| 61. |
- Alfredson, Håkan, et al.
(author)
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Superior results with continuous passive motion compared to active motion after periosteal transplantation : A retrospective study of human patella cartilage defect treatment
- 1999
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In: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer. - 0942-2056 .- 1433-7347. ; 7:4, s. 232-238
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Journal article (peer-reviewed)abstract
- Fifty-seven consecutive patients (33 men and 24 women), with a mean age of 32 years (range 16-53 years), who suffered from an isolated full-thickness cartilage defect of the patella and disabling knee pain of long duration, were treated by autologous periosteal transplantation to the cartilage defect. The first 38 consecutive patients (group A) were postoperatively treated with continuous passive motion (CPM), and the next 19 consecutive patients (group B) were treated with active motion for the first 5 days postoperatively. In both groups, the initial regimens were followed by active motion, slowly progressive strength training, and slowly progressive weight bearing. In group A, after a mean follow-up of 51 months (range 33-92 months), 29 patients (76%) were graded as excellent or good, 7 patients (19%) were graded as fair, and 2 patients (5%) were graded as poor. In group B, after a mean follow-up of 21 months (range 14-28 months), 10 patients (53%) were graded as excellent or good, 6 patients (32%) were graded as fair, and 3 patients (15%) were graded as poor. Altogether, nine of the fair or poor cases (50%) were diagnosed with chondromalacia of the patella. Our results, after performing autologous periosteal transplantation in patients with full-thickness cartilage defects of the patella and disabling knee pain, are good if CPM is used postoperatively. The clinical results using active motion postoperatively are not acceptable, especially not in patients with chondromalacia of the patella.
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| 62. |
- Alfredson, Håkan, et al.
(author)
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Surgical plantaris tendon removal for patients with plantaris tendon-related pain only and a normal Achilles tendon : a case series
- 2018
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In: BMJ Open Sport & Exercise Medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 4:1
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Journal article (peer-reviewed)abstract
- Objectives: Surgical removal of the plantaris tendon can cure plantaris-associated Achilles tendinopathy, a condition in which Achilles and plantaris tendinopathy coexist. However, rare cases with plantaris tendinopathy alone are often misdiagnosed due to a normal Achilles tendon.Design and setting: Prospective case series study at one centre.Participants: Ten consecutive patients (9 men and one woman, mean age 35 years, range 19–67) with plantaris tendon-related pain alone in altogether 13 tendons were included. All had had a long duration (median 10 months, range 3 months to 10 years) of pain symptoms on the medial side of the Achilles tendon mid-portion. Preoperative ultrasound showed thickened plantaris tendon but a normal Achilles tendon.Interventions: Operative treatment consisting of ultrasound-guided excision of the plantaris tendon.Primary and secondary outcome measures: Scores from Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A)were taken preoperatively and postoperatively (median duration 10 months). Patient satisfaction and time until full return to sports activity level was asked by a questionnaire.Results: The VISA-A scores increased from 61 (range 45–81) preoperatively to 97 (range 94–100) postoperatively (p<0.01). Follow-up results at 10 months (range 7–72 months) on 9/10 patients showed full satisfaction and return to their preinjury sports or recreational activityConclusion: The plantaris tendon should be kept in mind when evaluating painful conditions in the Achilles tendon region, especially when no Achilles tendinopathy is present. Excision of the plantaris tendon via a minor surgical procedure in local anaesthesia results in a good outcome.
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| 63. |
- Alfredson, Håkan, et al.
(author)
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Surgical treatment of insertional Achilles tendinopathy : results after removal of the subcutaneous bursa alone-a case series
- 2020
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In: BMJ OPEN SPORT & EXERCISE MEDICINE. - : BMJ PUBLISHING GROUP. - 2398-9459 .- 2055-7647. ; 6:1
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Journal article (peer-reviewed)abstract
- Background Insertional Achilles tendinopathy is well known to be difficult to treat, especially when there is intra-tendinous bone pathology. This study is a case series on patients with chronic insertional Achilles tendon pain and major intra-tendinous bony pathology together with bursa and tendon pathology, treated with excision of the subcutaneous bursa alone. Methods Eleven patients (eight men and three women) with a mean age of 44 years (range 24-62) and a chronic (>6 months) painful condition from altogether 15 Achilles tendon insertions were included. In all patients, ultrasound examination showed intra-tendinous bone pathology together with pathology in the tendon and subcutaneous bursa, and all were surgically treated with an open excision of the whole subcutaneous bursa alone. This was followed by full weight-bearing walking in a shoe with open heel for 6 weeks. Results At follow-up 21 (median, range 12-108) months after surgery, 9/11 patients (12/15 tendons) were satisfied with the result of the operation and 10/11 (13/15 tendons) were back in their previous sport and recreational activities. The median VISA-A score had improved from 41 (range 0-52) to 91 (range 33-100) (p<0.01). Conclusion In patients with chronic painful insertional Achilles tendinopathy with intra-tendinous bone pathology, tendon and bursa pathology, open removal of the subcutaneous bursa alone can relieve the pain and allow for Achilles tendon loading activities. The results in this case series highlight the need for more studies on the pain mechanisms in insertional Achilles tendinopathy and the need for randomised studies to strengthen the conclusions.
