| 1. |
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| 2. |
- Laxdal, Gauti, 1966, et al.
(författare)
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A prospective randomized comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction
- 2005
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Ingår i: Arthroscopy. - 1526-3231. ; 21:1, s. 34-42
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BPTB group), 3-strand semitendinosus (ST group), or 4-strand semitendinosus/gracilis (ST/G group) autografts. TYPE OF STUDY: Prospective randomized trial. METHODS: A randomized series of 134 patients, all with unilateral ACL rupture was included in the study. In all 3 groups, interference screw fixation of the graft was used at both ends and 125 of 134 (93%) of the patients returned for the follow-up examination after 26 months (range, 20 to 43 months). The preoperative assessments in all 3 groups were similar in terms of gender, Tegner activity level, Lysholm score, KT-1000 measurements, 1-leg hop test, and the knee-walking test. RESULTS: At follow-up, the knee-walking test was significantly worse in the BPTB group than in the ST group (P = .0004) and ST/G group (P < .0001). Furthermore, the knee-walking test was significantly worse at follow-up than preoperatively in the BPTB group (P < .0001). The corresponding findings were not made in the other 2 groups. A significant reduction in knee laxity and an increase in activity level compared with the preoperative assessments were found in all 3 groups, without any significant differences between the groups. CONCLUSIONS: Two years after ACL reconstruction, the use of ST and ST/G autografts rendered significantly less discomfort during the knee-walking test than the use of BPTB autografts. However, in terms of functional outcome and knee laxity, the groups displayed no significant differences. LEVEL OF EVIDENCE: Level I.
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| 3. |
- Magnusson, Lennart, 1959, et al.
(författare)
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A prospective, randomized, clinical and radiographic study after arthroscopic Bankart reconstruction using 2 different types of absorbable tacks
- 2006
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Ingår i: Arthroscopy. - 1526-3231. ; 22:2, s. 143-51
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of the study was to compare the clinical and radiographic results after arthroscopic Bankart reconstruction using 2 different types of absorbable implant. TYPE OF STUDY: Randomized controlled trial. METHODS: A randomized series of 40 patients who had recurrent, unidirectional, post-traumatic shoulder instability were included in the study. All patients underwent an arthroscopic Bankart reconstruction involving either polygluconate co-polymer (PGACP group, n = 20) or self-reinforced poly-L-lactic acid polymer (PLLA group, n = 20) tack implants. The patients underwent clinical and radiographic assessments preoperatively and at 2 years. Additional radiographic assessments were performed at 6 months. RESULTS: Preoperatively, the study groups were comparable in terms of demographics as well as clinical parameters. One patient in each group had a redislocation (5%) during the follow-up period of 2 years. No subluxations were registered. No statistically significant differences were found between the study groups in terms of strength in abduction, range of motion, and Rowe or Constant scores. There was a significant increase in degenerative changes during the follow-up period in both study groups (P = .004). However, no significant differences in degenerative changes were registered between the study groups either preoperatively or at the 2-year follow-up. There were no significant differences in the radiographic visibility of the drill holes used for the absorbable implants between the study groups at the 6-month assessment. However, at the 2-year assessment, the radiographic visibility of the drill holes was significantly greater (P = .004) in the patients in the PLLA group than those in the PGACP group. At the 2-year assessment, no correlation was found between the appearance of the drill holes and the degenerative findings (PGACP group, rho = 0.44; PLLA group, rho = 0.42). CONCLUSIONS: Two years after arthroscopic Bankart reconstruction using either PGA polymer or PLA polymer implants, the overall clinical results were comparable. Radiographic assessments revealed that the degenerative changes increased in both study groups during the follow-up period. Furthermore, the visibility of the drill holes on the 2-year radiographs was greater after using PLLA implants than after using PGACP implants. LEVEL OF EVIDENCE: Level I.
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| 4. |
- Magnusson, Lennart, 1959, et al.
