| 1. |
- Tabiri, S, et al.
(författare)
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- 2021
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swepub:Mat__t
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| 2. |
- Bravo, L, et al.
(författare)
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- 2021
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swepub:Mat__t
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| 3. |
- Khatri, C, et al.
(författare)
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Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study
- 2021
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 11:11, s. e050830-
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Tidskriftsartikel (refereegranskat)abstract
- Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.SettingProspective, international, multicentre, observational cohort study.ParticipantsPatients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.ResultsThis study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).ConclusionsPatients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration numberNCT04323644
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| 4. |
- Ayeni, O. R., et al.
(författare)
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Clinical and Radiographic Criteria Define "Acceptable" Surgical Correction of Hip Femoroacetabular Impingement Syndrome as Well as Postoperative Complications: An International Modified Delphi Study
- 2023
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Ingår i: Arthroscopy-the Journal of Arthroscopic and Related Surgery. - : Elsevier BV. - 0749-8063. ; 39:5, s. 1198-1210
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To develop recommendations for clinical and radiographic criteria to help define the "acceptable" surgical correction of femoroacetabular impingement syndrome (FAIS) and identify/define complications postoperatively. Methods: A 3-phase modified Delphi study was conducted involving a case-based survey; a Likert/multiple choice-based survey concerning radiographic and physical examination characteristics to help define FAIS correction, as well as the prevalence and definition of potential postoperative complications; and 2 consensus meetings. Results: Of the 75 experts invited, 54 completed the Phase I survey, 50 completed the Phase II survey (72% and 67% response rate), and 50 participated in the Phase III consensus meetings. For both typical and atypical (complex) cases, there was consensus that fluoroscopy with multiple views and dynamic hip assessment should be used intraoperatively (96% and 100%, respectively). For typical FAIS cases, the Expert Panel agreed that Dunn lateral and anteroposterior radiographs were the most important radiographs to evaluate the hip postoperatively (88%, consensus). When asked about evaluating the correction of cam impingement postoperatively, 87% voted that they use subjective evaluation of the "sphericity" of the femoral head. In the case of focal and global pincer-type FAIS, there was consensus that the reduction or elimination of the crossover sign (84%) and lateral center-edge angle (91%) were important to inform the extent of the FAIS correction. There was consensus for recommending further investigation at 6 months postoperatively if hip pain had increased/plateaued (92% agreed); that additional investigation and treatment should occur between 6 and 12 months (90% agreed); and that a reoperation may be recommended at 12 months or later following this investigation period (89% agreed). Conclusions: This consensus project identified the importance of using fluoroscopy and dynamic hip assessment intraoperatively; Dunn lateral and anteroposterior view radiographs postoperatively; evaluating the "sphericity" of the femoral head for cam-type correction and the use of dynamic hip assessment; reducing/eliminating the crossover sign for focal pincertype FAIS; evaluating the lateral center-edge angle for global pincer-type FAIS; and avoiding overcorrection of pincer-type FAIS. In cases in which postoperative hip pain increased/plateaued, further investigation and treatment is warranted between 6 and 12 months, and a reoperation may be recommended at a minimum of 12 months depending on the cause of the hip pain. Clinical Relevance: Hip arthroscopy surgeons have yet to reach a firm agreement on what constitutes an "acceptable" or "good" surgery radiographically and how they can achieve desired clinical outcomes. Although this was a comprehensive effort, more study is needed to determine therapeutic thresholds that can be universally applied.
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| 5. |
- Prill, R., et al.
(författare)
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Author guidelines for conducting systematic reviews and meta-analyses
- 2021
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 29, s. 2739-2744
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Tidskriftsartikel (refereegranskat)abstract
- This article is a guidance how to write systematic reviews (SR's) and meta-analyses (MA) in orthopaedics and which aspects to focus on for transparency, systematicity and readability. Both SR and MA summarise and synthesise the best evidence available on a specific topic. This requires a systematic, structured and transparent process of analysis. The title should be concise, indicate type of review and ideally report the most important finding. Next, the structured abstract (no more than 350 words) should also raise key points and report the overall level of evidence. A relevant clinical question must be defined before the literature search is started. Methodological details such as databases searched, the exact search strategy (including time frame), inclusion/exclusion criteria, method of literature appraisal and statistical analysis must be described briefly. The primary and secondary outcomes should be mentioned. SR's be pre-registered before data extraction, to ensure transparency and the reduction of risk of bias. If registered, registration number should be stated in the abstract and the funding sources. A clear summary of the findings is important including the number of identified studies (depicted in a flowchart) and for meta-analyses a forest plot. The results of the literature appraisal and statistical analyses should be reported precisely. Subsequently, a general interpretation of findings and their significance and relevance to clinical practice should be provided. Clinical implications from the analysis should be drawn carefully and further research questions should be addressed. Finally, a conclusion, based solely on the results of the study is a necessity. Up to ten keywords are requested representing the main content of the article. Most applicable keywords should facilitate finding the manuscript in the databases and therefor considered carefully.
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| 6. |
- Öhlin, Axel, 1990, et al.