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| 64. |
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| 65. |
- Alfredson, Håkan, et al.
(author)
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Total and regional bone mass in female soccer players
- 1996
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In: Calcified Tissue International. - : Springer. - 0171-967X .- 1432-0827. ; 59:6, s. 438-442
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Journal article (peer-reviewed)abstract
- This cross-sectional study investigated bone mass in female athletes participating in an impact-loading sport (soccer), and evaluated whether any changes in bone mass could be related to the type of weight-bearing loading and muscle strength. The group of soccer players consisted of 16 second-division female players (age 20.9 +/- 2.2 years) training for about 6 hours/week. The reference group consisted of 13 nonactive females (age 25.0 +/- 2.4 years) not participating in any kind of regular or organized sport activity. The groups were matched according to weight and height. Areal bone mineral density (BMD) was measured in total body, head, lumbar spine, femoral neck, Ward's triangle, trochanter, the whole femur and humerus, and in specific sites in femur diaphysis, distal femur, proximal tibia, and tibia diaphysis using dual X-ray absorptiometry. Isokinetic concentric peak torque of the quadriceps and hamstring muscles was measured using an isokinetic dynamometer. The soccer players had significantly (P < 0.05-0.01) higher BMD in the lumbar spine (10.7%), femoral neck (13.7%), Ward's triangle (19.6%), nondominant femur and humerus (8.2 and 8.0%, respectively), distal femur (12.6%), and proximal tibia (12.0%) compared with the nonactive women. There was no significant difference in muscle strength of the thigh between the two groups. In the nonactive group, muscle strength in the quadriceps and especially hamstrings, was correlated to BMD of the adjacent bones (whole femur, hip sites) and also to distant sites (humerus). In the soccer group, there were no correlations between muscle strength and BMD of the adjacent and distant bones. Soccer playing and training appears to have a beneficial effect on bone mass in young females, and it seems that there is a site-specific skeletal response to the type of loading subjected to each BMD site. Muscle strength in the thigh is not related to bone mass in female soccer players.
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| 66. |
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| 67. |
- Alfredson, Håkan, et al.
(author)
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Treatment of tear of the anterior cruciate ligament combined with localised deep cartilage defects in the knee with ligament reconstruction and autologous periosteum transplantation.
- 1999
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In: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer. - 0942-2056 .- 1433-7347. ; 7:2, s. 69-74
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Journal article (peer-reviewed)abstract
- An acute tear of the anterior cruciate ligament (ACL) is frequently associated with injuries to the joint cartilage and subchondral bone. These injuries may progress to deep cartilage defects, causing disabling pain, and represent a therapeutic challenge in patients with the combination instability and pain. At our clinic we treat patients with the combined injury with simultaneous ACL reconstruction and autologous periosteum transplantation of the cartilage defect. This report describes the technique for periosteum transplantation of full-thickness cartilage defects in the medial femoral condyle. Our clinical report includes the first 7 patients (6 men and 1 woman, mean age 29.1 years at operation) who have been followed for 2 years or longer of 14 consecutive patients (12 men and 2 women). All patients had suffered a total tear of the ACL and a full-thickness defect of the cartilage at the medial femoral condyle. The cartilage defects had a mean area of 7.3 cm2 (range 1.0-13.5 cm2). All patients had disabling instability and medial knee pain when walking. The anterior cruciate ligament was reconstructed with a bone-tendon-bone graft of the central third of the patellar ligament. After preparation of the cartilage lesion, the periosteum transplant was anchored to the underlying bone with suture anchors and fibrin glue. Postoperatively, these patients (n = 7) were initially treated with continuous passive motion, followed by active flexibility training and slowly progressing strength training and weight-bearing activities. At follow-up a mean of 31.3 months (range 24-38 months) later, 6 patients evidenced subjectively stable knees, no pain during rest or when walking, and had returned to not too heavy knee-loading work. One patient had a subjectively stable knee, but felt medial knee pain. Meticulous surgical technique and rigorous postoperative rehabilitation are probably of the greatest importance in this procedure. With the use of suture anchors and fibrin glue, the periosteum transplant can be well adapted to the condylar subchondral bone bed.
