Foot and Ankle International - 2026-03-17 - Journal Article
Does Platelet-Rich Plasma Speed Recovery After Acute Lateral Ankle Sprain? A Prospective Comparative Study Among Athletes.
Genuth G, Stavrou P, Brown C, Iselin LD
Topics
Key Takeaway
Leukocyte-poor PRP reduced median time to unrestricted sport by 3.3 weeks (14.5 vs 17.8 weeks, P=.042) but produced no significant difference in PROMIS Physical Function or Pain Interference scores at 6 or 12 months.
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Summary
This nonmasked RCT randomized 40 athletes with acute lateral ankle sprain to RICE plus physiotherapy with or without 3 weekly leukocyte-poor PRP injections, assessing PROMIS PF and PI at 6 and 12 months plus time to unrestricted sport. PROMIS scores improved substantially in both groups with no between-group difference at either timepoint (PF P=.68; PI P=.74). PRP shortened median return to sport by 3.3 weeks (14.5 vs 17.8 weeks, P=.042), though this was a secondary exploratory endpoint in an underpowered trial.
Key Limitation
The trial was nonmasked and enrolled only 40 patients, making it critically underpowered to detect between-group differences in primary outcomes or to confirm the exploratory return-to-sport finding, which risks both false-negative and false-positive conclusions simultaneously.
Original Abstract
BACKGROUND
Acute lateral ankle sprains are among the most common musculoskeletal injuries, accounting for up to 20% of all sports-related injuries and a leading cause of time lost from athletic participation. Although most cases respond to conservative care, 20% to 40% of athletes develop persistent pain, recurrent sprains, or chronic instability. Biologic therapies such as platelet-rich plasma (PRP) have gained interest for their potential to accelerate ligament healing, but evidence in acute athletic ankle sprains remains limited.
METHODS
This study was designed as a nonmasked randomized controlled trial of consecutively recruited patients presenting with acute lateral ankle sprain. This prospective comparative study enrolled 40 athletic patients (mean age 33.1 years; 50% male) who sustained an acute lateral ankle sprain and presented within 2 weeks of injury. All patients engaged in ≥3 sports sessions weekly, including 8 professional athletes. Participants were randomized to conventional treatment with rest, ice, compression, elevation (RICE) and physiotherapy (n = 20) or the same regimen plus 3 leukocyte-poor PRP injections administered at weekly intervals (n = 20). Primary outcomes were functional and pain assessment using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) computer adaptive tests at baseline, 6, and 12 months. The secondary outcome was time to return to unrestricted sport.
RESULTS
Baseline PROMIS scores were similar between groups. PROMIS PF improved from 42.6 to 69.8 in the control group and from 43.0 to 71.4 in the PRP group by 12 months, whereas PROMIS PI decreased from 61.2 to 38.4 and 60.8 to 37.4, respectively. Both groups exceeded established minimal clinically important differences by 6 months, with no significant between-group differences at 6 or 12 months (PF, P = .68; PI, P = .74). Median time to unrestricted sports return was significantly shorter with PRP (14.5 weeks, 95% CI 13.1-15.9) compared to controls (17.8 weeks, 95% CI 16.2-19.4; P = .042). At 12 months, 3 PRP patients (15%) and 5 controls (25%) underwent surgery for persistent instability, consistent with published rates of failed conservative management.
CONCLUSION
Leukocyte-poor PRP did not improve PROMIS Pain Interference, PROMIS Physical Function, or overall return to sport rates compared with conventional care. Although a statistically significant and clinically meaningful acceleration in time to return to sport with a moderate effect size was observed, this outcome was exploratory and underpowered, and larger prospective trials are required for confirmation.