Application of platelet rich plasma injection in the therapy of youth ankle joint instability with cartilage injury

Application of platelet rich plasma injection in the therapy of youth ankle joint instability with cartilage injury | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Application of platelet rich plasma injection in the therapy of youth ankle joint instability with cartilage injury Yiqin Zhou, Xiaolei Yang, Huan Wang, Ziye Liu, Jun Zhu, Wei Wang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2290465/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim To estimate the clinical efficacy of platelet-rich plasma (PRP) injection in the therapy of Chronic Ankle Instabiliy (CAI) in young adults. Methods 80 sufferers with CAI with cartilage injury (from March 2018 to March 2021) enrolled to our hospital were differentiated into two groups at random (n = 40/group). The arthroscopic group and the PRP with arthroscopic group were handled with ankle arthroscopy and PRP injection combined with ankle arthroscopy respectively. The ankle dorsal extension, metatarsal flexion range of motion and pain, ankle function and balance ability were contrasted among the two groups before and 6 months after therapy. The levels of serum indexes were contrasted among the two groups pre-therapy and post-therapy. Results 6 months after therapy, the ankle dorsal extension, metatarsal flexion activity, visual analog score (VAS), American orthopedic foot, ankle society (AOFAS) and Berg Balance Scale (BBS) scores were boosted in two groups, and versus the arthroscopic group, the ankle dorsal extension, metatarsal flexion motion and AOFAS, BBS scores were enhanced and VAS scores were lessened in the PRP with arthroscopic group. The contents of MMP-3, TIMP-1 and TNF- α were boosted in both groups, and versus the arthroscopic group, the contents of MMP-3, TIMP-1 and TNF-α were memorably lessened in the PRP with arthroscopic group. Conclusion The application of PRP injection combined with ankle arthroscopic surgery in the therapy of young CAI sufferers merged with cartilage injury is helpful to relieve ankle pain and improve ankle function. Ankle instability Cartilage injury Platelet rich plasma Ankle arthroscopic surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Background The ankle joint is mainly maintained by the internal and external ligaments, while the external ligaments are very prone to sprain and tear. Once the sprain and tear occur repeatedly, it will lead to the Chronic Ankle Instabiliy (CAI). It is a relatively common orthopedic disease in the clinic. The typical clinical manifestations are ankle pain, swelling, and repeated sprains. In severe instances, it can cause serious osteoarthritis, joint deformity, joint necrosis, etc. [ 1 – 2 ]. According to the epidemiological investigation results [ 3 ], the incidence rate of CAI in China is gradually increasing, and the proportion of CAI with cartilage damage is as high as 60%. At present, surgery is the main method to treat CAI with cartilage injury, which has certain clinical value in relieving ankle pain and delaying joint lesions [ 4 ]. Platelet rich plasma (PRP) is a platelet concentrate, which contains a large number of growth factors and proteins. It has been widely applied in the therapy of bone injury and other diseases, and some scholars said [ 5 ] that the therapy of ankle intra-articular injection of PRP in sufferers with cartilage injury plays a positive role in alleviating clinical symptoms and promoting the recovery of ankle function. However, there are few reports on the therapy of youth ankle joint instability with cartilage injury by PRP combined with ankle arthroscopy, in order to further explore the clinical effect of PrP injection combined with ankle arthroscopic surgery on young CAI sufferers with cartilage injury, this experiment will select 80 young CAI sufferers with cartilage injury admitted to our hospital for research, and the following reports are made, as shown in Fig. 1 . 1. Subject Items 1.1 Subjects data 80 sufferers with CAI with cartilage injury (from March 2018 to March 2021) enrolled to Shanghai Changzheng Hospital were differentiated into two groups at random (n = 40/group). In the PRP with arthroscopic group, 23 males and 17 females were contained, aged 19–34 years, mean (26.51 ± 3.97) years. The site of onset: left side (n = 21) and right side (n = 19); In the arthroscopic group, 26 males and 14 females were contained, aged 18–35 years, mean (26.64 ± 3.99) years. The site of onset: left side (n = 24) and right side (n = 16). General data had no notable discrepancy among the two groups. 1.2 Selection Criteria Inclusion standard ① Age 15–35 years; ②Through imaging examination, it met the diagnostic criteria of CAI with cartilage injury in "foot and ankle surgery" [ 6 ]; ③ There were no contraindications to surgery, and all sufferers underwent surgical therapy; ④ The study was reviewed and implemented by the ethics committee of our hospital. Exclusion standard ① Suffering from mental illness, unable to cooperate with the completion of the experiment; ② Severe coagulation dysfunction; ③ Foot and ankle joint deformity; ④ Complicated with severe infectious diseases. Informed consent was obtained from all participants and approval for this study was given by the Ethics Committee and Institutional Review Board of Shanghai Changzheng Hospital. All methods were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. 1.3 Methods The arthroscopic group underwent ankle arthroscopic surgery: The sufferer took the supine position, placed the silicone pad on the hip of the sufferer and placed the affected limb. After general anesthesia, the sufferer's thigh was bound with an inflatable tourniquet. Using anterior medial ankle joint and anterolateral approaches of the ankle joint, the cartilage damage of the sufferer was carefully explored under arthroscopy, and then the synovial tissue of inflammatory hyperplasia was cleaned, the osteophytes were ground and the free bone was taken out. Placed a 4.75mm rivet at the fibular side, so as to repair anterior talofibular ligament. Then a same rivet was placed at the talus point, and the band connection among the two rivets plays a role in strengthening protection. Then microfracture therapy was performed on the cartilage damage area of the sufferer: The micro fracture tip was applied to drill holes in the cartilage damage area, and the bone marrow or fat droplets flowing out of the drill hole as the appropriate depth. After the liquid flowing out formed blood clot and the cartilage defect was completely filled, the wound was sutured and the operation was completed. The PRP with arthroscopic group was treated with PRP injection combined with ankle arthroscopic surgery: Before the operation, collected 10ml venous blood of the sufferer, 