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1.	Beischer, Susanne, et al. (author) How Is Psychological Outcome Related to Knee Function and Return to Sport Among Adolescent Athletes After Anterior Cruciate Ligament Reconstruction? 2019 In: American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 47:7, s. 1567-1575 Journal article (peer-reviewed)abstract Background: Adult patients who succeed in returning to their preinjury levels of sport after anterior cruciate ligament (ACL) reconstruction have been characterized by a more positive psychological response. It is not known whether this relationship is valid for adolescent athletes. Purpose: To investigate psychological readiness to return to sport, knee-related self-efficacy, and motivation among adolescent (15-20 years old) and adult (21-30 years old) athletes after ACL reconstruction. A further aim was to compare athletes (15-30 years old) who had recovered their muscle function and returned to sport with athletes who had not. Study Design: Case-control study; Level of evidence, 3. Methods: Data were extracted from a rehabilitation-specific register 8 and 12 months after ACL reconstruction. Athletes previously involved in knee-strenuous sport who had undergone primary ACL reconstruction were included. Data comprised psychological patient-reported outcomes and results from 5 tests of muscle function. Comparisons were performed between age groups, between athletes who had and had not recovered their muscle function, and between patients who had returned to sport and not. Results: In all, 384 (50% females) and 271 athletes (52% females) were included at the 8- and 12- month follow-ups, respectively. Enhanced self-efficacy was reported at both follow-ups by adolescents and by athletes who had recovered their muscle function. Athletes who had recovered their muscle function reported higher (P = .0007) motivation to achieve their goals. Subgroup analyses on patient sex revealed findings similar to those in the main analyses for females but not for males. Moreover, adolescent and adult athletes who had returned to sport reported significantly higher levels on the Knee Self-Efficacy Scale and the ACL-Return to Sport After Injury scale at both follow-ups. Conclusion: Adolescent athletes, especially females, perceived enhanced self-efficacy, had a higher return-to-sport rate, and were more motivated to reach their goals after ACL reconstruction compared with adults. Regardless of age, athletes who had returned to sport and athletes with more symmetrical muscle function had a stronger psychological profile.
2.	Beischer, Susanne, et al. (author) Knee strength, hop performance and self-efficacy at 4 months are associated with symmetrical knee muscle function in young athletes 1 year after an anterior cruciate ligament reconstruction. 2019 In: BMJ open sport & exercise medicine. - : BMJ. - 2055-7647. ; 5:1 Journal article (peer-reviewed)abstract We investigated whether patient demographics, 4-month patient-reported outcomes (PRO) and muscle function predicted young athletes regaining symmetrical muscle function in five tests of muscle function 1year after ACL reconstruction.We extracted data on patient demographics, PROs and the results of five tests of muscle function from a rehabilitation-specific register. Athletes were 15-30 years of age, involved in knee-strenuous sport and had undergone a primary ACL reconstruction. The primary outcome was achieving a Limb Symmetry Index of ≥90% for the battery of tests 1year after ACL reconstruction. Patient demographics, muscle-function data and results for PROs at the 4-month follow-up were analysed.In all, 237 athletes (59% female; mean age 22±4 years) were included in the study. One year after ACL reconstruction, 26% (62/237) of the included athletes had achieved symmetrical muscle function. Univariable analysis showed that symmetrical muscle function was associated with present self-efficacy, OR 1.28 (95%CI 1.04 to 1.58, p=0.011), knee-extension strength, OR 1.73 (95% CI 1.28 to 2.34), knee-flexion strength, OR 1.39 (95% CI 1.07 to 1.81), vertical hop, OR 1.77 (95% CI 1.27 to 2.45), single-leg hop for distance, OR 1.98 (95% CI 1.24 to 3.17) and side hop, OR 1.64 (95% CI 1.15 to 2.33).Symmetrical knee-extension and knee-flexion strength, a more symmetrical hop performance and higher present self-efficacy at an early stage all increased the odds of achieving symmetrical muscle function in young athletes 1year after ACL reconstruction.
