Healthcare Professionals - Studies

Peri-articular Hyaluronic Acid in Acute Ankle Sprain

RJ Petrella, MJ Petrella, A Cogliano
Faculties of Medicine and Health Sciences
University of Western Ontario
London, Canada

Abstract

Background: Ankle sprains account for almost 2 million sport medicine visits in the US every year. Many lead to impaired performance and chronic disability. Unfortunately, current therapies are of limited effectiveness in altering recovery or have associated adverse effects.

Objectives: In this study we determined the efficacy and safety of peri-articular hyaluronic acid injections in acute lateral ankle sprain compared to standard or care treatment in a cohort of athletes presenting over 9 months to a sports injuries center.
Methods: One hundred and fifty-eight consecutive competitive athletes who suffered an acute Grade 1 or 2 lateral ankle sprain were randomized within 48 hours of injury (baseline) to peri-articular injection with hyaluronic acid (HA) + standard of care or placebo injection (PL) + standard of care treatment at baseline assessment and Day 4 post injury,. No other treatment modalities were delivered during the study but patients could adopt any alternate treatment after Day 9. Assessments at baseline and Days 4, 8, 30 and 90 included VAS (0-10 cm) pain on weight bearing and walking 20 m, patient global assessment of ankle injury (5-point categorical scale), patient satisfaction with treatment (5-point categorical scale), time to return to pain-free and disability-free sport and adverse events. Differences between groups were determined using an intent-to-treat ANOVA. Data are reported as mean (SD) and significance was accepted as p<0.05.
Results: About 30% of the ankle sprains were “first” events and no differences in clinical assessments with those presenting but not volunteering for the study (N=341) was observed. No serious adverse events were recorded during the 8-day treatment period. Sixteen subjects took oral NSAIDs after day 8 for 14 (±9) days. Physical therapy was utilized by 33 patients but for only 4 (±3) sessions for ankle indications over the 90 day followup. No difference in concomitant treatment or physical therapy was observed between groups.

A significant reduction in VAS pain on both weight bearing and walking was observed at Day 8 for HA compared to PL (p<0.05). Significantly greater patient satisfaction was observed for HA vs PL at Days 4 (p<0.05), 8 (p<0.001), 30 (p<0.001) and 90 (p<0.05). Patient global assessment of ankle injury was significantly better compared to baseline in the HA group at Day 8 but this was not different between groups. Time to pain-free and disability-free return to sport was 11 (±8) vs 17 (±8) days for HA and PL respectively (p<0.05).

Conclusion: HA treatment for acute ankle sprain was highly satisfactory in the short and long term versus PL. This was associated with reduced pain and more rapid return to sport with few associated adverse events.

Peri-articular Hyaluronic Acid in Acute Ankle Sprain: 18 months follow-up

RJ Petrella, A Cogliano, J Decaria
Faculties of Medicine and Health Sciences
University of Western Ontario
London, Canada

Abstract

Background: We previously have reported the efficacy and safety of peri-articular injection of Hyaluronic acid (HA) in acute ankle sprain to 90 days followup. Objectives: To determine the long-term efficacy and safety to 18 months of peri-articular hyaluronic acid injections in acute lateral ankle sprain. Methods: One hundred and fifty-eight consecutive competitive athletes who suffered an acute Grade 1 or 2 lateral ankle sprain were randomized within 48 hours of injury.

Interventions: Patients were randomized at baseline to peri-articular injection with hyaluronic acid (HA) + standard of care (RICE) or placebo injection (PL) + standard of care (RICE) treatment at baseline assessment and Day 4 post injury. This report describes the 18 month followup results of this cohort.

Outcomes measures: Assessments at baseline and Days 4, 8, 30, 90 and 18 months included VAS (0-10 cm) pain on weight bearing and walking 20 m, patient global assessment of ankle injury (5-point categorical scale), patient satisfaction with treatment (5-point categorical scale), time to return to pain-free and disability-free sport, adverse events, recurrent ankle sprain and total number of days missing primary sport activity. Differences between groups were determined using an intent-to-treat ANOVA.

Results: About 30% of the ankle sprains were ’’first’’ events and no differences in clinical assessments with those presenting but not volunteering for the study (N=341) was observed. Time to intervention was 39±4 hours with no difference between groups. A significant reduction in VAS pain on both weight bearing and walking was observed at Day 8 for HA compared to PL (p<0.05). There was a significant difference in VAS pain on weight bearing at 18 months favoring the HA group (p<0.05). At 18 months, in the PL versus HA group, there were 2 versus 0 lower limb fractures, 16 versus 8 second ankle sprains (p<0.05), 3 versus 1 third ankle sprains, and a significantly greater number of days missing primary sport activity (43±4 versus 21±6, p<0.002). An increased number of concomitant treatment was observed in the PL vs the HA group at 18 months. This included greater external ankle bracing (61 versus 28, p<0.02) and orthotics (21 versus 11, p<0.05). Significantly greater patient satisfaction was observed for HA vs PL at Days 4 (p<0.05), 8 (p<0.001), 30 (p<0.001), 90 (p<0.05) and 18 months (p<0.05). Time to pain-free and disability-free return to sport was 11 (±8) vs 17 (±8) days for HA and PL respectively (p<0.05).

Conclusion: Peri-articular HA treatment for acute ankle sprain was highly satisfactory in the short and long term versus PL. This was associated with reduced pain, more rapid return to sport, fewer recurrent ankle sprains, fewer missed days from sport with few associated adverse events.

Ann Rheum Dis 2008;67(Suppl II):392

Original Research: Long-Term Efficacy and Safety of Periarticular Hyaluronic Acid in Acute Ankle Sprain

RJ Petrella, A Cogliano, J Decaria
Faculties of Medicine and Health Sciences
University of Western Ontario
London, Canada

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