| 1. |
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| 2. |
- Karikis, Ioannis, 1985, et al.
(författare)
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Radiographic Tibial Tunnel Assessment After Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autografts and Biocomposite Screws: A Prospective Study With 5-Year Follow-Up
- 2017
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Ingår i: Arthroscopy - Journal of Arthroscopic and Related Surgery. - : Elsevier BV. - 0749-8063 .- 1526-3231. ; 33, s. 2184-2194
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Tidskriftsartikel (refereegranskat)abstract
- © 2017 Arthroscopy Association of North America Purpose To radiographically assess the tibial tunnel up to 5 years after anterior cruciate ligament (ACL) reconstruction using hamstring tendon autografts and biocomposite interference screws. Methods Fifty-one patients underwent anatomic single-bundle ACL reconstruction with metal interference screws in the femur and biocomposite interference screws in the tibia. Standardized digital radiographs with weight-bearing anteroposterior and lateral views of the index knee were taken in the early postoperative period and at 2 and 5 years postoperatively. Of 51 patients, 40 (78%) underwent radiographic assessment on all 3 occasions. Subjective and objective clinical assessments were obtained preoperatively and at the 5-year follow-up. Results The mean follow-up period was 65 months (±3.9 months), with a minimum of 59 months. The width of the tibial tunnel on the anteroposterior view was 9.4 mm (±1.4 mm) in the early postoperative period and 9.2 mm (±1.5 mm) at 5 years (P =.64). The corresponding widths on the lateral view were 9.6 mm (±1.5 mm) in the early postoperative pe riod and 9.0 mm (±1.4 mm) at 5 years (P =.014). In 33 of 40 patients (83%) the width of the tibial tunnel had decreased on 1 or both views at 5 years compared with the early postoperative period. The study group had improved significantly at the 5-year follow-up compared with the preoperative assessments in terms of the KT-1000 arthrometer laxity tests (MEDmetric, San Diego, CA), pivot-shift test, Tegner activity scale, and Lysholm knee score (P < .001). No correlations were found between the tunnel widths and the KT-1000 assessment. Conclusions In 83% of patients, the width of the tibial tunnel had decreased on 1 or both radiographic views at 5 years compared with the early postoperative period after ACL reconstruction using biocomposite interference screws. Level of Evidence Level II, prospective study.
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| 3. |
- Karikis, Ioannis, 1985, et al.
(författare)
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The Long-Term Outcome After Early and Late Anterior Cruciate Ligament Reconstruction.
- 2018
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Ingår i: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. - : Elsevier BV. - 1526-3231. ; 34:6, s. 1907-1917
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Tidskriftsartikel (refereegranskat)abstract
- To compare long-term clinical and radiographic outcomes in patients undergoing either early (group A) or late (group B) surgery after anterior cruciate ligament (ACL) injury.ACL reconstruction using hamstring tendon autografts was performed in 30 patients in group A (median age, 23years; range, 17-49years) and 31 patients in group B (median age, 27years; range, 17-38years). The patients in group A were operated on within 5months (median, 3months; range, 2-5months) of injury, whereas those in group B were operated on more than 24months (median, 30months; range, 24-48months) after injury. The follow-up period was 10years (median, 117months [range, 77-222months] in group A and 129months [range, 77-206months] in group B; P= .44). Multiple objective clinical evaluation tests and patient-reported outcome measures were obtained preoperatively and at follow-up. At follow-up, radiographic assessments of knee osteoarthritis (OA) bilaterally were performed.The frequency of meniscectomy at the index operation was significantly lower in group A (20%) than in group B (52%) (P= .01). There were no significant differences between the groups in terms of Tegner and Lysholm scores and laxity tests both preoperatively and at follow-up. Both groups improved over time in terms of Tegner and Lysholm scores (P < .05). At follow-up, significantly more medial-compartment OA in the index knee was found in group B than in group A (P= .037) according to the Ahlbäck classification system. The index knee showed significantly more OA than the contralateral knee in both groups (P< .01).Patients who underwent early ACL reconstruction required significantly fewer meniscectomies at the index operation than patients who underwent late reconstruction and showed significantly less OA on the medial side of the knee 10years after reconstruction. However, no significant differences were found between the groups in terms of clinical assessments.Level III, retrospective comparative study.
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| 4. |
- Stener, Sven, 1953, et al.
(författare)
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A long-term, prospective, randomized study comparing biodegradable and metal interference screws in anterior cruciate ligament reconstruction surgery: radiographic results and clinical outcome.
