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  • Alfredson, Håkan, et al. (författare)
  • Achilles tendinosis and calf muscle strength : the effect of short-term immobilization after surgical treatment
  • 1998
  • Ingår i: American Journal of Sports Medicine. - 0363-5465 .- 1552-3365. ; 26:2, s. 166-71
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>We prospectively studied calf muscle strength in 7 men and 4 women (mean age, 40.9 +/- 10.1 years) who had surgical treatment for chronic Achilles tendinosis. Surgery was followed by immobilization in a weightbearing below-the-knee plaster cast for 2 weeks followed by a stepwise increasing strength training program. Strength measurements (peak torque and total work) were done preoperatively (Week 0) and at 16, 26, and 52 weeks postoperatively. We measured isokinetic concentric plantar flexion strength at 90 and 225 deg/sec and eccentric flexion strength at 90 deg/sec on both the injured and noninjured sides. Preoperatively, concentric and eccentric strength were significantly lower on the injured side at 90 and 225 deg/sec. Postoperatively, concentric peak torque on the injured side decreased significantly between Weeks 0 and 16 and increased significantly between Weeks 26 and 52 at 90 deg/sec but was significantly lower than that on the noninjured side at all periods and at both velocities. The eccentric strength was significantly lower on the injured side at Week 26 but increased significantly until at Week 52 no significant differences between the sides could be demonstrated. It seems, therefore, that the recovery in concentric and eccentric calf muscle strength after surgery for Achilles tendinosis is slow. We saw no obvious advantages in recovery of muscle strength with a short immobilization time (2 weeks) versus a longer (6 weeks) period used in a previous study.</p>
  • Ackermann, Paul, et al. (författare)
  • Reduced time to surgery improves patient-reported outcome after achilles tendon rupture.
  • 2018
  • Ingår i: The American Journal of Sports Medicine. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0363-5465. ; 2934.
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Patient outcome after an acute Achilles tendon rupture (ATR) continues to be suboptimal and heterogeneous. Thus, prognostic factors are called for to optimize evidence-based ATR treatment protocols, however, the influence of delayed time from injury to surgery (TTS) on patient outcome after ATR remains largely unknown. Purpose: To determine whether patient outcomes and adverse events after surgical repair of acute ATR are related to delayed TTS. Study Design: Cohort study; Level of evidence, 3. Methods: Two hundred and twenty-eight ATR patients treated with uniform anesthetic and surgical techniques, within 10 days after injury, were retrospectively assessed. TTS depended on a free slot in the operating theatre and neither surgeon nor patient could affect TTS. Patients were assigned into three groups according to trichotomized TTS; short- (<48hours), intermediate- (48-72hours) and long TTS (>72hours). Patient-reported outcome at one-year was assessed using the validated Achilles tendon Total Rupture Score, with scores>80 on a 0- to 100-point scale indicating an overall good outcome. The incidences of adverse events (peri- and postoperative) and deep venous thrombosis were assessed. Results: Shorter TTS was significantly associated with increased rate of good outcome and reduced risk of adverse events. Seventy-one percent (95% CI, 60%-83%) of the patients with short TTS attained a good outcome compared to 44% (95% CI, 33%-56%) of the patients 3 with long TTS (p=.002), and with the intermediate TTS group in between (63%, 95% CI, 47%-78%). The incidence of adverse events was significantly reduced among patients with short TTS 1.4% (95% CI, 1%-4%) as compared to those with intermediate TTS 11% (95% CI, 2%-21%) (p=.035) and to patients with long TTS 14.8% (95% CI, 7%-23%) (p=.003). The risk of sustaining a deep venous thrombosis was not statistically significant different among the three groups (p=.15). Conclusion: Patients with acute ATR operated on within 48 hours after injury yielded better outcomes and a lower number of adverse events compared to patients operated on after 72 hours. These results conform to evidence-based recommendations from other surgical disciplines and should be used as guidelines for optimizing ATR treatment protocols.