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| 68. |
- Alfredson, Håkan
(author)
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Ultrasound and Doppler-guided mini-surgery to treat midportion Achilles tendinosis : results of a large material and a randomised study comparing two scraping techniques.
- 2011
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In: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 45:5, s. 407-410
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Journal article (peer-reviewed)abstract
- BACKGROUND: Treatment based on ultrasound (US) and colour Doppler (CD) findings in midportion Achilles tendinosis has shown promising results. In a randomised study on a small patient material, similar short-term clinical results were demonstrated with surgery outside the tendon and sclerosing polidocanol injections, but surgical treatment led to a faster return to activity.OBJECTIVE: To evaluate the clinical results of US and CD-guided mini-surgery (scraping) outside the ventral tendon in a larger patient material and, in a randomised study, compare two different techniques for surgical scraping.MATERIAL AND METHODS: 103 patients (66 men, 37 women), mean age 43 years (range 24-77), with midportion tendinosis in 125 Achilles tendons were included. Patients from a large group (88 tendons), and a randomised study (37 tendons), were in local anaesthesia treated with a US and CD-guided new surgical approach outside the ventral tendon. All patients in the large group, and one arm of the randomised study, were treated open with a scalpel, while the other arm of the randomised study were treated percutaneously. Pain during Achilles tendon loading activity (Visual Analogue Scale (VAS)), and satisfaction with treatment, were evaluated.RESULTS: Before surgery, the mean VAS was 73. After surgery (follow-up mean 18 months, range 6-33), the mean VAS was 3 in 111 tendons (89%) from satisfied patients back in full Achilles tendon loading activity. In the randomised study, there were no significant differences in the results between open treatment with a scalpel and percutaneous treatment with a needle.CONCLUSIONS: US and CD-guided scraping show good short-term results in midportion Achilles tendinosis.
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| 69. |
- Alfredson, Håkan, et al.
(author)
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Ultrasound and surgical inspection of plantaris tendon involvement in chronic painful insertional Achilles tendinopathy: A case series
- 2021
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In: BMJ Open Sport and Exercise Medicine. - : BMJ Publishing Group Ltd. - 2055-7647. ; 7:1
-
Journal article (peer-reviewed)abstract
- Objectives: Chronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy.Methods: Ninety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24-64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement.Results: In 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients.Conclusion: Plantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness.Level of evidence: IV case series.
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| 70. |
- Alfredson, Håkan, et al.
(author)
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Unilateral surgical treatment for patients with midportion Achilles tendinopathy may result in bilateral recovery
- 2014
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In: British Journal of Sports Medicine. - : BMJ Publishing Group. - 0306-3674 .- 1473-0480. ; 48:19, s. 1421-1424
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Journal article (peer-reviewed)abstract
- BACKGROUND: Bilateral midportion Achilles tendinopathy/tendinosis is not unusual, and treatment of both sides is often carried out. Experiments in animals suggest of the potential involvement of central neuronal mechanisms in Achilles tendinosis. OBJECTIVES: To evaluate the outcome of surgery for Achilles tendinopathy. METHODS: This observational study included 13 patients (7 men and 6 women, mean age 53 years) with a long duration (6-120 months) of chronic painful bilateral midportion Achilles tendinopathy. The most painful side at the time for investigation was selected to be operated on first. Treatment was ultrasound-guided and Doppler-guided scraping procedure outside the ventral part of the tendon under local anaesthetic. The patients started walking on the first day after surgery. Follow-ups were conducted and the primary outcome was pain by visual analogue scale. In an additional part of the study, specimens from Achilles and plantaris tendons in three patients with bilateral Achilles tendinosis were examined. RESULTS: Short-term follow-ups showed postoperative improvement on the non-operated side as well as the operated side in 11 of 13 patients. Final follow-up after 37 (mean) months showed significant pain relief and patient satisfaction on both sides for these 11 patients. In 2 of 13 patients operation on the other, initially non-operated side, was instituted due to persisting pain. Morphologically, it was found that there were similar morphological effects, and immunohistochemical patterns of enzyme involved in signal substance production, bilaterally. CONCLUSION: Unilateral treatment with a scraping operation can have benefits contralaterally; the clinical implication is that unilateral surgery may be a logical first treatment in cases of bilateral Achilles tendinopathy.
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