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Tomás René Leyva-Ortega Col, Edgardo Alonso-Montelongo, Jorge Alfonso Morones-Torres. Periarticular hyaluronic acid versus conventional treatment for grade II ankle sprain.Treatment of ankle sprains. Volume 69, No. 4, July-August 2015

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Key words:
ankle sprain, hyaluronic acid.

Background:
Ankle sprain is one of the main conditions treated by the Orthopedic Emergency Department. Treatment currently focuses on immobilization to allow the affected ligament to heal, but this involves several short-, medium-, and long-term complications.

Objective:
To determine the effect of periarticular hyaluronic acid on regeneration of the injured ligament by preventing the formation of fibrotic scarring, limiting the expression of proinflammatory factors at the injury site, and reducing pain and functional limitation.

Materials and methods:
A clinical trial to assess patients with grade II ankle sprain in two randomized groups. The control group was prescribed immobilization with a long splint and nonsteroidal anti-inflammatory drugs. The study group received hyaluronic acid (12 mg/1.2 mL) in the lateral ligament complex and immobilization of the affected ankle with a splint. Both groups were given the AOFAS (American Orthopedic Foot and Ankle Society) survey to assess pain and functionality on the day of diagnosis and treatment, and at 2 and 4 weeks, and the outcomes in the two groups were compared.

Results:
The results of the AOFAS survey and the analysis of the two groups found that the pain and degree of functional limitation decreased in the study group as of the second week after the intervention, with marked improvement until recovery. In the control group, the improvement was partial at two weeks, and mild pain and functional limitation persisted at the end of the study.

Conclusions:
Periarticular application of hyaluronic acid together with immobilization provides better patient outcomes as of the second week after treatment in both assessed variables. The trend toward improvement persisted for four weeks until recovery of function and pain relief were achieved. While conventional treatment with immobilization and NSAIDs provides good results, there is no major change in the two variables at two weeks compared with the intervention group, and by the end of the study pain and mild to moderate functional limitation persisted in the latter [sic] group of patients.