Sports Medicine Research: In the Lab & In the Field: PRP or Hyaluronate in the Management of Talar Osteochondral Lesions (Sports Med Res)
Wednesday, April 4, 2012

PRP or Hyaluronate in the Management of Talar Osteochondral Lesions

Platelet-Rich Plasma or Hyaluronate in the Management of Osteochondral Lesions of the Talus

Mei-Dan O, Carmont MR, Laver L, Mann G, Maffulli N, & Nyska M. American Journal of Sports Medicine. 2012; 40: 534-541

Platelet-rich plasma (PRP) injections have recently gained a significant amount of attention in the treatment of various injuries, and this is supported by the number of SMR posts that cover this topic.  PRP injections have been identified as a treatment option for osteochondral lesions (OCL) of the knee, ankle, and hip.  The purpose of this clinical trial was to assess the short-term outcomes of PRP injections in comparison to hyaluronic acid (HA) injections, which has been demonstrated to be effective for reducing pain in knee and ankle osteoarthritis as well as ankles with talar OCL. The authors prepared the PRP injections to be plasma rich in growth factors by collecting peripheral blood, centrifuging, aspirating the plasma, and then adding calcium chloride prior to injection.  Thirty symptomatic ankles with OCLs (from 29 patients), that were unresponsive to prior treatments, were quasirandomized to receive either HA or PRP injections, and outcomes were assessed at baseline and 4-, 12-, and 28-weeks post-injection.  Three HA injections were administered every 7 days over the course of 2 weeks (day 0, day 7, and day 14), while 3 PRP injections were administered every 2 weeks over the course of 4 weeks (day 0, day 14, and day 28).  Both injection groups showed significant improvements in all outcomes (i.e., Ankle-Hindfoot Scale, visual analog scale [VAS] for pain, VAS stiffness, VAS function, patient-reported global function) at all time points post-injection; however, ankles receiving PRP injections demonstrated greater overall improvements in all outcomes except VAS pain compared to the HA injection group.  There were no reported adverse events that lasted more than 2 weeks, with the most commonly reported adverse outcome being minor discomfort that lasted 1 to 2 days.

Clinically, it appears that PRP injection may be an equally successful, and possibly superior, treatment option for ankles with OCLs of the talus when compared to HA injections.  Both nonsurgical options appear to be beneficial and should be considered prior to surgery.  Both injection groups demonstrated no complications and extremely favorable outcomes.  The authors note that a limitation of this study is that both groups consisted of 4 or 5 patients with prior history of surgery to treat the OCL.  It would be interesting to see if the time since onset of symptoms relates to outcome improvement.  In theory, both HA and PRP may be more successful in early onset or early injury when compared to longer term, more chronic injuries.  While, the inclusion of post-surgical OCLs may be a limitation of this study it may actually strengthen the generalizability of PRP use in either pre- or post-surgical instances.  PRP and HA injections are proposed to aid in the biological stimulation or supplementation of the synovial fluid.  So my question is do the symptoms correlate with a lack of a product in the synovial fluid (e.g., HA)?  What would be extremely interesting would be to see the biochemical changes that occur as a result of these injections, and how this correlates with outcome improvement.  By indentifying mechanistically what these injections are doing, we may be able to better identify who would optimally respond to specific injections based on pre-treatment measurements.  Does anyone have any experience in dealing with an athlete who has had either HA or PRP injections in any area of the body? 

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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Mei-Dan, O., Carmont, M., Laver, L., Mann, G., Maffulli, N., & Nyska, M. (2012). Platelet-Rich Plasma or Hyaluronate in the Management of Osteochondral Lesions of the Talus The American Journal of Sports Medicine, 40 (3), 534-541 DOI: 10.1177/0363546511431238

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