  • Adalberth, Torsten, et al. (författare)
  • Magnetic resonance imaging, scintigraphy, and arthroscopic evaluation of traumatic hemarthrosis of the knee
  • 1997
  • Ingår i: The American journal of sports medicine. - SAGE Publications. - 0363-5465. ; 25:2, s. 231-237
  • Tidskriftsartikel (refereegranskat)abstract
    • Forty patients with traumatic knee hemarthrosis were examined within 1 week after injury and observations made with magnetic resonance imaging, scintigraphy, arthroscopic evaluation, radiography, and physical examination were compared. Thirty-four patients (85%) had anterior cruciate ligament injuries according to the arthroscopic findings and 28 (83%) of these had associated meniscal tears. Magnetic resonance imaging confirmed the arthroscopic findings, especially if only meniscal tears that required surgery were taken into account (sensitivity, 94% for the lateral and 83% for the medial meniscus). However, the specificity of magnetic resonance imaging was only 29% and 27% for the lateral and medial menisci, respectively, and the accuracy was 28% and 50%, respectively. Marrow edemas, or bone bruises, were seen on magnetic resonance imaging in 80% of the patients and were mainly seen in the lateral compartment. Bone scans correlated well with magnetic resonance imaging findings of marrow edemas. Plain radiographs were normal in all but one case. We show that magnetic resonance imaging does not add information on the status of the anterior cruciate ligament compared with the clinical examination, and that it may be as good as arthroscopic evaluation for the diagnosis of meniscal tears that require surgery.
  • Ahldén, Mattias, et al. (författare)
  • A Prospective Randomized Study Comparing Double- and Single-Bundle Techniques for Anterior Cruciate Ligament Reconstruction.
  • 2013
  • Ingår i: American Journal of Sports Medicine. - 0363-5465. ; 41:11, s. 2484-2491
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND:The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using either the double-bundle or single-bundle technique with hamstring tendon autografts in an unselected group of patients. HYPOTHESIS:Double-bundle ACL reconstruction will render a better outcome on the pivot-shift test. STUDY DESIGN:Randomized controlled trial; Level of evidence, 1. METHODS:A randomized series of 103 patients (33 women, 70 men; median age, 27 years; range, 18-52 years) with a unilateral ACL rupture underwent anatomic ACL reconstruction. The double-bundle technique was used in 53 patients, and the single-bundle technique was used in 50 patients. The ACL footprint was visualized, and the femoral tunnel was drilled through the anteromedial portal; interference screw fixation was used at both ends. The patients were examined preoperatively and at a median of 26 months (range, 22-42 months) after the reconstruction by a blinded observer. The primary variable was the pivot-shift test. RESULTS:At 2-year follow-up, 98 patients (93%) were examined. Clinical assessments at follow-up revealed no significant differences between the double-bundle and single-bundle groups in terms of the pivot-shift test, KT-1000 arthrometer laxity measurements, manual Lachman test, range of motion, Lysholm knee scoring scale, Tegner activity scale, Knee Injury and Osteoarthritis and Outcome Score (KOOS), 1-legged hop test, and square hop test. A significant improvement was seen in both groups compared with the preoperative values in terms of most clinical assessments. CONCLUSION:In this prospective randomized study, the primary variable, the pivot-shift test, and other subjective and objective outcome variables revealed no significant differences between the double-bundle and single-bundle techniques at 2 years after ACL reconstruction in an unselected group of patients.
