| 1. |
- Lohmander, Stefan, et al.
(författare)
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Osteoarthritis
- 2003
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Ingår i: Textbook of sports medicine. - 0632065095 ; , s. 422-422:10, s. 1402-1430, s. 1301-1301
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 2. |
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| 3. |
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| 4. |
- Ageberg, Eva, et al.
(författare)
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Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post surgery
- 2009
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 1433-7347 .- 0942-2056. ; 17:2, s. 162-9
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Tidskriftsartikel (refereegranskat)abstract
- Hamstring muscles play a major role in knee-joint stabilization after anterior cruciate ligament (ACL) injury. Weakness of the knee extensors after ACL reconstruction with patellar tendon (PT) graft, and in the knee flexors after reconstruction with hamstring tendons (HT) graft has been observed up to 2 years post surgery, but not later. In these studies, isokinetic muscle torque was used. However, muscle power has been suggested to be a more sensitive and sport-specific measures of strength. The aim was to study quadriceps and hamstring muscle power in patients with ACL injury treated with surgical reconstruction with PT or HT grafts at a mean of 3 years after surgery. Twenty subjects with PT and 16 subjects with HT grafts (mean age at follow up 30 years, range 20-39, 25% women), who were all included in a prospective study and followed the same goal-based rehabilitation protocol for at least 4 months, were assessed with reliable, valid, and responsive tests of quadriceps and hamstring muscle power at 3 years (SD 0.9, range 2-5) after surgery. The mean difference between legs (injured minus uninjured), the hamstring to quadriceps (H:Q, hamstring divided by quadriceps) ratio, and the limb symmetry index (LSI, injured leg divided by uninjured and multiplied by 100) value, were used for comparisons between the groups (analysis of variance). The mean difference between the injured and uninjured legs was greater in the HT than in the PT group for knee flexion power (-21.3 vs. 7.7 W, p = 0.001). Patients with HT graft had lower H:Q ratio in the injured leg than the patients with PT graft (0.63 vs. 0.77, p = 0.012). They also had lower LSI for knee flexion power than those in the PT group (88 vs. 106%, p < 0.001). No differences were found between the groups for knee extension power. The lower hamstring muscle power, and the lower hamstring to quadriceps ratio in the HT graft group than in the PT graft group 3 years (range 2-5) after ACL reconstruction, reflect imbalance of knee muscles after reconstruction with HT graft that may have a negative effect on dynamic knee-joint stabilization.
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| 5. |
- Frobell, Richard, et al.
(författare)
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A randomized trial of treatment for acute anterior cruciate ligament tears.
- 2010
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Ingår i: New England Journal of Medicine. - 0028-4793. ; 363:4, s. 331-342
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown. METHODS: We conducted a randomized, controlled trial involving 121 young, active adults with acute ACL injury in which we compared two strategies: structured rehabilitation plus early ACL reconstruction and structured rehabilitation with the option of later ACL reconstruction if needed. The primary outcome was the change from baseline to 2 years in the average score on four subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS)--pain, symptoms, function in sports and recreation, and knee-related quality of life (KOOS(4); range of scores, 0 [worst] to 100 [best]). Secondary outcomes included results on all five KOOS subscales, the Medical Outcomes Study 36-Item Short-Form Health Survey, and the score on the Tegner Activity Scale. RESULTS: Of 62 subjects assigned to rehabilitation plus early ACL reconstruction, 1 did not undergo surgery. Of 59 assigned to rehabilitation plus optional delayed ACL reconstruction, 23 underwent delayed ACL reconstruction; the other 36 underwent rehabilitation alone. The absolute change in the mean KOOS(4) score from baseline to 2 years was 39.2 points for those assigned to rehabilitation plus early ACL reconstruction and 39.4 for those assigned to rehabilitation plus optional delayed reconstruction (absolute between-group difference, 0.2 points; 95% confidence interval, -6.5 to 6.8; P=0.96 after adjustment for the baseline score). There were no significant differences between the two treatment groups with respect to secondary outcomes. Adverse events were common in both groups. The results were similar when the data were analyzed according to the treatment actually received. CONCLUSIONS: In young, active adults with acute ACL tears, a strategy of rehabilitation plus early ACL reconstruction was not superior to a strategy of rehabilitation plus optional delayed ACL reconstruction. The latter strategy substantially reduced the frequency of surgical reconstructions. (Funded by the Swedish Research Council and the Medical Faculty of Lund University and others; Current Controlled Trials number, ISRCTN84752559.)
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| 6. |
- Frobell, Richard B., et al.
(författare)
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Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. : Five year outcome of randomised trial
- 2013
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Ingår i: BMJ: British Medical Journal. - : BMJ. - 1756-1833. ; 346:7895, s. 232-232
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare, in young active adults with an acute anterior cruciate ligament (ACL) tear, the mid-term (five year) patient reported and radiographic outcomes between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL reconstruction. Design Extended follow-up of prospective randomised controlled trial. Setting Orthopaedic departments at two hospitals in Sweden. Participants 121 young, active adults (mean age 26 years) with acute ACL injury to a previously uninjured knee. One patient was lost to five year follow-up. Intervention All patients received similar structured rehabilitation. In addition to rehabilitation, 62 patients were assigned to early ACL reconstruction and 59 were assigned to the option of having a delayed ACL reconstruction if needed. Main outcome measure The main outcome was the change from baseline to five years in the mean value of four of the five subscales of the knee injury and osteoarthritis outcome score (KOOS4). Other outcomes included the absolute KOOS4 score, all five KOOS subscale scores, SF-36, Tegner activity scale, meniscal surgery, and radiographic osteoarthritis at five years. Results Thirty (51%) patients assigned to optional delayed ACL reconstruction had delayed ACL reconstruction (seven between two and five years). The mean change in KOOS4 score from baseline to five years was 42.9 points for those assigned to rehabilitation plus early ACL reconstruction and 44.9 for those assigned to rehabilitation plus optional delayed reconstruction (between group difference 2.0 points, 95% confidence interval -8.5 to 4.5; P=0.54 after adjustment for baseline score). At five years, no significant between group differences were seen in KOOS4 (P=0.45), any of the KOOS subscales (P≥0.12), SF-36 (P≥0.34), Tegner activity scale (P=0.74), or incident radiographic osteoarthritis of the index knee (P=0.17). No between group differences were seen in the number of knees having meniscus surgery (P=0.48) or in a time to event analysis of the proportion of meniscuses operated on (P=0.77). The results were similar when analysed by treatment actually received. Conclusion In this first high quality randomised controlled trial with minimal loss to follow-up, a strategy of rehabilitation plus early ACL reconstruction did not provide better results at five years than a strategy of initial rehabilitation with the option of having a later ACL reconstruction. Results did not differ between knees surgically reconstructed early or late and those treated with rehabilitation alone. These results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear.
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| 7. |
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| 8. |
- Frobell, Richard, et al.
(författare)
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The acutely ACL injured knee assessed by MRI: are large volume traumatic bone marrow lesions a sign of severe compression injury?
