104 research outputs found
sj-docx-1-sph-10.1177_19417381231157746 – Supplemental material for Only 10% of Patients With a Concomitant MCL Injury Return to Their Preinjury Level of Sport 1 Year After ACL Reconstruction: A Matched Comparison With Isolated ACL Reconstruction
No full textSupplemental material, sj-docx-1-sph-10.1177_19417381231157746 for Only 10% of Patients With a Concomitant MCL Injury Return to Their Preinjury Level of Sport 1 Year After ACL Reconstruction: A Matched Comparison With Isolated ACL Reconstruction by Eleonor Svantesson, Ramana Piussi, Susanne Beischer, Christoffer Thomeé, Kristian Samuelsson, Jón Karlsson, Roland Thomeé and Eric Hamrin Senorski in Sports Health: A Multidisciplinary Approach</p
DS_10.1177_0363546518788325 – Supplemental material for Ten-Year Risk Factors for Inferior Knee Injury and Osteoarthritis Outcome Score After Anterior Cruciate Ligament Reconstruction: A Study of 874 Patients From the Swedish National Knee Ligament Register
No full textSupplemental material, DS_10.1177_0363546518788325 for Ten-Year Risk Factors for Inferior Knee Injury and Osteoarthritis Outcome Score After Anterior Cruciate Ligament Reconstruction: A Study of 874 Patients From the Swedish National Knee Ligament Register by Eric Hamrin Senorski, Eleonor Svantesson, Kurt P. Spindler, Eduard Alentorn-Geli, David Sundemo, Olaf Westin, Jon Karlsson and Kristian Samuelsson in The American Journal of Sports Medicine</p
sj-pdf-1-ajs-10.1177_03635465211069995 – Supplemental material for Superior Outcome of Early ACL Reconstruction versus Initial Non-reconstructive Treatment With Late Crossover to Surgery: A Study From the Swedish National Knee Ligament Registry
No full textSupplemental material, sj-pdf-1-ajs-10.1177_03635465211069995 for Superior Outcome of Early ACL Reconstruction versus Initial Non-reconstructive Treatment With Late Crossover to Surgery: A Study From the Swedish National Knee Ligament Registry by Emma Bergerson, Kajsa Persson, Eleonor Svantesson, Alexandra Horvath, Jonas Olsson Wållgren, Jon Karlsson, Volker Musahl, Kristian Samuelsson and Eric Hamrin Senorski in The American Journal of Sports Medicine</p
Minimally Invasive Versus Open Repair for Acute Achilles Tendon Rupture: Meta-Analysis Showing Reduced Complications, with Similar Outcomes, After Minimally Invasive Surgery
No full textBACKGROUND: There is no consensus on the optimal technique for repairing an acute Achilles tendon rupture. The purpose of this meta-analysis was to compare the complications, subjective outcomes, and functional results between minimally invasive surgery and open repair of an Achilles tendon rupture. METHODS: A systematic literature search of MEDLINE/PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EBSCOhost, and ClinicalTrials.gov was performed. Eligible studies were randomized controlled trials (RCTs) comparing minimally invasive surgery and open repair of acute Achilles tendon ruptures. A meta-analysis was performed, while bias and the quality of the evidence were rated according to the Cochrane Database questionnaire and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. The meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. RESULTS: Eight studies, with 182 patients treated with minimally invasive surgery and 176 treated with open repair, were included. The meta-analysis showed a significantly decreased risk ratio (RR) of 0.21 (95% confidence interval [CI] = 0.10 to 0.40, p = 0.00001) for overall complications and 0.15 (95% CI = 0.05 to 0.46, p = 0.0009) for wound infection after minimally invasive surgery. Patients treated with minimally invasive surgery were more likely to report good or excellent subjective results (RR = 1.18, 95% CI = 1.04 to 1.33, p = 0.009). No differences between groups were found with respect to reruptures, sural nerve injury, return to preinjury activity level, time to return to work, or ankle range of motion. The overall quality of evidence was generally low because of a substantial risk of bias, heterogeneity, indirectness of outcome reporting, and evaluation of a limited number of patients. CONCLUSIONS: There was a significantly decreased risk of postoperative complications, especially wound infection, when acute Achilles tendon rupture was treated with minimally invasive surgery compared with open surgery. Patients treated with minimally invasive surgery were significantly more likely to report a good or excellent subjective outcome. Current evidence is associated with high heterogeneity and a considerable risk of bias. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence
Pseudo-patella baja: a minor yet frequent complication of total knee arthroplasty
