Lateral Ankle Sprain and Platelet Rich Plasma
Condition: Ankle Injuries
MeSH terms: Sprains and Strains; Ankle Injuries
Study type: Interventional

Summary: 
      Lateral ankle sprains are one of the most common in sports medicine. Considering the sprains
      in general, they represent an 85% of the ankle lesions. The incidence in high performance
      athletes range from 16 to 21%. It is estimated that 10,000 to 25,000 peoples suffers a
      lateral ankle sprain per hour in the United States. The objective of the treatment is to
      normalize the articular function and allow the patient to return to his or her normal
      physical activities. Platelet rich plasma is a simple of autologous blood with concentrations
      of platelets above baseline values. This is rich in platelet derived growth factor which
      stimulates cell replication, angiogenesis, transforming growth factor B1, fibroblast growth
      factor, epidermal growth factor, and insulin like growth factor. The risks of its
      applications are minimal and are usually involved with allergic reactions to other
      medications that are applied in combination with the platelet-rich plasma.

      To establish that the use of platelet rich plasma and immobilization with a short leg cast in
      acute lateral ankle sprains will enhance an early recovery in comparison with just
      immobilization with the cast.
    

Detailed description: 
      Lateral ankle sprains are one of the most common in sports medicine. Considering the sprains
      in general, they represent an 85% of the ankle lesions. The incidence in high performance
      athletes range form 16 to 21%. It is estimated that 10,000 to 25,000 suffers a lateral ankle
      sprain per hour in the United States. The objective of the treatment is to normalize the
      articular function and allow the patient to return to his or her normal physical activities.

      The lateral ligamentous complex of the ankle consists of three ligaments: the anterior
      talofibular, the calcaneofibular, and the posterior talofibular. The anterior talofibular
      ligament is the most affected. The patient describes a tear sensation in the ankle after an
      acute inversion of it. The injuries occur during physical activities as running. The patients
      presents with pain, swelling and tenderness over the affected ligaments. The proper diagnosis
      of the sprain includes anteroposterior, lateral and mortise view X rays of the affected
      ankle; if there is any suspicion of instability of the ankle, the physician shall order a
      Magnetic Resonance Image (MRI) to evaluate the ligaments.

      Lateral ankle sprains have been classified by numerous methods. By anatomic site, lateral
      ankle sprains can be classified as grade I: anterior talofibular sprain, grade II: anterior
      talofibular and calcaneofibular sprains, and grade III: anterior talofibular, calcaneofibular
      and posterior talofibular sprains. By clinical system the sprains can be classified as mild
      with minimal function loss, no limp, minimal swelling, tenderness, pain with reproduction of
      mechanism of injury; moderate with moderate functional loss, unable to rise on toes, limp
      when walking, localized swelling; and severe with diffuse tenderness, patient use crouches
      for ambulation.

      Conventional treatment for lateral ankle sprains is conservative, but a 32% of the patients
      have chronic complications as edema, pain, and ankle instability. The treatment for acute
      sprains have good to excellent results. Ankle dorsiflexion allows the fibers of the affected
      ligament to approximate and gives stability of the ankle. The first phase of the treatment
      requires rest, immobilization, compression with orthesis, and the use of non steroidal
      anti-inflammatory drug.

      Platelet rich plasma is a sample of autologous blood with concentrations of platelets above
      baseline values, is rich in platelet derived growth factor which stimulates cell replication,
      angiogenesis, transforming growth factor beta-1, fibroblast growth factor, epidermal growth
      factor, and insulin like growth factor. The risks of its applications are minimal and are
      usually involved with allergic reactions to other medications that are applied in combination
      with the platelet rich plasma.

      Purpose To establish that the use of platelet rich plasma and immobilization with a short leg
      cast in acute lateral ankle sprains will enhance an early recovery in comparison with just
      immobilization with the cast.
    

Intervention name(s): Short leg cast; Platelet-rich plasma
Intervention type(s): Other; Procedure
Intervention description(s): Immobilization with short leg cast with a dorsiflexed foot for two weeks; Will be applied 5 mL of autologous platelet-rich plasma under the lateral malleolus, over the anterior talofibular ligament
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Use of platelet rich plasma in patients with ankle sprain
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: ankle sprain; platelet-rich plasma; ankle injuries