  • Ahldén, Mattias, et al. (författare)
  • The Swedish National Anterior Cruciate Ligament Register A Report on Baseline Variables and Outcomes of Surgery for Almost 18,000 Patients
  • 2012
  • Ingår i: American Journal of Sports Medicine. - 0363-5465. ; 40:10, s. 2230-2235
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The Swedish National Anterior Cruciate Ligament Register provides an opportunity for quality surveillance and research. Purpose: The primary objective was to recognize factors associated with a poorer outcome at an early stage. Study Design: Case series; Level of evidence, 4. Methods: Registrations are made using a web-based protocol with 2 parts: a patient-based section with self-reported outcome scores and a surgeon-based section, where factors such as cause of injury, previous surgery, time between injury and reconstruction, graft selection, fixation technique, and concomitant injuries are reported. The self-reported outcome scores are registered preoperatively and at 1, 2, and 5 years. Results: Approximately 90% of all anterior cruciate ligament (ACL) reconstructions performed annually in Sweden are reported in the register. Registrations during the period 2005-2010 were included (n = 17,794). After excluding multiligament reconstructions and reoperations, the male: female ratio was 57.5: 42.5 for both primary (n = 15,387) and revision (n = 964) surgery. The cause of injury was soccer in approximately half the male patients and in one third of the female patients. All subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS) were significantly improved 1, 2, and 5 years postoperatively in patients undergoing primary reconstructions. In terms of the KOOS, revisions did significantly less well than primary reconstructions on all follow-up occasions, and smokers fared significantly less well than nonsmokers both preoperatively and at 2 years. Patients who had concomitant meniscal or chondral injuries at reconstruction did significantly less well preoperatively and at 1 year in terms of most KOOS subscales compared with patients with no such injuries. At 5 years, a significant difference was only found in terms of the sport/recreation subscale. Double-bundle reconstructions revealed no significant differences in terms of all the KOOS subscales at 2 years compared with single-bundle reconstructions (114 double-bundle vs 5109 single-bundle). During a 5-year period, 9.1% (contralateral, 5.0%; revision, 4.1%) of the patients underwent a contralateral ACL reconstruction or revision reconstruction of the index knee. The corresponding figure for 15- to 18-year-old female soccer players was 22.0%. Conclusion: Primary ACL reconstruction significantly improves all the subscales of the KOOS. Young female soccer players run a major risk of reinjuring their ACL or injuring the contralateral ACL; revision ACL reconstructions do less well than primary reconstructions, and smokers do less well than nonsmokers.
  • Alfredson, Håkan, et al. (författare)
  • Chronic Achilles tendinitis and calf muscle strength
  • 1996
  • Ingår i: American Journal of Sports Medicine. - Sage. - 0363-5465 .- 1552-3365. ; 24:6, s. 829-833
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>We evaluated 10 men and 3 women (mean age, 44 +/- 8.5 years) with chronic Achilles tendinitis who underwent surgical treatment. Surgery was followed by immobilization in a weightbearing below-the-knee plaster cast for 6 weeks and a stepwise increasing strength training program. We prospectively studied calf muscle strength on the injured and noninjured sides preoperatively and at 16, 26, and 52 weeks postoperatively. Preoperatively, concentric peak torque in dorsiflexion at 90 deg/sec and plantar flexion at 225 deg/sec was significantly lower on the injured side. Postoperatively, concentric plantar flexion peak torque on the injured side increased significantly between Weeks 16 and 26 at 90 deg/sec but was significantly lower than the noninjured side from Weeks 16 to 52 at 90 and 225 deg/sec. Dorsiflexion peak torque at 90 and 225 deg/sec increased between Weeks 0 and 26 and was significantly higher on the injured side at Week 26. Eccentric plantar flexion peak torque was significantly lower on the injured side at Week 26 but not at 1 year. This prospective study demonstrates that 6 months of postoperative rehabilitation for chronic Achilles tendinitis is not enough to recover concentric and eccentric plantar flexion muscle strength compared with the noninjured side.</p>
  • Alfredson, Håkan, et al. (författare)
  • Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis
  • 1998
  • Ingår i: American Journal of Sports Medicine. - Sage. - 0363-5465 .- 1552-3365. ; 26:3, s. 360-366
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>We prospectively studied the effect of heavy-load eccentric calf muscle training in 15 recreational athletes (12 men and 3 women; mean age, 44.3 +/- 7.0 years) who had the diagnosis of chronic Achilles tendinosis (degenerative changes) with a long duration of symptoms despite conventional nonsurgical treatment. Calf muscle strength and the amount of pain during activity (recorded on a visual analog scale) were measured before onset of training and after 12 weeks of eccentric training. At week 0, all patients had Achilles tendon pain not allowing running activity, and there was significantly lower eccentric and concentric calf muscle strength on the injured compared with the noninjured side. After the 12-week training period, all 15 patients were back at their preinjury levels with full running activity. There was a significant decrease in pain during activity, and the calf muscle strength on the injured side had increased significantly and did not differ significantly from that of the noninjured side. A comparison group of 15 recreational athletes with the same diagnosis and a long duration of symptoms had been treated conventionally, i.e., rest, nonsteroidal antiinflammatory drugs, changes of shoes or orthoses, physical therapy, and in all cases also with ordinary training programs. In no case was the conventional treatment successful, and all patients were ultimately treated surgically. Our treatment model with heavy-load eccentric calf muscle training has a very good short-term effect on athletes in their early forties.</p>
  • Askling, Carl M, et al. (författare)
  • Acute first-time hamstring strains during high-speed running : a longitudinal study including clinical and magnetic resonance imaging findings.