3.	Beischer, Susanne, et al. (author) Validation of an 18-item version of the Swedish Knee Self-Efficacy Scale for patients after ACL injury and ACL reconstruction 2021 In: Journal of Experimental Orthopaedics. - : Springer Science and Business Media LLC. - 2197-1153. ; 8:1 Journal article (peer-reviewed)abstract Purpose To evaluate the measurement properties of a new version of the Swedish Knee Self-Efficacy Scale (K-SES) in samples of individuals with an anterior cruciate ligament (ACL) injury and after ACL reconstruction. A secondary aim was to translate the new version of K-SES into English in order to prepare for future complete cross-cultural adaptation. Methods The reliability, structural validity, internal consistency and construct validity of the new, 18-item version of the K-SES (K-SES18) were assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for evaluating methodological quality. The Swedish version of the K-SES18 was translated to English using recommended guidelines. Results The test-retest reliability for the K-SES18 subscale present and the K-SES18 subscale future showed an Interclass Correlation Coefficient (ICC) = 0.92. In addition, the K-SES18 had a Cronbach's alpha ranging from 0.93 to 0.96 for the K-SES18 subscale present and from 0.81 to 0.91 for the K-SES18 subscale future. No floor and ceiling effects were identified for the subscale present or the subscale future of the K-SES18. A factor analysis produced 2 factors of importance; K-SES(18)present and K-SES(18)future. Seven predefined hypotheses were confirmed. Conclusion The K-SES18 has acceptable reliability and validity to assess knee self-efficacy in patients up to 18 months after ACL injury and reconstruction.
4.	Beischer, Susanne, et al. (author) Young athletes return too early to knee-strenuous sport, without acceptable knee function after anterior cruciate ligament reconstruction 2018 In: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 26, s. 1966-1974 Journal article (peer-reviewed)abstract © 2017 The Author(s) Purpose: The purpose of this study was to evaluate the return to knee-strenuous sport rate, muscle function and subjective knee function among adolescent patients (15–20 years of age) and adult patients (21–30 years of age) 8 and 12 months, respectively, after anterior cruciate ligament (ACL) reconstruction. It was hypothesised that no differences in outcome would be found between age groups at 8 or 12 months after ACL reconstruction. Methods: Cross-sectional data from five tests of muscle function, from the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Scale (Tegner), performed at 8 and 12 months after a primary ACL reconstruction, were extracted from a rehabilitation outcome register. A total of 270 (51% women) athletes, aged 15–30 years, who were all involved in knee-strenuous sport prior the injury, were included at 8 months after ACL reconstruction. At 12 months 203 (51% women) were included. The return to knee-strenuous-sport rates and the rate of achieving a limb symmetry index of ≥ 90% in all five tests of muscle function, defined as recovery of muscle function, and subjective knee function scores, as measured with the KOOS, were compared between age groups. Results: The adolescent patients had a higher (50%) return to knee-strenuous sport rate compared with the adult patients (38%) 8 months after ACL reconstruction (p = 0.04). At the 12-month follow-up, no difference was found between the age groups; 74 and 63%, respectively. At the 8-month follow-up, 29% of the patients, in both age groups, who had returned to sport had recovered their muscle function in all five tests of muscle function. At the 12-month follow-up, the corresponding results were 20% for the adolescents and 28% for the adult patients. No difference in mean KOOS scores was found between the age groups at 8 or at 12 months after ACL reconstruction. Conclusion: The majority of young athletes make an early return to knee-strenuous sport after a primary ACL reconstruction, without recovering their muscle function. To set realistic expectations, clinicians are recommended to ensure that young athletes receive information about not to return before muscle function is recovered and that this may take longer time than 12 months. Level of evidence: II.