- 2008
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Ingår i: Osteoarthritis and Cartilage. - : Elsevier BV. - 1063-4584. ; 16, s. 829-836
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To map by magnetic resonance imaging (MRI) and quantitative MRI (qMRI) concomitant fractures and meniscal injuries, and location and volume of traumatic bone marrow lesions (BMLs) in the acutely anterior cruciate ligament (ACL) injured knee. To relate BML location and volume to cortical depression fractures, meniscal injuries and patient characteristics. METHODS: One hundred and twenty-one subjects (26% women, mean age 26 years) with an ACL rupture to a previously un-injured knee were studied using a 1.5T MR imager within 3 weeks from trauma. Meniscal injuries and fractures were classified by type, size and location. BML location and volume were quantified using a multi-spectral image data set analyzed by computer software, edited by an expert radiologist. RESULTS: Fractures were found in 73 (60%) knees. In 67 (92%) of these knees at least one cortical depression fracture was found. Uni-compartmental meniscal tears were found in 44 (36%) subjects and bi-compartmental in 24 (20%). One hundred and nineteen (98%) knees had at least one BML, all but four (97%) located in the lateral compartment. Knees with a cortical depression fracture had larger BML volumes (P<0.001) than knees without a cortical depression fracture, but no associations were found between meniscal tears and BML volume or fractures. Older age at injury was associated with smaller BML volumes (P<0.01). CONCLUSION: A majority of the ACL injured knees had a cortical depression fracture, which was associated with larger BML volumes. This indicates strong compressive forces to the articular surface and cartilage at the time of injury, which may constitute an additional risk factor for later knee osteoarthritis development.
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| 9. |
- Frobell, Richard, et al.
(författare)
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Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial.
- 2015
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Ingår i: British journal of sports medicine. - : BMJ. - 1473-0480 .- 0306-3674. ; 49:10, s. 700-700
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Tidskriftsartikel (refereegranskat)abstract
- In young active adults with an acute anterior cruciate ligament (ACL) rupture, do patient reported or radiographic outcomes after five years differ between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL reconstruction?
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| 10. |
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| 11. |
- Renstrom, P, et al.
(författare)
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Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement
- 2008
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Ingår i: British journal of sports medicine. - : BMJ. - 1473-0480 .- 0306-3674. ; 42:6, s. 394-412
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Forskningsöversikt (refereegranskat)abstract
- The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery and conservative management; and (5) identify areas for further research. Risk factors for female athletes suffering ACL injury include: (1) being in the preovulatory phase of the menstrual cycle compared with the postovulatory phase; (2) having decreased intercondylar notch width on plain radiography; and (3) developing increased knee abduction moment (a valgus intersegmental torque) during impact on landing. Well-designed injury prevention programmes reduce the risk of ACL for athletes, particularly women. These programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular and proprioceptive training. They emphasise proper landing and cutting techniques. This includes landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion and, where possible, landing on two feet. Players are trained to avoid excessive dynamic valgus of the knee and to focus on the "knee over toe position'' when cutting.
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| 12. |
- Roos, Ewa M., et al.
(författare)
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Knee Injury and Osteoarthritis Outcome Score (KOOS) - Development of a self-administered outcome measure
- 1998
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Ingår i: Journal of Orthopaedic and Sports Physical Therapy. - 0190-6011. ; 28:2, s. 88-96
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Tidskriftsartikel (refereegranskat)abstract
- There is broad consensus that good outcome measures are needed to distinguish interventions that are effective from those that are not. This task requires standardized, patient-centered measures that can be administered at a low cost. We developed a questionnaire to assess short- and long-term patient-relevant outcomes following knee injury, based on the WOMAC Osteoarthritis Index, a literature review, an expert panel, and a pilot study. The Knee Injury and Osteoarthritis Outcome Score (KOOS) is self- administered and assesses five outcomes: pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life. In this clinical study, the KOOS proved reliable, responsive to surgery and physical therapy, and valid for patients undergoing anterior cruciate ligament reconstruction. The KOOS meets basic criteria of outcome measures and can be used to evaluate the course of knee injury and treatment outcome.
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| 13. |
- Roos, E.M., et al.
(författare)
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Long-term outcome of meniscectomy : symptoms, function, and performance tests in patients with or without radiographic osteoarthritis compared to matched controls
- 2001
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Ingår i: Osteoarthritis and Cartilage. - : Elsevier. - 1063-4584 .- 1522-9653. ; 9:4, s. 316-324
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the long-term influence of meniscectomy on pain, functional limitations, and muscular performance. To assess the effects of radiographic osteoarthritis (OA), gender and age on these outcomes in patients with meniscectomy.DESIGN: 159 subjects (35 women), mean age 53 years, were examined 19 (17-22) years after open meniscectomy. Self-reported symptoms and function were assessed, performance tests were carried out and radiographs were taken. Sixty-eight age- and gender-matched controls were examined likewise. The data was analysed in two steps. First, subjects with meniscectomy were compared to the controls, and subgroup analyses were carried out with regard to radiographic OA, gender and age. Second, similar comparisons were carried out within the meniscectomized group.RESULTS: Meniscectomized subjects reported significantly (P< 0.001) more symptoms and functional limitations than did controls. This was also true when operated subjects without OA were compared to controls without OA. Within the meniscectomized group, severe radiographic OA (joint space narrowing grade 2 or more) and female gender, but not older age, was associated with more symptoms and functional limitations. Meniscectomy was associated with worse muscular performance. Female gender and older age were associated with worse muscular performance in the study group.CONCLUSIONS: Meniscectomy is associated with long-term symptoms and functional limitations, especially in women. Patients who had developed severe radiographic OA experienced more symptoms and functional limitations. Age did not influence self-reported outcomes, however older age was associated with worse muscular performance.
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| 14. |
- Roos, Ewa M., et al.
(författare)
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Substantial disability 3 months after arthroscopic partial meniscectomy: : A prospective study of patient-relevant outcomes
- 2000
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Ingår i: Arthroscopy. - : Elsevier BV. - 0749-8063. ; 16:6, s. 619-626
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Tidskriftsartikel (refereegranskat)abstract
- To our knowledge, this is the first prospective study using validated questionnaires to assess patient-relevant outcomes after arthroscopic partial meniscectomy. Data from the Knee Injury and Osteoarthritis Outcome Score (KOOS), the SF-36 Medical Outcomes Study Short-Form Health Survey, and the Lysholm Knee Scoring Scale were available for 74 consecutive patients (50 males, 24 females; mean age, 45 years) with isolated meniscus tear (n = 47) or meniscus tear combined with cartilage damage (n = 27). At postoperative follow-up (mean, 14.4 weeks) significant improvement was seen, but despite only minor pain and other symptoms postoperatively, significant physical disability and handicap were reported. Postoperatively, 30% of patients were active in sports compared with 63% before injury. A sedentary lifestyle was reported by 38% compared with 9% before injury. We conclude that patient-relevant outcomes provide additional information and should be assessed after arthroscopic partial meniscectomy. We further suggest that preoperative information for the meniscectomy patient should include a realistic expected functional outcome.
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| 15. |
- Roos, Ewa M., et al.
