| 1. |
- Roos, Ewa, et al.
(författare)
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A more correct interpretation.
- 2015
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Ingår i: CMAJ. - : CMA Joule Inc.. - 1488-2329. ; 187:5, s. 358-358
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 2. |
- Thorlund, Jonas B., et al.
(författare)
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Large increase in arthroscopic meniscus surgery in the middle-aged and older population in Denmark from 2000 to 2011
- 2014
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 85:3, s. 287-292
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Tidskriftsartikel (refereegranskat)abstract
- Background - Arthroscopic meniscal surgery is the most common orthopedic procedure, and the incidence has increased in Denmark over the last 10 years. Concomitantly, several randomized controlled trials have shown no benefit of arthroscopic procedures including arthroscopic partial meniscectomy in middle-aged and older individuals suffering from knee pain with or without knee osteoarthritis. We examined the annual incidence of meniscal procedures together with age, sex, and diagnosis for patients who underwent meniscal procedures in the period 20002011 in Denmark. Methods - Data on age, sex, diagnosis, and surgical procedures were extracted from the Danish National Patient Register for the years 2000-2011, for all records containing meniscal surgery as a primary or secondary procedure. Results - The overall annual incidence of meniscal procedures per 100,000 persons in Denmark doubled from 164 in 2000 to 312 in 2011 (i.e. 8,750 procedures to 17,368 procedures). A 2-fold increase was found for patients aged between 35 and 55, and a 3-fold increase was found for those older than 55. Middle-aged and older patients accounted for 75% of all 151,228 meniscal procedures carried out between 2000 and 2011. Interpretation - The incidence of meniscal procedures performed in Denmark doubled from 2000 to 2011, with the largest increase in middle-aged and older patients. This increase contrasts with the mounting evidence showing no added benefit of arthroscopic partial meniscectomy over non-surgical treatments. Our observations illustrate the long delay in the dissemination, acceptance, and implementation of research evidence into the practice of arthroscopic surgery.
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| 3. |
- Johansson, Melker S., et al.
(författare)
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Use of prescribed analgesics before and after exercise therapy and patient education in patients with knee or hip osteoarthritis
- 2023
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Ingår i: Rheumatology International. - 0172-8172.
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate utilisation patterns of prescribed analgesics before, during, and after an exercise therapy and patient education program among patients with knee or hip osteoarthritis. This cohort study is based on data from the nationwide Good Life with osteoarthritis in Denmark (GLA:D®) patient-register linked with national health registries including data on prescribed analgesics. GLA:D® consists of 8–12 weeks of exercise and patient education. We included 35,549 knee/hip osteoarthritis patients starting the intervention between January 2013 and November 2018. Utilisation patterns the year before, 3 months during, and the year after the intervention were investigated using total dispensed defined daily doses (DDDs) per month per 1000 population as outcome. During the year before the intervention, use of prescribed paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids increased with 85%, 79% and 22%, respectively. During the intervention, use of paracetamol decreased with 16% with a stable use the following year. Use of NSAIDs and opioids decreased with 38% and 8%, respectively, throughout the intervention and the year after. Sensitivity analyses indicated that the prescription of most analgesics changed over time. For paracetamol, NSAIDs, and opioids, 10% of analgesic users accounted for 45%, 50%, and 70%, respectively, of the total DDDs dispensed during the study period. In general, analgesic use increased the year before the intervention followed by a decrease during the intervention and the year after. A small proportion of analgesic users accounted for half or more of all paracetamol, NSAIDs, and opioids dispensed during the study period.
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| 4. |
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| 5. |
- Lundberg, Matilde, et al.
(författare)
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Declining trends in arthroscopic meniscus surgery and other arthroscopic knee procedures in Denmark : a nationwide register-based study
- 2022
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 93, s. 783-793
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — A doubling of arthroscopic meniscal procedures was observed in Denmark from 2000 to 2011, but arthroscopic meniscal procedures for degenerative meniscal tears are no longer recommended. We performed an updated investigation of Danish meniscal procedure trends in the private and public healthcare sectors in Denmark from 2006 to 2018, including trends for other arthroscopic knee procedures. Patients and methods — We extracted data on the 5 most commonly registered arthroscopic knee procedures (diagnostic arthroscopy, meniscal surgery, anterior cruciate ligament reconstruction, synovectomy, and cartilage resection) from the Danish National Patient Register from January 1, 2006 to December 31, 2018, linked with the Danish Population Statistic Register, to obtain data on age and sex. Results — 414,253 arthroscopic knee procedures were registered during 315,290 surgeries on 244,113 individual patients in the study period. For meniscal procedures, the highest incidence was observed in 2010 (319 per 105 persons/year, 95% CI 314–323) and the lowest in 2018 (173 per 105 persons/year, CI 169–176), corresponding to relative decrease of 46% from 2010 to 2018. Remaining arthroscopic procedures also showed declining trends, with lowest incidence for all procedures in 2018. Interpretation — A large decrease in the incidence for arthroscopic meniscal procedures was observed from 2010 to 2018, possibly in response to mounting evidence of limited benefit of this procedure for degenerative knee disease. All other investigated arthroscopic knee procedures also declined in the same period.