(författare)
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The evolution of femoroacetabular impingement surgical management as a model for introducing new surgical techniques
- 2020
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 28, s. 1333-1340
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Tidskriftsartikel (refereegranskat)abstract
- Introducing new surgical techniques and concepts can be difficult. There are many hurdles to overcome initially, such as the learning curve, equipment and technique development, before a standard of care can be established. In the past, new surgical techniques have been developed, and even widely accepted, before any scientific evaluation has been made. At that stage, it may be too late properly to evaluate the effectiveness of treatments, as the objectiveness and/or randomisation process may be obstructed. Since the introduction of evidence-based medicine (EBM), there have been high standards of scientific rigour to prove the efficacy of treatments. Based on the nature of evidence-based acceptance, innovations cannot be subjected to this final process before their evolution process is complete and, as a result, there is a need for the staged scientific development of new surgical techniques that should be adopted. This paper presents a model for this kind of stepwise introduction based on the actual evolution of FAI syndrome surgery. By following a scientific algorithmic methodology, new surgical techniques and concepts can be introduced in a stepwise manner to ensure the evidence-based progression of knowledge. © 2019, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
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| 7. |
- Figueroa, D., et al.
(författare)
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Return to sport soccer after anterior cruciate ligament reconstruction: ISAKOS consensus
- 2022
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Ingår i: Journal of ISAKOS. - : Elsevier BV. - 2059-7754. ; 7:6, s. 150-161
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects play an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for returning to sports in soccer—one of the most demanding level I pivoting sports after anterior cruciate ligament (ACL) reconstruction. Methods: 34 International experts in the management of ACL injuries, representing all the Continents were convened and participated in a process based on the Delphi method to achieve a consensus. 37 statements related to ACL reconstruction were reviewed by the experts in three rounds of surveys in complete anonymity. The statements were prepared by the working group based on previous literature or systematic reviews. Rating agreement through a Likert Scale: strongly agree, agree, neither agree or disagree, disagree and strongly disagree was used. To define consensus, it was established that the assertions should achieve a 75% of agreement or disagreement. Results: Of the 37 statements, 10 achieved unanimous consensus, 18 non-unanimous consensus and 9 did not achieve consensus. In the preoperative, the correction of the range of motion deficit, the previous high level of participation in sports and a better knowledge of the injury by the patient and compliance to participate in Rehabilitation were the statements that reached unanimous consensus. During the surgery, the treatment of associated injuries, as well as the use of autografts, and the addition of a lateral extra-articular tenodesis in some particular cases (active young athletes, <25 years old, hyperlaxity, high rotatory laxity and revision cases) obtained also 100% consensus. In the postoperative period, psychological readiness and its validation with scales, adequate physical preparation, as well as not basing the RTSS purely on the time of evolution after surgery, were the factors that reached unanimous Consensus. Conclusions: The consensus statements derived from this international ISAKOS leaders, may assist clinicians in deciding when to return to sports soccer in patients after an ACL reconstruction. Those statements that reached 100% consensus have to be strongly considered in the final decision to RTS soccer. © 2022 The Authors
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| 8. |
- Judy, R. P., et al.
(författare)
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Level of evidence and authorship trends of clinical studies in knee surgery, sports traumatology, arthroscopy, 1995-2015
- 2018
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 26:1, s. 9-14
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Tidskriftsartikel (refereegranskat)abstract
- There is increasing emphasis on publication quality and internationalization of author groups in orthopaedic literature. The purpose of this review was to evaluate the type of studies and the level of evidence (LOE) published in knee surgery, sports traumatology, arthroscopy (KSSTA) from 1995 to 2015. The secondary aim was to analyze trends in authorship characteristics in KSSTA. Two reviewers reviewed the table of contents of KSSTA and identified original papers from 1995, 2000, 2005, 2010, and 2015. The reviewers graded LOE from Levels I to IV using guidelines from the University of Oxford's Centre for Evidence-Based Medicine. For each article, the total number of authors and country of author group were also analyzed. A total of 880 papers were analyzed. The proportions in LOE have stayed consistent throughout the study period (n.s.). There has been a significant increase in the number of published articles and the number of Level I and II studies (P < 0.01). Therapeutic articles were the most common type. The mean number of authors per KSSTA article significantly increased from 3.9 to 5.7 over the 20-year period (P < 0.01). The number of represented countries increased yearly and academic institutions from 40 different nationalities published articles in the Journal. Of the examined years, the percent of articles with international collaboration was 17.6%. The proportion of LOE I and II articles published in KSSTA remains consistently high. Therapeutic studies are the most frequently published articles. There is an increase in international groups publishing in KSSTA.
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| 9. |
- Svantesson, Eleonor, et al.
(författare)
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Future Perspectives of Anterior Cruciate Ligament Reconstruction
- 2017
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Ingår i: Operative Techniques in Orthopaedics. - : Elsevier BV. - 1048-6666. ; 27:1, s. 79-87
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Tidskriftsartikel (refereegranskat)abstract
- Reconstruction of the anterior cruciate ligament (ACL) is a common procedure of orthopaedic surgery. The challenges of recreating normal knee function after an injury to the ACL have led to excessive research and continuous innovation of the surgical techniques for ACL reconstruction. Recently, focus has been turned toward the anatomical ACL reconstruction that is one of the most intriguing approaches regarding the surgical technique. Furthermore, exploration of basic anatomy of the knee has led to further insight in concepts of tunnel placement, graft options, and treatment strategies. The possibility of quantitative measurement of knee laxity has evolved and is presented as one future approach to individualized surgery. The vast amount of literature available on ACL reconstruction illustrates that evidence regarding many aspects is advancing. However, it also illustrates that some studies are not generalizable, and that there is a need for further high-quality research. This article presents an overview of the development of ACL reconstruction and existing evidence. It reviews important aspects that influence current and future perspectives on ACL reconstruction.
