Platelet-rich plasma, a biomaterial, for the treatment of anterior talofibular ligament in lateral ankle sprain

Abstract

Background: Because of the rising prevalence of anterior talofibular ligament (ATFL) damage, there is a considerable interest in developing innovative techniques to improve the biological healing response of ATFL. Platelet-rich plasma (PRP) includes several growth factors linked to a favorable healing response, however none of the studies involved both quality evaluation and clinical results to evaluate this treatment.Purpose: To determine the clinical results of PRP injections into the ATFL in lateral ankle sprain (LAS) patients, as well as the quality of the ATFL based on radiographic outcomes.Methods: Patients with clinically confirmed grade II LAS for the first time (n = 83) were examined. The clinical outcomes of three types of injection methods were evaluated: none, once within 48 h after the sprain, and once more 4 weeks later after first injection. PRP was injected into the tear site of the ATFL using ultrasound guidance, and all ankles were immobilized for 2 weeks. The American Orthopedic Foot and Ankle Score (AOFAS) ankle-hindfoot scale and the Visual Analogue Scale (VAS) were used to assess the results at 2, 6, 8, 24, and 48 weeks of follow-up. The signal/noise ratio (SNR) value of Magnetic Resonance Imaging (MRI)-based ATFL signal intensity can disclose ATFL quality. The ATFL SNR results were then assessed 8, 24 and 48 weeks following the first injection to compare ATFL quality.Results: The PRP injection groups outperformed the control group in terms of clinical outcomes, and the two injections group outperformed other groups in terms of pain reduction and functional outcome at 8 weeks. The clinical results of all groups were comparable at 6 and 12 months follow-up. ATFL SNR findings improved significantly across all groups over time. At the same follow-up time, the PRP injection groups outperformed the control group, and the best SNR result showed in the two injections group at the final follow-up.Conclusion: PRP injection helped relieve early symptoms of LAS, although all patients saw a similar development after 6 months. The two PRP injections group produced considerably better clinical results and quality of the ATFL in short-term follow-up.

Effectiveness of Ultrasound-Guided Platelet-Rich Plasma Injection in Comparison with Standard Conservative Treatment on Improving Pain and Function Among the Athletes with Partial Tear of Anterior Talofibular Ligament of Ankle: A Randomized Controlled Trial

“…Because of the rising prevalence of ATFL damage, there is a considerable interest in developing innovative techniques to improve the biological healing response of ATFL. 19 In our study, we have found that both PRP plus rehabilitation and rehabilitation alone groups provided significant improvement in subsequent follow ups. However, more statistically significant improvements were seen in PRP plus rehabilitation group when comparing with Rehabilitation alone.…”

“…They proposed that PRP might serve as an alternative non-surgical treatment option in LAS in future research, with the potential to prevent the development of CAI and PTOA. Zhang J et al 19 concluded that PRP injection helped relieve early symptoms of LAS, although all patients saw a similar development after 6 months. Naidu A et al 7 conducted a study and gave single dose of PRP along with walking cast application in acute ankle sprains and showed improvement in VAS, FADI and AOFAS score at 6 months.…”

Platelet-Rich Plasma Injections in Chronic Lateral Ankle Instability: A Case Series

“…Zhang et al compared different types of injection methods into the tear site of the anterior talofibular ligament (ATFL) and immobilization with immobilization alone in patients with acute lateral ankle sprain (LAS). After treatment, a significant reduction in VAS score and American Orthopedic Foot and Ankle Score (AOFAS) was documented at 6-and 12-month follow-ups [29]. These findings are in line with those achieved by Samra et al, who reported a significant improvement in functional capacity-agility (p = 0.002) and vertical jump (p = 0.001)-and reduction in fear avoidance (p = 0.014) after a single ultrasoundguided PRP administration into the anterior inferior tibiofibular ligament (AITFL) in 10 Rugby Union players within 14 days of MRI-confirmed ankle syndesmosis injury.…”

The Role of Ultrasound in the Management of Ankle Sprains and a Clinically Relevant Geisinger Ankle Sprain Sports Ultrasound Protocol

“…In addition, accurate and early diagnosis of specific ligament injuries may help guide injection therapies. Multiple studies have shown that platelet rich plasma (PRP) injected into the ATFL results in higher reduction in pain and better functional outcomes in the short term (8 to 12 wk); however, no difference is seen in the longer term (6 months) (46,47). Thus, PRP injections may play a role in higher level athletes and result in a quicker return to sport.…”