5.	Beischer, Susanne, et al. (author) Young Athletes Who Return to Sport Before 9 Months After Anterior Cruciate Ligament Reconstruction Have a Rate of New Injury 7 Times That of Those Who Delay Return 2020 In: Journal of Orthopaedic & Sports Physical Therapy. - : Journal of Orthopaedic & Sports Physical Therapy (JOSPT). - 0190-6011 .- 1938-1344. ; 50:2, s. 83-90 Journal article (peer-reviewed)abstract OBJECTIVE: To investigate the association between sustaining a second anterior cruciate ligament (ACL) injury and (1) time to return to sport, (2) symmetrical muscle function, and (3) symmetrical quadriceps strength at the time of return to sport in young athletes after primary ACL reconstruction. DESIGN: Prospective cohort study. METHODS: Patient demographics and results from 5 tests of muscle function (2 strength tests and 3 hop tests) were extracted from a rehabilitation registry. A questionnaire was sent to athletes (1530 years old) who were involved in knee-strenuous sport before the injury and had undergone primary ACL reconstruction to determine time of return to knee-strenuous sport (preinjury Tegner Activity Scale score of 6 or greater). We used the Cox proportional hazard regression model to analyze time to event. RESULTS: One hundred fifty-nine (32% of initial sample) athletes (mean +/- SD age, 21.5 +/- 4.4 years; 64% female) were included. Athletes with a higher preinjury Tegner Activity Scale score had a higher rate of second ACL injury (hazard ratio = 2.1; 95% confidence interval: 1.2, 3.6; P<.01). Athletes who returned to knee-strenuous sport before 9 months after reconstruction had a higher rate of second ACL injury (hazard ratio = 6.7; 95% confidence interval: 2.6,16.7; P<.001). There was no association between symmetrical muscle function or quadriceps strength and second ACL injury. CONCLUSION: Returning to knee-strenuous sport before 9 months after ACL reconstruction was associated with an approximately 7-fold increased rate of sustaining a second ACL injury. Achieving symmetrical muscle function or quadriceps strength was not associated with new ACL injury in young athletes.
6.	Bergman, Henrik, et al. (author) Physical Exercise in Forensic Psychiatric Care 2019 In: 13th Nordic Symposium on Forensic Psychiatry, Gothenburg, August 20-22, 2019.. Conference paper (other academic/artistic)
7.	Bergman, Henrik, et al. (author) Physical performance and physical activity of patients under compulsory forensic psychiatric inpatient care. 2020 In: Physiotherapy theory and practice. - : Informa UK Limited. - 1532-5040 .- 0959-3985. ; 36:4, s. 507-15 Journal article (peer-reviewed)abstract Research stresses the importance of physical activity in general psychiatric care. There is very little research made in the area of forensic psychiatric care. The aim of this exploratory, cross-sectional study was to assess various physical, psychological, and health variables of patients under compulsory forensic psychiatric inpatient care, and to examine correlations among these variables. Maximal oxygen uptake (VO2max), walking ability, running speed, and explosive leg strength were examined in 28 patients. Patients answered questionnaires about physical activity, aggression, stress, character maturity, and health-related quality of life (HRQL). The patients had a mean age of 33.6years, a mean VO2max of 25.3 (8.4) mL 02/min/kg and a mean physical activity level of 268.0 (272.4) min/week. Results from the 6-min walk test were 612.5 (102.8) m. Nine patients had physical activity levels below the international recommendations of 150min/week. Levels of aggression and stress were high and HRQL was low. The results indicate that patients in forensic psychiatric care are in a very poor physical state, which warrants physiotherapeutic interventions, adapted to the unique demands of forensic psychiatric care.