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| 6. |
- Pihl, Kenneth, et al.
(författare)
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Association of specific meniscal pathologies and other structural pathologies with self-reported mechanical symptoms : A cross-sectional study of 566 patients undergoing meniscal surgery
- 2019
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Ingår i: Journal of Science and Medicine in Sport. - : Elsevier BV. - 1440-2440. ; 22:2, s. 151-157
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: We explored associations between specific meniscal pathologies and other concurrent structural knee pathologies with presence of self-reported mechanical symptoms in patients undergoing meniscal surgery. Design: Cross-sectional study. Methods: We included patients undergoing surgery for a meniscal tear from Knee Arthroscopy Cohort Southern Denmark (KACS). Pre-surgery, patients completed online questionnaires including self-reported presence of mechanical symptoms. At arthroscopy, surgeons recorded information about specific meniscal pathologies and other concurrent structural knee pathologies. Relative risks (RR) were estimated to assess associations between specific meniscal pathologies and other structural knee pathologies with preoperative mechanical symptoms from multivariable logistic regression. Results: 566 of 641 patients (mean age 48.6[SD 12.9] years, 57% men) with complete data were included. 386 (68%) patients reported mechanical symptoms of knee catching/locking and/or extension deficit. Most evaluated joint pathologies were not associated with mechanical symptoms of any kind with RRs close to 1.0. Meniscal tears involving both the posterior and anterior horn (n = 22) were associated with knee catching/locking (RR: 1.49[95%CI:1.15–1.93]), and a tear in both menisci (n = 49) was associated with extension deficit of the knee (RR: 1.32[95%CI:1.01–1.73]). A partial (n = 29) and total ACL rupture (n = 37) were each associated with extension deficit (RR: 1.83[95%CI:1.47–2.28] and RR: 1.44[95%CI:1.05–1.98], respectively). Conclusions: Limited associations between specific meniscal pathology and other concurrent knee joint pathologies with presence of self-reported mechanical symptoms were found in patients undergoing meniscal surgery. The findings question the clinical importance of mechanical symptoms as an indicator for arthroscopy for specific meniscal tears with the specific aim to relieve such symptoms.
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| 7. |
- Pihl, Kenneth, et al.
(författare)
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Less improvement following meniscal repair compared with arthroscopic partial meniscectomy : a prospective cohort study of patient-reported outcomes in 150 young adults at 1- and 5-years’ follow-up
- 2021
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 92:5, s. 589-596
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Meniscal repair may reduce long-term risk of knee osteoarthritis compared with arthroscopic partial meniscectomy (APM), whereas patient-reported outcomes may be poorer at short term than for APM. We compared patient-reported outcomes in young adults undergoing meniscal repair or APM up to ∼5 years after surgery. Patients and methods — We included 150 patients aged 18–40 years from the Knee Arthroscopy Cohort Southern Denmark (KACS) undergoing meniscal repair or APM. Between-group differences in change in a composite of 4 of 5 Knee injury and Osteoarthritis Outcome Score (KOOS) subscales (pain, symptoms, sport and recreation, and quality of life—KOOS4) from baseline, 12, and 52 weeks, and a median of 5 years (range 4–6 years) were analyzed using adjusted mixed linear models, with 52 weeks being the primary endpoint. Results — 32 patients had meniscal repair (mean age 26 [SD 6]), and 118 patients underwent APM (mean age 32 [SD 7]). The repair and APM groups improved in KOOS4 from before to 52 weeks after surgery (least square means 7 and 19, respectively; adjusted mean difference –12, [95% CI –19 to –4] in favor of APM). Both groups improved further from 52 weeks to 5 years after surgery with the difference in KOOS4 scores between the groups remaining similar. Interpretation — Patients having meniscal repair experienced less improvements in patient-reported outcomes from baseline to 52 weeks and 5 years post-surgery. The findings highlight the need for randomized trials comparing these interventions in terms of patient-reported outcomes and knee OA development.
