| 1. |
- Hamrin Senorski, Eric, 1989, et al.
(författare)
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Preoperative and Intraoperative Predictors of Long-Term Acceptable Knee Function and Osteoarthritis After Anterior Cruciate Ligament Reconstruction: An Analysis Based on 2 Randomized Controlled Trials.
- 2019
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Ingår i: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. - : Elsevier BV. - 1526-3231. ; 35:2, s. 489-99
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Tidskriftsartikel (refereegranskat)abstract
- To determine preoperative predictors of long-term acceptable knee function and the development of osteoarthritis (OA) in long-term follow-up after anterior cruciate ligament (ACL) reconstruction.This study is a long-term follow-up of 2 previous randomized controlled trials that included 193 patients who underwent unilateral ACL reconstruction with ipsilateral hamstring tendon or patellar tendon autografts. Patients who suffered multiligament injuries, major meniscal injuries, chondral lesions requiring surgical treatment, or had a previous ACL reconstruction were excluded. Patient demographics, preoperative clinical assessments, and intraoperative findings were used to create stepwise multivariable regression models to determine the patient-acceptable symptom state (PASS) in the International Knee Documentation Committee and the development of OA defined as a Kellgren-Lawrence grade ≥2. Knee laxity measurements, hop performance, patient-reported outcome, and concomitant injuries were determined as variables.A total of 147 patients (63.7% men) were eligible for inclusion, with a mean follow-up of 16.4 ± 1.3 years. The patients were an average age of 27.9 ± 8.3 years at the time of ACL reconstruction. One-half of the cohort reported an International Knee Documentation Committee evaluation system score above the PASS cutoff. The presence of a concomitant injury at operation (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.10-6.21; P = .030) and greater preoperative anteroposterior laxity (OR, 1.87; 95% CI, 1.05-3.35; P = .034) increased the likelihood of achieving a PASS. A longer period between ACL injury and reconstruction (OR, 2.25; 95% CI, 1.02-5.00; P = .046) and older age at reconstruction (OR, 2.28; 95% CI, 1.34-3.86; P = .0023) increased the odds of developing OA at follow-up.Patients who were older at the time of ACL reconstruction and had waited >1 year between the injury and reconstruction ran an increased risk of having OA 16 years after reconstruction. One in 2 patients reported acceptable long-term knee function, but no risk factor for poorer subjective knee function was identified. Patients who had a minor concomitant injury and increased preoperative anteroposterior knee laxity had increased odds of reporting an acceptable long-term knee function.Level II; prospective comparative study.
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| 2. |
- Sundemo, David, et al.
(författare)
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Editorial Commentary: Diagnosis and Treatment of Generalized Joint Hypermobility in Patients With Anterior Cruciate Ligament Injury
- 2021
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Ingår i: Arthroscopy - Journal of Arthroscopic and Related Surgery. - : Elsevier BV. - 0749-8063 .- 1526-3231. ; 37:7, s. 2348-2350
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Generalized joint hypermobility (GJH), or laxity, is defined as hyperextensibility of the synovial joints. Hypermobility is caused by alterations in the connective tissues, in turn caused by various factors including impaired function of collagen proteins. For measurement of knee GJH, we highly recommend using the Beighton score, the most frequently used method in both the sports medicine and other literature. Our recommendations on how to treat patients with anterior cruciate ligament (ACL) injury with generalized joint hypermobility include the following: (1) use patellar-tendon or quadriceps tendon autograft for ACL reconstruction; (2) always consider performing a lateral extra-articular tenodesis; and (3) make sure patients pass a return to sport test battery including strength, hop performance, subjective knee function, and movement quality. Delay to return to sport may be as long as 1 year after surgery.
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| 3. |
- Svantesson, Eleonor, et al.
(författare)
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Graft Choice for Anterior Cruciate Ligament Reconstruction With a Concomitant Non-surgically Treated Medial Collateral Ligament Injury Does Not Influence the Risk of Revision.
