Disclosures: Joshua M. Romero, MD: No financial relationships or conflicts of interest

Case Diagnosis: Collegiate soccer player with persistent medial ankle pain treated with PRP

Case Description or Program Description: An 18-year-old collegiate soccer player presented with eight weeks of medial ankle pain following two injuries. She initially developed pain and felt a pop in her medial ankle with an eversion injury. She continued to play with pain, but five weeks later she was kicked in the medial ankle and was removed from play due to pain. Initial physical examination revealed medial ankle swelling, decreased active range of motion, and pain with deltoid ligament stress testing. A diagnostic ultrasound revealed findings of a chronic deltoid ligament and flexor retinaculum injury and a small ankle effusion with suspected cartilage injury. She was immobilized and began a return-to-play protocol; however, she was unable to return to sport and had continued pain. An MRI of her ankle was obtained to evaluate the ankle cartilage, revealing chondromalacia in the medial tibiotalar joint.

Setting: Quaternary Care Academic Hospital – Sports Medicine Clinic

Assessment/Results: After discussion of further conservative treatment options, she elected to undergo a PRP injection for her chronic deltoid ligament, flexor retinaculum and cartilage injuries. An 18.2x concentration PRP product was utilized. Under ultrasound guidance, 7.9 billion platelets were injected into the ankle joint, 12.4 billion platelets were injected into the tibiotalar and tibionavicular ligaments and anterior aspect of the flexor retinaculum, and 7.4 billion platelets were injected into the tibiocalcaneal ligament and inferior flexor retinaculum. At eight weeks, she was 90% back to baseline function and able to sprint pain free for the first time since being removed from play.

Discussion (relevance): This is the first reported case, to our knowledge, of PRP being utilized to manage persistent pain secondary to a chronic deltoid ligament injury.

Conclusions: PRP may be considered to manage persistent pain secondary to a chronic deltoid ligament and medial flexor retinacular injury.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/persistent-ankle-pain-from-a-chronic-deltoid-ligament-injury-in-a-collegiate-soccer-player-treated-with-platelet-rich-plasma-prp-a-case-report/