Laver Lior, Carmont Michael R, McConkey Mark O, Palmanovich Ezequiel, Yaacobi Eyal, Mann Gideon, Nyska Meir, Kots Eugene, Mei-Dan Omer
Department of Orthopaedic Surgery, Sports Medicine Unit, "Meir" Medical Center, The Sackler School of Medicine (Tel-Aviv University), Kfar-Saba, Israel.
Division of Sports Medicine, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
Knee Surg Sports Traumatol Arthrosc. 2015 Nov;23(11):3383-92. doi: 10.1007/s00167-014-3119-x. Epub 2014 Jun 18.
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.
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.
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.
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.
II.
下胫腓联合韧带扭伤是一种不常见的损伤，需要较长时间恢复。本研究探讨超声引导下向受伤的胫腓前下韧带（AITFL）注射富血小板血浆（PRP）对运动员重返赛场（RTP）和动态稳定性的影响。
16名患有AITFL撕裂的精英运动员被随机分为接受PRP注射的治疗组和对照组。所有患者遵循相同的康复方案和RTP标准。对患者进行前瞻性评估，以确定其恢复完全活动的临床能力和残留疼痛情况。在初次检查时和受伤后6周进行动态超声检查，以显示下胫腓联合关节的重新稳定以及与主观结果的相关性。
所有患者均表现为AITFL撕裂，在背屈-外旋时动态下胫腓联合不稳定，超声显示胫腓骨中立位间距增大。早期诊断和治疗导致RTP时间缩短，PRP组和对照组分别为40.8（±8.9）天和59.6（±12.0）天（p = 0.006）。PRP组在恢复活动时残留疼痛明显较少；对照组有5名患者（62.5%）在轻微不适的情况下重返赛场，而治疗组只有1名患者（12.5%）。对照组有1名患者持续疼痛且功能障碍，随后接受了下胫腓联合重建手术。
患有高位踝关节扭伤的运动员受益于超声引导下的PRP注射，RTP时间缩短，下胫腓联合关节重新稳定且长期残留疼痛较少。
II级。