2000r / min, centrifuged for 10min, took the supernatant and place it in another centrifuge tube, centrifuged again to take the supernatant and platelet layer, and then added calcium chloride solution to activate it to stand, that was, PRP. The operation method was the same as that of the arthroscopic group, after the ankle arthroscopic strengthening repair operation of the anterior talofibular ligament and the therapy of the micro fracture in the cartilage damage area are completed, the anteromedial clearance of the ankle joint was selected as the needle entry point. After puncturing the joint cavity, 2ml of PRP was injected slowly, and then the injection needle hole was covered with dressing. Postoperative referred to the control of ankle movement for 1 day. And PRP was injected again every 10 days, a total of 3 times. All sufferers were given routine anti infection therapy after operation, and the affected foot was fixed in neutral position with plaster for 4–6 weeks. After the plaster was removed, the ankle joint flexion and extension exercise was carried out with brace. 1.4 Observation Indicators ① Ankle dorsiflexion and range of metatarsal flexion were recorded and contrasted before and 6 months post-therapy. ② Visual analog score (VAS), American orthopedic foot and ankle society (AOFAS) and Berg Balance Scale (BBS) were applied to evaluate the pain, ankle function and balance ability of the two groups before and 6 months post-therapy. 0 ~ 10 was the range of VAS score, and higher scores were positively correlated with more severe injuries; The AOFAS scale was mainly composed of 9 items such as pain, maximum walking distance, ground walking and abnormal gait, 0 ~ 10 was the range of total score. and higher scores were positively correlated with better ankle function; The BBS scale was embodied of 14 items, 0 ~ 56 was the range of total score. Higher scores were associated with stronger balance ability of the body. ③ The fasting venous blood of the two groups before and post-therapy was 5ml, 3500r / min, and the supernatant was taken after centrifugation for 10min. The tumor necrosis factor was measured by enzyme-linked immunosorbent assay-α (TNF-α). The levels of TIMP metallopeptidase inhibitor 1 (TIMP-1) and matrix metalloproteinase-3 (MMP-3) were detected. 1.5 Statistical Analysis SPSS22.0 software was applied for statistical processing, and "±s" was applied to indicate the measurement data conforming to normal distribution, and t test was conducted. If P < 0.05, the discrepancy was statistically notable. 2. Results 2.1 Diversity of ankle dorsiflexion and plantar flexion activity The experimental results corroborated that, among the two groups pre-therapy, ankle dorsiflexion and plantar flexion activity had no notable discrepancy ( P > 0.05), but ankle dorsiflexion and plantar flexion activity were boosted 6 months post-therapy, and versus the arthroscopic group, the ankle dorsiflexion and plantar flexion activity were boosted of the PRP with arthroscopic group ( P < 0.05). As corroborated in Table 1 and Figs. 2 – 3 : Table 1 Diversity of ankle dorsiflexion and plantar flexion activity (‾ x ± s ) Group n Ankle dorsiflexion activity (°) Ankle plantar flexion activity (°) Pre-therapy 6 months after therapy Pre-therapy 6 months after therapy The PRP with arthroscopic group 40 8.19 ± 1.22 13.16 ± 1.97 a 24.21 ± 3.63 33.79 ± 5.06 a The arthroscopic group 40 8.22 ± 1.23 10.37 ± 1.55 a 24.25 ± 3.64 30.43 ± 4.56 a t 0.109 7.039 0.049 3.119 P 0.913 < 0.001 0.960 0.025 Note: a represented the diversity with that pre-therapy, P 0.05), but the VAS, AOFAS and BBS scores were boosted 6 months post-therapy. The VAS score of the PRP with arthroscopic group was lessened, and the AOFAS and BBS scores were enhanced versus the arthroscopic group ( P < 0.05). As corroborated in Table 2 and Figs. 4 – 6 : Table 2 Diversity of VAS, AOFAS and BBS scores Group n VAS (score) AOFAS (score) BBS (score) Pre-therapy 6 months after therapy Pre-therapy 6 months after therapy Pre-therapy 6 months after therapy The PRP with arthroscopic group 40 6.11 ± 0.92 2.95 ± 0.44 a 57.53 ± 8.62 73.76 ± 11.06 a 29.52 ± 4.43 50.53 ± 7.57 a The arthroscopic group 40 6.07 ± 0.91 3.88 ± 0.58 a 57.62 ± 8.64 66.38 ± 9.95 a 29.47 ± 4.42 42.26 ± 6.33 a t 0.195 8.079 0.046 3.137 0.050 5.300 P 0.845 < 0.001 0.962 0.002 0.959 < 0.001 Note: a represented the diversity with that pre-therapy, P 0.05), but the MMP-3, TIMP-1 and TNF-α concentrations were boosted post-therapy, and versus the arthroscopic group, the MMP-3, TIMP-1 and TNF-α concentrations were memorably lessened in the PRP with arthroscopic group ( P < 0.05). As corroborated in Table 3 and Fig. 6 A- 6 C: Table 3 Diversity of serum index concentrations (‾ x ± s ) Group n MMP−3(ng/ml) TIMP−1(ng/ml) TNF-α(pg/ml) Pre-therapy Post-therapy Pre-therapy Post-therapy Pre-therapy Post-therapy The PRP with arthroscopic group 40 95.73 ± 14.35 38.75 ± 5.81 a 112.44 ± 16.86 81.37 ± 12.20 a 15.26 ± 2.28 10.28 ± 1.54 a The arthroscopic group 40 95.64 ± 14.34 61.83 ± 9.27 a 112.36 ± 16.85 105.41 ± 15.81 a 15.19 ± 2.27 13.97 ± 2.09 a t 0.028 13.342 0.021 7.613 0.137 8.989 P 0.977 < 0.001 0.983 < 0.001 0.890 < 0.001 Note: a represented the diversity with that pre-therapy, P < 0.05. 3. Discussion Repeated sprain of ankle joint caused by CAI can cause injury of articular cartilage, so CAI with cartilage injury has a high incidence rate [ 7 ]. If effective therapy measures are not given in time, with the development of the disease, sufferers will have persistent pain and will cause certain damage to ankle joint function. At present, surgery is mainly applied to treat CAI sufferers with cartilage injury. Arthroscopic repair of anterior talofibular ligament and microfracture operation are the most commonly applied surgical methods, which have the advantages of small surgical trauma and less intraoperative bleeding [ 8 – 9 ]. However, it has been reported [ 10 ] that for sufferers with CAI and cartilage injury with large injury area, the effect of the above-mentioned surgical therapy is not good, and some sufferers will have relapse again. Therefore, it is necessary to consider the combination therapy to improve the clinical effect of CAI sufferers with cartilage injury [ 11 ]. PRP is a platelet concentrate produced by extracting autologous venous blood by centrifugation, and activated by calcium chloride and thrombin to form a platelet rich gel, which can effectively promote cell proliferation and differentiation. In recent years, it has been gradually applied to the therapy of refractory wound healing and bone injury diseases [ 12 – 14 ]. The results of this study corroborated that 6 months post-therapy, contrasted with the arthroscopic group, the ankle dorsiflexion, plantar flexion activity, AOFAS and BBS scores of the PRP with arthroscopic group were enhanced, suggesting