Case Study : Treating Chronic Ankle Ligament Injury with Comprehensive Platelet Rich Plasma + Dextrose Prolotherapy

Patient Profile

Name : Mr. Raju

Age : 35 years

Occupation : App developer

Sports Background : Former college-level basketball player

Chief Complaint : Chronic ankle pain and instability

Background

Mr. Raju, a 35-year-old app developer, had a history of repeated injuries to his left ankle, mainly attributed to his extensive basketball career. Over the years, he played through pain and discomfort, often strapping up his ankle to continue competing. These injuries led to persistent pain, intermittent swelling, and reduced mobility, significantly affecting his quality of life.

Clinical Presentation

Mr. Raju sought medical attention at the Alleviate Pain Clinic with the following symptoms:

Severe pain on the lateral aspect of the left ankle

Intermittent but troublesome swelling, primarily during physical activity

Restricted mobility and discomfort during weight-bearing activities

Injury of the lateral ligament complex Ankle

Imaging Findings (MRI Report - Left Ankle Joint)

The MRI of Mr. Raju’s left ankle revealed the following findings:

Mild ankle joint effusion

Grade-II sprain of the anterior talo-fibular ligament

Mild tenosynovitis of the tibial posterior tendon

Subtle marrow edema at the calcaneal insertion of the inter-osseous ligament of the subtalar joint

Mild Achilles tendinosis with subtle patchy marrow edema at the tendon insertion

No evidence of effusion or subchondral edema in the ankle joint

The lower end of the tibia and fibula appeared normal, with no evidence of bone marrow edema or focal lesions

The plantar fascia appeared normal, with no evidence of tendonitis or tendon tear in any of the tendons

The retrocalcaneal bursa and the fat in Kager’s triangle appeared normal

The talus, navicular, cuboid, and the cuneiform appeared normal

Impression

Based on the MRI findings, the following impressions were made:

Mild ankle joint effusion

Grade-II sprain of anterior talo-fibular ligament

Mild tenosynovitis of tibial posterior tendon

Subtle marrow edema at the calcaneal insertion of the inter-osseous ligament of the subtalar joint

Mild Achilles tendinosis

Intrarticular Ankle Platelet Rich Plasma Infiltration under fluoroscopy

Treatment Approach

At Alleviate Pain Clinic, Mr. Raju was treated with a comprehensive approach that included Image-Guided Platelet Rich Plasma (PRP) with Prolotherapy. The treatment targeted the attachments of the lateral ligament complex at the fibular end and the foot. Additionally, the ankle joint was injected with PRP to prevent further degenerative changes, and the Achilles tendon was addressed.

Mr. Raju underwent a total of five treatment sessions, with each session spaced three weeks apart. A structured physical therapy regimen was also incorporated into his treatment plan to optimize the healing process.

Outcome

After the completion of the treatment protocol, Mr. Raju experienced significant improvements in his condition:

Pain reduced by 80%
Swelling drastically reduced
Increased strength and stability in the ankle during weight-bearing activities

Furthermore, Mr. Raju was able to return to playing basketball, something he had been unable to do for the past 10 years due to chronic ankle pain.
This case demonstrates the effectiveness of a comprehensive approach involving PRP and Prolotherapy, along with physical therapy, in successfully treating a chronic ankle ligament injury and significantly improving the patient’s quality of life and athletic performance.