Conservative treatment using plasma rich in growth factors (PRGF) for injury to the ligamentous complex of the ankle
Abstract
Purpose of the study: The authors describe the therapeutic utilization of separated/isolated autologous growth factors in semiconservative treatment of type III injury to the ankle ligamentous complex. Material: Between October 2004 and March 2005 a group of 11 patients, two women and nine men, aged 18 to 41 (average, 25.09) years with acute injury to the lateral ligamentous complex of the ankle were treated by plasma rich in growth factors (PRGF) infiltration.
On functional radiographic examination, the post-traumatic lateral opening of the tibiotalar intraarticular space was 17.45 degrees (range, 12.0-30.0; s = 5.68). Methods: The injured patients were clinically examined and standard forced inversion radiographs were made using topical anesthesia.
Autologous PRGF activated with calcium chloride was used to infiltrate the injured tissues. The treatment was followed by immobilization of the joint and its subsequent rehabilitation.
Clinical examination of injured tissues was carried out at 4 and 6 weeks of follow-up, using stability assessment tests and functional radiography of the ankle. Physical therapy included standard procedures, but faster regeneration of the soft tissues allowed for more exercises.
Results: The average time of healing was 5.18 weeks. Five patients showed no signs of instability at 4 weeks after therapy and could return to their previous sports activities.
One patient had lateral ankle instability at 5 weeks and therefore the therapy continued with prolonged immobilization and then rehabilitation at a slower pace. The average lateral opening of the tibiotalar intra-articular space at 4 or 6 follow-up weeks was 4.73 degrees (range, 3.0 - 7.0; s = 1.19).
At 6 weeks after therapy, 90.9% of the patients resumed their full sports activities. Discussion: Ankle distortion with swelling, hematoma and pain, but with no radiographic findings of ligament lesions, is usually treated conservatively by ankle immobilization and early rehabilitation.
When an injury to the fibular ankle ligaments occurs (i.e., opening of the tibiotalar intra-articular space laterally by more than 10 degrees), surgery and reconstruction of the injured tissues is indicated. An alternative treatment of acute injury to the ligamentous ankle complex includes application of growth factors into the injured tissues.
The presence of growth factors facilitates the healing and remodeling of soft tissues and regenaration may begin before leukocytes infiltrate the affected site. At a relatively low level of interleukins, the inflammatory phase of healing is suppressed, pain is reduced and the process of reparation and regenaration is accelerated.
Conclusions: The use of bioinductive properties of growth factors is one of the options for treating injuries to the ligamentous complex of the ankle. It can be used alternatively to conventional surgery or as an adjunct accelerating and improving the healing of traumatic lesions and postoperative conditions.