that the therapy of PRP injection combined with ankle arthroscopic surgery for young CAI sufferers with cartilage injury has positive significance in promoting the functional recovery of ankle joint and lower limb. The reason may be that PRP contains a large number of growth factors that can promote the repair of joint tissue, which can stimulate bone marrow stromal cells to migrate to the lesion, thus inducing the differentiation and maturation of chondrocytes. Injection of PRP into the ankle joint of the sufferer can promote the repair and regeneration of damaged cartilage, which is conducive to improving the clinical efficacy and improving the functional level of the ankle joint [ 15 – 17 ]. In addition, the fibrinogen rich in PRP can form a fiber network, undertake the role of tissue repair cells and promote cell adhesion, and be activated to form a fibrin matrix to fill the injured cartilage, which can effectively reduce synovial inflammation and relieve ankle pain [ 18 – 20 ]. Therefore, in this experiment, the level of VAS in the PRP with arthroscopic group was memorably lessened than that in the arthroscopic group 6 months after therapy. It has been reported that [ 21 ], CAI with cartilage injury can promote the release of inflammatory factors, in which TNF- α has a certain inhibitory effect on the formation of chondrocytes, thus aggravating cartilage tissue injury. MMP-3 exists widely in human cartilage, and the higher its level is, the more serious the lesion of cartilage tissue is, and TIMP-1 can degrade interstitial collagen [ 22 – 23 ]. The results of this study corroborated that the levels of MMP-3, TIMP-1 and TNF-α in the PRP with arthroscopic group were memorably lessened than those in the arthroscopic group post-therapy. The reason may be that combined with PRP injection on the basis of ankle arthroscopic surgery, PRP contains TGF-β, PDGF, VEGF and other growth factors, which can effectively promote wound healing through platelet activation and release. However, there is a lack of vascular and nerve tissue repair factors in cartilage tissue, so injection of PRP into the ankle joint of sufferers can not only inhibit joint inflammation, but also effectively promote chondrocyte regeneration [ 24 ], which is basically consistent with the results of Reda et al[ 25 ]. 4. Conclusion To sum up, PRP injection combined with ankle arthroscopic surgery is effective in the therapy of young CAI with cartilage injury, which can effectively relieve ankle pain and promote the recovery of ankle function, which is worth popularizing and applying in clinic. Abbreviations PRP Platelet-rich plasma CAI Chronic Ankle Instabiliy VAS Visual analog score AOFAS American orthopedic foot, ankle society BBS Berg Balance Scale. Declarations Acknowledgements None Funding Not Applicable Author contributions Yiqin Zhou and Xiaolei Yang were major contributors in writing the manuscript. Huan Wang and Ziye Liu collected the patient data. Jun Zhu and Wei Wang performed both surgeries and followed up the patients. Yaguang Han and Song Wang realized the scarcity of the two cases, did literature searches, and revised the manuscript. All authors read and approved the fnal manuscript. Availability of data and materials The datasets used and/or analysed during the current study were available from the corresponding author on reasonable request. Ethics approval and consent to participate Informed consent was obtained from all participants and approval for this study was given by the Ethics Committee and Institutional Review Board of Shanghai Changzheng Hospital. All methods were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. References Monckeberg JE, Rafols C, Apablaza F, et al. Intra-articular administration of peripheral blood stem cells with platelet-rich plasma regenerated articular cartilage and improved clinical outcomes for knee chondral lesions[J].Knee. 2019 Aug;26(4):824–831. 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Safety and Efficacy of Intra-articular Injection of Platelet-Rich Plasma in Patients With Ankle Osteoarthritis[J].Foot Ankle Int. 2017 Jun;38(6):596–604. Repetto I, Biti B, Cerruti P,et al. Conservative Treatment of Ankle Osteoarthritis: Can Platelet-Rich Plasma Effectively Postpone Surgery?[J].J Foot Ankle Surg. 2017 Mar-Apr;56(2):362–365. Badahdah HM, Zgonis T. Ankle Arthrodiastasis with Circular External Fixation for the Treatment of Posttraumatic Ankle Arthritis[J].Clin Podiatr Med Surg. 2017 Oct;34(4):425–431. Bernstein M, Reidler J, Fragomen A, et al. Ankle Distraction Arthroplasty: Indications, Technique, and Outcomes[J].J Am Acad Orthop Surg. 2017 Feb;25(2):89–99. Jackson AT, Drayer NJ, Samona J, et al. Osteochondral Allograft Transplantation Surgery for Osteochondral Lesions of the Talus in Athletes[J].J Foot Ankle Surg. 2019 Jul;58(4):623–627. Lanham NS, Carroll JJ, Cooper MT, et al. A Comparison of Outcomes of Particulated Juvenile Articular Cartilage and Bone Marrow Aspirate Concentrate for Articular Cartilage Lesions of the Talus[J].Foot Ankle Spec. 2017 Aug;10(4):315–321. Reda Y, Farouk A, Abdelmonem I, et al. Surgical versus non-surgical treatment for acute Achilles' tendon rupture. A systematic review of literature and meta-analysis[J].Foot Ankle Surg. 2020 Apr;26(3):280–288. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2290465","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":162930639,"identity":"1bc78ab7-7212-47b7-9fbc-1711141164f6","order_by":0,"name":"Yiqin Zhou","email":"","orcid":"","institution":"Department of Radiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai","correspondingAuthor":false,"prefix":"","firstName":"Yiqin","middleName":"","lastName":"Zhou","suffix":""},{"id":162930641,"identity":"1bc2f996-ee24-479c-8f94-c75b358995e4","order_by":1,"name":"Xiaolei 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Shanghai","correspondingAuthor":false,"prefix":"","firstName":"Song","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2022-11-19 07:14:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2290465/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2290465/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":31030716,"identity":"64d56cc9-6217-4e0c-95a3-b4a13f8510fd","added_by":"auto","created_at":"2023-01-03 15:03:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":35194,"visible":true,"origin":"","legend":"\u003cp\u003eClinical observation of platelet rich plasma injection combined with ankle arthroscopic surgery in the therapy of youth ankle joint instability with cartilage injury\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2290465/v1/7da16e2c8e9b92ff2682cae6.png"},{"id":31032711,"identity":"9b3789c7-22fb-464e-9678-e04d516a292f","added_by":"auto","created_at":"2023-01-03 15:19:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":24870,"visible":true,"origin":"","legend":"\u003cp\u003eAnkle dorsiflexion activity.