(författare)
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WOMAC Osteoarthritis Index - Additional dimensions for use in subjects with post-traumatic osteoarthritis of the knee
- 1999
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Ingår i: Osteoarthritis and Cartilage. - : Elsevier BV. - 1063-4584. ; 7:2, s. 216-221
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare the sensitivity of WOMAC and the two added dimensions Sport and Recreation Function and Knee Related Quality of Life in subjects with radiographic knee OA to that in controls. To study the influence of age on the reported outcomes. Design: Outcomes were compared between subjects having had meniscectomy 21 years ago and which at time of follow-up had definite radiographic OA (N=41, mean age 57), and age- and sex- matched controls without radiographic OA (N=50, mean age 53). For the purpose of studying the impact of age, the groups were divided in two age groups, younger and older than 50 years, respectively. Close to 50% of both groups reported current physical activity levels of at least recreational golf, dancing, hiking, etc. Symptoms and function were assessed by WOMAC Osteoarthritis Index and the added dimensions Sport and Recreational Function (Sport/Rec) and Knee Related Quality of Life (QOL). A percentage score was calculated, 0 indicating extreme knee problems and 100 indicating no knee problems. Results: The control group had mean scores of 88-98 for the different dimensions. The OA group scored significantly lower in all dimensions (P
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| 16. |
- Roos, Harald, et al.
(författare)
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Knee osteoarthritis after meniscectomy : Prevalence of radiographic changes after twenty-one years, compared with matched controls
- 1998
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Ingår i: Arthritis and Rheumatism. - 0004-3591. ; 41:4, s. 687-693
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To study the long-term outcome of surgical removal of a meniscus in the knee with regard to radiographic signs of osteoarthritis (OA). Methods. Of the 123 patients who underwent an open meniscectomy due to an isolated meniscus tear in 1973 at Lund University Hospital, 107 were followed up 21 years later by clinical examination and by review of knee radiographs obtained with weight bearing. Seventy-nine of the 107 patients were men, and the mean age of the total study group at examination was 55 years (range 35-77). Sixty-eight sex- and age-matched individuals with healthy knees served as controls. Results. Mild radiographic changes were found in 76 (71%) of the knees, while more advanced changes, comparable with a Kellgren-Lawrence grade of 2 or higher, were seen in 51 (48%). The corresponding prevalence values in the control group were 12 (18%) and 5 (7%), respectively. The relative risk for the presence of the more advanced radiographic changes representing definite radiographic tibiofemoral OA was 14.0 (95% confidence interval 3.5-121.2), using age- and sex-matched pairs for comparison. No correlation with sex, localization to compartment, type of meniscus tear, or work load was found. Knee symptoms were reported twice as often in the study group as in the controls. Conclusion. Surgical removal of a meniscus following knee injury represents a significant risk factor for radiographic tibiofemoral OA, with a relative risk of 14.0 after 21 years.
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| 17. |
- von Porat, Anette, et al.
(författare)
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High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes.
- 2004
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 63:3, s. 269-273
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To identify the consequences of an anterior cruciate ligament (ACL) tear in a cohort of male soccer players 14 years after the initial injury with respect to radiographic knee osteoarthritis and patient relevant outcomes. Methods: Of 219 male soccer players with an ACL injury in 1986, 205 (94%) were available for follow up after 14 years; 75% of the cohort (154/205) answered mailed questionnaires (KOOS, SF-36, and Lysholm knee scoring scale) and 122 of these consented to weight bearing radiographs. Results: Radiographic changes were found in 95 (78%) of the injured knees, while more advanced changes, comparable with Kellgren-Lawrence grade 2 or higher, were seen in 50 (41%). In the uninjured knees more advanced changes, comparable with Kellgren-Lawrence grade 2 or higher, were seen in five knees (4%). No differences were seen between surgically and conservatively treated players. The patient relevant outcome was affected and did not differ between subjects with and without radiographic changes. Eighty per cent reported reduced activity level. Conclusions: A high prevalence of radiographic knee osteoarthritis was seen in male soccer players 14 years after an ACL disruption. The injury and the osteoarthritis, irrespective of the treatment provided to these patients, often result in knee related symptoms that severely affect the knee related quality of life by middle age.
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| 18. |
- Östenberg, Anna, et al.
(författare)
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Physical capacity in female soccer players : does age make a difference?
- 2000
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Ingår i: Advances in Physiotherapy. - : Taylor & Francis. - 1403-8196 .- 1651-1948. ; 2:1, s. 39-48
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Tidskriftsartikel (refereegranskat)abstract
- There is an increased risk of injuries, especially knee injuries, in young female soccer players. If age-related differences in physical capacity could be identified, the possibilities for injury prevention may increase. The objective was to study possible age-related differences in isokinetic muscle strength, aerobic capacity, functional performance, and general joint laxity in female soccer players. Body mass index (BMI) (kg × m-2) was also measured. In total 108 players, recruited from seven soccer teams, were tested. The mean age was 20.2 years (SD=4.1, range=14-30). Players aged ≦20 years and>20 years were compared. The following tests were employed: isokinetic knee extensor and flexor strength at velocities of 60 °/s and 180°/s, one-leg hop, triple jump, vertical jump, square-hop, and aerobic capacity. The older group had greater isokinetic strength for the flexor muscles at a peak torque of 60°/s (p=0.04), and total work at 60°/s and 180°/s (p=0.04 and 0.03). The older group had a higher BMI and more years of soccer playing (p≪0.001). The results revealed no significant differences between the age groups regarding, functional performance, aerobic capacity, or general joint laxity. Further studies are needed on intrinsic risk factors to identify variables explaining the difference in injury rate between younger and older players.
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| 19. |
- Adolfsson, Peter, et al.
(författare)
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Speciella aspekter på damfotboll
- 1998. - 1
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Ingår i: Fotbollsmedicin. - Solna : Svenska fotbollförbundet. - 9188474062 ; , s. 435-450
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 20. |
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| 21. |
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| 22. |
- Beynnon, Bruce D, et al.
(författare)
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Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Double-Blind Comparison of Programs Administered Over 2 Different Time Intervals.
- 2005
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 33:3, s. 347-359
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Tidskriftsartikel (refereegranskat)abstract
- There are adverse effects associated with immobilization of the knee after anterior cruciate ligament reconstruction, yet very little is known about how much activity will promote adequate rehabilitation without permanently elongating the graft, producing graft failure, or creating damage to articular cartilage. Hypothesis Rehabilitation with either an accelerated or nonaccelerated program produces no difference in anterior-posterior knee laxity, clinical assessment, patient satisfaction, functional performance, and the synovial fluid biomarkers of articular cartilage metabolism. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods Twenty-five patients who tore their anterior cruciate ligament were enrolled and underwent anterior cruciate ligament reconstruction. Patients were randomized to accelerated rehabilitation or nonaccelerated rehabilitation. At the time of surgery and 3, 6, 12, and 24 months later, measurements of anterior-posterior knee laxity, clinical assessment, patient satisfaction, functional performance, and cartilage metabolism were completed. Results At the 2-year follow-up, there was no difference in the increase of anterior knee laxity relative to the baseline values that were obtained immediately after surgery between the 2 groups (2.2-mm vs 1.8-mm increase relative to the normal knee). The groups were similar in terms of clinical assessment, patient satisfaction, activity level, function, and response of the bio-markers. After 1 year of healing, synthesis of collagen and turnover of aggrecan remained elevated in both groups. Conclusion Anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft followed by either accelerated or nonaccelerated rehabilitation produces the same increase of anterior knee laxity. Both programs had the same effect in terms of clinical assessment, patient satisfaction, functional performance, and the biomarkers of articular cartilage metabolism. There is concern that the cartilage biomarkers remained elevated for an extended period.