8.	Bergman, Henrik, et al. (author) The use of physical exercise in forensic psychiatric care in Sweden: a nationwide survey. 2021 In: Journal of mental health (Abingdon, England). - : Informa UK Limited. - 1360-0567 .- 0963-8237. ; , s. 1-9 Journal article (peer-reviewed)abstract Exercise protects against somatic comorbidities and positively affects cognitive function and psychiatric symptoms in patients with severe mental illness. In forensic psychiatry, exercise is a novel concept. Staff at inpatient care facilities may be important resources for successful intervention. Little is known about staff's knowledge, attitudes and behaviors regarding exercise in forensic psychiatric care.To translate, culturally adapt and test the feasibility of the Exercise in Mental Health Questionnaire-Health Professionals Version (EMIQ-HP) in the Swedish context, and to use this EMIQ-HP-Swedish version to describe staff's knowledge, attitudes and behaviors regarding exercise.The EMIQ-HP was translated, culturally adapted, pilot-tested and thereafter used in a cross-sectional nationwide survey.Ten of 25 clinics and 239 health professionals (50.1%) participated. Two parts of the EMIQ-HP-Swedish version showed problems. Most participants considered exercise to be a low-risk treatment (92.4%) that is beneficial (99.2%). Training in exercise prescription was reported by 16.3%. Half of participants (52.7%) prescribed exercise and 50.0% of those undertook formal assessments prior to prescribing.Creation of the EMIQ-HP-Swedish version was successful, despite some clarity problems. Exercise appears to be prescribed informally by non-experts in Swedish forensic psychiatric care and does not address treatment goals.
9.	Börjesson, Mats, 1965, et al. (author) Tilltro till den egna förmågan - viktigt för återgång till idrott. 2010 In: Svensk Idrottsforskning. ; 19, s. 64-66 Journal article (other academic/artistic)
10.	Gustavsson, Alexander, et al. (author) A test battery for evaluating hop performance in patients with an ACL injury and patients who have undergone ACL reconstruction 2006 In: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 14:8, s. 778-88 Journal article (peer-reviewed)abstract The purpose of this study was to develop a test battery of hop tests with high ability to discriminate (i.e. high test-retest reliability, sensitivity, specificity and accuracy) between the hop performance of the injured and the uninjured side in patients with an ACL injury and in patients who have undergone ACL reconstruction. Five hop tests were analysed: three maximum single hop tests and two hop tests while developing fatigue. Fifteen healthy subjects performed the five hop tests on three separate occasions in a test-retest design. Thirty patients, mean 11 months after an ACL injury and 35 patients, mean 6 months after ACL reconstruction were tested. ICC values ranged from 0.85 to 0.97 for the five hop tests, indicating that all the tests had high test-retest reliability. Sixty-seven percent to 100% of the healthy subjects had normal symmetry (i.e. <10% side-to-side difference) in the five hop tests. Abnormal symmetry in the five hop tests ranged from 43 to 77% for patients with an ACL injury and from 51 to 86% for patients who had undergone ACL reconstruction respectively. The three tests with the highest ability to discriminate hop performance were chosen for the test battery; they were the vertical jump, the hop for distance and the side hop. The test battery revealed a high level of sensitivity and accuracy in patients with an ACL injury (87 and 84%) and in patients who had undergone ACL reconstruction (91 and 88%), when at least one of the three tests was classified as abnormal. To summarise, the test battery consisting of both maximum single hop performances: the vertical jump and the hop for distance and hop performance while developing fatigue: the side hop, produced high test-retest reliability, sensitivity and accuracy. Further, the test battery produced higher values compared with any of the three hop tests individually revealing that only one out of ten patients had restored hop performance 11 months after an ACL injury and 6 months after ACL reconstruction. It is concluded that this test battery showed a high ability to discriminate between the hop performance of the injured and the uninjured side both in patients with an ACL injury and in patients who have undergone ACL reconstruction.