(författare)
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Absorbable implants for open shoulder stabilization. A 7-8-year clinical and radiographic follow-up
- 2006
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - 0942-2056. ; 14:2, s. 182-8
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Tidskriftsartikel (refereegranskat)abstract
- Eighteen consecutive patients who had recurrent, unidirectional, post-traumatic shoulder instability were included. All these patients underwent surgery using an open Bankart technique involving absorbable suture anchors. The median age at the index operation was 27 (16-50) years. One subluxation and two re-dislocations occurred during the follow-up period of 90 (80-95) months. At the 90-month control, the Rowe and Constant scores were 94 (63-100) points and 88.5 (65-100) points, respectively. The strength measurements on the index side in 90 degrees abduction revealed 8.1 (3.7-17.2) kg compared with 7.6 (2.7-17.6) kg on the contra lateral side (n.s.). The external rotation in abduction was 80 (60-95) degrees compared with 100 (70-120) degrees for the contra lateral side (p = 0.0015). Signs of minor or moderate degeneration were found in five of 18 patients (28%) on the preoperative radiographs. There was a significant continuous increase in degenerative changes during the follow-up period as seen on the seven, 33 and 90-month radiographs (p = 0.01, 0.03 and 0.01, respectively). On the 90-month radiographs, 12 of 18 patients (67%) had minor, moderate or severe degenerative changes (p = 0.0004 preoperative vs. 90 months). On the 7-month radiographs, two of 18 patients (11%) had invisible or hardly visible drill holes in conjunction with the absorbable implants. On the 90-month radiographs, 12 of 18 patients (67%) had invisible or hardly visible drill holes (p = 0.003 7 months vs. 90 months). In the long term, the method resulted in stable, well-functioning shoulders in 15 of 18 patients (83%). The stabilisation was not, however, able to prevent further increases in radiographic degenerative changes during the 7-8-year follow-up. The drill holes used for the absorbable suture anchors appeared to heal in the majority of patients during the follow-up period.
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| 5. |
- Ejerhed, Lars, 1951, et al.
(författare)
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Antimicrobial coating is associated with significantly lower aerobic colony counts in high-touch areas in an orthopedic ward environment
- 2020
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Ingår i: Annals of Clinical Microbiology and Antimicrobials. - : Springer Science and Business Media LLC. - 1476-0711. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Hospital acquired infections (HAI) are the most common complication found in the hospital environment. The aim of the study was to examine whether the use of an antimicrobial coating in high-touch areas in an orthopedic ward could reduce bacterial growth and HAI. Methods From December 2017 to February 2018, HAI were registered on two orthopedic wards. A second registration was performed from December 2018 to February 2019. On the second occasion, an antimicrobial organosilane coating was applied just before the study period and thereafter weekly on one ward, while the other ward served as a control. Twenty defined high-touch areas on each ward were cultured before treatment and after 1, 2, 4, 8, 12, 14 and 16 weeks. Samples were cultured for aerobic colony counts, Staphylococcus aureus and E. coli. Results The total aerobic colony counts were 47% lower on the treated ward compared with the non-treated ward over the study period (p = 0.02). The colony counts for Staphylococcus aureus and E. coli were low on both wards. During the first registration period, the incidence of HAI was 22.7% and 20.0% on the non-treated and subsequently treated ward respectively. On the second occasion, after treatment, the incidence was 25.0% and 12.5% (treated ward) respectively (p = 0.0001). Conclusions The use of a long-lasting antimicrobial organosilane coating appears to reduce the bioburden and reduce HAI. Since the incidence of HAI varies substantially over time, longer observation times are needed.
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| 6. |
- Ejerhed, L., et al.
(författare)
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The effect of anterior cruciate ligament surgery on bone mineral in the calcaneus: a prospective study with a 2-year follow-up evaluation
- 2004
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Ingår i: Arthroscopy. - 1526-3231. ; 20:4, s. 352-9
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The goal of this study was to evaluate the effect of anterior cruciate ligament (ACL) reconstruction on the bone mineral area mass (BMA) in the calcaneus on the injured and noninjured sides. TYPE OF STUDY: A prospective cohort study with sequential assessments of bone mineral in the calcaneus before and after ACL reconstruction. METHODS: Thirty-four consecutive patients with a unilateral ACL rupture underwent arthroscopic reconstruction using patellar tendon autografts. The BMA was assessed bilaterally in the calcaneus using a gamma camera according to the dual-energy photon absorptiometry technique, before surgery and after 6 and 26 months. RESULTS: Thirty-one of 34 patients (20 men and 11 women) underwent all BMA measurements. The median age at index surgery was 27 (16 to 50) years, and the reconstruction was performed 12 (2 to 192) months after the injury. The median preoperative Tegner activity level increased from 3 (2 to 8) to 7 (2 to 9) at 26 months (P <.0001). The BMA in the calcaneus on both the injured and noninjured side decreased by 16% and 17% respectively from the preoperative measurement to the 26-month control (P =.0014; P =.0006). On all occasions, the BMA was lower on the injured side than on the noninjured side (P =.012). CONCLUSIONS: Patients with a unilateral ACL rupture had a lower BMA in the calcaneus on the injured side compared with the noninjured side. Although patients increased activity levels after reconstruction, the BMA in the calcaneus decreased on both the injured and the noninjured side up to 2 years after surgery. LEVEL OF EVIDENCE: Level II-1, prospective cohort study.