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| 23. |
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| 24. |
- Celemín, Enrique, et al.
(författare)
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Evolutionary history and seascape genomics of Harbour porpoises (Phocoena phocoena) across environmental gradients in the North Atlantic and adjacent waters
- 2023
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Ingår i: Molecular Ecology Resources. - 1755-098X .- 1755-0998.
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Tidskriftsartikel (refereegranskat)abstract
- The Harbour porpoise (Phocoena phocoena) is a highly mobile cetacean species primarily occurring in coastal and shelf waters across the Northern hemisphere. It inhabits heterogeneous seascapes broadly varying in salinity and temperature. Here, we produced 74 whole genomes at intermediate coverage to study Harbour porpoise's evolutionary history and investigate the role of local adaptation in the diversification into subspecies and populations. We identified ~6 million high quality SNPs sampled at eight localities across the North Atlantic and adjacent waters, which we used for population structure, demographic and genotype–environment association analyses. Our results suggest a genetic differentiation between three subspecies (P.p. relicta, P.p. phocoena and P.p. meridionalis), and three distinct populations within P.p. phocoena: Atlantic, Belt Sea and Proper Baltic Sea. Effective population size and Tajima's D suggest population contraction in Black Sea and Iberian porpoises, but expansion in the P.p. phocoena populations. Phylogenetic trees indicate post-glacial colonization from a southern refugium. Genotype–environment association analysis identified salinity as major driver in genomic variation and we identified candidate genes putatively underlying adaptation to different salinity. Our study highlights the value of whole genome resequencing to unravel subtle population structure in highly mobile species, shows how strong environmental gradients and local adaptation may lead to population differentiation, and how neutral and adaptive markers can give different perspectives on population subdivision. The results have great conservation implications as we found inbreeding and low genetic diversity in the endangered Black Sea subspecies and identified the critically endangered Proper Baltic Sea porpoises as a separate population.
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| 25. |
- Frobell, Richard, et al.
(författare)
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Acute rotational trauma to the knee: poor agreement between clinical assessment and magnetic resonance imaging findings.
- 2007
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Ingår i: Scandinavian Journal of Medicine & Science in Sports. - : Wiley. - 1600-0838 .- 0905-7188. ; 17:2, s. 109-114
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Tidskriftsartikel (refereegranskat)abstract
- To determine the incidence of anterior cruciate ligament (ACL) injuries in the general population; the pathology associated with a knee sprain verified by magnetic resonance imaging (MRI); and the agreement between clinical findings and MRI.Materials and methods: Inclusion criterion was an acute rotational trauma to the knee associated with effusion. One hundred and fifty-nine consecutive patients, mean age 27 years and 36% women, were included after clinical assessment at the orthopedic emergency unit. Patients were referred to an MRI examination (1.0 or 1.5 T) performed within a median of 8 days of the initial visit.Results: The annual incidence of MRI verified ACL injuries was 0.81/1000 inhabitants aged 10-64 years. Fifty-six percent (n=89) of those included had sustained an ACL injury of whom 38% had an associated medial meniscus tear. There was a poor agreement between initial clinical antero-posterior laxity and MRI verified presence of an ACL tear (kappa 0.281). Every second patellar dislocation was diagnosed as a ligament injury. Conclusions: Our findings indicate that the incidence of ACL injuries is higher than previously described. We also show that the first clinical examination after an acute knee trauma has a low diagnostic value. Further assessment with MRI improves the chances of a correct diagnosis of intraarticular pathology and is recommended in the early phase after a rotational knee trauma.
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| 26. |
- Kobayashi, Tatsuo, et al.
(författare)
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Synovial fluid concentrations of the C-propeptide of type II collagen correlate with body mass index in primary knee osteoarthritis
- 1997
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Ingår i: Annals of the Rheumatic Diseases. - 1468-2060. ; 56:8, s. 500-503
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore in a cross sectional study in patients with primary knee osteoarthritis (OA) the relations between body mass index (BMI), disease stage, and the concentrations of a putative joint fluid marker of type II collagen synthesis, procollagen II C-propeptide.PATIENTS AND METHODS: The study included 142 patients with knee OA (median age 68, median BMI 24.1). OA was staged radiologically. The concentrations in synovial fluid of procollagen II C-propeptide were measured by a sandwich enzyme immunoassay.RESULTS: Joint fluid concentrations of procollagen II C-propeptide were increased in knees with OA (median 3.7 ng/ml), compared with published reference values for knees in healthy adult volunteers (median 1.3 ng/ml). The concentrations of procollagen II C-propeptide were independently related to both OA stage and BMI (rs = 0.343, p < 0.0001 and rs = 0.253, p = 0.002, respectively).CONCLUSIONS: Joint fluid concentrations of this putative marker of collagen II synthesis are high in early and mid-stage OA, but decrease in end stage disease. In addition and for the first time it was shown that the concentrations in synovial fluid of procollagen II C-propeptide increase with increasing BMI in primary knee OA. The increased joint fluid values of this marker in patients with primary knee OA and a high BMI, may reflect increased rates of collagen synthesis in their joint cartilage and could relate to the previously shown increased risk for disease progression in such patients.
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| 29. |
- Kostogiannis, Ioannis, et al.
(författare)
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Activity Level and Subjective Knee Function 15 Years After Anterior Cruciate Ligament Injury: A Prospective, Longitudinal Study of Nonreconstructed Patients.
- 2007
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 35:7, s. 1135-1143
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Tidskriftsartikel (refereegranskat)abstract
- Background: The activity level and subjective knee function after an anterior cruciate ligament (ACL) injury treated without reconstruction have not been well elucidated. Hypothesis: Patients with ACL injury can achieve good knee function and satisfactory long-term activity level when treated by early activity modification combined with rehabilitation. Study Design: Cohort study (prognosis); Level of evidence, 2. Materials and Methods: One hundred patients with an acute total ACL injury were observed for 15 years. All patients initially underwent arthroscopic surgery and a rehabilitation program. They were advised to modify their activity level, especially by avoiding contact sports. Patients with recurrent giving-way episodes and/or secondary meniscal injuries that required fixation (n = 6) were subsequently excluded and underwent reconstruction (n = 22). Sixty-seven patients with unilateral nonreconstructed ACL injury remained at the 15-year follow-up. The Lysholm knee score, Tegner activity level, and a visual analog score for global knee function were recorded at regular intervals. At the final follow-up, patients were further evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) subjective knee evaluation form. Results: Forty patients resumed their preinjury activity level or higher within 3 years. The median activity level 15 years after injury had decreased from 7 to 4 according to Tegner activity scale (P < .001). The mean Lysholm knee score was 96 and 95, 1 and 3 years after injury, respectively, but declined to 86 after 15 years (P < .001). Forty-nine patients had good/excellent results, and 14 had fair (n = 6) or poor function (n = 8) at 15 years. Patients injured in contact sports scored lower in the quality of life subscale of KOOS than those injured in noncontact sports (P < .05). Thirteen of the 67 patients (19%) were reoperated with an arthroscopic procedure because of knee symptoms. Conclusion: Early activity modification and neuromuscular rehabilitation resulted in a good knee function and an acceptable activity level in the majority of the non reconstructed patients. The decline in activity level of patients engaged in contact sports at the time of injury affected their subjective quality of life more than patients involved in noncontact sports.
