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

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

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.

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? 

by: Nicole Cattano
by: Jeffrey Driban


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