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| 7. |
- Laxdal, Gauti, 1966, et al.
(författare)
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A prospective comparison of bone-patellar tendon-bone and hamstring tendon grafts for anterior cruciate ligament reconstruction in male patients
- 2007
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 15:2, s. 115-25
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BPTB Group) (n = 45) and four-strand semitendinosus/gracilis (ST/G Group) (n = 78) autografts in male patients. The type of study is non-randomised, prospective consecutive series. A consecutive series of 126 male patients, all with unilateral ACL ruptures, was included in the study. In both groups, interference screw fixation of the graft was used at both ends and 123/126 (97%) of the patients returned for the follow-up examination after a period of 25 (23-33) months. The pre-operative assessments in both groups were similar in terms of the Tegner activity level, the Lysholm knee scoring scale, KT-1000 measurements, one-leg-hop test and knee-walking test. A significant reduction in knee laxity as measured with the KT-1000 arthrometer, compared with the pre-operative assessments, was found in both groups (P < 0.001). No significant differences in the post-operative knee-laxity measurements were found between the groups. Both groups had a significantly improved functional outcome at follow-up in terms of the Lysholm knee scoring scale, Tegner activity level and one-leg-hop test. The BPTB Group had a significantly higher Tegner activity level at follow-up, compared with the ST/G Group (P = 0.02). Moreover, the patients in the BPTB Group were significantly more likely to have a Tegner activity level of 6 or above (P = 0.03). Otherwise, no significant differences were found between the two study groups at the 2-year follow-up. Two years after an ACL reconstruction, the two groups displayed no significant differences in terms of functional outcome and knee laxity. However, more patients in the BPTB Group returned to a higher Tegner activity level than that in the ST/G Group.
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| 8. |
- Laxdal, Gauti, 1966, et al.
(författare)
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Outcome and risk factors after anterior cruciate ligament reconstruction: a follow-up study of 948 patients
- 2005
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Ingår i: Arthroscopy. - : Elsevier BV. - 1526-3231. ; 21:8, s. 958-964
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of the study was to assess the outcome and risk factors after anterior cruciate ligament (ACL) reconstruction in a large group of patients. TYPE OF STUDY: Case series. METHODS: Included in this retrospective study were 948 patients (323 female, 625 male) with a symptomatic unilateral ACL rupture, who underwent arthroscopic reconstruction using patellar tendon autograft and interference screw fixation at 3 Swedish hospitals. The median age of the patients at the time of the index operation was 26 years (range, 14 to 53 years). The patients underwent surgery at a median of 12 months (range, 0.5 to 360 months) after their injury. Independent physiotherapists performed the follow-up examinations at a median of 32 months (range, 21 to 117 months) postoperatively. RESULTS: Of the 948 patients, 550 (58%) underwent meniscal surgery before, during, or after the ACL reconstruction. The median Tegner activity level was 8 (range, 2-10) before injury, 3 (range, 0-9) preoperatively, and 6 (range, 1-10) at follow-up (P < .0001 preoperative v follow-up). At follow-up, the median Lysholm score was 90 points (range, 14-100), the median KT-1000 anterior side-to-side laxity difference was 1.5 mm (range, -6 to 13 mm), and the median 1-leg hop test quotient was 95% (0% to 167%) compared with the contralateral normal side. At follow-up, 69.3% of the patients were classified as normal or nearly normal according to the International Knee Documentation Committee evaluation system. However, 36% of the patients were unable to or had severe problems performing the knee-walking test. Inferior results correlated with increased time period between the index injury and reconstruction and concomitant joint damage found at the index operation. CONCLUSIONS: Overall, the results were good after ACL reconstruction using patellar tendon autograft and interference screw fixation. Concomitant joint damage and a long time period between the injury and reconstruction are major risk factors for inferior outcome after ACL reconstruction. LEVEL OF EVIDENCE: Level IV, case series.
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| 9. |
- Liden, M, et al.
