Effectiveness of a single platelet-rich plasma injection to promote recovery in rugby players with ankle syndesmosis injury

David J Samra; Amy D Sman; Katherine Rae; James Linklater; Kathryn M Refshauge; Claire E Hiller

doi:10.1136/bmjsem-2015-000033

Effectiveness of a single platelet-rich plasma injection to promote recovery in rugby players with ankle syndesmosis injury

BMJ Open Sport Exerc Med. 2015 Sep 10;1(1):e000033. doi: 10.1136/bmjsem-2015-000033. eCollection 2015.

Authors

David J Samra¹, Amy D Sman², Katherine Rae¹, James Linklater³, Kathryn M Refshauge⁴, Claire E Hiller⁴

Affiliations

¹ The Sports Clinic, University of Sydney , Sydney, New South Wales , Australia.
² Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia; The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
³ Castlereagh Imaging , Sydney, New South Wales , Australia.
⁴ Faculty of Health Sciences , University of Sydney , Sydney, New South Wales , Australia.

Abstract

Aims: To determine whether a single ultrasound-guided platelet-rich plasma (PRP) injection into the anterior inferior tibiofibular ligament (AITFL) reduces the time for rugby athletes to return to function and match play following MRI confirmed ankle syndesmosis injury.

Methods: Cohort controlled pilot study. 10 Rugby Union players were recruited during the 2014 season, and consented to receive a single autologous PRP injection into the AITFL within 14 days of MRI confirmed ankle syndesmosis injury. A historical control group included 11 comparable Rugby Union players between 2011 and 2013 who were treated conservatively with the same inclusion criteria and rehabilitation protocol as the intervention group. Participants followed a standardised rehabilitation protocol involving simple milestones for progression. Early functional tests were performed 2 weeks after the removal of the CAM (controlled ankle motion) boot. Time to return to play was recorded. Repeat functional testing occurred within 1 week of return to play.

Results: Groups were comparable in anthropometrics, playing position and MRI injury severity. Time to return to play was significantly less in the intervention group (p=0.048). Following return to play, athletes in the intervention group showed higher agility (p=0.002) and vertical jump (p=0.001). There was a lower level of fear avoidance associated with rugby in the intervention group (p=0.014).

Conclusions: This pilot study shows that, following ankle syndesmosis injury, a single autologous PRP injection may accelerate safe and successful return to Rugby Union, with improved functional capacity and reduced fear avoidance. It demonstrates the feasibility of a randomised controlled trial to further assess this therapy.

Trial registration number: ANZCTRN12614000055606.

Keywords: Ankle; Platelet-Rich Plasma; Rugby; Sprain.