Platelet-rich plasma on ankle sprains – efficacy on pain reduction and shorter return to play: A systematic review of available randomized control trials

Background@#The role of platelet-rich plasma (PRP) has been widely studied, but only recently did trials emerge that probed into its potential role in ankle sprains. With the limited available literature, most of the trials results showed that it might have a role in faster healing and pain reduction. @*Objectives@#The purpose of this review is to summarize available studies on ankle sprains in order to identify if there is good initial evidence of its role on return to play (RTP) among active individuals as well as pain reduction. It is also to identify if results were consistent among studies. @*Methodology@#A systematic search of available literature in online databases was done to compare results about outcome measures on pain score and RTP. Included studies are those with a population of 18 years and above treated with PRP with or without post-procedural immobilization. Outcome scorings that assessed pain as a parameter was also included. @*Results@#Three randomized controlled trials and two prospective studies were identified. Results showed an average of 8 weeks to RTP (p-value - 0.006) with decreased pain in ankle sprains treated with PRP and functional therapy. @*Limitation@#Only one randomized controlled trial (RCT) compared PRP with a placebo and a small population of all studies made available. More comparable RCTs are needed to strengthen results of the studies. @*Conclusion@#The use of PRP on ankle sprains may have a potential role in shorter time to RTP and pain reduction.

Stress Radiographs under Anesthesia for Painful Chronic Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: Anterior drawer and varus stress radiographs are commonly to diagnose chronic lateral ankle instability. We compared the preoperative stress radiographs with the intraoperative radiographs under anesthesia to determine the accuracy and efficacy of stress radiographs in an outpatient clinical environment. MATERIALS AND METHODS: Data was collected from patients who underwent a modified Broström operation for painful chronic unilateral lateral ankle instability between January 2014 and June 2016. Subjects were divided into three groups—complete tear, partial tear, and instability without rupture—according to the status of preoperative MRI findings of the anterior talofibular ligament. The anterior drawer and varus stress radiographs were taken preoperatively and intraoperatively under anesthesia. RESULTS: Ninety-six patients, with a mean age of 29.63 years, were enrolled. There were 39, 46, and 11 patients in the complete tear, partial tear, and instability without rupture groups, respectively. On the anterior drawer and varus stress radiographs of the affected limb, talar anterior translation and varus tilting were significantly increased by 2.56 mm and 2.0°. The gaps between the unaffected limbs were also increased by 2.47 mm and 1.32° after anesthesia. Although the stress radiographs were taken under anesthesia, the results were often smaller than the diagnostic value. CONCLUSION: Stress radiographs for painful chronic lateral ankle instability taken at the outpatient clinic might be inaccurate for diagnosis.

Research progress of ankle sprains, protection and rehabilitation / 医用生物力学

Ankle sprains are one of the most common surgical injuries in clinic. In this article, the foot anatomy structure was elaborated, and the biomechanics of ankle ligaments during sports was mainly reviewed. At the same time, the mechanism of ankle sprains was analyzed, the principal means of ankle sprains, prevention and rehabilitation at present were summarized, and the use of ankle braces to prevent ankle sprains as well as its research progress were introduced emphatically. The classification and characteristics of ankle braces were then summarized, and the prevention of ankle sprains and development of ankle braces were prospected. The multiple ankle lateral ligament damage was due to the physiological structure differences between lateral and medial ligaments of the ankle joints, and such structure characteristic should be considered while improving ankle braces and designing new ankle braces. Wearing ankle braces plays a key role in ankle sprains protection, which can shorten the recovery time and avoid re-injury in clinical rehabilitation. For rehabilitation of severe ankle sprains, semi-rigid ankle braces are better than elastic ones.

Avaliação funcional dos pacientes operados pelatécnica cirúrgica de brostrõm devido à instabilidadelateral crônica do tornozelo / The outcome of patients who underwent the brostrõm's technique with chronic lateral ankle instability

Objetivo. As entorses do complexo lateral do tornozelo são lesões freqüentementeencontradas na prática de atividades físicas, sendo o ligamento fibulotalar anterior o mais comumente lesado; a maioria delas responde satisfatoriamente ao tratamento conservador. Parte dos pacientes desenvolve dor e instabilidade crônica, necessitando tratamento cirúrgico. A proposta deste estudo foi avaliar os pacientes operados pela técnica de Brostrõm devido à instabilidade lateral crônica do tornozelo.MétodosForam analisados no Hospital e Maternidade Celso Pierro 20 pacientes cominstabilidade lateral crônica do tornozelo submetidos à técnica cirúrgica deBrostrõm, sendo onze mulheres e nove homens, com média de idade de 32,7 anos. Os pacientes foram submetidos à avaliação clínica funcional por meio dos protocolos da American Orthopaedics Foot and Ankle Society e Maryland Foot Score no momento da indicação cirúrgica e um ano após a cirurgia. Resultados As avaliações pós-operatórias mostraram acréscimo de zero a 64, com média de 25,1 pontos, pelo protocolo da American Orthopaedics Foot and Ankle Society, e de zero a 45 com média de 14,6 pontos pelo protocolo da Maryland Foot Score, que classificou 14 resultados como excelentes (70%), cinco como bons (25%), e um como regular (5%). ConclusãoA técnica de Brostrõm mostrou-se eficaz no tratamento das instabilidades laterais crônicas do tornozelo.

Objective Spraining of the ankle's lateral complex are lesions that occur frequently during the practice of sports activities. The anterior fibulotalar ligament is most commonly affected and usually responds well to non-surgical treatment. The patients that present pain and chronic instability usually require surgery. The purpose of this study was to evaluate the patients who underwent the Brostrõm?s technique with chronic lateral ankle instability.MethodsTwenty patients were analyzed at the Maternity Hospital Celso Piero. Eleven women and nine men, with an average age of 32.7 years, presenting chronic lateral instability were submitted to surgery using the Brostrõm?s technique. A clinical analysis of the patients was done at the moment of the surgical indication and one year after the procedure. The parameters analyzed were based on the protocols established by the American Orthopaedics Foot and Ankle Society (AOFAS) and Maryland Foot Score.ResultsThe post-operative scores showed an increase of zero to 64 points, with an average of 25.1 points according to the American Orthopaedics Foot and Ankle Society protocol. An increase of zero to 45 points, with the average of 14.6 points was observed using the Maryland Foot Scores, being 14 results classified as excellent (70%), five as effective (25%) and one as regular (5%).ConclusionThe Brostrõm?s technique therefore presents good results for the surgicaltreatment of chronic lateral instabilities of the ankle.