(författare)
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A histological and ultrastructural evaluation of the patellar tendon 10 years after reharvesting its central third
- 2008
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 36:4, s. 781-788
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Tidskriftsartikel (refereegranskat)abstract
- This study was undertaken to evaluate the histologic and ultrastructural characteristics of the patellar tendon 10 years after reharvesting its central third. Hypothesis In the long term, after its central third is reharvested, the patellar tendon does not regain a normal histological and ultrastructural appearance. Study Design Case-control study; Level of evidence, 3. Methods Twelve consecutive patients (4 women, 8 men) who underwent anterior cruciate ligament revision surgery using reharvested ipsilateral patellar tendon autografts were included in the study. Percutaneous biopsy samples were obtained from the central and lateral parts of the patellar tendon under ultrasonographic guidance at a median of 116 months (range, 102–127 months) after the revision procedure. Eleven biopsy specimens from asymptomatic patellar tendons obtained from open anterior cruciate ligament reconstructions served as controls. The histologic characteristics and the presence of glycosaminoglycans were assessed using a light microscope, and the ultrastructure was assessed using a transmission electron microscope. Results The histological evaluation revealed deterioration in fiber structure, increased cellularity, and increased vascularity in both the central and peripheral parts of the reharvested patellar tendon specimens compared with normal tendon specimens. No difference in the amount of glycosaminoglycans was seen in specimens from either part of the reharvested patellar tendons and the control specimens. The ultrastructural evaluation revealed that all the control specimens had a normal morphologic appearance and a compact extracellular matrix with regularly oriented collagen fibrils. Furthermore, in the control specimens, the fibril diameter was heterogeneous, with all fibril size classes present. Specimens from the central and the lateral part of the reharvested tendon displayed pathological cell appearance and a more heterogeneous extracellular matrix. The lateral specimens from the reharvested tendons also displayed all fibril size classes but with a more homogeneous distribution. In the central specimens, the largest fibril size class was absent. Conclusion Ten years after its central third was reharvested for anterior cruciate ligament revision surgery, the patellar tendon had not normalized in terms of its histological and ultrastructural appearance.
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| 10. |
- Sernert, Ninni, 1954, et al.
(författare)
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Knee-laxity measurements examined by a left-hand- and a right-hand-dominant physiotherapist, in patients with anterior cruciate ligament injuries and healthy controls
- 2007
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - 0942-2056.
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was to analyse and compare KT-1000 knee laxity as examined by a left-hand- and a right-hand-dominant physiotherapist in a group of patients with an anterior cruciate ligament (ACL) injury and a group of patients, 2 years after ACL reconstruction. The other aim was to measure and analyse knee laxity in a group of persons without any known knee problems. A cross-sectional examination of two groups of patients pre-operatively and post-operatively after ACL reconstruction and examination of healthy controls on two different occasions was performed. Fifty-three patients who were scheduled for ACL reconstruction and 39 patients who attended a 2-year follow-up examination were included in the study. In the ACL-deficient group, 32 patients had a right-sided ACL injury and 21 patients a left-sided ACL injury. The corresponding figures in the post-operative group were 21 patients with a right-sided ACL injury and 18 patients with a left-sided ACL injury. Twenty-eight healthy persons without any known knee problems served as controls. One left-hand- and one right-hand-dominant experienced physiotherapist performed all the examinations. To be able to evaluate the intra and inter-reliability of the examiners the controls were examined at two occasions. The left-hand-dominant physiotherapist measured significantly higher absolute laxity values in the left knee, both injured and non-injured ones, compared with the right-hand-dominant physiotherapist. This was found irrespectively of whether the patients belonged to the ACL deficient or the post-operative group. In the healthy control group, the right-hand-dominant physiotherapist measured significantly higher knee-laxity values in the right knee compared with the left-hand-dominant physiotherapist. Correspondingly, the left-hand-dominant physiotherapist measured significantly higher knee laxity values in the left knee. We conclude that KT-1000 arthrometer laxity measurements can be affected by the hand dominance of the examiner. This might affect the reliability of KT-1000 arthrometer measurements. Level of evidence is II.
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| 11. |
- Sernert, Ninni, 1954, et al.