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| 10. |
- Zhang, K. L., et al.
(författare)
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In-Office Needle Arthroscopy: A Systematic Review of Indications and Clinical Utility
- 2019
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Ingår i: Arthroscopy-the Journal of Arthroscopic and Related Surgery. - : Elsevier BV. - 0749-8063. ; 35:9, s. 2709-2721
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This review explores the current literature regarding both the clinical indications and utility of minimally invasive in-office needle arthroscopy (IONA) relative to conventional imaging modalities. Methods: In compliance with R-AMSTAR (Revised Assessment of Multiple Systematic Reviews) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, 3 databases (MEDLINE, Embase, and PubMed) were searched in July 2018, in addition to the conference abstract databases of 5 prominent meetings between 2013 and 2018, for studies using IONA for diagnostic purposes. Study quality was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: Among 932 conference abstracts and 369 studies identified, 11 publications involving 404 patients (395 knees and 9 shoulders) were included, with 9 clinical studies and 2 cost analyses. The median Methodological Index for Non-Randomized Studies (MINORS) score was 9 for noncomparative and 23 for comparative studies. Among the 9 clinical studies, IONA had a superior sensitivity, specificity, positive predictive value, and negative predictive value to magnetic resonance imaging (MRI) in the evaluation of knee osteoarthritis, anterior cruciate ligament insufficiency, and meniscal tears. IONA was comparable or inferior to MRI in the same parameters for the diagnosis of osteochondral defects and rotator cuff tears. In the 2 cost analyses, IONA had lower costs when used in place of MRI for treatment algorithms involving medial meniscal tears and rotator cuff tears but not lateral meniscal tears. Conclusions: IONA holds potential for cost savings and improved diagnostic accuracy relative to MRI, primarily for intra-articular meniscal, ligamentous, and chondral defects of the knee. However, its current indications for use in other joints are limited to rotator cuff tears in the shoulder, making its diagnostic value in other joints much more limited. The current quality and breadth of evidence are significantly lacking, with numerous practical shortcomings. To improve acceptance of IONA, priority should be placed on establishing defined protocols, indications, contraindications, and patient perspectives for the procedure.
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| 11. |
- Öhlin, Axel, 1990, et al.
(författare)
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Protocol for a multicenter prospective cohort study evaluating arthroscopic and non-surgical treatment for microinstability of the hip joint
- 2022
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Microinstability of the hip joint is a proposed cause of hip pain and reduced function in young individuals. The underlying mechanism is thought to be extraphysiological hip motion due to bony deficiency and/or soft tissue deficiency or decreased soft tissue function. Recently, the condition has gained increased attention, and despite the fact that treatment today includes both non-surgical and surgical approaches, there is limited evidence on diagnostic specificity and treatment effects. The aim of this study is to evaluate clinical outcomes of both nonsurgical and surgical treatment for microinstability of the hip joint. Methods: A multicenter prospective cohort study is planned to evaluating the outcome of physical therapy aimed at stabilizing the hip joint, as well as arthroscopic plication of the hip joint capsule, if the physical therapy fails. Outcomes will be evaluated using hip-specific patient-reported outcome measures: the short version of the International Hip Outcome Tool and the Copenhagen Hip and Groin Outcome Score, strength and function tests, health-related quality of life as determined using the European Quality of Life-5 Dimensions and the European Quality of Life-Visual Analog Scale, sports activity levels according to the Hip Sport Activity Scale, and reported complications. Patients will be evaluated at 6, 12 and 24 months after each treatment. Discussion: It is important to evaluate the clinical outcomes of both non-surgical and surgical treatment for suspected microinstability of the hip joint, and the planned prospective evaluation will contribute to the understanding of non-surgical as well as surgical treatment outcomes, including complications.
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| 12. |
- Ayeni, O. R., et al.
(författare)
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Diagnostic accuracy of physical examinations for ACL injury
- 2017
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Ingår i: Diagnostic Accuracy of Physical Examinations for ACL Injury. In: Nakamura N., Zaffagnini S., Marx R., Musahl V. (eds) Controversies in the Technical Aspects of ACL Reconstruction.. - Berlin, Heidelberg : Springer Berlin Heidelberg. - 9783662527429 ; , s. 35-43
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- The three common physical examinations that are used to aid in the diagnosis of anterior cruciate ligament (ACL) injury are the anterior drawer test, Lachman’s test, and the pivot shift test. The anterior drawer test is the oldest and easiest maneuver to learn; however, various limitations contribute to a relatively low accuracy of this examination. The poor sensitivity of the anterior drawer test is improved when anesthesia is used and for patients with chronic, rather than acute, ACL injuries. Lachman’s test has the highest sensitivity of all three tests and is useful for ruling out complete ACL ruptures with a negative test result. The specificity of Lachman’s test is high, but the pivot shift test has the highest specificity of all three physical examinations. Thus a positive pivot shift test is most accurate in diagnosing an ACL insufficiency. Studies, particularly those before the year 2000, indicate that a negative pivot shift test does not provide useful information for exclusion, and improved results of the test performed with anesthesia indicate that these false-negative results are partially caused by muscle guarding.