- 2010
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 38:8, s. 1598-605
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Tidskriftsartikel (refereegranskat)abstract
- During the past decade, the use of biodegradable implants in anterior cruciate ligament surgery has increased.Poly-L-lactide acid (PLLA) interference screws would render the same clinical results but greater tunnel enlargement than metal screws 8 years after anterior cruciate ligament reconstruction using hamstring tendon (semitendinosus/gracilis) autografts.Randomized controlled trial; Level of evidence, 1.A randomized series of 77 patients, all with a unilateral anterior cruciate ligament rupture, were divided into 2 groups (PLLA and metal). In both groups, hamstring tendon autografts were used with interference screw fixation at both ends and the patients were examined with standard radiographs, Tegner activity level, Lysholm knee score, single-legged hop test, early C-reactive protein response, and KT-1000 arthrometer knee laxity measurements.The preoperative assessments in both groups were similar in terms of gender, clinical tests, and the time from injury to surgery. The patients returned for a radiographic and clinical examination a mean of 96 months (range, 78-120 months) after the index operation. The PLLA group displayed significantly larger bone tunnels on the radiographs than the metal group on the femoral side (mean, 11.4 mm [range, 0-17.8 mm] vs 8.0 mm [range, 0-16.3 mm]; P < .005) but not on the tibial side (mean, 10.7 mm [range, 7.8-14.1 mm] vs 10.5 mm [range, 0-20.3 mm]; difference not significant). At follow-up, no significant differences were found between the PLLA and metal groups in terms of knee laxity measurements (median, 1.0 mm [range, -2.0-4.0 mm] vs 1.0 mm [range, -3.0-6.5 mm]), Tegner activity level (median, 7 [range,3-9] vs 6 [range, 2-9]), or the Lysholm knee score (median, 90 points [range, 51-100] vs 89 points [range, 53-100]). The C-reactive protein values did not differ significantly between the 2 groups except for an increase in the PLLA group compared with the metal group at day 1 postoperatively-23 mg/L (range, <6-55) vs 9 mg/L (range, <6-55) (P < .001).There were significantly larger radiographically visible bone tunnels on the femoral side but not on the tibial side in the PLLA group compared with the metal group 8 years after anterior cruciate ligament reconstruction using hamstring tendon autografts. This finding did not correlate with inferior clinical results. Because of the results in the present study, the authors have discontinued the use of PLLA interference screws.
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| 5. |
- Ahldén, Mattias, et al.
(författare)
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Knee laxity measurements after anterior cruciate ligament reconstruction, using either bone-patellar-tendon-bone or hamstring tendon autografts, with special emphasis on comparison over time
- 2009
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 1433-7347 .- 0942-2056. ; 17:9, s. 1117-24
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Tidskriftsartikel (refereegranskat)abstract
- The aims of the study were to analyse the change in knee laxity over time after anterior cruciate ligament (ACL) reconstruction, using either bone-patellar-tendon-bone (BPTB) or hamstring (HS) tendon autografts, and to compare the knee laxity measurements between the study groups both pre-operatively and on multiple follow-up occasions. Another aim was to compare the radiographic findings in terms of degenerative changes between the study groups. A randomised series of 71 patients, who underwent ACL reconstruction using BPTB or HS tendon autografts and interference screw fixation, were included in the study. Of these patients, 47/71 (66%) attended a clinical examination, including laxity measurements using the KT-1000 arthrometer, pre-operatively and on four post-operative occasions; 6 months, 1 year, 2 years and 7 years after the reconstruction. The BPTB group consisted of 22 patients, while there were 25 patients in the HS group. There were no significant differences in the mean side-to-side knee laxity between the BPTB and the HS group pre-operatively or at the follow-up examinations. There was a tendency towards a reduction in side-to-side knee laxity over time in both groups, measured with the KT-1000 arthrometer. The decrease was significant when analysing the injured and uninjured knee separately (injured side p < 0.001 (BPTB) and p = 0.005 (HS), uninjured side p = 0.008 and p = 0.042, respectively). Forty-four patients (BPTB 21, ST 23) underwent a radiographic assessment at the 7-year follow-up, which revealed no significant differences between the study groups in terms of osteoarthritic findings classified according to the Fairbank and Ahlback rating systems. In overall terms, osteoarthritis was identified in 16% (BPTB 19%; ST 13%; n.s.) according to the Ahlback rating system and 68% (BPTB 67%; ST 70%; n.s.) according to the Fairbank rating system. There were no significant differences in knee laxity measurements between the two study groups pre-operatively or at 7 years. A decrease in knee laxity over time was seen in both groups. There were no significant differences between the BPTB and ST groups in terms of osteoarthritic findings at 7 years.