(författare)
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Right and left knee laxity measurements: a prospective study of patients with anterior cruciate ligament injuries and normal control subjects
- 2004
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Ingår i: Arthroscopy. - 1526-3231. ; 20:6, s. 564-71
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The purpose of this study was to analyze and compare knee laxity in a group of patients with a unilateral right anterior cruciate ligament (ACL) rupture and a group of patients with a unilateral left ACL rupture. Another goal was to analyze and compare the knee laxity of the right and left knees in a group of persons without any known knee problems. TYPE OF STUDY: Prospective examination of the same patients preoperatively and 2 years after the reconstruction with examination of the healthy controls at 2 different occasions. METHODS: Group A was composed of 41 patients with a right-sided chronic ACL rupture, and group B was composed of 44 patients with a left-sided chronic ACL rupture. All patients underwent an arthroscopic ACL reconstruction using patellar tendon autograft. Group C was composed of 35 persons without any known knee problems. One experienced physiotherapist performed all the KT-1000 measurements and the clinical examinations. RESULTS: Group A displayed an increased difference in side-to-side laxity between the injured and non-injured side compared with group B in terms of both anterior and total knee laxity. This difference was found to be statistically significant preoperatively (P =.01, anterior; P =.001, total) and at follow-up evaluation 2 years after the index surgery (P =.008, anterior; P =.006, total). In group C, a significant increase was seen in absolute anterior and total laxity in the right knee compared with the left knee when 2 repeated measurements were performed (P <.0001 and P =.003, anterior; P <.0001 and P =.001, total). CONCLUSIONS: The KT-1000 arthrometer revealed a significant increase in laxity measurements in right knees compared with left knees. This difference was found both preoperatively and postoperatively in patients undergoing ACL reconstruction. The same thing was found in a group of persons without any known knee problems. LEVEL OF EVIDENCE: Level II.
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| 12. |
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| 13. |
- Svensson, Michael, 1964, et al.
(författare)
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A prospective comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction in female patients
- 2006
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - 0942-2056. ; 14:3, s. 278-86
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study is to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BTB group) (n = 28) and four-strand semitendinosus/gracilis (ST/G group) (n = 31) autografts in female patients. The type of study was non-randomised prospective consecutive series. A consecutive series of 61 female patients, all with unilateral ACL ruptures, was included in the study. In both groups, interference screw fixation of the graft was used at both ends, and 59/61 (97%) of the patients returned for the follow-up examination after a period of 26 (23-31) months. The pre-operative assessments in both groups were similar in terms of the Lysholm score, KT-1000 measurements, one-leg-hop test, and knee-walking test. At the 2-year follow-up, the knee-walking test was significantly worse in the BTB group than in the ST/G group (P = 0.003). Furthermore, the knee-walking test was significantly worse at follow-up than pre-operatively in the BTB group (P < 0.005). The corresponding finding was not made in the ST/G group. A reduction in knee laxity compared with the pre-operative assessments was found in both groups. No significant difference in the post-operative knee laxity measurement was found between the groups. A significant increase in activity level and subjective scores was found in both groups compared with pre-operative values, without any significant differences between the groups. Two years after ACL reconstruction, the groups displayed no significant differences in terms of functional outcome and knee laxity. However, the use of ST/G autografts rendered significantly less discomfort during the knee-walking test than the use of BTB autografts.
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| 14. |
- Svensson, M., et al.
(författare)
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Does the patellar tendon normalize after harvesting its central third?: a prospective long-term MRI study
- 2004
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Ingår i: Am J Sports Med. - 0363-5465. ; 32:1, s. 34-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The central third of the patellar tendon is the most frequently used autograft for ACL reconstruction. HYPOTHESIS: The patellar tendon at the donor site would look normal as seen on MRI 6 years after harvesting its central third. METHODS: Nineteen consecutive patients were included in the study. MRI examinations of the donor site were performed at 6 (5 to 10) weeks, 6 (6 to 8) months, 27 (24 to 29) months, and 71 (68 to 73) months postoperatively. The contralateral normal side was examined only on the first occasion. RESULTS: The size of the donor-site gap decreased significantly (P = 0.0001) between 6 weeks and 6 years. In most patients, a thinning of the central part of the patellar tendon was still found at 6 years. The thickness of the peripheral patellar tendon was increased, compared with the contralateral healthy side, until 2 years (P = 0.003). On all occasions, the width was increased compared with the contralateral side (P < 0.015). CONCLUSION: Prospective MRI examinations revealed that the patellar tendon at the donor site had not normalized 6 years after harvesting its central third. The reharvesting of the patellar tendon can therefore not be recommended.
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