No full textPurpose: One of the complications in total knee arthroplasty (TKA) is pseudo-patella baja (PPB). PPB is present when there is no shortening of the patellar tendon, but the joint line is elevated. The purpose of this study is to investigate the incidence of PPB after TKA and its clinical effects. Methods: A case series of 158 patients undergoing TKA surgery between 1999 and 2012 at the 2nd Department of Orthopaedics and Traumatology, Pisa were retrospectively reviewed. Surgeries were performed by three senior surgeons, using the same surgical procedure for the implantation of a cemented posterior stabilized prosthesis. Lateral radiographs at 30° knee flexion were evaluated and the presence of PPB defined as modified Blackburne–Peel Index (mBPI) of < 0.54. All the patients were clinically evaluated using the Knee Society Score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC). Anterior knee pain was evaluated by visual analogue scale (VAS) and range of motion (ROM) was assessed through clinical examination. Results: The cohort group consisted of 158 patients, 109 (69.0%) female and 49 (31.0%) male. Median age at time of surgery was 74 years (range 36–87) and median follow-up was 66 months (range 12–163 months). Bilateral TKA surgery was performed in 50 patients, resulting in a total of 208 implants for investigation. On radiological evaluation, 139 (66.8%) showed no abnormalities (no joint line elevation and no patellar tendon shortening) and 55 (26.4%) presented joint line elevation with absence of patellar tendon shortening (PPB). No significant differences were found between the groups in terms of the KSS, WOMAC score, VAS or ROM. Conclusion: Post TKA PPB is a relatively common complication. Careful preoperative planning, adequate soft tissue release, optimal cutting of bone components, on the femoral side in particular, and the use of thin polyethylene inserts can help to avoid this complication. Level of evidence: IV. © 2017, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)
Mapping functions in health-related quality of life: mapping from the Achilles Tendon Rupture Score to the EQ-5D
No full textPurpose: Health state utility values are derived from preference-based measurements and are useful in calculating quality-adjusted life years (QALYs), which is a metric commonly used in cost-effectiveness studies. The purpose of this study was to convert the Achilles Tendon Rupture Score (ATRS) to the preference-based European Quality of Life-5 Dimension Questionnaire (EQ-5D) by estimating the relationship between the two scores using mapping. Methods: Data were collected from a randomised controlled trial, where 100 patients were treated either surgically or non-surgically for Achilles tendon rupture. Forty-three and forty-four patients in surgical group and non-surgical group completed the ATRS and the EQ-5D alongside each other during follow-up at three time points. Different models of the relationship between the ATRS and the EQ-5D were developed and analysed based on direct mapping and cross-validation. The model with the lowest mean absolute error was observed as the one with the best fit. Results: Among the competing models, mapping based on using a combination of the ATRS items four, five, and six associated with limitation due to pain, during activities of daily living and when walking on uneven ground, produced the best predictor of the EQ-5D score. Conclusions: The present study provides a mapping algorithm to enable the derivation of utility values directly from the ATRS. This approach makes it feasible for researchers, as well as medical practitioners, to obtain preference-based values in clinical studies or settings where only the ATRS is being administered. The algorithm allows for the calculation of QALYs for use in cost-effectiveness analyses, making it valuable in the study of acute Achilles tendon ruptures. Level of evidence: II
Revision anterior cruciate ligament reconstruction - current evidence, predictors and outcome
No full textDespite extensive research in the field of anterior cruciate ligament (ACL) reconstruction, primary ACL reconstruction failure and a high re-rupture rate remain a problem. Far too many patients experience a second devastating hit – the need to undergo a revision ACL reconstruction. This thesis aims to review current evidence, predictors and outcome related to revision ACL reconstruction. For this purpose, seven studies were conducted and they were stratified into three distinct themes – Current evidence, The impact of a concomitant medial collateral ligament (MCL) injury and Outcome after revision. Registry-based data formed the foundation of this thesis, for which the Swedish national knee ligament registry and a local rehabilitation registry were utilized. Additionally, evidence from all three Scandinavian knee ligament registries was synthesized.
In Theme I, the evidence provided from the Scandinavian knee ligament registries was systematically reviewed to find predictors of ACL revision and to determine the robustness of these predictors by applying the Fragility index. Young age was the strongest and most robust predictor of ACL revision, where an approximately 5-fold increase in the risk of revision was found for adolescents compared with the oldest age group (patients over 35 years of age). Patient sex did not influence the risk of revision. The use of hamstring tendon (HT) autografts was associated with an increased risk of revision compared with patellar tendon (PT) autografts, although a larger HT graft diameter was protective in terms of ACL revision. Notably, there was great variability in current Scandinavian knee ligament registry studies in terms of the statistical robustness of significant predictors of ACL revision. Nearly one third of the analyses had a fragility index of zero, which indicates high statistical fragility and questions the robustness of current predictors of revision reported by the registries.