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| 30. |
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| 31. |
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| 32. |
- Kostogiannis, Ioannis, et al.
(författare)
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Clinically Assessed Knee Joint Laxity as a Predictor for Reconstruction After an Anterior Cruciate Ligament Injury: A Prospective Study of 100 Patients Treated With Activity Modification and Rehabilitation.
- 2008
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 36:8, s. 1528-1533
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The association of early knee joint laxity with the need for later reconstruction of the anterior cruciate ligament has not been extensively studied. HYPOTHESIS: The grade of knee laxity can be used as an early predictor of the need for later reconstruction. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: One hundred consecutive patients with an acute arthroscopically verified total anterior cruciate ligament rupture were followed prospectively for 15 years. Lachman and pivot-shift tests were performed with the patient under general anesthesia before arthroscopy. After 3 months, the tests were repeated in an ordinary clinical setting. All patients underwent rehabilitation as the first choice of treatment. Anterior cruciate ligament reconstruction was performed only in cases of significant reinjuries (n = 16) or reparable meniscal lesions (n = 6) at a mean of 4 years after injury (range, 4 months-11 years). After 15 years, 94 patients were available for follow-up. RESULTS: Of the later reconstructed patients (n = 18), 82% had a high-grade Lachman test under anesthesia compared with 63% of the nonreconstructed patients (n = 45; P = .048). At 3 months, 44% of the nonreconstructed patients (n = 32) had a high-grade Lachman test compared with 82% of the reconstructed patients (n = 18; P = .007). Twenty-five patients displayed a normal pivot-shift test at 3 months, of whom 1 underwent later reconstruction (P = .009). A high-grade pivot-shift test at 3 months was associated with an 11.4 relative risk for reconstruction. CONCLUSION: A positive pivot-shift test at 3 months after injury in an awake patient is the strongest predictor for the future need for reconstruction. Furthermore, a normal pivot-shift test at 3 months indicates a low risk for reconstruction and is characteristic for copers.
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| 33. |
- Kostogiannis, Ioannis, et al.
(författare)
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The influence of posterior-inferior tibial slope in ACL injury.
- 2011
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 1433-7347 .- 0942-2056. ; 19, s. 592-597
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To explore the effect of different posterior-inferior tibial slope (PITS) angles on ACL injury at non-contact sports, knee laxity and the need for ACL reconstruction. METHODS: One hundred patients with an acute, arthroscopically verified total ACL rupture were followed prospectively with the intention of treating the injury without reconstruction. Knee laxity was assessed with the Lachman and pivot shift tests with the patients under general anesthesia within 10 days of injury. After 15 years, 22 patients of 94 available for follow-up had undergone reconstruction a mean of 4 years after injury. Reconstruction was performed in case of repeated giving-way episodes (n = 16) or meniscus lesions suitable for fixation (n = 6). Knee radiographs were available from 82 patients. Two independent readers determined the PITS angle. RESULTS: Patients injured in contact sports had a greater mean PITS angle than those injured in non-contact sports (10.5° and 9.3°, respectively, P = 0.03). The mean PITS angle was 10.1 (SD = 2.3) for non-reconstructed knees and 9.1 (SD = 3.0) for reconstructed knees (P = NS). Eight of 17 reconstructed knees showed a PITS angle of less than 7.6° (P = 0.006), and the odds ratio of need for reconstruction was 3.9 (CI 1.26-12.3, P = 0.02). No significant difference in PITS angle was found between patients with low- and high-grade instability. CONCLUSION: The main finding of the study was that reconstructed knees were overrepresented in knees with extremely low PITS angles. Additionally, patients injured in contact sports had higher PITS angles than those injured in non-contact sports, and PITS angle did not influence knee laxity.
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| 34. |
- Kristenson, Karolina, 1984-
(författare)
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Risk factors for injury in men´s professional football
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis includes four papers based on three different prospective cohort studies on injury characteristics in men’s professional football. The same general methodology was used in all papers. Time-loss injuries and player individual exposure was registered for match and training separately. The general aim was to investigate potential internal and external risk factors for injury, with a focus on age, playing position, time in professional football, playing surface (artificial turf and natural grass), changes between surfaces and climate; and to evaluate the study methodology.Paper I was based on data collected between 2001 and 2010 from 26 top professional clubs in Europe; the UCL injury study. In total, 6140 injuries and 797 389 hours of exposure were registered. A decreased general injury rate was observed for newcomers compared with established players (hazard ratio (HR), 0.77; 95% CI 0.61-0.99). Using goalkeepers as a reference, all outfield playing positions had significantly higher age-adjusted injury rates. Using players aged ≤ 21 years as a reference, the overall adjusted injury rate increased with age, with a peak injury rate among players aged 29 to 30 years (HR, 1.44; 95% CI, 1.24-1.68).Paper II and Paper III are based on data collected during two consecutive seasons, 2010 and 2011, in the Swedish and Norwegian male first leagues. In total, 2186 injuries and 367 490 hours of football exposure were recorded. No statistically significant differences were found in acute injury rates on artificial turf (AT) compared with natural grass (NG) during match play (rate ratio, 0.98, 99% CI 0.79-1.22) or training (rate ratio 1.14, 99% CI 0.86-1.50) when analysing at the individual player level. However, when analysing at the club level, clubs with AT installed at their home arena had a significantly higher acute training injury rate (rate ratio 1.31, 99% CI 1.04-1.63) and overuse injury rate (rate ratio 1.38, 99% CI 1.14-1.65) compared to clubs with NG installed at their home venue. No association was found between frequent surface shifts and subsequent overuse injury risk (risk ratio 1.01, 95% CI 0.91-1.12). Analyses on the total cohort showed no difference in injury rates between clubs in the two climate zones (total rate ratio 1.01, 95% CI 0.92-1.10).Data included in Paper IV were collected during two consecutive seasons 2008 and 2009. During this period, two Norwegian elite football clubs were concurrently included in two research groups’ surveillance systems. The capture rate for match injuries was similar between the two audits, while the capture rate for training injuries was slightly higher with individual-based exposure recording. The inter-rater agreement in injury variable categorisations was in most aspects very high.
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| 35. |
- Lah, Ljerka, et al.