  • 2007
  • Ingår i: American Journal of Sports Medicine. - 0363-5465 .- 1552-3365. ; 35:2, s. 197-206
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>BACKGROUND: Hamstring muscle strain is one of the most common injuries in sports. Still, knowledge is limited about the progression of clinical and magnetic resonance imaging characteristics and their association with recovery time in athletes. HYPOTHESIS: Knowing the anatomical location and extent of an acute first-time hamstring strain in athletes is critical for the prognosis of recovery time. STUDY DESIGN: Case series (prognosis); Level of evidence, 2. METHODS: Eighteen elite sprinters with acute first-time hamstring strains were prospectively included in the study. All subjects were examined, clinically and with magnetic resonance imaging, on 4 occasions after injury: at day 2 to 4, 10, 21, and 42. The clinical follow-up period was 2 years. RESULTS: All sprinters were injured during competitive sprinting, and the primary injuries were all located in the long head of the biceps femoris muscle. There was an association between the time to return to pre-injury level (median, 16; range, 6-50 weeks) and the extent of the injury, as indicated by the magnetic resonance imaging parameters. Involvement of the proximal free tendon, as estimated by MRI, and proximity to the ischial tuberosity, as estimated both by palpation and magnetic resonance imaging, were associated with longer time to return to pre-injury level. CONCLUSION: Careful palpation during the first 3 weeks after injury and magnetic resonance imaging investigation performed during the first 6 weeks after injury provide valuable information that can be used to predict the time to return to pre-injury level of performance in elite sprinting.</p>
  • Backman, Ludvig J, et al. (författare)
  • Low range of ankle dorsiflexion predisposes for patellar tendinopathy in junior elite basketball players : a 1-year prospective study
  • 2011
  • Ingår i: American Journal of Sports Medicine. - 0363-5465 .- 1552-3365. ; 39:12, s. 2626-2633
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>BACKGROUND: Patellar tendinopathy (PT) is one of the most common reasons for sport-induced pain of the knee. Low ankle dorsiflexion range might predispose for PT because of load-bearing compensation in the patellar tendon.</p> <p>PURPOSE: The purpose of this 1-year prospective study was to analyze if a low ankle dorsiflexion range increases the risk of developing PT for basketball players. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2.</p> <p>METHODS: Ninety junior elite basketball players were examined for different characteristics and potential risk factors for PT, including ankle dorsiflexion range in the dominant and nondominant leg. Data were collected over a 1-year period and follow-up, including reexamination, was made at the end of the year.</p> <p>RESULTS: Seventy-five players met the inclusion criteria. At the follow-up, 12 players (16.0%) had developed unilateral PT. These players were found to have had a significantly lower mean ankle dorsiflexion range at baseline than the healthy players, with a mean difference of -4.7° (P = .038) for the dominant limb and -5.1° (P = .024) for the nondominant limb. Complementary statistical analysis showed that players with dorsiflexion range less than 36.5° had a risk of 18.5% to 29.4% of developing PT within a year, as compared with 1.8% to 2.1% for players with dorsiflexion range greater than 36.5°. Limbs with a history of 2 or more ankle sprains had a slightly less mean ankle dorsiflexion range compared to those with 0 or 1 sprain (mean difference, -1.5° to -2.5°), although this was only statistically significant for nondominant legs.</p> <p>CONCLUSION: This study clearly shows that low ankle dorsiflexion range is a risk factor for developing PT in basketball players. In the studied material, an ankle dorsiflexion range of 36.5° was found to be the most appropriate cutoff point for prognostic screening. This might be useful information in identifying at-risk individuals in basketball teams and enabling preventive actions. A history of ankle sprains might contribute to reduced ankle dorsiflexion range.</p>
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