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| 6. |
- 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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| 7. |
- Ejerhed, Lars, 1951
(författare)
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On surgical techniques to reduce morbidity after anterior cruciate ligament reconstruction. The significance of harvesting technique, preconditioning, graft choice and the course of bone mineral in the calcaneus.
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the study was to reduce undesired postoperative effects, such as anterior knee pain, loss of sensitivity in the knee region and problems with knee-walking after anterior cruciate ligament (ACL) reconstructive surgery. Furthermore, prospectively to evaluate the bone mineral in the calcanei before and after ACL reconstruction.In a study of 124 consecutive patients we compared the traditional one-incision technique and the subcutaneous two-incision technique to harvest the central third bone-patellar tendon bone (BTB) autograft. The subcutaneous two-incision technique rendered less disturbance in anterior knee sensitivity and a tendency towards less discomfort during knee-walking.In a prospective randomised study of 53 patients we evaluated the effect of preconditioning the BTB autograft with 39 N for ten minutes before implantation. The preconditioning rendered no advantages in terms of less laxity or better clinical outcome at the 2-year follow-up.Thirty-four consecutive patients with a unilateral ACL injury underwent arthroscopic reconstruction using BTB autografts. The bone mineral areal mass (BMA) was assessed bilaterally in the calcaneus using a g-camera according to the Dual-energy Photon Absorptiometry technique. The BMA was measured before the operation, after six and 26 months. The BMA in the calcaneus on both the injured and non-injured side decreased by 16% and 17% respectively from the preoperative measurement to the 26-month control. The Tegner activity level, though, increased from 3 preoperatively to 7 at 26 months.In a retrospective study we compared the outcome after ACL reconstruction in 49 recreational athletes with 226 competitive athletes with a minimum follow-up of two years. The functional and objective results were similar.In a prospective randomised study of seventy-one patients we compared the results after ACL reconstruction using either the central third BTB autograft or triple/quadruple semitendinosus autografts. At the two-year follow-up, the use of semitendinosus autografts rendered less discomfort during knee-walking, otherwise the subjective and objective results were similar.In conclusion, when the BTB autograft is used for ACL reconstruction, the donor-site morbidity in terms of loss of sensitivity and impaired knee walking ability can be reduced with a two incision subcutaneous harvesting technique. Preconditioning of BTB autografts does not decrease laxity or improve function in the perspective of two years. Arthroscopic ACL reconstruction using BTB autografts renders similar results irrespective of the preoperative activity level. ACL injury followed by reconstructive surgery causes a substantial loss of bone mineral in the calcaneus in the perspective of two years, in spite of a signifcantly increased activity level. This was found on both the injured and non-injured side and could be a risk factor for osteoporosis later in life. The use of triple/quadruple semitendinosus autografts renders a better knee walking ability than the use of BTB autografts. Both grafts render equal results in terms of stability and function. We therefore recommend the semitendinosus autograft as a first choice of graft when ACL reconstructive surgery is required.
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| 8. |
- Elmlund, Anna, et al.
(författare)
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Bone mineral decreases in the calcanei in men after arthroscopic shoulder surgery: a prospective study over 5years.
- 2016
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Ingår i: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 24:12, s. 3848-3854
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Tidskriftsartikel (refereegranskat)abstract
- It is well known that injuries and surgical procedures in the lower extremities affect bone mineral both in the injured limb and in the contralateral limb. The possible effect on bone mineral after upper extremity surgery is not well studied, and the aim of this study was to study the effect on bone mineral in the calcanei after arthroscopic shoulder surgery.
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| 9. |
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| 10. |
- Ibrahim, Mustafa, et al.
(författare)
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No significant histological or ultrastructural tendinosis changes in the hamstring tendon in patients with mild to moderate osteoarthritis of the knee?
- 2021
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 29:4, s. 1067-1074
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To investigate the periarticular degenerative changes of the knee joint in association with osteoarthritis (OA). More tendinosis was expected to be found in the semitendinosus tendon in patients with knee OA than in patients without knee OA. Methods: Samples from 41 patients were included between January 2016 and October 2017. Twenty-one patients median age 53 (33–63) years with mild to moderate OA underwent high tibial osteotomy (HTO) and 20 patients median age 38 (31–57) years without OA underwent anterior cruciate ligament reconstruction (ACLR). Biopsies from the semitendinosus tendon were obtained at the time of surgery and examined histologically, morphologically and ultrastructurally using light and electron microscope. Results: The histological evaluation of the semitendinosus tendon revealed the presence of more hemosiderin in the ACLR group. No significant morphological or ultrastructural differences were shown between patients in the HTO and ACLR group. Conclusion: Patients with mild and moderate medial compartment knee OA displayed no more degenerative changes in their semitendinosus tendon than patients without OA, as seen in both the light and the electron microscope. Level of evidence: III. © 2020, The Author(s).
