title: Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  METHODS
  II.
authors.affiliation: Department of Orthopaedic Surgery, Sports Medicine Unit, "Meir" Medical Center, The Sackler School of Medicine (Tel-Aviv University), Kfar-Saba, Israel. laver17@gmail.com.|Division of Sports Medicine, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA. laver17@gmail.com.
authors.forename: Lior
authors.initials: L
authors.lastname: Laver
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Princess Royal Hospital, Telford, Shropshire, UK.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Carmont
authors.affiliation: Pacific Orthopaedics and Sports Medicine, North Vancouver, BC, Canada.
authors.forename: Mark O
authors.initials: MO
authors.lastname: McConkey
authors.affiliation: Department of Orthopaedic Surgery, Sports Medicine Unit, "Meir" Medical Center, The Sackler School of Medicine (Tel-Aviv University), Kfar-Saba, Israel.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Palmanovich
authors.affiliation: Department of Orthopaedic Surgery, Sports Medicine Unit, "Meir" Medical Center, The Sackler School of Medicine (Tel-Aviv University), Kfar-Saba, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Yaacobi
authors.affiliation: Department of Orthopaedic Surgery, Sports Medicine Unit, "Meir" Medical Center, The Sackler School of Medicine (Tel-Aviv University), Kfar-Saba, Israel.|Ribstein Center for Sport Medicine Sciences and Research, Wingate Institute, Netanya, Israel.
authors.forename: Gideon
authors.initials: G
authors.lastname: Mann
authors.affiliation: Department of Orthopaedic Surgery, Sports Medicine Unit, "Meir" Medical Center, The Sackler School of Medicine (Tel-Aviv University), Kfar-Saba, Israel.
authors.forename: Meir
authors.initials: M
authors.lastname: Nyska
authors.affiliation: Department of Radiology, Sports Medicine Unit, "Meir" Medical Center, Kfar-Saba, Israel.
authors.forename: Eugene
authors.initials: E
authors.lastname: Kots
authors.affiliation: Department of Sports Medicine, University of Colorado Hospitals, Boulder, CO, USA.
authors.forename: Omer
authors.initials: O
authors.lastname: Mei-Dan
mesh_terms: D016512:Ankle Injuries / Q000628:therapy*; D001265:Athletic Injuries / Q000628:therapy; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D053657:Platelet-Rich Plasma; D011446:Prospective Studies; D000068958:Return to Sport; D013180:Sprains and Strains / Q000628:therapy*; D018084:Ultrasonography, Interventional; D055815:Young Adult
keywords: Injections; Platelet-rich plasma; Return to play; Syndesmosis; Ultrasound