Prolotherapy As a Treatment Choice for Lateral Ankle Ligament Injuries in Elite Athletes : a Case Series

Injuries to the lateral ankle ligaments are among the most common sustained in professional football. The return to elite level sport within a predictable timeframe after injury is a key aim of the medical team managing professional athletes. Prolotherapy involves injection of dextrose/sucrose injection into injured tissues which is presumed to stimulate the body's self-healing mechanisms, leading to the re-establishment of structural integrity and improved function. This study reports on the results of prolotherapy used to treat anterior talofibular ligament (ATFL) and anterior inferior tibiofibular ligament (AITFL) injuries in elite level athletes and describes the time to return to play (RTP) and rate of reinjury. Patients who had undergone prolotherapy treatment since February 2014 under the care of three specialist sports musculoskeletal radiologists for ankle sprains were identified using the patient database. A retrospective review of the patients medical and rehabilitation records was then carried out. A literature review was carried out to identify the RTP times for conservative and surgical treatments of ATFL and AITFL injuries to allow comparisons with prolotherapy treatments to be made. Standard rehabilitation protocols were then followed and managed by the clubs. Nine elite athletes where treated with prolotherapy for isolated lateral ankle ligament tears since February 2014. Mean age was 23.7 years. Grade III ATFL RTP mean duration was 62 days and AITFL Grade IIa RTP was also 62 days. Importantly there were no reinjuries in any of the prolotherapy groups. To our knowledge this is the first study investigating prolotherapy treatment of ATFL/AITFL in elite athletes. Prolotherapy is safe and appears effective as no re-injuries were identified. However our results have not demonstrated any improvement in RTP when compared to similar injuries treated conservatively without prolotherapy.