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| 13. |
- Diermeier, T. A., et al.
(författare)
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Treatment after ACL injury: Panther Symposium ACL Treatment Consensus Group
- 2021
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Ingår i: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 55:1, s. 14-22
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Tidskriftsartikel (refereegranskat)abstract
- Treatment strategies for ACL injuries continue to evolve. Evidence supporting best practice guidelines to manage ACL injury is largely based on studies with low-level evidence. An international consensus group of experts was convened determine consensus regarding best available evidence on operative versus non-operative treatment for ACL injury. The purpose of this study is to report the consensus statements on operative versus non-operative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. Sixty-six international experts on the management of ACL injuries, representing 18 countries, convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the Scientific Organising Committee and Session Chairs. Panel participants reviewed preliminary statements prior to the meeting and provided initial agreement and comments on the statement via online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Eighty per cent agreement was defined a priori as consensus. A total of 11 of 13 statements on operative versus non-operative treatment of ACL injury reached consensus during the Symposium. Nine statements achieved unanimous support, two reached strong consensus, one did not achieve consensus, and one was removed due to redundancy in the information provided. In highly active patients engaged in jumping, cutting and pivoting sports, early anatomical ACL reconstruction is recommended due to the high risk of secondary meniscus and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight plane activities, non-operative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomical ACL reconstruction is indicated. The consensus statements derived from international leaders in the field may assist clinicians in deciding between operative and non-operative treatment with patients after an ACL injury.
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| 14. |
- Diermeier, T., et al.
(författare)
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Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group
- 2020
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 28, s. 2390-2402
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Tidskriftsartikel (refereegranskat)abstract
- Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance toward consensus opinions regarding the best available evidence on operative vs. non-operative treatment for ACL injury. The purpose of this study is to report the consensus statements on operative vs. non-operative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. Sixty-six international experts on the management of ACL injuries, representing 18 countries, were convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the Scientific Organizing Committee and Session Chairs for the three working groups. Panel participants reviewed preliminary statements prior to the meeting and provided the initial agreement and comments on the statement via an online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Eighty percent agreement was defined a-priori as consensus. A total of 11 of 13 statements on operative v. non-operative treatment of ACL injury reached the consensus during the Symposium. Nine statements achieved unanimous support, two reached strong consensus, one did not achieve consensus, and one was removed due to redundancy in the information provided. In highly active patients engaged in jumping, cutting, and pivoting sports, early anatomic ACL reconstruction is recommended due to the high risk of secondary meniscus and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight plane activities, non-operative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomic ACL reconstruction is indicated. The consensus statements derived from international leaders in the field will assist clinicians in deciding between operative and non-operative treatments with patients after an ACL injury. Level of evidence V. © 2020, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
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| 15. |
- Diermeier, T., et al.
(författare)
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Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group
- 2021
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Ingår i: Journal of Isakos Joint Disorders & Orthopaedic Sports Medicine. - : Elsevier BV. - 2059-7754. ; 6:3, s. 129-137
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Tidskriftsartikel (refereegranskat)abstract
- Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance towards consensus opinions regarding the best available evidence on operative versus non-operative treatment for ACL injury. The purpose of this study was to report the consensus statements on operative versus non-operative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. Sixty-six international experts on the management of ACL injuries, representing 18 countries, convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the Scientific Organising Committee and Session Chairs for the three working groups. Panel participants reviewed preliminary statements prior to the meeting and provided initial agreement and comments on the statement via online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Eighty per cent agreement was defined a priori as consensus. A total of 11 of 13 statements on operative veresus non-operative treatment of ACL injury reached consensus during the symposium. Nine statements achieved unanimous support; two reached strong consensus; one did not achieve consensus; and one was removed due to redundancy in the information provided. In highly active patients engaged in jumping, cutting and pivoting sports, early anatomical anterior cruciate ligament reconstruction (ACLR) is recommended due to the high risk of secondary meniscus and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight plane activities, non-operative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability or when episodes of giving way occur, anatomical ACLR is indicated. The consensus statements derived from international leaders in the field will assist clinicians in deciding between operative and non-operative treatment with patients after an ACL injury. Level of evidence: V
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| 16. |
- Kay, J., et al.