11.	Hamrin Senorski, Eric, 1989, et al. (author) Concomitant injuries may not reduce the likelihood of achieving symmetrical muscle function oneyear after anterior cruciate ligament reconstruction: a prospective observational study based on 263 patients. 2018 In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 26:10, s. 2966-2977 Journal article (peer-reviewed)abstract A better understanding of patient characteristics and the way common concomitant injuries affect the recovery of muscle function after surgery should help providers to treat patients with anterior cruciate ligament (ACL) injuries. The aim of this study was to determine whether patient characteristics, concomitant injuries and graft choice at ACL reconstruction were associated with symmetrical knee muscle function at one year. The hypothesis was that the presence of concomitant injuries would negatively influence the opportunity to achieve symmetrical knee function at the one-year follow-up.Data was extracted from the Swedish National Knee Ligament Register and a rehabilitation outcome register between August 2012 and December 2016. The patients had been evaluated with a battery of tests comprising knee extension and flexion strength, vertical jump, hop for distance and the side-hop test one year after ACL reconstruction. Univariable and multivariable logistic regression analyses were performed with achieving a limb symmetry index (LSI) of ≥90% in all tests of muscle function as primary outcome.A total of 263 patients with a mean age of 26.7±10.3years were included in the study (47% females). No patient demographic or intra-operative predictors were found to be significant when attempting to predict the achievement of a symmetrical muscle function. Lateral meniscus injury and a patellar tendon autograft reduced the odds of achieving an LSI of ≥90% in knee extension strength, OR=0.49 [(95% CI 0.25-0.97), p=0.039] and OR=0.30 [(95% CI 0.14-0.67), p=0.0033] respectively. In addition, reduced odds of recovering knee extension strength were found in older patients, OR=0.76 [(95% CI 0.60-0.98), p=0.034]. A higher pre-injury level of physical activity increased the odds of recovering knee flexion strength, OR=1.14 [(95% CI 1.01-1.29), p=0.037].Intra-operatively identified concomitant injuries or graft choice did not affect the likelihood of recovering symmetrical performance in five different tests of muscle function one year after ACL reconstruction. However, fewer than one in four patients achieved an LSI of ≥90% in all tests.Prospective observational study: Level 2.
12.	Hamrin Senorski, Eric, 1989, et al. (author) Low 1-Year Return-to-Sport Rate After Anterior Cruciate Ligament Reconstruction Regardless of Patient and Surgical Factors A Prospective Cohort Study of 272 Patients 2018 In: American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 46:7, s. 1551-1558 Journal article (peer-reviewed)abstract Background: There is insufficient knowledge about the way that concomitant injuries affect the short-term likelihood of a return to a knee-strenuous sport after anterior cruciate ligament (ACL) reconstruction. Hypotheses/Purpose: The purpose was to study whether patient characteristics, concomitant injuries, and graft choice at primary ACL reconstruction can predict return to sport (RTS) 1 year after surgery. The hypotheses were that younger age at the time of ACL reconstruction would positively affect RTS, while the presence of concomitant injuries would negatively affect RTS 1 year after surgery. Methods: Data were extracted from a rehabilitation-specific register and the Swedish National Knee Ligament Register. Twelve months after surgery, all patients were evaluated for RTS via the Tegner Activity Scale. The primary outcome was a return to kneestrenuous sport, defined as a Tegner Activity Scale >= 6. Univariable and multivariable logistic regression analyses were performed with patient characteristics, concomitant knee injuries, and graft choice as independent variables. Results: A total of 272 patients (51% female) with a mean +/- SD age of 25.0 +/- 6 9.2 years were included. In the multivariable analysis, a favorable odds ratio (OR) for returning to sport was found for patients of male sex (OR, 2.58; 95% CI, 1.43-4.65; P = .0016), younger age at the time of ACL reconstruction (OR, 2.32; 95% CI, 1.59-3.33; P < 0001), a higher preinjury score on the Tegner Activity Scale (OR, 1.45; 95% CI, 1.13-1.87; P = .0038), and an absence of injury to the meniscus (OR, 1.92; 95% CI, 1.10-3.36; P = .023) and medial collateral ligament (OR, 7.61; 95% CI, 1.42-40.87; P = .018). In addition, the absence of cartilage injury was favorable in terms of RTS in the univariable analysis (OR, 2.48; 95% CI, 1.40-4.39; P = .0018). Conclusion: Positive predictors of a return to knee-strenuous sport 1 year after ACL reconstruction were male sex, younger age, a high preinjury level of physical activity, and the absence of concomitant injuries to the medial collateral ligament and meniscus.