Theme II explored the impact of a concomitant MCL injury on the risk of ACL revision and how the treatment of these injuries affects outcome. Patients without a concomitant MCL injury ran an approximately 30% lower risk of revision ACL reconstruction compared with patients who had a concomitant MCL injury at primary ACL reconstruction. Specifically, the risk of ACL revision was increased for patients in whom the concomitant MCL injury was treated non-surgically, while patients receiving surgical treatment for an MCL injury did not display any difference in the risk of revision compared with patients without a concomitant MCL injury. The ACL graft choice between HT and PT did not influence the risk of revision in patients undergoing ACL reconstruction with a concomitant non-surgically treated MCL injury. In terms of functional outcome, patients with and without a non-surgically treated MCL injury were able to attain similar outcomes in terms of return to sport, tests of muscle function and patient-reported outcome (PRO) at one year postoperatively. However, only 10% of the patients with a concomitant non-surgically treated MCL injury had returned to their pre-injury level of sport, compared with 26% of the patients without an MCL injury at one year after ACL reconstruction.
In Theme III, a systematic review of the Scandinavian knee ligament registries found that the PRO was significantly lower after an ACL revision compared with the primary ACL reconstruction, although a few assessments between the 1- to 5-year follow-ups revealed a clinically relevant difference. The largest impairments after a revision compared with a primary ACL reconstruction were found in sport and recreational activities, as well as in quality of life. In Study VII, when a cohort that had undergone both a primary and a revision ACL reconstruction was assessed, there were minor differences between the two occasions according to the one-year PRO. However, the prevalence of cartilage injuries increased significantly at the revision ACL reconstruction (35.1%) compared with the primary ACL reconstruction (18.3%), which could indicate potential for a further deterioration in knee function after ACL revision with time. Clinically relevant predictors of significantly inferior PROs one year after revision ACL reconstruction were the use of an allograft and a concomitant injury to the posterolateral corner at the time of revision ACL reconstruction
Association between incision technique for hamstring tendon harvest in anterior cruciate ligament reconstruction and the risk of injury to the infra-patellar branch of the saphenous nerve: a meta-analysis
No full textPurpose: To determine how the incision technique for hamstring tendon (HT) harvest in anterior cruciate ligament (ACL) reconstruction affects the risk of injury to the IPBSN and clinical outcome. Methods: A systematic literature search of the MEDLINE/Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL) and EBSCOhost electronic databases and clinicaltrials.gov for unpublished studies was performed to identify comparative studies investigating injury to the IPBSN after HT ACL reconstruction by comparing at least two different incision techniques. Data were extracted for the number of patients with evidence of any neurologic deficit corresponding to injury to the IPBSN, area of sensory deficit, the Lysholm score and patient satisfaction. The mean difference (MD) in study outcome between incision groups was assessed. The relative risk (RR) and the number needed to treat (NNT) were calculated. The Chi-square and Higgins’ I 2 tests were applied to test heterogeneity. Data were pooled using a Mantel–Haenszel random-effects model if the statistical heterogeneity was > 50% and a fixed-effects model if the statistical heterogeneity was < 50%. The risk of bias was evaluated according to the Cochrane Database questionnaire and the quality of evidence was graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Results: A total of eight studies (three randomized controlled trials (RCTs) and five comparative studies) were included, of which six compared vertical and oblique incisions, one horizontal and vertical incisions, and one compared all three techniques. HT harvest was performed through a vertical incision in 329 patients, through an oblique incision in 195 patients and through a horizontal incision in 151 patients. Considering the meta-analysis of the RCTs, the performance of a vertical incision significantly increased the risk of causing IPBSN deficiency compared with both oblique and horizontal incision [RR 1.65 (CI 1.10–2.49, p = 0.02) and RR 2.45 (CI 1.73–3.47, p < 0.0001), respectively]. A significantly larger area of sensory deficit was found with vertical incisions compared with oblique ones, with an MD of 22.91 cm 2 (95% CI 7.73–38.08; p = 0.04). No significant differences were found between the incision techniques in relation to patient-reported outcomes. The same trend was obtained after the performing a meta-analysis of all eight included studies. The quality of evidence in this meta-analysis was determined as “low” to “moderate”, mostly due to inadequate methods of randomization and high heterogeneity among the included studies. Conclusion: The performance of a vertical incision to harvest HTs for ACL reconstruction significantly increased the risk of iatrogenic injury to the IPBSN compared with both oblique and horizontal incisions. Level of evidence: Level I–III, meta-analysis of comparative studies
Patellar resurfacing versus patellar retention in primary total knee arthroplasty: a systematic review of overlapping meta-analyses