(författare)
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Earlier anterior cruciate ligament reconstruction is associated with a decreased risk of medial meniscal and articular cartilage damage in children and adolescents: a systematic review and meta-analysis
- 2018
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 26:12, s. 3738-3753
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To evaluate the association between surgical timing and the incidence of secondary meniscal or chondral damage in children and adolescents with anterior cruciate ligament (ACL) ruptures. Methods Three electronic databases, PubMed, MEDLINE, and EMBASE, were systematically searched from database inception until October 16, 2017 by two reviewers independently and in duplicate. The inclusion criteria were English language studies that reported the incidence of meniscal and articular cartilage damage in children or adolescent athletes with ACL injuries as well as the timing of their ACL reconstruction (ACLR). Risk ratios were combined in a meta-analysis using a random effects model. Results A total of nine studies including 1353 children and adolescents met the inclusion criteria. The mean age of patients included was 14.2 years (range 6-19), and 45% were female. There was a significantly decreased risk of concomitant medial meniscal injury in those reconstructed early (26%) compared to those with delayed reconstruction (47%) [pooled risk ratio (RR) = 0.49, 95% CI 0.36-0.65, p < 0.00001]. There was also a significantly reduced risk of medial femoral chondral (RR = 0.48, 95% CI 0.31-0.75, p = 0.001), lateral femoral chondral (RR = 0.38, 95% CI 0.20-0.75, p = 0.005), tibial chondral (RR = 0.45, 95% CI 0.27-0.75, p = 0.002), and patellofemoral chondral (RR = 0.41, 95% CI 0.20-0.82, p = 0.01) damage in the early reconstruction group in comparison to the delayed group. Conclusion Pooled results from observational studies suggest that early ACLR results in a significantly decreased risk of secondary medial meniscal injury, as well as secondary medial, lateral, and patellofemoral compartment chondral damage in children and adolescents. This study provides clinicians with valuable information regarding the benefits of early ACL reconstruction in children and adolescents, and can be used in the decision making for athletes in this population.
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| 17. |
- Khan, Moin, et al.
(författare)
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Sources and quality of literature addressing femoroacetabular impingement: a scoping review 2011-2015.
- 2016
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Ingår i: Current reviews in musculoskeletal medicine. - : Springer Science and Business Media LLC. - 1935-973X .- 1935-9748. ; 9:4, s. 396-401
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Tidskriftsartikel (refereegranskat)abstract
- A systematic review was performed to explore the current trends over the last 5years in femoroacetabular impingement (FAI) literature and compare the quality and sources of publications in the literature to that published previously. We identified 1066 relevant studies including 186,572 patients. The number of publications increased during the reviewed time period with the most dramatic increase from 2011 to 2013. Seventy-three percent (N=786) of all studies were of levels 4 and 5 quality evidence. The percent of publications which were levels 1, 2 and 3 increased by almost twofold from 16.1% (N=26) to 28.7% (N=51) between 2011 and 2015. In comparison to previous work, there has been 3.5-fold increase in the number of publications over the past 5years with a shift towards improving the level of evidence available guiding the arthroscopic management of FAI.IV-Systematic Review.
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| 18. |
- Memon, M., et al.
(författare)
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Arthroscopic Management of Septic Arthritis of the Native Shoulder: A Systematic Review
- 2018
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Ingår i: Arthroscopy-the Journal of Arthroscopic and Related Surgery. - : Elsevier BV. - 0749-8063. ; 34:2
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To investigate arthroscopic management of native shoulder joint septic arthritis-specifically, indications, patient outcomes, and complications. Methods: PubMed, MEDLINE, and Embase were used to search the literature, and data abstraction was performed independently and in duplicate. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist guided reporting and data abstraction. The quality of all included studies was assessed with the Methodological Index for Non-randomized Studies (MINORS) criteria. The results are presented in a narrative summary fashion using descriptive statistics including means, proportions, ranges, kappa values, and intraclass correlation coefficient values. Results: Overall, 27 studies (19 case reports and 8 case series) were identified, including 115 patients (121 shoulders). The mean follow-up period was 29.1 months (range, 1-199 months). The indications for shoulder arthroscopy owing to infection included pain; limited range of motion; swelling, erythema, and tenderness; fever; elevated leukocyte count, erythrocyte sedimentation rate, and/or C-reactive protein level; synovial aspirate findings; and/or imaging findings. Overall, 46 patients (40%) achieved infection eradication and functional improvement after a single arthroscopic procedure. However, 43 patients (37%) had ongoing symptoms or complications, including 32 (30%) who required revision arthroscopic procedures, 7 (6%) who underwent open arthrotomy for septic arthritis management, 2 (2%) in whom avascular necrosis of the humeral head developed, 1 (1%) in whom adhesive capsulitis developed, and 1 (1%) in whom an irregular profile of the humeral epiphysis developed on plain radiographs. Conclusions: Arthroscopic management of native shoulder septic arthritis can yield alleviation of pain and a return to full range of motion, daily activities, and sports. However, there is a high reoperation rate, which may correlate with poor patient prognostic factors. This systematic review did not show the superiority of either arthroscopic surgery or open arthrotomy for the management of shoulder septic arthritis.
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| 19. |
- Phillips, M., et al.