\u003c/p\u003e\n\u003cp\u003eVersus the same group pre-therapy,\u003csup\u003ea \u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05; Versus the artistic group after 6 months after therapy, \u003csup\u003eb \u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-2290465/v1/5bd5146878ac2835e6dd42ea.png"},{"id":31031525,"identity":"2c641d93-80d7-4b5d-801a-32cbf7a07012","added_by":"auto","created_at":"2023-01-03 15:11:11","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":26341,"visible":true,"origin":"","legend":"\u003cp\u003eAnkle plantar flexion activity.\u003c/p\u003e\n\u003cp\u003eVersus the same group pre-therapy,\u003csup\u003ea \u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05; Versus the artistic group after 6 months after therapy, \u003csup\u003eb \u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-2290465/v1/2a5b2283baebb92c9e1e9028.png"},{"id":31030717,"identity":"38b6af37-57f6-4bb6-ab9e-385816e86609","added_by":"auto","created_at":"2023-01-03 15:03:11","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":21067,"visible":true,"origin":"","legend":"\u003cp\u003eVAS score.\u003c/p\u003e\n\u003cp\u003eVersus the same group pre-therapy,\u003csup\u003ea \u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05; Versus the artistic group after 6 months after therapy, \u003csup\u003eb \u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-2290465/v1/4ff220a27204b741f032c9a3.png"},{"id":31032710,"identity":"da823872-e2d9-4cff-b488-655d7dc7bba0","added_by":"auto","created_at":"2023-01-03 15:19:11","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":23446,"visible":true,"origin":"","legend":"\u003cp\u003eAOFAS score.\u003c/p\u003e\n\u003cp\u003eVersus the same group pre-therapy,\u003csup\u003ea \u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05; Versus the artistic group after 6 months after therapy, \u003csup\u003eb \u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-2290465/v1/4a47fc5a7295e46cd3ea4141.png"},{"id":31031527,"identity":"f3507692-f71b-4e76-83d7-d4f111df1e67","added_by":"auto","created_at":"2023-01-03 15:11:11","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":21396,"visible":true,"origin":"","legend":"\u003cp\u003eBBS score.\u003c/p\u003e\n\u003cp\u003eVersus the same group pre-therapy,\u003csup\u003ea \u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05; Versus the artistic group after 6 months after therapy, \u003csup\u003eb \u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-2290465/v1/6ec985b9053324cd55709926.png"},{"id":31030721,"identity":"8515d4f1-f5bb-4f2d-bdf9-9aeca8934ce9","added_by":"auto","created_at":"2023-01-03 15:03:11","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":18758,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 6 Serum index concentrations. (A) MMP-3. (B) TIMP-1. (C) TNF-α.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVersus the same group pre-therapy,\u003csup\u003ea \u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05; Versus the artistic group after 6 months after therapy, \u003csup\u003eb \u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05.\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-2290465/v1/8312b1351079176ec2361284.png"},{"id":32834711,"identity":"10f6556a-d619-4bfa-9002-9e9c34a634a9","added_by":"auto","created_at":"2023-02-13 09:29:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":530469,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2290465/v1/3d979746-b0b1-453d-b0fb-ea552850eb0d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application of platelet rich plasma injection in the therapy of youth ankle joint instability with cartilage injury","fulltext":[{"header":"Background","content":"\u003cp\u003eThe ankle joint is mainly maintained by the internal and external ligaments, while the external ligaments are very prone to sprain and tear. Once the sprain and tear occur repeatedly, it will lead to the Chronic Ankle Instabiliy (CAI). It is a relatively common orthopedic disease in the clinic. The typical clinical manifestations are ankle pain, swelling, and repeated sprains. In severe instances, it can cause serious osteoarthritis, joint deformity, joint necrosis, etc. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to the epidemiological investigation results [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], the incidence rate of CAI in China is gradually increasing, and the proportion of CAI with cartilage damage is as high as 60%. At present, surgery is the main method to treat CAI with cartilage injury, which has certain clinical value in relieving ankle pain and delaying joint lesions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Platelet rich plasma (PRP) is a platelet concentrate, which contains a large number of growth factors and proteins. It has been widely applied in the therapy of bone injury and other diseases, and some scholars said [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] that the therapy of ankle intra-articular injection of PRP in sufferers with cartilage injury plays a positive role in alleviating clinical symptoms and promoting the recovery of ankle function. However, there are few reports on the therapy of youth ankle joint instability with cartilage injury by PRP combined with ankle arthroscopy, in order to further explore the clinical effect of PrP injection combined with ankle arthroscopic surgery on young CAI sufferers with cartilage injury, this experiment will select 80 young CAI sufferers with cartilage injury admitted to our hospital for research, and the following reports are made, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e"},{"header":"1. Subject Items","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Subjects data\u003c/h2\u003e \u003cp\u003e80 sufferers with CAI with cartilage injury (from March 2018 to March 2021) enrolled to Shanghai Changzheng Hospital were differentiated into two groups at random (n\u0026thinsp;=\u0026thinsp;40/group). In the PRP with arthroscopic group, 23 males and 17 females were contained, aged 19\u0026ndash;34 years, mean (26.51\u0026thinsp;\u0026plusmn;\u0026thinsp;3.97) years. The site of onset: left side (n\u0026thinsp;=\u0026thinsp;21) and right side (n\u0026thinsp;=\u0026thinsp;19); In the arthroscopic group, 26 males and 14 females were contained, aged 18\u0026ndash;35 years, mean (26.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.99) years. The site of onset: left side (n\u0026thinsp;=\u0026thinsp;24) and right side (n\u0026thinsp;=\u0026thinsp;16). General data had no notable discrepancy among the two groups.