospective PRP study group and were compared with a retrospective control group of 72 patients from a previous randomized controlled trial (RCT). The mean difference between groups in isokinetic plantar flexion strength (injured/uninjured) at 1 year after injury was À4.3% (95% confidence interval [CI], À15.9 to 7.3; P ¼ .5) and 2.4% (95% CI, À8.6 to 13.5; P ¼ .7) at 30 /s and 60 /s, respectively. Results at 2 years after injury were À3.1% (95% CI, À13.5 to 7.2; P ¼ .6) and 4.8% (95% CI, À3.5 to 13.1; P ¼ .3) at 30 /s and 60 /s, respectively. All secondary outcomes were also not statistically different. Conclusions: The results of this study suggest that there is no measurable clinical benefit to the addition of PRP to the treatment regimen for nonoperatively treated acute Achilles tendon rupture. Level of Evidence: Level III, retrospective comparative study.
Platelet-Rich Plasma Treatment for Ligament and Tendon Injuries
Clinical Journal of Sport Medicine, 2011
Platelet-rich plasma (PRP) is derived from centrifuging whole blood, has a platelet concentration higher than that of the whole blood, is the cellular component of plasma that settles after centrifugation, and contains numerous growth factors. There is increasing interest in the sports medicine and athletic community about providing endogenous growth factors directly to the injury site, using autologous blood products such as PRP, to potentially facilitate healing and earlier return to sport after musculoskeletal injury. Despite this interest, and apparent widespread use, there is a lack of high-level evidence regarding randomized clinical trials assessing the efficacy of PRP in treating ligament and tendon injuries. Basic science and animal studies and small case series reports on PRP injections for ligament or tendon injuries, but few randomized controlled clinical trials have assessed the efficacy of PRP injections and none have demonstrated scientific evidence of efficacy. Scientific studies should be performed to assess clinical indications, efficacy, and safety of PRP, and this will require appropriately powered randomized controlled trials with adequate and validated clinical and functional outcome measures and sound statistical analysis. Other aspects of PRP use that need to be determined are (1) volume of injection/application, (2) most effective preparation, (3) buffering/activation, (4) injection technique (1 depot vs multiple depots), (5) timing of injection to injury, (6) single application versus series of injections, and (7) the most effective rehabilitation protocol to use after PRP injection. With all proposed treatments, the doctor and the patient should weigh up potential benefits of treatment, potential risks, and costs. Based on the limited publications to date and theoretical considerations, the potential risks involved with PRP are fortunately very low. However, benefits remain unproven to date, particularly when comparing PRP with other injections for ligament and tendon injuries.
The epidemiology, evaluation, and assessment of lateral ankle sprains in athletes
Journal of Sports Medicine and Therapy, 2021
Approximately 30,000 ankle injuries occur every day in the United States. With the incidence estimated at more than 3 million a year and at a rate of 2.15/1,000 in the U.S. alone, medical specialists and other healthcare providers caring for the foot and ankle must take notice. Despite the millions of ankle injuries sustained annually, the true incidence may be underestimated, as fewer than half of individuals with ankle sprains seek medical attention from healthcare professionals. The economic burden associated with the evaluation, diagnosis, and treatment is close to $4 billion annually. Ankle sprains account for half of all sports injuries and remains a difficult diagnostic and therapeutic challenge in the athlete. Accurate diagnosis is critical as 40% of ankle sprains are misdiagnosed or poorly treated leading to chronic ankle pain and disability. Implementing evidence supported diagnostic and treatment strategies is the goal for ensuring safe and rapid return to play. The Later...