(författare)
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Meniscus repair with simultaneous ACL reconstruction demonstrated similar clinical outcomes as isolated ACL repair: a result not seen with meniscus resection
- 2018
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 26:8, s. 2270-2277
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Tidskriftsartikel (refereegranskat)abstract
- To compare Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQol-5D (EQ-5D) subscale scores at 2-year follow-up for patients with primary isolated ACL reconstruction with patients undergoing ACL reconstruction and simultaneous meniscal treatment in terms of either resection or repair in the Swedish National Knee Ligament Register (SNKLR). All ACL reconstruction patients within the SNKLR at 2-year follow-up were reviewed. The KOOS and EQ-5D subscales were assessed in four distinct patient groups: isolated ACL reconstruction, ACL reconstruction + medial meniscus resection, ACL reconstruction + lateral meniscus resection, ACL reconstruction + medial meniscus repair, and ACL reconstruction + lateral meniscus repair. The primary analysis was conducted using linear regression with isolated ACL reconstruction designated as the reference group, and was adjusted for patient age, gender, and time from injury to surgery. The included patients consisted of 10,001 (65.0%) individuals with an isolated ACL injury, 588 (3.8%) with ACL injury plus treated with medial meniscus repair, 2307 (15.0%) with ACL injury plus treated with medial meniscus resection, 323 (2.1%) with ACL injury plus treated with lateral meniscus repair, and 2173 (14.1%) with ACL injury plus treated with lateral meniscus resection. Meniscus resection demonstrated significantly worse results with respect to the KOOS Symptoms subscale for both the medial and lateral meniscus resection groups. Medial meniscus resection also demonstrated worse results for the KOOS quality of life (QoL) subscale, while lateral meniscus resection only approached significance. Outcomes were not different between the isolated ACL reconstruction group and the meniscus repair groups. Meniscus resection in addition to ACL reconstruction resulted in worse clinical outcomes than isolated ACL reconstruction patients; a result not seen within the meniscus repair group. This suggests that, when possible, meniscus repair may provide greater clinical outcomes over resection when treating a reparable meniscal tear that presents along with an ACL tear. Clinicians should consider and implement these findings for the management of future meniscus tear patients within their clinical practice.
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| 20. |
- Shanmugaraj, A., et al.
(författare)
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Press-fit fixation in anterior cruciate ligament reconstruction yields low graft failure and revision rates: a systematic review and meta-analysis
- 2021
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 29, s. 1750-1759
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Press-fit fixation is a hardware-free technique in anterior cruciate ligament reconstruction (ACLR). The purpose of this review was to quantitatively assess the risk profile and outcomes of press-fit fixation and provide an update on its effectiveness compared to more standard fixation techniques of ACLR. Methods The electronic databases PUBMED, MEDLINE, and EMBASE were searched on March 26, 2020 for therapeutic randomized controlled trials (RCT) addressing press-fit fixation for primary ACLR. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the quality for randomized studies. A meta-analysis with a random-effects model was used to pool applicable outcomes data. Results A total of six eligible RCTs were included in this review. There were 292 patients (72.9% male) with a mean age of 28.8 +/- 3.8 years and a mean follow-up of 81.3 +/- 88.3 months that underwent press-fit ACLR on the femoral, tibial or both tunnels. Femoral fixation techniques included press-fit fixation (96.6%) and cross-pin fixation (3.4%). Tibial fixation techniques included press-fit (37.0%), staples (28.1%), interference screws (21.2%) and abarticular post-screws (13.7%). Graft options included bone-patellar tend--bone autografts (73.6%) and semitendinosus and gracilis tendon autograft (26.4%). Significant improvements (p < 0.05) from baseline to follow-up were found for clinical outcomes. Significantly less postoperative bone tunnel enlargement (p < 0.05) was found with tibial press-fit fixation when compared to biodegradable screws. The overall complication rate was 13.3%. There were no significant differences in complication rates [odds ratio = 0.84 (95%CI 0.43-1.66);p = n.s.] (I-2 = 0%) between patients undergoing femoral press-fit fixation and femoral metal interference screw fixation. Conclusion The overall graft failure and revision rates with press-fit ACLR were low. There were no significant differences in complication rates between patients undergoing femoral press-fit and femoral metal interference screw fixation. Included studies found that patients undergoing press-fit fixation for ACLR had significant improvements in functional outcome scores postoperatively and had significantly reduced postoperative bone tunnel enlargement compared to patients undergoing bioabsorbable fixation. Thus, early evidence suggests that press-fit fixation appears to be a good option for patients undergoing ACLR.
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| 21. |
- Snaebjörnsson, Thorkell, 1982, et al.
(författare)
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Most Elite Athletes Who Underwent Hip Arthroscopy for Femoroacetabular Impingement Syndrome Did Not Return to the Same Level of Sport, but the Majority Were Satisfied With the Outcome of Surgery
- 2022
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Ingår i: Arthroscopy, Sports Medicine, and Rehabilitation. - : Elsevier BV. - 2666-061X. ; 4:3
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the 2-year outcomes after arthroscopic surgical treatment for femoroacetabular impingement syndrome (FAIS) using validated patient-reported outcome measurements in young elite athletes and to report the rate of return to sport. Methods: Young elite athletes undergoing arthroscopic surgery for FAIS with 2 years of follow-up were included. A young elite athlete was defined as an athlete aged 18 to 22 years at the time of surgery with a Hip Sports Activity Scale (HSAS) level greater than 6 before the onset of symptoms. The following patient-reported outcome measurements were collected prospectively: Copenhagen Hip and Groin Outcome Score, 12-item International Hip Outcome Tool, HSAS, visual analog scale (VAS), European Quality of Life (EQ) 5 Dimensions questionnaire, and EQ VAS. Furthermore, the patients answered a question related to satisfaction with surgery at follow-up. Results: A total of 84 athletes (67 male and 17 female athletes), with a mean age of 19.8 ± 1.5 years, completed the 2-year follow-up. Bilateral hip arthroscopy was performed in 57 athletes, generating a total of 141 included hips. The improvements in the Copenhagen Hip and Groin Outcome Score subscales, 12-item International Hip Outcome Tool, EQ 5 Dimensions questionnaire, EQ VAS, and VAS for overall hip function were statistically significant (P < .001). At the 2-year follow-up, 42% of the athletes reported an HSAS level of either 7 or 8 whereas 28% reported an HSAS level of 5 or 6. In total, 79% of the athletes were satisfied with the surgical procedure. Conclusions: There are significant improvements in outcome measurements at the 2-year follow-up in elite young athletes undergoing arthroscopic hip surgery for FAIS. Although many of the athletes remained in high-level sports 2 years after surgery, only 30% of the athletes returned to sport at the same level. Level of Evidence: Level IV, therapeutic case series. © 2022 The Authors
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| 22. |
- Svantesson, Eleonor, et al.
