Influence of Hyaluronic Acid on the Clinical Course of Ankle Sprains

Christian Jakobs1; Reiner Wirbel1; Jan Korner2

1 Department of Trauma-, Hand-, and Reconstructive Surgery, Verbundkrankenhaus Bernkastel-Wittlich, Wittlich, Germany

Summary

Purpose: The proven positive clinical effects of hyaluronic acid on intra-articular pathologies may lead to the assumption of similar effects on extra-articular soft tissue structures. Hypothesis: Local application of hyaluronic acid has positive effects on the clinical course of ankle sprains.

Materials and methods: Study Design: prospective randomized clinical trial. Forty patients with acute primary ankle sprain of clinical grade I and II and sonographically proven isolated ruptures of the anterior talofibular ligament were randomized in two groups, each n = 20. Group I received standard care including brace immobilisation for 6 weeks; group II also received two periarticular injections of hyaluronic acid , which were administered 24 hours after the injury and two days later. Assessments using the visual analogue scale included rest pain, weight bearing, walking pain, subjective patient satisfaction at primary date, on day 3, and weekly up to the fifth week as well as the period to return to work and sporting activities.

Results:27 men and 13 women (mean age 30.5, range 16-73 years), 29 athletic injuries, 8 domestic accidents and 3 workplace accidents were observed. In group II, a significant faster pain relief and higher patient satisfaction were observed at every evaluation date. The patients in group II could return to work 4 days earlier, on average after 14 days versus 18 days in group I. They also could restart their sporting activities 11 days earlier (23 versus 34 days).

Conclusion: Additional periarticular injection of hyaluronic acid for the treatment of acute ankle sprains leads to a significant faster pain relief, return to work and sporting activities.

Keywords: hyaluronic acid; ankle sprain; efficacy