13.	Hamrin Senorski, Eric, 1989, et al. (author) Return to knee-strenuous sport after anterior cruciate ligament reconstruction: a report from a rehabilitation outcome registry of patient characteristics. 2017 In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 25:5, s. 1364-1374 Journal article (peer-reviewed)abstract To characterise patients who returned to knee-strenuous sports after an anterior cruciate ligament (ACL) reconstruction.Data from isotonic tests of muscle function and patient-reported outcome measures, Tegner activity scale (Tegner and Lysholm in Clin Orthop Relat Res 198:43-49, 1985), physical activity scale, knee injury and osteoarthritis scale and knee self-efficacy scale were extracted from a registry. The 157 included patients, 15-30years of age, had undergone primary ACL reconstruction and were all involved in knee-strenuous sports, i.e. pre-injury Tegner of 6 or higher. Return to sport was studied in two different ways: return to pre-injury Tegner and return to knee-strenuous sport (Tegner 6).Fifty-two patients (33%), who returned to pre-injury Tegner, 10months after surgery, were characterised by better subjective knee function measured with the knee injury and osteoarthritis outcome score (p<0.05), compared with patients who did not. These patients also had higher perceived self-efficacy of knee function (p<0.01), measured with knee self-efficacy scale. Eighty-four patients (54%) who returned to knee-strenuous sports, i.e. Tegner 6 or higher, were characterised by higher goals for physical activity (p<0.01) and higher self-efficacy of future knee function (p<0.05). Strength measurements showed that women who returned to sports were stronger in leg extension than women who did not. No differences were found in Limb Symmetry Index for knee strength or jumping ability.Patients who returned to sports after ACL reconstruction had better subjective knee function and higher self-efficacy of knee function. Results highlight that further emphasis should be placed at psychological factors during rehabilitation of patients after ACLR.II.
14.	Jonasson, Pall, et al. (author) A standardised outcome measure of pain, symptoms and physical function in patients with hip and groin disability due to femoro-acetabular impingement: cross-cultural adaptation and validation of the international Hip Outcome Tool (iHOT12) in Swedish. 2014 In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 22:4, s. 826-834 Journal article (peer-reviewed)abstract There is a lack of standardised outcome measures in Swedish for active, young and middle-aged patients with hip and groin disability. The purpose of this study was to adapt the English version of the international Hip Outcome Tool (iHOT12) patient-reported outcome instrument for use in Swedish patients and evaluate the adaptation according to the consensus-based standards for the selection of health status measurement instruments checklist.
15.	Neeter, Camille, 1968, et al. (author) Development of a strength test battery for evaluating leg muscle power after anterior cruciate ligament injury and reconstruction 2006 In: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 14:6, s. 571-80 Journal article (peer-reviewed)abstract A more sports-specific and detailed strength assessment has been advocated for patients after anterior cruciate ligament (ACL) injury and reconstruction. The purpose of this study was to develop a test battery of lower extremity strength tests with high ability to discriminate between leg power development on the injured and uninjured sides in patients after ACL injury and in patients who have undergone ACL reconstruction. Twenty-three patients were tested 6 months after ACL injury and 44 patients were tested 6 months after ACL reconstruction. Twenty-four of the 44 patients were operated on using a hamstrings graft and 20 patients were operated on using a patellar tendon graft. All the patients performed a test battery of three strength tests for each leg in a randomised order. The three strength tests were chosen to reflect quadriceps and hamstring muscular power in a knee-extension and a knee-flexion test (open kinetic chain) and lower-extremity muscular power in a leg-press test (closed kinetic chain). There was a higher sensitivity for the test battery to discriminate abnormal leg power compared with any of the three strength tests individually. Nine out of ten patients after ACL reconstruction and six out of ten of the patients after ACL injury exhibited abnormal leg power symmetry using the test battery. Thus, this test battery had high ability in terms of discriminating between the leg power performance on the injured and uninjured side, both in patients with an ACL injury and in patients who have undergone ACL reconstruction. It is concluded that a test battery consisting of a knee-extension, knee-flexion and leg-press muscle power test had high ability to determine deficits in leg power 6 months after ACL injury and reconstruction. Only a minority of the patients had restored leg muscle power. The clinical relevance is that the test battery may contribute to the decision-making process when deciding whether and when patients can safely return to strenuous physical activities after an ACL injury or reconstruction.