(författare)
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Spatially Explicit Analysis of Genome-Wide SNPs Detects Subtle Population Structure in a Mobile Marine Mammal, the Harbor Porpoise
- 2016
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:10, s. e0162792-
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Tidskriftsartikel (refereegranskat)abstract
- The population structure of the highly mobile marine mammal, the harbor porpoise (Phocoena phocoena), in the Atlantic shelf waters follows a pattern of significant isolation-bydistance. The population structure of harbor porpoises from the Baltic Sea, which is connected with the North Sea through a series of basins separated by shallow underwater ridges, however, is more complex. Here, we investigated the population differentiation of harbor porpoises in European Seas with a special focus on the Baltic Sea and adjacent waters, using a population genomics approach. We used 2872 single nucleotide polymorphisms (SNPs), derived from double digest restriction-site associated DNA sequencing (ddRAD-seq), as well as 13 microsatellite loci and mitochondrial haplotypes for the same set of individuals. Spatial principal components analysis (sPCA), and Bayesian clustering on a subset of SNPs suggest three main groupings at the level of all studied regions: the Black Sea, the North Atlantic, and the Baltic Sea. Furthermore, we observed a distinct separation of the North Sea harbor porpoises from the Baltic Sea populations, and identified splits between porpoise populations within the Baltic Sea. We observed a notable distinction between the Belt Sea and the Inner Baltic Sea sub-regions. Improved delineation of harbor porpoise population assignments for the Baltic based on genomic evidence is important for conservation management of this endangered cetacean in threatened habitats, particularly in the Baltic Sea proper. In addition, we show that SNPs outperform microsatellite markers and demonstrate the utility of RAD-tags from a relatively small, opportunistically sampled cetacean sample set for population diversity and divergence analysis.
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| 36. |
- Lohmander, L. Stefan, et al.
(författare)
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Cartilage matrix metabolism in osteoarthritis : markers in synovial fluid, serum, and urine
- 1992
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Ingår i: Clinical Biochemistry. - 0009-9120. ; 25:3, s. 167-174
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Tidskriftsartikel (refereegranskat)abstract
- Osteoarthritis is a major cause of disability and early retirement. Yet we lack the means to diagnose the disease in its early stages or to monitor the effects of treatment on the target tissue, the joint cartilage. Neither can we identify the disease mechanisms at the tissue or cell level. Current research focuses on the use of markers of cartilage matrix metabolism in body fluids as a means to diagnose and monitor osteoarthritis. Cartilage proteoglycan, collagen and glycoprotein fragments, as well as proteinases and their inhibitors, are being suggested for this purpose. Structural information on matrix molecule fragments released into body fluids may also help to identify the enzymes active in the destruction of the cartilage, a central issue in osteoarthritis.
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| 37. |
- Lohmander, L. Stefan, et al.
(författare)
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Knee ligament injury, surgery and osteoarthrosis : Truth or consequences?
- 1994
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 0001-6470. ; 65:6, s. 605-609
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Tidskriftsartikel (refereegranskat)abstract
- We reviewed reports that describe development of osteoarthrosis of the knee after anterior cruciate ligament or meniscus injury. the occurrence of posttraumatic osteoarthrosis varied considerably from one report to another. the literature does not lend support to the efficacy of cruciate ligament repair or reconstruction in retarding the progression of osteoarthrosis after knee injury. We encourage prospective, controlled, randomized and masked studies that aim to evaluate the utility of ligament reconstruction, meniscus suture or meniscus transplantation for preventing posttraumatic osteoarthrosis.
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| 38. |
- Lohmander, Stefan, et al.
(författare)
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High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury
- 2004
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Ingår i: Arthritis and Rheumatism. - : John Wiley & Sons. - 0004-3591 .- 1529-0131. ; 50:10, s. 3145-3152
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine the prevalence of radiographic knee osteoarthritis (OA) as well as knee-related symptoms and functional limitations in female soccer players 12 years after an anterior cruciate ligament (ACL) injury.METHODS: Female soccer players who sustained an ACL injury 12 years earlier were examined with standardized weight-bearing knee radiography and 2 self-administered patient questionnaires, the Knee Injury and Osteoarthritis Outcome Score questionnaire and the Short Form 36-item health survey. Joint space narrowing and osteophytes were graded according to the radiographic atlas of the Osteoarthritis Research Society International. The cutoff value to define radiographic knee OA approximated a Kellgren/Lawrence grade of 2.RESULTS: Of the available cohort of 103 female soccer players, 84 (82%) answered the questionnaires and 67 (65%) consented to undergo knee radiography. The mean age at assessment was 31 years (range 26-40 years) and mean body mass index was 23 kg/m2 (range 18-40 kg/m2). Fifty-five women (82%) had radiographic changes in their index knee, and 34 (51%) fulfilled the criterion for radiographic knee OA. Of the subjects answering the questionnaires, 63 (75%) reported having symptoms affecting their knee-related quality of life, and 28 (42%) were considered to have symptomatic radiographic knee OA. Slightly more than 60% of the players had undergone reconstructive surgery of the ACL. Using multivariate analyses, surgical reconstruction was found to have no significant influence on knee symptoms.CONCLUSION: A very high prevalence of radiographic knee OA, pain, and functional limitations was observed in young women who sustained an ACL tear during soccer play 12 years earlier. These findings constitute a strong rationale to direct increased efforts toward prevention and better treatment of knee injury.
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| 39. |
- Messner, Karola, et al.
(författare)
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Editorial
- 2000
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Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : John Wiley & Sons. - 0905-7188 .- 1600-0838. ; 10:4, s. 183-185
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 40. |
- Neuman, Paul, et al.
(författare)
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Knee laxity after complete anterior cruciate ligament tear: a prospective study over 15 years.
- 2012
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Ingår i: Scandinavian Journal of Medicine & Science in Sports. - : Wiley. - 1600-0838 .- 0905-7188. ; 22, s. 156-163
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Tidskriftsartikel (refereegranskat)abstract
- There is limited knowledge of knee laxity in the long term after a complete anterior cruciate ligament (ACL) tear treated without ACL reconstruction. The aim of this study was (1) to describe the clinical course of knee laxity after a complete ACL tear over 15 years, and (2) to study the association between knee laxity and meniscal injuries and the development of knee osteoarthritis (OA). We studied 100 consecutive subjects [mean (SD) age 26 (8) years] presenting with acute ACL injury prospectively. The initial treatment in all subjects was knee rehabilitation without reconstructive surgery. The subjects were examined with Lachman's and pivot-shift tests at baseline, 6 weeks, 3 months, 1 year, 3 years and 15 years after the injury. Sagittal knee laxity was also evaluated with the KT-1000 arthrometer at the 15-year follow-up. During follow-up, 22 subjects were ACL reconstructed due to unacceptable knee instability. There was only a mild remaining knee laxity [median Lachman grade and pivot-shift test value of 1 on a 4-grade scale (0-3)] after 15 years in subjects treated without primary ACL reconstruction. Knees with higher anterior sagittal knee laxity 3 months after the injury had a worse long-term outcome with respect to meniscal injuries and knee OA development.
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| 41. |
- Neuman, Paul, et al.