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| 8. |
- Pihl, Kenneth, et al.
(författare)
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Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear
- 2017
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 88:1, s. 90-95
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose — Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA and patients’ characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear. Patients and methods — 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18–77) years, 57% men) with full datasets available were included in the present study. Prior to surgery, patients completed questionnaires regarding onset of symptoms, duration of symptoms, and mechanical symptoms along with the knee injury and osteoarthritis outcome score (KOOS). At arthroscopy, the operating surgeon recorded information about meniscal pathology and cartilage damage. Early or more established knee OA was defined as the combination of self-reported frequent knee pain, cartilage damage, and the presence of degenerative meniscal tissue. Results — 43% of patients (269 of 620) had early or more established knee OA. Of these, a large proportion had severe cartilage lesions with almost half having a severe cartilage lesion in at least 1 knee compartment. Interpretation — Based on a definition including frequent knee pain, cartilage damage, and degenerative meniscal tissue, early or more established knee OA was present in 43% of patients undergoing knee arthroscopy for meniscal tear.
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| 9. |
- Shadbolt, Cade, et al.
(författare)
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The Surgeon's Role in the Opioid Crisis : A Narrative Review and Call to Action
- 2020
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Ingår i: Frontiers in surgery. - : Frontiers Media SA. - 2296-875X. ; 7
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Forskningsöversikt (refereegranskat)abstract
- Over the past two decades, there has been a sharp rise in the use of prescription opioids. In several countries, most notably the United States, opioid-related harm has been deemed a public health crisis. As surgeons are among the most prolific prescribers of opioids, growing attention is now being paid to the role that opioids play in surgical care. While opioids may sometimes be necessary to provide patients with adequate relief from acute pain after major surgery, the impact of opioids on the quality and safety of surgical care calls for greater scrutiny. This narrative review summarizes the available evidence on rates of persistent postsurgical opioid use and highlights the need to target known risk factors for persistent postoperative use before patients present for surgery. We draw attention to the mounting evidence that preoperative opioid exposure places patients at risk of persistent postoperative use, while also contributing to an increased risk of several other adverse clinical outcomes. By discussing the prevalence of excess opioid prescribing following surgery and highlighting significant variations in prescribing practices between countries, we note that there is a pressing need to optimize postoperative prescribing practices. Guided by the available evidence, we call for specific actions to be taken to address important research gaps and alleviate the harms associated with opioid use among surgical patients.
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| 10. |
- Thorlund, Jonas B, et al.
(författare)
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Clinically Assessed Mediolateral Knee Motion: Impact on Gait.
- 2011
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Ingår i: Clinical Journal of Sport Medicine. - 1536-3724. ; 21, s. 515-520
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Mediolateral knee movement can be assessed visually with clinical tests. A knee-medial-to-foot position is associated with an increased risk of knee injuries and pathologies. However, the implications of such findings on daily tasks are not well understood. The aim of this study was to investigate if a knee-medial-to-foot position assessed during a clinical test was associated with altered hip and knee joint kinematics and knee joint kinetics during gait compared with those with a knee-over-foot position. DESIGN: Participants were visually assessed during a single-limb mini squat test and classified by a physiotherapist as exhibiting either a knee-medial-to-foot or knee-over-foot position. A comparison of 3-dimensional hip and knee gait kinematics and kinetics between the knee-over-foot and knee-medial-to-foot classifications was performed. SETTING: Research laboratory. PARTICIPANTS: Twenty-five healthy participants were recruited and visually assessed as either knee-over-foot (n = 15; 26.2 ± 6.1 years) or knee-medial-to-foot (n = 10; 24.8 ± 4.1 years). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Peak knee valgus angle and peak internal hip rotation during normal gait. RESULTS: No differences were observed in peak knee valgus angle [3.6 (3.7) vs 5.2 (2.5) degrees; P = 0.19], peak internal hip rotation [8.4 (7.0) vs 4.3 (8.1) degrees; P = 0.21], or knee joint kinetics between groups. CONCLUSIONS: A knee-medial-to-foot position observed during the single-limb mini squat was not reflected during gait measured by 3-dimensional motion analysis in knee healthy individuals. Furthermore, those assessed to have a knee-medial-to-foot position did not display increased loading of the knee joint compared with the knee-over-foot group. Care should be taken when extrapolating results from one movement to another.
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