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e1.2 Selection Criteria\u003c/h3\u003e\n\u003cp\u003eInclusion standard ① Age 15\u0026ndash;35 years; ②Through imaging examination, it met the diagnostic criteria of CAI with cartilage injury in \"foot and ankle surgery\" [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]; ③ There were no contraindications to surgery, and all sufferers underwent surgical therapy; ④ The study was reviewed and implemented by the ethics committee of our hospital. Exclusion standard ① Suffering from mental illness, unable to cooperate with the completion of the experiment; ② Severe coagulation dysfunction; ③ Foot and ankle joint deformity; ④ Complicated with severe infectious diseases. Informed consent was obtained from all participants and approval for this study was given by the Ethics Committee and Institutional Review Board of Shanghai Changzheng Hospital. All methods were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003ch3\u003e1.3 Methods\u003c/h3\u003e\n\u003cp\u003eThe arthroscopic group underwent ankle arthroscopic surgery: The sufferer took the supine position, placed the silicone pad on the hip of the sufferer and placed the affected limb. After general anesthesia, the sufferer's thigh was bound with an inflatable tourniquet. Using anterior medial ankle joint and anterolateral approaches of the ankle joint, the cartilage damage of the sufferer was carefully explored under arthroscopy, and then the synovial tissue of inflammatory hyperplasia was cleaned, the osteophytes were ground and the free bone was taken out. Placed a 4.75mm rivet at the fibular side, so as to repair anterior talofibular ligament. Then a same rivet was placed at the talus point, and the band connection among the two rivets plays a role in strengthening protection. Then microfracture therapy was performed on the cartilage damage area of the sufferer: The micro fracture tip was applied to drill holes in the cartilage damage area, and the bone marrow or fat droplets flowing out of the drill hole as the appropriate depth. After the liquid flowing out formed blood clot and the cartilage defect was completely filled, the wound was sutured and the operation was completed.\u003c/p\u003e \u003cp\u003eThe PRP with arthroscopic group was treated with PRP injection combined with ankle arthroscopic surgery: Before the operation, collected 10ml venous blood of the sufferer, 2000r / min, centrifuged for 10min, took the supernatant and place it in another centrifuge tube, centrifuged again to take the supernatant and platelet layer, and then added calcium chloride solution to activate it to stand, that was, PRP. The operation method was the same as that of the arthroscopic group, after the ankle arthroscopic strengthening repair operation of the anterior talofibular ligament and the therapy of the micro fracture in the cartilage damage area are completed, the anteromedial clearance of the ankle joint was selected as the needle entry point. After puncturing the joint cavity, 2ml of PRP was injected slowly, and then the injection needle hole was covered with dressing. Postoperative referred to the control of ankle movement for 1 day. And PRP was injected again every 10 days, a total of 3 times. All sufferers were given routine anti infection therapy after operation, and the affected foot was fixed in neutral position with plaster for 4\u0026ndash;6 weeks. After the plaster was removed, the ankle joint flexion and extension exercise was carried out with brace.\u003c/p\u003e\n\u003ch3\u003e1.4 Observation Indicators\u003c/h3\u003e\n\u003cp\u003e① Ankle dorsiflexion and range of metatarsal flexion were recorded and contrasted before and 6 months post-therapy. ② Visual analog score (VAS), American orthopedic foot and ankle society (AOFAS) and Berg Balance Scale (BBS) were applied to evaluate the pain, ankle function and balance ability of the two groups before and 6 months post-therapy. 0\u0026thinsp;~\u0026thinsp;10 was the range of VAS score, and higher scores were positively correlated with more severe injuries; The AOFAS scale was mainly composed of 9 items such as pain, maximum walking distance, ground walking and abnormal gait, 0\u0026thinsp;~\u0026thinsp;10 was the range of total score. and higher scores were positively correlated with better ankle function; The BBS scale was embodied of 14 items, 0\u0026thinsp;~\u0026thinsp;56 was the range of total score. Higher scores were associated with stronger balance ability of the body. ③ The fasting venous blood of the two groups before and post-therapy was 5ml, 3500r / min, and the supernatant was taken after centrifugation for 10min. The tumor necrosis factor was measured by enzyme-linked immunosorbent assay-α (TNF-α). The levels of TIMP metallopeptidase inhibitor 1 (TIMP-1) and matrix metalloproteinase-3 (MMP-3) were detected.\u003c/p\u003e\n\u003ch3\u003e1.5 Statistical Analysis\u003c/h3\u003e\n\u003cp\u003eSPSS22.0 software was applied for statistical processing, and \"\u0026plusmn;s\" was applied to indicate the measurement data conforming to normal distribution, and t test was conducted. If P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, the discrepancy was statistically notable.\u003c/p\u003e"},{"header":"2. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Diversity of ankle dorsiflexion and plantar flexion activity\u003c/h2\u003e \u003cp\u003eThe experimental results corroborated that, among the two groups pre-therapy, ankle dorsiflexion and plantar flexion activity had no notable discrepancy (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), but ankle dorsiflexion and plantar flexion activity were boosted 6 months post-therapy, and versus the arthroscopic group, the ankle dorsiflexion and plantar flexion activity were boosted of the PRP with arthroscopic group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). As corroborated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDiversity of ankle dorsiflexion and plantar flexion activity (\u0026oline;\u003cem\u003ex\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003es\u003c/em\u003e)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAnkle dorsiflexion activity (\u0026deg;)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAnkle plantar flexion activity (\u0026deg;)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-therapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 months after therapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePre-therapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 months after therapy\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe PRP with arthroscopic group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.79\u0026thinsp;\u0026plusmn;\u0026thinsp;5.06\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe arthroscopic group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.25\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.56\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.119\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.960\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNote: a represented the diversity with that pre-therapy, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e2.2 Diversity Of Vas, Aofas And Bbs Scores\u003c/h3\u003e\n\u003cp\u003eThe results corroborated, among the two groups pre-therapy, VAS, AOFAS and BBS scores had no notable discrepancy (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), but the VAS, AOFAS and BBS scores were boosted 6 months post-therapy. The VAS score of the PRP with arthroscopic group was lessened, and the AOFAS and BBS scores were enhanced versus the arthroscopic group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). As corroborated in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Figs.