%D 2009 %0 In-Process %T Original research : long-term efficacy and safety of periarticular hyaluronic acid in acute ankle sprain . %J Phys Sportsmed %V 37 %P 64-70 %A Petrella MJ %A Cogliano A %A Petrella RJ %M pub20048489 %X The objectives of this study were to determine the long-term efficacy and safety of periarticular hyaluronic acid ( HA ) injections in acute lateral ankle sprain . A randomized , controlled , prospective trial in a primary sports medicine and emergency practice involved 158 competitive athletes who suffered an acute grade 1 or 2 lateral ankle sprain , and who were randomly assigned within 48 hours of injury . Patients were randomly assigned at baseline to periarticular injection with HA + standard of care ( rest , ice , elevation , and compression [ RICE ] ) or placebo injection ( PL ) + standard of care ( RICE ) treatment at baseline assessment and day 4 after injury . Follow-up was at 30 , 90 , and 712 days after treatment . Assessments at baseline and days 4 , 8 , 30 , 90 , and 712 included visual analogue scale ( VAS ) ( 0-10 cm ) pain on weight bearing and walking 20 m , patient global assessment of ankle injury ( 5-point categorical scale ) , patient satisfaction with treatment ( 5-point categorical scale ) , time to return to pain-free and disability-free sport , recurrent ankle sprain , total number of days missing from primary sport activity , and adverse events ( AEs ) . Time to intervention was 39 +/- 4 hours with no difference between groups . A significant reduction in VAS pain on both weight bearing and walking was observed at all follow-up assessments for HA compared with PL ( P < 0 . 001 ) . Time to pain-free and disability-free return to sport was 11 ( +/- 8 ) versus 17 ( +/- 8 ) days for HA and PL , respectively ( P < 0 . 05 ) . At 24 months , in the PL versus HA group , there were 2 versus 0 lower limb fractures , 16 versus 7 second ankle sprains ( P < 0 . 05 ) , 3 versus 1 third ankle sprains , and a significantly greater number of days missing primary sport activity ( 41 vs 21 ; P < 0 . 002 ) . Significantly greater patient satisfaction was also observed for HA versus PL at all follow-up assessments . No serious AEs were recorded throughout follow-up . Periarticular HA treatment for acute ankle sprain was highly satisfactory in the short and long term versus PL . This was associated with reduced pain , more rapid return to sport , fewer recurrent ankle sprains , fewer missed days from sport , and with few associated AEs to 24 months .