High-grade Tear Of Anterior Talofibular Ligament
Aug 14, 2017 - Grade 1 sprains involve ligament stretching without obvious tearing. A grade 2 sprain describes a partial ligament tear, and grade 3 sprains.
Lateral Ankle sprain (LAS) is a common sports injury associated with recurrent ankle sprain, chronic ankle instability (CAI) and post-traumatic ankle osteoarthritis (PTOA). Platelet Rich Plasma (PRP) has been increasingly used for herapeutic applications in sports-related injuries, and is thought to stimulate tissue healing. We reported a case of LAS with complete tear of anterior talofibular ligament, which showed complete healing of ligament and early ankle stabilization after PRP. The healing is supported by dynamic ultrasound images and magnetic resonance imaging.
We therefore proposed that PRP may serve as an alternative non-surgical treatment option in LAS in future research, with the potential to prevent the development of CAI and PTOA. Level of evidence: IV. Introduction Lateral ankle sprain (LAS) is the most common musculoskeletal injury in the physically active population; it is also a common condition in the general population (). Apart from the pain and temporary period of reduced functioning and disability, it is also associated with increased risk of recurrent ankle sprain, the development of chronic ankle stability (CAI) and post-traumatic ankle osteoarthritis (PTOA). While the direct costs for treatment of an isolated LAS are relatively low, compounding these are indirect costs from follow up care, loss of productivity, time loss of activity and care of its long-term consequences.
Therefore, it becomes apparent that the healthcare burden that emerges from so called “simple” LAS is substantial. Conservative management and early functional rehabilitation remain to be the standard of care for all grades of LAS. Platelet-rich plasma (PRP) is an autologous derivative of whole blood that stimulates a supra-physiological release of growth factors to jump start healing in chronic injuries. Growth factors are released from the alpha granules of platelets which induce chemotaxis, cell migration, angiogenesis, proliferation, differentiation and matrix production (, ). PRP is progressively emerging at the forefront of sports and rehabilitation medicine, and its role in different soft injuries has become the focus of research in recent years. Despite the popularity of PRP research, little was known about its role in the management of LAS.
Therefore, we reported a case of high grade LAS with complete tear of the left anterior talofibular ligament (ATFL), its speedy healing and the early achievement of ankle stability after a single injection of PRP. The healing progress was supported by dynamic ultrasound and magnetic resonance imaging (MRI). Patient information Consent for this publication has been obtained from the patient. This is a case of a 39 years old enthusiastic runner who sprained his left ankle on 13 th March 2016. He first consulted his family doctor on 14 th March with prescription of oral analgesics and a referral of physiotherapy.