(författare)
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Longitudinal assessment of femoral knee cartilage quality using contrast enhanced MRI (dGEMRIC) in patients with anterior cruciate ligament injury - comparison with asymptomatic volunteers.
- 2011
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Ingår i: Osteoarthritis and Cartilage. - : Elsevier BV. - 1063-4584. ; 19, s. 977-983
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: In this observational longitudinal study we estimate knee joint cartilage glycosaminoglycan (GAG) content, in patients with an acute anterior cruciate ligament (ACL) injury, with or without a concomitant meniscus injury. METHODS: 29 knees (19 men/10 women) were prospectively examined by repeat delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC), approximately 3 weeks and 2.3±1.3 (range 4.5) years after the injury. We estimated the GAG content (T1Gd) in the central weight-bearing parts of the medial and lateral femoral cartilage and compared results with a reference cohort (n=24) with normal knees and no history of injury examined by dGEMRIC at one occasion previously. RESULTS: The healthy reference group had longer T1Gd values compared with the ACL-injured patients at follow-up both medially: 428±38 vs 363±61ms (P<0.0001) and laterally: 445±41 vs 396±48ms (P=0.0002). At follow-up T1Gd was lower in meniscectomized patients compared to those without a meniscectomy, both medially (-84ms, P=0.002) and laterally (-38ms, P=0.05). In the injured group, the medial femoral cartilage showed similar T1Gd at the two dGEMRIC investigations: 357±50 vs 363±61ms (P=0.57), whereas the lateral femoral cartilage T1Gd increased: 374±48 vs 396±48ms (P=0.04). CONCLUSIONS: The general decrease in cartilage T1Gd in ACL-injured patients compared with references provide evidence for structural matrix GAG changes that seem more pronounced if a concomitant meniscal injury is present. The fact that post-traumatic OA commonly develops in ACL-injured patients, in particularly those with meniscectomy, suggests that shorter T1Gd may be an early biomarker for OA.
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| 42. |
- Neuman, Paul, et al.
(författare)
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Patellofemoral osteoarthritis 15 years after anterior cruciate ligament injury - a prospective cohort study.
- 2009
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Ingår i: Osteoarthritis and Cartilage. - : Elsevier BV. - 1063-4584. ; Sep 2, s. 284-290
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Prevalence and clinical relevance of patellofemoral (PF) osteoarthritis (OA) after anterior cruciate ligament (ACL) injury. METHOD: Prospectively we studied 94 out of 100 consecutive patients 15 years after acute ACL injury. ACL reconstructions were only performed late if recurrent "give way" persisted or a secondary meniscal injury suitable for repair occurred. The subjects, mean age 42 years, had knee radiographs including skyline PF view taken, which were graded according to the atlas of the Osteoarthritis Research Society International. Knee-related symptoms and function were assessed by questionnaires. RESULTS: PF OA was present in 12/75 knees (16%). Of 94 patients 22 (23%) have had their ACL reconstructed during follow-up. Meniscal injury and ACL reconstruction had occurred more often in knees with PF OA than in knees without PF OA (P=0.004 and P=0.002, respectively). Seven of 15 ACL reconstructed knees showed radiographic PF OA at follow-up. Knees with PF OA had more extension and flexion deficit than knees without PF OA. Subjects with PF OA maintained a higher activity level from injury to follow-up, but did not differ significantly from those without PF OA regarding patient-relevant symptoms and knee function. However, there was a trend for worse outcome in subjects with PF OA. CONCLUSION: We found a relatively low prevalence of mild PF OA after ACL injury treated non-operatively, and it had limited impact on knee symptoms and patient-relevant knee function. At follow-up PF OA was associated with higher activity level, meniscal injury, extension and flexion deficit, and ACL reconstruction.
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| 43. |
- Neuman, Paul, et al.
(författare)
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Prevalence of Tibiofemoral Osteoarthritis 15 Years After Nonoperative Treatment of Anterior Cruciate Ligament Injury: A Prospective Cohort Study.
- 2008
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 36:9, s. 1717-1725
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The occurrence of osteoarthritis (OA), associated meniscal injuries, meniscectomy, and patient-related measures for patients treated nonoperatively after anterior cruciate ligament (ACL) injuries have not been well described in the literature in terms of natural history. HYPOTHESIS: Patients with ACL injury can achieve a low occurrence of tibiofemoral OA and good knee function when treated without ACL reconstruction. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: One hundred consecutive patients with an acute, complete ACL injury were observed for 15 years. All patients were primarily treated with activity modification and without ACL reconstruction. To achieve improved functional stability, supervised physical therapy was initiated early after injury. The patients were examined using anteroposterior weightbearing radiography. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used to quantify knee-related symptoms and knee function. RESULTS: Seventy-nine patients consented to radiographic examination and 93 completed the KOOS questionnaire. Thirteen patients (16%), all of whom were among the 35 patients whose knees were meniscectomized, developed radiographic tibiofemoral OA. In contrast, none of the remaining nonmeniscectomized and radiographed knees developed OA (n = 44) (P < .0001). Sixty-three patients (68%) had an asymptomatic knee. Twenty-two patients (23%) had undergone ACL reconstruction with a mean time of 4 years after injury. CONCLUSION: The study had a favorable long-term outcome regarding incidence of radiographic knee OA, knee function and symptoms, and need for ACL reconstruction. Although risk factors for posttraumatic OA are multifactorial, the primary risk factor that stood out in this study was if a meniscectomy had been performed. Early activity modification and neuromuscular knee rehabilitation might also have been related to the low prevalence of radiographic knee OA. In patients with ACL injury willing to moderate activity level to avoid reinjury, initial treatment without ACL reconstruction should be considered.
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| 44. |
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| 45. |
- Roos, Harald, et al.
(författare)
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Markers of cartilage matrix metabolism in human joint fluid and serum : the effect of exercise
- 1995
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Ingår i: Osteoarthritis and Cartilage. - 1063-4584 .- 1522-9653. ; 3:1, s. 7-14
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Tidskriftsartikel (refereegranskat)abstract
- The concentrations of cartilage proteoglycan (aggrecan), stromelysin-1, tissue inhibitor of metalloproteinases-1 (TIMP-1) and procollagen II C-propeptide in knee joint fluid and the levels of aggrecan, hyaluronan and keratan sulfate in serum were measured before and after exercise in 33 healthy athletes. The samples before exercise were obtained after 24 h rest from running or soccer and the samples after exercise were obtained 30-60 min after the exercise. Nine athletes ran on a treadmill for 60 min, 16 ran on road for 80 min and 8 played one soccer game (90 min). A reference group of 28 patients with knee pain but not evidence of joint pathology or injury was used for comparison. In joint fluid no single marker from the degradative processes in cartilage matrix changed significantly with exercise but all showed a rising trend. All markers except stromelysin showed lower concentrations in athletes at rest compared to the reference group. In serum from runners before exercise the concentration of keratan sulfate was significantly higher than in both the soccer and reference groups and further increased after exercise. The increase in markers after exercise may reflect an effect of mechanical loading in combination with a possible high turnover rate of body cartilage matrix in these individuals.
