Addition of hyperbaric oxygen to the treatment of acute ankle sprains did not accelerate recovery.

Clinical Bottom Line:
1. There was no improvement in the time to recovery by the addition of hyperbaric oxygen to a standard treatment protocol.
2. Both groups recovered function and lost symptoms over 15 to 16 days.
3. There was no improvement in resolution of oedema or active/passive movement range.

Appraised by: Mike Bennett, Dept. of Diving and Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Wednesday, 16 December, 1998

Clinical Scenario: A patient with a soft-tissue sprain to the ankle.
Three-part Question: In patients with an acute ankle sprain does the addition of hyperbaric oxygen therapy to standard therapy result in any reduction in the time taken to recover function?
Search Terms: Athletic injury, soft-tissue trauma, sprains and strains.

The Study:
Double-blinded randomised controlled trial without intention-to-treat.
Young adults with lateral ankle sprains evaluated by an orthopaedic surgeon within 72 hours and who had not received treatment other than rest, ice and elevation.
Control group (N =16 ;16 analysed): Standard program of treatment including posterior splint, crutches, naproxen, active range of motion and ankle stirrup. Sham hyperbaric exposure of air at 1.1ATA for 90 minutes, then twice more for 60 minutes within 7 days.
Experimental group (N =16 ;16 analysed): Standard treatment program plus 100% oxygen at 2ATA on the same time protocol as above.

Outcomes:
Non-event outcomes
Control group
HBO group
P-value
Time to recovery of function (days)
15.4
16.0
>0.05
Improvement in functional score (initial to final)
4.5
5.9
<0.05


Comments:
1. The greater improvement reported in functional score in the hyperbaric group from the start to finish of treatment is probably of little real significance.
2. There is a delay to treatment of over 30 hours in both groups.
3. A methodologically sound study but of low power.
4. Three treatment regime may be considered a low dose.

Expiry date: March 2021
References:
1. Borromeo CN, Ryan JL, Marchetto PA, Peterson R, Bove AA. Hyperbaric oxygen therapy for acute ankle sprains. American Journal of Sports Medicine 1997;25:619-625.

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