- 2020
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Ingår i: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. - : Elsevier BV. - 1526-3231. ; 31:1, s. 199-211
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Tidskriftsartikel (refereegranskat)abstract
- To compare the risk of anterior cruciate ligament (ACL) revision and the patient-reported outcome after ACL reconstruction with a concomitant non-surgically treated medial collateral ligament (MCL) injury with regard to 3 ACL graft choices; the use of semitendinosus (ST), the use of semitendinosus-gracilis (ST-G), and the use of patellar tendon (PT) autograft. It was hypothesized that the use of ST-G would be associated with a greater risk of ACL revision and poorer patient-reported knee function.Patients older than 15 years of age registered for a primary ACL reconstruction with a concomitant non-surgically treated MCL injury in the Swedish National Knee Ligament Registry were assessed for eligibility. Three groups were created according to ACL autograft choice; the ST, the ST-G, and the PT group. The primary outcomes were ACL revision and the 1- and 2-year Knee injury and Osteoarthritis Outcome Score (KOOS), including the KOOS patient acceptable symptom state (PASS). Cox regression analysis was applied to determine the proportional hazard ratio (HR) of primary ACL reconstruction survival. The KOOS was compared using the Mann-Whitney U test and Fisher exact test.A total of 622 patients (mean age 29.7 years, 42.4% women) were included. There was no difference in the risk of ACL revision for either the ST group (HR 1.354; 95% confidence interval [CI] 0.678-2.702 or the PT group (HR 0.837; 95% CI 0.334-2.100), compared with the ST-G group. The ST group reported a greater mean 2-year KOOS sports and recreation (68.5, standard deviation [SD] 28.5) than the ST-G group (57.4 [SD 27.6], P = .010) and the PT group (54.1 [SD 30.3], P = .006). The ST group was superior in terms of achieving PASS in sports and recreation (55.3%; 95% CI 44.1-66.1%) compared with both the ST-G (37.4%; 95% CI 29.8-45.5%; P = .014) and the PT group (33.9%; 95% CI 22.1-47.4%; P = .009).The risk of ACL revision did not differ between HT and PT autografts in patients undergoing ACL reconstruction with a non-surgically treated MCL injury. However, the use of ST-G was associated with poorer 2-year patient-reported knee function compared with the ST.Retrospective comparative trial, Level III.
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| 4. |
- Piussi, R., et al.
(författare)
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Greater Psychological Readiness to Return to Sport, as Well as Greater Present and Future Knee-Related Self-Efficacy, Can Increase the Risk for an Anterior Cruciate Ligament Re-Rupture: A Matched Cohort Study
- 2022
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Ingår i: Arthroscopy - Journal of Arthroscopic and Related Surgery. - : Elsevier BV. - 0749-8063. ; 38:4, s. 1267-1276.e1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To determine the psychological characteristics and strength outcomes of patients who sustained an early anterior cruciate ligament (ACL) re-rupture after their primary ACL reconstruction and cross-sectionally compare them with a matched cohort of patients who did not sustain a reinjury during the first 2 years after primary ACL reconstruction. Methods: In this matched cohort study, data for quadriceps and hamstring strength and 3 hop tests and answers to standardized patient-reported outcomes (the Anterior Cruciate Ligament Return to Sport after Injury scale and a short version of the Knee Self-Efficacy Scale) were extracted from a rehabilitation outcome registry. Data for patients suffering a re-rupture were extracted, and patients were matched in terms of sex, age, and activity level with patients not suffering an ACL re-rupture within 2 years of primary reconstruction. The groups were compared 10 weeks and 4, 8, and 12 months after the primary reconstruction. Results: A total of 36 patients suffering an ACL re-rupture were matched with 108 patients not suffering a re-rupture after ACL reconstruction. Patients who suffered an ACL re-rupture had greater psychological readiness, that is, greater confidence in performance, lesser negative emotions, and lesser risk appraisal, to return to sport (RTS) at 8 months (81.2 vs 67.9 [95% Δconfidence interval {CI} 2.7-23.8) P = .014) and at 12 months (95.2 vs 67.1, (95% ΔCI 14.3-41.8) P ≤ .001), and greater knee-related self-efficacy at 8 months (8.6 vs 8.0 [95% ΔCI 0.1-1.2], P = .021) and 12 months (9.4 vs 8.1, [95% ΔCI 0.3-2.2] P = .012) after primary ACL reconstruction, compared with the matched group. Conclusions: A stronger psychological profile, defined by a greater psychological readiness to RTS and knee-related self-efficacy, may be associated with an ACL re-rupture within 2 years of the primary reconstruction. Level of Evidence: Matched cohort study, level III. © 2021 The Author(s).
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