Corticosteroid Injections Hasten Return to Play of National Football League Players Following Stable Ankle Syndesmosis Sprains

Abstract

Objectives: Injuries to the ankle syndesmosis are common in contact athletes and may result in significant time lost from sport. Syndesmosis sprains require more treatment and time off for recovery as compared to lateral ankle sprains. A previous study of collegiate football players described an average of 31 days lost from these injuries treated with standard conservative measures and rehabilitation protocols. Treatment methods for stable syndesmosis sprains are not well documented in the literature. The purpose of this study was to compare our series of stable ankle syndesmosis sprains treated with or without corticosteroid injections. Methods: A retrospective review of ankle syndesmosis sprains from two National Football League (NFL) teams over an eight-year period (2003-2011) was performed. All players were evaluated with standard radiographs as well as magnetic resonance imaging (MRI) to confirm their diagnosis. All players were subsequently treated with (Group 1) or without (Group 2) a corticosteroid injection into the syndesmosis within 72 hours of injury and progressed through a nonoperative rehabilitation program based on the treatment practices of the team. Time lost was calculated as total days from date of onset before returning to unrestricted activity including practice and games. Results: A total of 31 stable ankle syndesmosis sprains were identified. All injuries confirmed with MRI were reviewed. Thirteen players received a corticosteroid injection (Group 1) within the syndesmosis and had an average return of 15 days (5-26). Eighteen players did not receive a corticosteroid injection (Group 2) within the syndesmosis and had an average return of 25 days (1-43). This difference in return was statistically significant (p=0.0097). All players in both groups returned to play. There was one recurrence in Group 1 and two recurrences in Group 2. Conclusion: Ankle syndesmosis sprains are debilitating injuries for NFL players and result in significant time lost from sport. Compared to our control group, the use of corticosteroid injection coupled with standard rehabilitation for acute stable ankle syndesmosis sprains hastened return to play by an average of 40% (10 days). In a highly competitive athlete, this may represent a significant clinical difference.