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e6\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDiversity of VAS, AOFAS and BBS scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eVAS (score)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAOFAS (score)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eBBS (score)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-therapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 months after therapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePre-therapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 months after therapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePre-therapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6 months after therapy\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe PRP with arthroscopic group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.53\u0026thinsp;\u0026plusmn;\u0026thinsp;8.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e73.76\u0026thinsp;\u0026plusmn;\u0026thinsp;11.06\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29.52\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e50.53\u0026thinsp;\u0026plusmn;\u0026thinsp;7.57\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe arthroscopic group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.62\u0026thinsp;\u0026plusmn;\u0026thinsp;8.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66.38\u0026thinsp;\u0026plusmn;\u0026thinsp;9.95\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42.26\u0026thinsp;\u0026plusmn;\u0026thinsp;6.33\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.300\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.959\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNote: a represented the diversity with that pre-therapy, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003ch3\u003e2.3 Diversity Of Serum Index Concentrations\u003c/h3\u003e\n\u003cp\u003eThe results corroborated that, among the two groups pre-therapy, the concentrations of MMP-3, TIMP-1 and TNF-α had no notable discrepancy (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), but the MMP-3, TIMP-1 and TNF-α concentrations were boosted post-therapy, and versus the arthroscopic group, the MMP-3, TIMP-1 and TNF-α concentrations were memorably lessened in the PRP with arthroscopic group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). As corroborated in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e6\u003c/span\u003eA-\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e6\u003c/span\u003eC:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDiversity of serum index concentrations (\u0026oline;\u003cem\u003ex\u003c/em\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cem\u003es\u003c/em\u003e)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMMP\u0026minus;3(ng/ml)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eTIMP\u0026minus;1(ng/ml)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eTNF-α(pg/ml)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-therapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-therapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePre-therapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePost-therapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePre-therapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePost-therapy\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe PRP with arthroscopic group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.73\u0026thinsp;\u0026plusmn;\u0026thinsp;14.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.81\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e112.44\u0026thinsp;\u0026plusmn;\u0026thinsp;16.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e81.37\u0026thinsp;\u0026plusmn;\u0026thinsp;12.20\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe arthroscopic group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.64\u0026thinsp;\u0026plusmn;\u0026thinsp;14.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.83\u0026thinsp;\u0026plusmn;\u0026thinsp;9.27\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e112.36\u0026thinsp;\u0026plusmn;\u0026thinsp;16.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e105.41\u0026thinsp;\u0026plusmn;\u0026thinsp;15.81\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13.97\u0026thinsp;\u0026plusmn;\u0026thinsp;2.09\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.989\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNote: a represented the diversity with that pre-therapy, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e "},{"header":"3. Discussion","content":" \u003cp\u003eRepeated sprain of ankle joint caused by CAI can cause injury of articular cartilage, so CAI with cartilage injury has a high incidence rate [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. If effective therapy measures are not given in time, with the development of the disease, sufferers will have persistent pain and will cause certain damage to ankle joint function. At present, surgery is mainly applied to treat CAI sufferers with cartilage injury. Arthroscopic repair of anterior talofibular ligament and microfracture operation are the most commonly applied surgical methods, which have the advantages of small surgical trauma and less intraoperative bleeding [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, it has been reported [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] that for sufferers with CAI and cartilage injury with large injury area, the effect of the above-mentioned surgical therapy is not good, and some sufferers will have relapse again. Therefore, it is necessary to consider the combination therapy to improve the clinical effect of CAI sufferers with cartilage injury [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. PRP is a platelet concentrate produced by extracting autologous venous blood by centrifugation, and activated by calcium chloride and thrombin to form a platelet rich gel, which can effectively promote cell proliferation and differentiation. In recent years, it has been gradually applied to the therapy of