(författare)
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Strength in numbers? The fragility index of studies from the Scandinavian knee ligament registries
- 2020
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 28, s. 339-352
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The fragility index (FI) is a metric to evaluate the robustness of statistically significant results. It describes the number of patients who would need to change from a non-event to an event to change a result from significant to non-significant. This systematic survey aimed to evaluate the feasibility of applying the FI to findings related to anterior cruciate ligament (ACL) reconstruction in the Scandinavian knee ligament registries. Methods: The PubMed, EMBASE, Cochrane Library and AMED databases were searched. Studies from the Scandinavian knee ligament registers were eligible if they reported a statistically significant result (p < 0.05) for any of the following dichotomous outcomes; ACL revision, contralateral ACL reconstruction or the presence of postoperative knee laxity. Only studies with a two-arm comparative analysis were included. Eligibility assessment, data extraction and quality assessment were performed by two independent reviewers. The dichotomous analyses were stratified according to the grouping variable for the two comparative arms as follows; age, patient sex, activity at injury, graft choice, drilling technique, graft fixation, single- versus double-bundle, concomitant cartilage injury and country. The two-sided Fisher’s exact test was used to calculate the FI of all statistically significant analyses. Results: From 158 identified studies, 13 studies were included. They reported statistical significance for a total of 56 dichotomous analyses, of which all but two had been determined by a time-to-event analysis. The median sample size for the arms was 5540 (range 92–38,666). The mean FI for all 56 dichotomous analyses was 80.6 (median 34.5), which means that a mean of 80.6 patients were needed to change outcome status to generate a non-significant result instead of a significant one. Seventeen analyses (30.4%) immediately became non-significant when performing the two-sided Fisher’s exact test and, therefore, had an FI of 0. The analyses related to age were the most robust, with a mean FI of 178.5 (median 116, range 1–1089). The mean FI of the other grouping variables ranged from 0.5 to 48.0. Conclusion: There was large variability in the FI in analyses from the Scandinavian knee ligament registries and almost one third of the analyses had an FI of zero. The FI is a rough measurement of robustness when applied to registry studies, however, future studies are needed to determine the most appropriate metric for robustness in registry studies. The use of the FI can provide clinicians with a deeper understanding of significant study results and promotes an evidence-based approach in the clinical care of patients. Level of evidence: Systematic review of prospective cohort studies, Level II. © 2019, The Author(s).
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| 23. |
- Walker, M., et al.
(författare)
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The dimensions of the hip labrum can be reliably measured using magnetic resonance and computed tomography which can be used to develop a standardized definition of the hypoplastic labrum
- 2021
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 29:5, s. 1432-1452
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The purpose of this study was to examine the existing literature to determine the dimensions of the acetabular labrum, with a focus on hypotrophic labra, including the modalities and accuracy of measurement, factors associated with smaller labra, and any impacts on surgical management. Methods Four databases (PubMed, Ovid [MEDLINE], Cochrane Database, and EMBASE) were searched from database inception to January 2020. Two reviewers screened the literature independently and in duplicate. Methodological quality of included papers was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Where possible, data on labral size were combined using a random effects model. Results Twenty-one studies (5 level II, 9 level III, 7 level IV) were identified. This resulted in 6,159 patients (6,436 hips) with a mean age of 34.3 years (range 8.4-85). The patients were 67.3% female with an average follow-up of 57.3 months. There was no consistent definition of labral size quoted throughout the literature. The mean width on MRI/MRA was 7.3 mm (95% CI 6.9-7.8 mm), on computed tomography arthrography was 8.7 mm (95% CI 8.0-9.3), and during arthroscopy was 5.0 mm (95% CI 4.9-5.2). Inter-observer reliability was good to excellent in all modalities. Labral hypotrophy may be associated with increased acetabular coverage. Hypertrophic labra were highly associated with acetabular dysplasia (r = - 0.706, - 0.596, - 0.504, respectively; P < 0.001). Conclusion Labral width can reliably be measured utilizing imaging techniques including magnetic resonance and computed tomography. The pooled mean labral width was 6.2 mm, and height 4.6 mm. The establishment of a gold-standard of measurement on arthroscopy and advanced imaging would aid in clinical decision-making regarding treatment options for patients presenting with a painful hip, particularly those with hypoplastic labra, and provide radiological guidelines for standardized labrum size classifications.
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| 24. |
- Öhlin, Axel, 1990, et al.