16.	Nilsson-Helander, Katarina, 1957, et al. (author) The Achilles tendon Total Rupture Score (ATRS): development and validation 2007 In: The American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 35:3, s. 421-426 Journal article (peer-reviewed)abstract BACKGROUND: There is a need for a patient-relevant instrument to evaluate outcome after treatment in patients with a total Achilles tendon rupture. PURPOSE: To develop and validate a new patient-reported instrument for measuring outcome after treatment for total Achilles tendon rupture. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 1. METHODS: Development of this instrument consisted of item generation and test construction, item reduction, validation, evaluation of structure and internal consistency, test-retest, and test for responsiveness. The final version, the Achilles tendon Total Rupture Score (ATRS), was tested for validity, structure, and internal consistency (Cronbach's alpha) on 82 patients and 52 healthy persons. A correlation analysis was performed of the ATRS with the 2 validated foot/ankle/Achilles tendon scores, the Foot and Ankle Outcome Score (FAOS) and the Swedish version of the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A-S). Structure was evaluated with factor analysis. Test-retest reliability was evaluated on 43 patients. The ATRS responsiveness was tested on 43 patients by calculating the effect size. RESULTS: The total score for the patients ranged from 17 to 100 with a mean (median) of 77 (85) and a standard deviation (interquartile range) of 21.4 (23). A significantly (P < .0001) higher total score was found for the healthy subjects, ranging from 94 to 100 with a mean (median) of 99.8 (100) and a standard deviation (interquartile range) of 1.1 (0). The ATRS correlated significantly (P < .01) with all subscales of the FAOS (r = 0.60-0.84) and the VISA-A-S (r = 0.78). The factor analysis gave 1 factor of importance. The internal consistency was 0.96 as measured with Cronbach's alpha. The test-retest produced an intraclass correlation coefficient of 0.98. The tests for responsiveness showed an effect size between 0.87 and 2.21. CONCLUSION: The ATRS is a patient-reported instrument with high reliability, validity, and sensitivity for measuring outcome after treatment in patients with a total Achilles tendon rupture. CLINICAL RELEVANCE: The ATRS is a self-administered instrument with high clinical utility, and we suggest the score for measuring the outcome, related to symptoms and physical activity, after treatment in patients with a total Achilles tendon rupture.
17.	Piussi, R., et al. (author) Greater Psychological Readiness to Return to Sport, as Well as Greater Present and Future Knee-Related Self-Efficacy, Can Increase the Risk for an Anterior Cruciate Ligament Re-Rupture: A Matched Cohort Study 2022 In: Arthroscopy - Journal of Arthroscopic and Related Surgery. - : Elsevier BV. - 0749-8063. ; 38:4 Journal article (peer-reviewed)abstract Purpose: To determine the psychological characteristics and strength outcomes of patients who sustained an early anterior cruciate ligament (ACL) re-rupture after their primary ACL reconstruction and cross-sectionally compare them with a matched cohort of patients who did not sustain a reinjury during the first 2 years after primary ACL reconstruction. Methods: In this matched cohort study, data for quadriceps and hamstring strength and 3 hop tests and answers to standardized patient-reported outcomes (the Anterior Cruciate Ligament Return to Sport after Injury scale and a short version of the Knee Self-Efficacy Scale) were extracted from a rehabilitation outcome registry. Data for patients suffering a re-rupture were extracted, and patients were matched in terms of sex, age, and activity level with patients not suffering an ACL re-rupture within 2 years of primary reconstruction. The groups were compared 10 weeks and 4, 8, and 12 months after the primary reconstruction. Results: A total of 36 patients suffering an ACL re-rupture were matched with 108 patients not suffering a re-rupture after ACL reconstruction. Patients who suffered an ACL re-rupture had greater psychological readiness, that is, greater confidence in performance, lesser negative emotions, and lesser risk appraisal, to return to sport (RTS) at 8 months (81.2 vs 67.9 [95% Δconfidence interval {CI} 2.7-23.8) P = .014) and at 12 months (95.2 vs 67.1, (95% ΔCI 14.3-41.8) P ≤ .001), and greater knee-related self-efficacy at 8 months (8.6 vs 8.0 [95% ΔCI 0.1-1.2], P = .021) and 12 months (9.4 vs 8.1, [95% ΔCI 0.3-2.2] P = .012) after primary ACL reconstruction, compared with the matched group. Conclusions: A stronger psychological profile, defined by a greater psychological readiness to RTS and knee-related self-efficacy, may be associated with an ACL re-rupture within 2 years of the primary reconstruction. Level of Evidence: Matched cohort study, level III. © 2021 The Author(s).
