SLR - July 2015 - Brian G. Kissel

Double-blind, Randomized, Placebo-controlled Study Evaluating the Use of Platelet-rich Plasma Therapy (PRP) for Acute Ankle Sprains in the Emergency Department

Reference: Rowden A, Dominici P, D’Orazio J, Manur R, Deitch K, Simpson S, Kowalski MJ, Salzman M, Ngu D. Double-blind, Randomized, Placebo-controlled Study Evaluating the Use of Platelet-rich Plasma Therapy (PRP) for Acute Ankle Sprains in the Emergency Department.  The Journal of Emergency Medicine. 2015 Jun 2. ISSN: 0736-4679.

Scientific Literature Review 

Reviewed By:  Brian G. Kissel, DPM
Residency Program: Detroit Medical Center

Podiatric Relevance: Ankle sprains are common complaints that podiatric physicians will encounter. They occur in all populations but occur more often in younger active individuals. Most people who sustain an ankle sprain do well, however, for some patients these injuries can turn into debilitating problems. Early diagnosis and treatment is key to prevent further damage. The use of platelet-rich plasma (PRP) is also on the rise in foot and ankle surgery and has been used widely in athletic type injuries. The authors of this article attempted to determine if PRP could be useful in acute ankle sprains seen in the emergency department.

Methods: This study was a prospective, randomized, and double blinded study that included 33 patients with severe ankle sprains after 1156 patients had been screened. They judged severity based on swelling, ecchymosis, and ability to weight bear. They separated these patients into a control group and a trial group. The control group was injected at the point of maximum tenderness under ultrasound with 0.9% saline and the trial group was injected in the same fashion with PRP, lidocaine and bupivacaine. Visual analog scale (VAS) pain scores and lower extremity functional scale was assessed on days 0, 3 and 8 and a pain score was obtained on day 30 by phone.  Both groups were also splinted given crutches and instructed to be non-weight bearing for 3 days.

Results: Of the 33 patients that received injections, 18 of them received the PRP injection and 15 received the placebo (0.9% saline). The visual analog scale pain scores and lower extremity functional scale assessments revealed no statistically significant differences between the control group and the PRP group.

Conclusions: The authors concluded that PRP did not provide a benefit in either pain control or function when compared to the placebo. This is something to keep in mind when evaluating a patient with this type of a condition.  If you are planning to use PRP in this type of scenario you may just be adding cost without adding benefit to the patient.

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