refractory wound healing and bone injury diseases [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The results of this study corroborated that 6 months post-therapy, contrasted with the arthroscopic group, the ankle dorsiflexion, plantar flexion activity, AOFAS and BBS scores of the PRP with arthroscopic group were enhanced, suggesting that the therapy of PRP injection combined with ankle arthroscopic surgery for young CAI sufferers with cartilage injury has positive significance in promoting the functional recovery of ankle joint and lower limb. The reason may be that PRP contains a large number of growth factors that can promote the repair of joint tissue, which can stimulate bone marrow stromal cells to migrate to the lesion, thus inducing the differentiation and maturation of chondrocytes. Injection of PRP into the ankle joint of the sufferer can promote the repair and regeneration of damaged cartilage, which is conducive to improving the clinical efficacy and improving the functional level of the ankle joint [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In addition, the fibrinogen rich in PRP can form a fiber network, undertake the role of tissue repair cells and promote cell adhesion, and be activated to form a fibrin matrix to fill the injured cartilage, which can effectively reduce synovial inflammation and relieve ankle pain [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Therefore, in this experiment, the level of VAS in the PRP with arthroscopic group was memorably lessened than that in the arthroscopic group 6 months after therapy.\u003c/p\u003e \u003cp\u003eIt has been reported that [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], CAI with cartilage injury can promote the release of inflammatory factors, in which TNF- α has a certain inhibitory effect on the formation of chondrocytes, thus aggravating cartilage tissue injury. MMP-3 exists widely in human cartilage, and the higher its level is, the more serious the lesion of cartilage tissue is, and TIMP-1 can degrade interstitial collagen [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The results of this study corroborated that the levels of MMP-3, TIMP-1 and TNF-α in the PRP with arthroscopic group were memorably lessened than those in the arthroscopic group post-therapy. The reason may be that combined with PRP injection on the basis of ankle arthroscopic surgery, PRP contains TGF-β, PDGF, VEGF and other growth factors, which can effectively promote wound healing through platelet activation and release. However, there is a lack of vascular and nerve tissue repair factors in cartilage tissue, so injection of PRP into the ankle joint of sufferers can not only inhibit joint inflammation, but also effectively promote chondrocyte regeneration [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], which is basically consistent with the results of Reda et al[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"4. Conclusion","content":"\u003cp\u003eTo sum up, PRP injection combined with ankle arthroscopic surgery is effective in the therapy of young CAI with cartilage injury, which can effectively relieve ankle pain and promote the recovery of ankle function, which is worth popularizing and applying in clinic.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePRP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePlatelet-rich plasma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCAI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic Ankle Instabiliy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual analog score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAOFAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican orthopedic foot, ankle society\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBBS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBerg Balance Scale.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYiqin Zhou and Xiaolei Yang were major contributors in writing the manuscript. Huan Wang and Ziye Liu collected the patient data. Jun Zhu and Wei Wang performed both surgeries and followed up the patients. Yaguang Han and Song Wang realized the scarcity of the two cases, did literature searches, and revised the manuscript. All authors read and approved the fnal manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study were available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants and approval for this study was given by the Ethics Committee and Institutional Review Board of Shanghai Changzheng Hospital. All methods were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMonckeberg JE, Rafols C, Apablaza F, et al. Intra-articular administration of peripheral blood stem cells with platelet-rich plasma regenerated articular cartilage and improved clinical outcomes for knee chondral lesions[J].Knee. 2019 Aug;26(4):824\u0026ndash;831.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen PD, Tran TD, Nguyen HT, et al. Comparative Clinical Observation of Arthroscopic Microfracture in the Presence and Absence of a Stromal Vascular Fraction Injection for Osteoarthritis[J].Stem Cells Transl Med. 2017 Jan;6(1):187\u0026ndash;195.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo T, Noshin M, Baker HB, et al. 3D printed biofunctionalized scaffolds for microfracture repair of cartilage defects[J].Biomaterials. 2018 Dec;185:219\u0026ndash;231.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSong B, Li C, Chen N, et al. All-arthroscopic anatomical reconstruction of anterior talofibular ligament using semitendinosus autografts[J].Int Orthop. 2017 May;41(5):975\u0026ndash;982.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArroyo-Hern\u0026aacute;ndez M, Mellado-Romero M, P\u0026aacute;ramo-D\u0026iacute;az P, et al. Chronic ankle instability: Arthroscopic anatomical repair[J].Rev Esp Cir Ortop Traumatol. 2017 Mar-Apr;61(2):104\u0026ndash;110. English, Spanish.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKo KR, Lee WY, Lee H, et al. Repair of only anterior talofibular ligament resulted in similar outcomes to those of repair of both anterior talofibular and calcaneofibular ligaments[J].Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):155\u0026ndash;162.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsuyuguchi Y, Nakasa T, Ishikawa M, et al. A Technique for the Reduction of Complications Associated With Anterior Portal Placement During Ankle Arthroscopy Using a Peripheral Vein Illumination Device[J].Arthrosc Tech. 2018 Jan 17;7(2):e125-e129.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline[J]. Br J Sports Med. 2018 Aug;52(15):956.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelton TJ, Dannenbaum JH, Drayer NJ, et al. Postoperative Outcome of the Modified Brostr\u0026ouml;m Procedure in the Active Duty Military Population: A Retrospective Cohort Study[J].J Foot Ankle Surg. 2018 May-Jun;57(3):527\u0026ndash;530.