Background Ankle sprains are among the most common of all sports injuries yet consensus regarding optimal treatment is lacking. Conservative treatment may limit disability to an average of 8 days for a grade 1 and 15 days for a grade 2 injury. However, failure to provide adequate therapy can limit a patient’s efforts in rehabilitation, prolong the recovery period and result in limited return to sport.
Objectives To determine the efficacy and safety of a single peri-articular injection of Hyaluronan in chronic, unremitting lateral ankle sprain.
Methods 28 patients (19 males) with unremitting, recurrent second or third degree lateral sprain unresponsive to conventional treatment and with persistent (over 6 months) moderate to severe pain (>45mm on 100 mm pain visual analogue scale /VAS) and failure to return to sport were included. Exclusion criteria included bilateral ankle sprain, ipsilateral knee trauma, or prior intra-or peri-articular ankle injection in the prior 6 months. All patients were university basketball or volleyball players. Screening assessment included a physical exam and an x-ray of the ankle joint to exclude fracture. Treatment included injection (2.8 mL total, 730-1300kDa) delivered during a single penetration along three planes anteroposterior, medial, and lateral to the proximal ligamentous landmark under ultrasound guideance. Assessments at baseline and Days 14, 30, and 90 post injection included VAS (0-10 cm) pain on weight bearing and walking 20 m, patient global assessment of ankle injury (5-point categorical scale), patient satisfaction with treatment (5-point categorical scale) and adverse events. Differences from baseline were determined using an ANOVA.
Results All patients completed the study. No serious adverse events were reported. A significant reduction from baseline in VAS pain on both weight bearing and walking was observed at Day 30 and 90 (p<0.05; p<0.001 respectively). Patient global assessment and satisfaction with treatment were improved at Day 30 (p<0.01) and Day 90 (p<0.05). One patient exhibited swelling at the injection site and 2 patients reported tenderness at the injection site.
Conclusions Peri-articular HA treatment for chronic, unremitting ankle sprain was highly satisfactory in the short and long term. This was associated with reduced pain at rest and during weight bearing with few associated adverse events.
Disclosure of Interest None Declared
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