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| 11. |
- Lidén, Mattias, 1973, et al.
(författare)
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Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction: a prospective, randomized study with a 7-Year follow-up
- 2007
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Ingår i: Am J Sports Med. - : SAGE Publications. - 0363-5465. ; 35:5, s. 740-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third bone-patellar tendon-bone (BTB) autografts and triple/quadruple semitendinosus (ST) autografts. HYPOTHESIS: In the long-term, ACL reconstruction using BTB autografts will render more donor-site problems than ST autografts. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A randomized series of 71 patients (22 women and 49 men) with a unilateral ACL rupture who underwent reconstructive surgery were included in the study. The BTB graft was used in 34 patients (BTB group) and the ST-tendon graft was used in 37 patients (ST group). The patients were examined a median of 86 months (range, 68 to 114 months) after the reconstruction. RESULTS: Sixty-eight of 71 patients (96%) were examined at follow-up. The clinical assessments at follow-up revealed no significant differences between the BTB group and the ST group in terms of the Lysholm score, Tegner activity level, International Knee Documentation Committee evaluation system, 1-legged hop test, KT-1000 arthrometer laxity measurements, manual Lachman test, and range of motion. A significant improvement was seen in both groups compared with the preoperative values in terms of most clinical assessments. Donor-site morbidity in the form of knee-walking ability, kneeling ability, and area of disturbed anterior knee sensitivity revealed no significant differences between the groups. CONCLUSION: Seven years after ACL reconstruction, the subjective and objective outcomes were similar after using the central-third BTB autograft and triple/quadruple ST autograft. Furthermore, no difference in terms of donor-site morbidity was found between the 2 groups.
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| 12. |
- Lidén, Mattias, 1973, et al.
(författare)
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The course of the patellar tendon after reharvesting its central third for ACL revision surgery: a long-term clinical and radiographic study
- 2006
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - 0942-2056. ; 14:11, s. 1130-8
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Tidskriftsartikel (refereegranskat)abstract
- The choice of the optimal graft for anterior cruciate ligament (ACL) revision surgery is still controversial. Reharvesting the patellar tendon has been suggested as one graft alternative. Our hypothesis was that in the long-term, ACL revision surgery using reharvested patellar tendon autografts would render a good clinical outcome and a normal patellar tendon at the donor site as seen on magnetic resonance imaging (MRI). Fourteen consecutive patients (five women, nine men), who underwent ACL revision surgery using reharvested ipsilateral patellar tendon grafts, were included in the study. They underwent bilateral MRI evaluations of the patellar tendon and were tested for clinical outcome 26 (20-35) and 115 months (102-127) after the revision procedure. On the second occasion, they also underwent standard weight-bearing X-ray examinations.The serial MRI evaluations revealed that the thickness of the patellar tendon at the donor site was significantly increased compared with the non-harvested, normal contralateral side and that the donor-site gap was still visible after 10 years. No significant differences were seen between the 2- and 10-year MRI evaluations. Standard weight-bearing X-ray examinations revealed signs of mild degenerative changes in all patients. Clinical results in terms of the Lysholm score, IKDC evaluation system, one-leg-hop test, KT-1000 laxity test and the knee-walking test revealed no significant differences between the 2- and 10-year assessments. In overall terms, the clinical results were considered to be poor on both occasions. The patellar tendon at the donor site had not normalised 10 years after the reharvesting procedure, as seen on MRI. Furthermore, the clinical results were poor after ACL revision surgery using reharvested patellar tendon autograft.
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| 13. |
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| 14. |
- Stener, Sven, 1953, et al.
(författare)
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Anterior cruciate ligament reconstruction reduces bonemineral areal mass.
- 2013
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Ingår i: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. - : Elsevier BV. - 1526-3231. ; 29:11, s. 1788-95
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to prospectively follow bone mineral areal mass (BMA) changes in the calcaneii, hips,and lumbar spine after anterior cruciate ligament (ACL) reconstruction using hamstring tendon autografts.
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