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| 46. |
- Roos, Harald, et al.
(författare)
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Menisk- och korsbandsskador
- 2007
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Ingår i: Läkartidningen. - 0023-7205. ; 104:19, s. 13-1509
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Tidskriftsartikel (refereegranskat)abstract
- The treatment of meniscus tears and anterior cruciate ligament (ACL) injuries are mainly considered as symptomatic. Meniscus tears can be divided into traumatic and degenerative tears, with different outcomes. A displaced meniscus with a locked knee constitutes an acute indication for arthroscopic surgery. A degenerative tear with mechanical symptoms also represents an indication for surgery. The main principle for treating an acute ACL injury is non-surgical treatment with a well-controlled muscular rehabilitation program for 3-4 months. If symptomatic instability remains, ACL reconstruction is considered. In highly active patients and also if there is a repairable associated meniscus tear, a subacute ACL reconstruction is recommended. Both meniscus tears and ACL injuries increase the risk of developing early osteoarthritis. Surgical procedures such as meniscus fixation or ACL reconstruction have not been shown to reduce the risk of osteoarthritis. Thus, prevention of osteoarthritis does not constitute an indication for surgical treatment of these injuries.
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| 47. |
- Roos, Harald, et al.
(författare)
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Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus : the influence of time and age
- 1995
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Ingår i: Osteoarthritis and Cartilage. - 1063-4584. ; 3:4, s. 261-267
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Tidskriftsartikel (refereegranskat)abstract
- The degree of cartilage changes by arthroscopic and radiologic examination was evaluated in a retrospective, cross-sectional study of 1012 patients with knee complaints at different times after knee injury. Patients were classified by age, sex, trauma date and type of injury. The condition of the cartilage was graded on a 1-10 scale based on findings at arthroscopy and on weight-bearing radiographs. Patients with injury to the anterior cruciate ligament (isolated or combined with injury to meniscus or collateral ligaments) showed the first radiologic signs (joint space narrowing) of osteoarthritis (OA) at an average age of about 40 years, while patients with isolated meniscus injury had the same stage of disease at an average age of about 50 years. Both study groups displayed the first radiologic signs of OA on average about 10 years after the injury and showed increasingly serious arthroscopic and radiologic signs of joint damage with increased time between injury and examination. For patients who sustained an isolated meniscus injury between the ages of 17 and 30, the average time until development of radiologic signs of OA was about 15 years, while for those who had the same injury over the age of 30, the corresponding time interval was only about 5 years. We conclude from this that knee OA becomes increasingly severe with increased time between joint injury and examination. OA changes appear sooner in older patients with knee injury than in the young.
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| 48. |
- Roos, Harald, et al.
(författare)
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Soccer after anterior cruciate ligament injury - An incompatible combination? A national survey of incidence and risk factors and a 7-year follow-up of 310 players
- 1995
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 0001-6470. ; 66:2, s. 107-112
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Tidskriftsartikel (refereegranskat)abstract
- All players in Swedish soccer teams are required to have insurance in the same company. from the archives of the insurance company, all 3,735 injuries reported in 1986 in 188,152 Swedish soccer players were reviewed. of these, 937 were knee injuries. All players were asked by mail to fill in a questionnaire and 83 percent replied. the patient records from the different hospitals were requested. the anterior cruciate injuries represented one third of the reported knee injuries. the relative risk of sustaining an anterior cruciate ligament Injury was increased in female players, in elite players, and in players in the forward position. the odds ratios were 1.6 (1.3-2.1), 3.3 (1.7-6.1) and 1.8 (1.4-2.5), respectively. the injuries occurred at a younger age in females than in males. 50 percent of the injured players were treated with anterior cruciate ligament surgery, predominantly as a reconstructive procedure, with use of a patellar tendon transplant. 30 (20) percent of the players with anterior cruciate ligament injury were active in soccer after 3 (7) years, compared to 80 (50) percent of an uninjured control population of soccer players. None of the elite players was active at the same level after 7 years. A comparison of anterior cruciate ligament-injured players, whether treated by surgical reconstruction or not, revealed no difference with regard to the proportion of players still playing soccer after 7 years.
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| 49. |
- Roos-Hesselink, Jolien W., et al.
(författare)
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Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 34:9, s. 657-665
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Tidskriftsartikel (refereegranskat)abstract
- Aims To describe the outcome of pregnancy in patients with structural or ischaemic heart disease. Methods and results In 2007, the European Registry on Pregnancy and Heart disease was initiated by the European Society of Cardiology. Consecutive patients with valvular heart disease, congenital heart disease, ischaemic heart disease (IHD), or cardiomyopathy (CMP) presenting with pregnancy were enrolled. Data for the normal population were derived from the literature. Sixty hospitals in 28 countries enrolled 1321 pregnant women between 2007 and 2011. Median maternal age was 30 years (range 16-53). Most patients were in NYHA class I (72%). Congenital heart disease (66%) was most prevalent, followed by valvular heart disease 25%, CMP 7%, and IHD in 2%. Maternal death occurred in 1%, compared with 0.007% in the normal population. Highest maternal mortality was found in patients with CMP. During pregnancy, 338 patients (26%) were hospitalized, 133 for heart failure. Caesarean section was performed in 41%. Foetal mortality occurred in 1.7% and neonatal mortality in 0.6%, both higher than in the normal population. Median duration of pregnancy was 38 weeks (range 24-42) and median birth weight 3010 g (range 300-4850). In centres of developing countries, maternal and foetal mortality was higher than in centres of developed countries (3.9 vs. 0.6%, P < 0.001 and 6.5 vs. 0.9% P < 0.001) Conclusion The vast majority of patients can go safely through pregnancy and delivery as long as adequate pre-pregnancy evaluation and specialized high-quality care during pregnancy and delivery are available. Pregnancy outcomes were markedly worse in patients with CMP and in developing countries.
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| 50. |
- Schwerzmann, Markus, et al.
(författare)
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Recommendations for advance care planning in adults with congenital heart disease: a position paper from the ESC Working Group of Adult Congenital Heart Disease, the Association of Cardiovascular Nursing and Allied Professions (ACNAP), the European Association for Palliative Care (EAPC), and the International Society for Adult Congenital Heart Disease (ISACHD).
- 2020
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Ingår i: European heart journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 41:43, s. 4200-4210
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Tidskriftsartikel (refereegranskat)abstract
- Survival prospects in adults with congenital heart disease (CHD), although improved in recent decades, still remain below expectations for the general population. Patients and their loved ones benefit from preparation for both unexpected and predictable deaths, sometimes preceded by a prolonged period of declining health. Hence, advance care planning (ACP) is an integral part of comprehensive care for adults with CHD. This position paper summarizes evidence regarding benefits of and patients' preferences for ACP and provides practical advice regarding the implementation of ACP processes within clinical adult CHD practice. We suggest that ACP be delivered as a structured process across different stages, with content dependent upon the anticipated disease progression. We acknowledge potential barriers to initiate ACP discussions and emphasize the importance of a sensitive and situation-specific communication style. Conclusions presented in this article reflect agreed expert opinions and include both patient and provider perspectives.
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