(författare)
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Bilateral femoroacetabular impingement syndrome managed with different approaches: a case report
- 2018
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Ingår i: Open Access Journal of Sports Medicine. - 1179-1543. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this case report is to present the successful management of symptomatic bilateral femoroacetabular impingement (FAI) syndrome in a patient who underwent surgical treatment on one side and non-surgical treatment on the other side. Methods: We evaluated the treatment outcome of a young female presenting with bilateral FAI syndrome of cam morphology. A follow-up was performed at 5 years following surgical treatment on the right hip and 2 years following non-surgical treatment on the left hip. The evaluation included a clinical examination, patient-reported outcome measurements (PROM), plain radiographs, and magnetic resonance imaging (MRI). Results: The patient experienced subjective improvements bilaterally. The clinical examination revealed differences in range of motion between the surgically treated and the non-surgically treated sides, with internal rotation differing the most (20 degrees vs almost 0 degrees). Flexion was, however, the same on both sides (125 degrees). The PROM results were satisfactory on both sides, with slightly better results for the surgically treated side (the short version of the International Hip Outcome Tool [iHOT-12]: 96.9 vs 90, the Copenhagen Hip and Groin Outcome Score [HAGOS]: 90-100 vs 65-100). On the surgically treated side, the alpha angle decreased by 19 degrees postoperatively. An MRI did not reveal any injury to the cartilage or labrum on either side. Conclusion: This patient with bilateral FAI syndrome treated with arthroscopic surgery on one side and physiotherapy together with reduced physical activity on the other side, presented with good results bilaterally at follow-up.
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| 25. |
- Öhlin, Axel, 1990, et al.
(författare)
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Low rate of adverse events in a randomized controlled trial addressing the surgical treatment of femoroacetabular impingement (FAI) syndrome
- 2021
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 29, s. 2015-2020
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The femoroacetabular impingement randomised controlled trial (FIRST) is a multi-center randomized controlled trial (RCT), comparing arthroscopic osteochondroplasty with arthroscopic lavage in adults aged 18-50 years diagnosed with non-arthritic femoroacetabular impingement (FAI) syndrome. The purpose of the present study is to report the prevalence, distribution and severity of adverse events during and within 24-month follow-up period. Methods Of the 220 patients included, 6 were adjudicated as ineligible, for a total of 214 patients included in the final analysis. An independent Adjudication Committee evaluated operatively treated and non-operatively treated adverse events that were related to the hip. Adverse events were also reported directly by each participating clinical site. Continuous variables were reported as mean and standard deviation, categorical variables were reported as counts and percentages. Results There were a total of 52 (24.2%, 52/214) adverse events in 46 (21.5%) patients (mean age 34.2 +/- 7.9 years, 58.7% male) during the 24-month follow-up. There were 12.6% (27/214) operatively treated adverse events for: hip pain, re-injury of labrum and heterotopic ossification. There were 11.7% (25/214) non-operatively treated adverse events for predominantly: hip pain, hip tendinopathy and hip popping/snapping. Approximately, 87% of adverse events resolved within the 24-month follow-up time. Conclusion Given the inherent challenges with conducting RCTs, the results of this adverse event study from the FIRST trial demonstrate that it is safe to perform an RCT addressing FAI syndrome.
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| 26. |
- Öhlin, Axel, 1990, et al.
(författare)
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Quality Assessment of Prospective Cohort Studies Evaluating Arthroscopic Treatment for Femoroacetabular Impingement Syndrome: A Systematic Review
- 2019
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Ingår i: Orthopaedic Journal of Sports Medicine. - : SAGE Publications. - 2325-9671. ; 7:5
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Forskningsöversikt (refereegranskat)abstract
- Background: Femoroacetabular impingement (FAI) syndrome is a cause of pain and reduced range of motion in the hip joint. Given the limited number of randomized controlled trials, prospective cohort studies constitute the dominant part of the available prospective evidence evaluating relevant clinical outcomes after arthroscopic hip surgery for FAI. Purpose: To assess the methodological quality of prospective cohort studies evaluating arthroscopic surgery for FAI and to determine whether there has been an improvement in methodological quality over time. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature search was performed in PubMed, Embase (OvidSP), and the Cochrane Library. Included studies were clinical prospective cohort studies of primary arthroscopic surgery for cam and/or pincer morphology FAI. Methodological quality was assessed with the Methodological Index for Non-randomized Studies (MINORS). The mean MINORS score for studies published during the first 5 years of the period was compared with those published during the last 5 years to evaluate methodological improvement over time. The methodological quality of randomized controlled trials was also assessed with the Coleman Methodology Score. Results: The search yielded 53 studies. There were 34 noncomparative studies, 15 nonrandomized comparative studies, and 4 randomized controlled trials. The included studies were published between 2008 and 2017. The mean +/- SD MINORS score for noncomparative and comparative studies was 10.4 +/- 1.4 of 16 possible and 18.7 +/- 2.0 of 24 possible, respectively. The mean Coleman Methodology Score for randomized controlled trials was 79.0 +/- 7.0 of 100 possible. Conclusion: The methodological quality of prospective cohort studies evaluating arthroscopic surgery for FAI is moderate for comparative and noncomparative studies. Common areas for improvement include unbiased assessment of study endpoints and prospective sample-size calculations. Despite an increase in the number of published studies, an improvement in methodological quality over time was not observed.
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