No full textPurpose: The need of patellar resurfacing in total knee arthroplasty (TKA) is a subject of debate. This systematic review of overlapping meta-analyses aimed to assess and analyze current evidence regarding patellar resurfacing and non-resurfacing in TKA. Methods: A systematic literature search was performed in March 2017 in PubMed, CINAHL and Cochrane Library. Inclusion criteria were meta-analysis of randomized controlled trials that compared TKA with and without patellar resurfacing considering as outcomes re-operations rate, complications, anterior knee pain, functional scores. The quality of meta-analyses was evaluated with AMSTAR score and the most relevant meta-analysis was determined by applying the Jadad algorithm. Results: Ten meta-analyses, published between 2005 and 2015, were included in the systematic review. Two studies found a significantly increased Knee Society Score in the resurfacing group. According to four meta-analyses, anterior knee pain incidence was lower in resurfacing group. Six of the included studies described a greater risk of re-intervention in the non-resurfacing groups. The overall quality of included studies was moderate. The most relevant meta-analysis reported no differences in functional scores and incidence of anterior knee pain between the groups. Conclusions: Comparable outcomes were found when comparing patellar resurfacing and non-resurfacing in TKA. The higher risk of re-operations after non-resurfacing should be interpreted with caution due to the methodological limitations of the meta-analyses regarding search criteria, heterogeneity and the inherent bias of easier indication to reoperation when the patella is not resurfaced. There is no clear superiority of patellar resurfacing compared to patellar retention. Level of evidence: Level II, systematic review of meta-analyses
Revision anterior cruciate ligament reconstruction - current evidence, predictors and outcome
No full textDespite extensive research in the field of anterior cruciate ligament (ACL) reconstruction, primary ACL reconstruction failure and a high re-rupture rate remain a problem. Far too many patients experience a second devastating hit – the need to undergo a revision ACL reconstruction. This thesis aims to review current evidence, predictors and outcome related to revision ACL reconstruction. For this purpose, seven studies were conducted and they were stratified into three distinct themes – Current evidence, The impact of a concomitant medial collateral ligament (MCL) injury and Outcome after revision. Registry-based data formed the foundation of this thesis, for which the Swedish national knee ligament registry and a local rehabilitation registry were utilized. Additionally, evidence from all three Scandinavian knee ligament registries was synthesized. In Theme I, the evidence provided from the Scandinavian knee ligament registries was systematically reviewed to find predictors of ACL revision and to determine the robustness of these predictors by applying the Fragility index. Young age was the strongest and most robust predictor of ACL revision, where an approximately 5-fold increase in the risk of revision was found for adolescents compared with the oldest age group (patients over 35 years of age). Patient sex did not influence the risk of revision. The use of hamstring tendon (HT) autografts was associated with an increased risk of revision compared with patellar tendon (PT) autografts, although a larger HT graft diameter was protective in terms of ACL revision. Notably, there was great variability in current Scandinavian knee ligament registry studies in terms of the statistical robustness of significant predictors of ACL revision. Nearly one third of the analyses had a fragility index of zero, which indicates high statistical fragility and questions the robustness of current predictors of revision reported by the registries. Theme II explored the impact of a concomitant MCL injury on the risk of ACL revision and how the treatment of these injuries affects outcome. Patients without a concomitant MCL injury ran an approximately 30% lower risk of revision ACL reconstruction compared with patients who had a concomitant MCL injury at primary ACL reconstruction. Specifically, the risk of ACL revision was increased for patients in whom the concomitant MCL injury was treated non-surgically, while patients receiving surgical treatment for an MCL injury did not display any difference in the risk of revision compared with patients without a concomitant MCL injury. The ACL graft choice between HT and PT did not influence the risk of revision in patients undergoing ACL reconstruction with a concomitant non-surgically treated MCL injury. In terms of functional outcome, patients with and without a non-surgically treated MCL injury were able to attain similar outcomes in terms of return to sport, tests of muscle function and patient-reported outcome (PRO) at one year postoperatively. However, only 10% of the patients with a concomitant non-surgically treated MCL injury had returned to their pre-injury level of sport, compared with 26% of the patients without an MCL injury at one year after ACL reconstruction. In Theme III, a systematic review of the Scandinavian knee ligament registries found that the PRO was significantly lower after an ACL revision compared with the primary ACL reconstruction, although a few assessments between the 1- to 5-year follow-ups revealed a clinically relevant difference. The largest impairments after a revision compared with a primary ACL reconstruction were found in sport and recreational activities, as well as in quality of life. In Study VII, when a cohort that had undergone both a primary and a revision ACL reconstruction was assessed, there were minor differences between the two occasions according to the one-year PRO. However, the prevalence of cartilage injuries increased significantly at the revision ACL reconstruction (35.1%) compared with the primary ACL reconstruction (18.3%), which could indicate potential for a further deterioration in knee function after ACL revision with time. Clinically relevant predictors of significantly inferior PROs one year after revision ACL reconstruction were the use of an allograft and a concomitant injury to the posterolateral corner at the time of revision ACL reconstruction
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