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVega J, Guelfi M, Malagelada F, et al. Arthroscopic All-Inside Anterior Talofibular Ligament Repair Through a Three-Portal and No-Ankle-Distraction Technique[J].JBJS Essent Surg Tech. 2018 Sep 26;8(3):e25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBatista JP, Del Vecchio JJ, Patthauer L, et al. Arthroscopic Lateral Ligament Repair Through Two Portals in Chronic Ankle Instability[J].Open Orthop J. Jul. 2017;31:11:617\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaget L, Bierma-Zeinstra S, Goedegebuure S, et al. Platelet-Rich plasma Injection Management for Ankle osteoarthritis study (PRIMA): protocol of a Dutch multicentre, stratified, block-randomised, double-blind, placebo-controlled trial[J].BMJ Open. 2019 Oct 7;9(10):e030961.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNwankwo EC Jr, Labaran LA, Athas V, et al. Pathogenesis of Posttraumatic Osteoarthritis of the Ankle[J]. Orthop Clin North Am. 2019 Oct;50(4):529\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurray C, Marshall M, Rathod T, et al. Population prevalence and distribution of ankle pain and symptomatic radiographic ankle osteoarthritis in community dwelling older adults: A systematic review and cross-sectional study[J].PLoS One. 2018 Apr 30;13(4):e0193662.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHana S, Aicha BT, Selim D, et al. Clinical and Radiographic Features of Knee Osteoarthritis of Elderly Patients[J]. Curr Rheumatol Rev. 2018;14(2):181\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVannabouathong C, Del Fabbro G, Sales B, et al. Intra-articular Injections in the Treatment of Symptoms from Ankle Arthritis: A Systematic Review[J].Foot Ankle Int. 2018 Oct;39(10):1141\u0026ndash;1150.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbbott JH, Usiskin IM, Wilson R, et al. The quality-of-life burden of knee osteoarthritis in New Zealand adults: A model-based evaluation[J].PLoS One. 2017 Oct 24;12(10):e0185676.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelco ML, Kennedy JG, Bonassar LJ,et al. Post-traumatic osteoarthritis of the ankle: A distinct clinical entity requiring new research approaches[J].J Orthop Res. 2017 Mar;35(3):440\u0026ndash;453.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFukawa T, Yamaguchi S, Akatsu Y, et al. Safety and Efficacy of Intra-articular Injection of Platelet-Rich Plasma in Patients With Ankle Osteoarthritis[J].Foot Ankle Int. 2017 Jun;38(6):596\u0026ndash;604.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRepetto I, Biti B, Cerruti P,et al. Conservative Treatment of Ankle Osteoarthritis: Can Platelet-Rich Plasma Effectively Postpone Surgery?[J].J Foot Ankle Surg. 2017 Mar-Apr;56(2):362\u0026ndash;365.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBadahdah HM, Zgonis T. Ankle Arthrodiastasis with Circular External Fixation for the Treatment of Posttraumatic Ankle Arthritis[J].Clin Podiatr Med Surg. 2017 Oct;34(4):425\u0026ndash;431.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernstein M, Reidler J, Fragomen A, et al. Ankle Distraction Arthroplasty: Indications, Technique, and Outcomes[J].J Am Acad Orthop Surg. 2017 Feb;25(2):89\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJackson AT, Drayer NJ, Samona J, et al. Osteochondral Allograft Transplantation Surgery for Osteochondral Lesions of the Talus in Athletes[J].J Foot Ankle Surg. 2019 Jul;58(4):623\u0026ndash;627.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLanham NS, Carroll JJ, Cooper MT, et al. A Comparison of Outcomes of Particulated Juvenile Articular Cartilage and Bone Marrow Aspirate Concentrate for Articular Cartilage Lesions of the Talus[J].Foot Ankle Spec. 2017 Aug;10(4):315\u0026ndash;321.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReda Y, Farouk A, Abdelmonem I, et al. Surgical versus non-surgical treatment for acute Achilles' tendon rupture. A systematic review of literature and meta-analysis[J].Foot Ankle Surg. 2020 Apr;26(3):280\u0026ndash;288.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ankle instability, Cartilage injury, Platelet rich plasma, Ankle arthroscopic surgery","lastPublishedDoi":"10.21203/rs.3.rs-2290465/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2290465/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eAim\u003c/b\u003e To estimate the clinical efficacy of platelet-rich plasma (PRP) injection in the therapy of Chronic Ankle Instabiliy (CAI) in young adults.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e 80 sufferers with CAI with cartilage injury (from March 2018 to March 2021) enrolled to our hospital were differentiated into two groups at random (n\u0026thinsp;=\u0026thinsp;40/group). The arthroscopic group and the PRP with arthroscopic group were handled with ankle arthroscopy and PRP injection combined with ankle arthroscopy respectively. The ankle dorsal extension, metatarsal flexion range of motion and pain, ankle function and balance ability were contrasted among the two groups before and 6 months after therapy. The levels of serum indexes were contrasted among the two groups pre-therapy and post-therapy.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e 6 months after therapy, the ankle dorsal extension, metatarsal flexion activity, visual analog score (VAS), American orthopedic foot, ankle society (AOFAS) and Berg Balance Scale (BBS) scores were boosted in two groups, and versus the arthroscopic group, the ankle dorsal extension, metatarsal flexion motion and AOFAS, BBS scores were enhanced and VAS scores were lessened in the PRP with arthroscopic group. The contents of MMP-3, TIMP-1 and TNF- α were boosted in both groups, and versus the arthroscopic group, the contents of MMP-3, TIMP-1 and TNF-α were memorably lessened in the PRP with arthroscopic group.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusion\u003c/b\u003e The application of PRP injection combined with ankle arthroscopic surgery in the therapy of young CAI sufferers merged with cartilage injury is helpful to relieve ankle pain and improve ankle function.\u003c/p\u003e","manuscriptTitle":"Application of platelet rich plasma injection in the therapy of youth ankle joint instability with cartilage injury","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-01-03 15:03:06","doi":"10.21203/rs.3.rs-2290465/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8236fcf9-ba02-4ab4-8865-48a49f4ef083","owner":[],"postedDate":"January 3rd, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-02-13T09:29:47+00:00","versionOfRecord":[],"versionCreatedAt":"2023-01-03 15:03:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2290465","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2290465","identity":"rs-2290465","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}