18.	Sansone, Mikael, et al. (author) A Swedish hip arthroscopy registry: demographics and development. 2014 In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 22:4, s. 774-780 Journal article (peer-reviewed)abstract Hip arthroscopy is a rapidly expanding field in orthopaedics. Indications and surgical procedures are increasing. Although several studies report favourable clinical outcomes, further scientific evidence is needed for every aspect of this area. Accordingly, a registry for hip arthroscopy was developed. The purpose of this study is to describe the development of the registry and present its baseline data.
19.	Sansone, Mikael, et al. (author) Good Results After Hip Arthroscopy for Femoroacetabular Impingement in Top-Level Athletes. 2015 In: Orthopaedic journal of sports medicine. - : SAGE Publications. - 2325-9671. ; 3:2 Journal article (peer-reviewed)abstract Femoroacetabular impingement (FAI) is a common cause of hip pain and dysfunction among athletes. Although arthroscopic surgery is an established treatment option for FAI, there are few studies reporting detailed outcomes using validated outcome measurements specifically designed for young and active athletes.
20.	Sansone, Mikael, et al. (author) Outcome after hip arthroscopy for femoroacetabular impingement in 289 patients with minimum 2-year follow-up. 2017 In: Scandinavian Journal of Medicine & Science in Sports. - : Wiley. - 0905-7188 .- 1600-0838. ; 27:2, s. 230-235 Journal article (peer-reviewed)abstract Femoroacetabular impingement (FAI) is a common cause of hip pain and dysfunction. The purpose of this study was to report outcome 2years after the arthroscopic treatment of FAI using validated outcome measurements. Two hundred and eighty-nine patients (males=190, females=99) with a mean age of 37years underwent arthroscopic surgery for FAI. Patients were included consecutively in a hip arthroscopy registry. The cohort was evaluated using online web-based validated health-related patient-reported outcomes measurements, including the iHOT-12, HAGOS, EQ-5D, HSAS for physical activity level, VAS for overall hip function and overall satisfaction. The mean follow-up time was 25.4months. Pre-operative scores compared with those obtained at follow-up revealed statistically and clinically significant improvements (P<0.05) for all measured outcomes; iHOT-12 (43 vs 66), VAS for global hip function (50 vs 71), HSAS (2.9 vs 3.6), EQ-5D index (0.58 vs 0.75), EQ-VAS (67 vs 75) and HAGOS different subscales (56 vs 76, 51 vs 69, 60 vs 78, 40 vs 65, 29 vs 57, 33 vs 58). At the 2-year follow-up, 236 patients (82%) reported they were satisfied with the outcome of surgery. We conclude that arthroscopic treatment for FAI resulted in statistically and clinically significant improvements in outcome parameters.
21.	Sansone, Mikael, et al. (author) Outcome of hip arthroscopy in patients with mild to moderate osteoarthritis-A prospective study. 2016 In: Journal of hip preservation surgery. - : Oxford University Press (OUP). - 2054-8397. ; 3:1, s. 61-7 Journal article (peer-reviewed)abstract Osteoarthritis (OA) of the hip is a common cause of hip pain. The arthroscopic management of patients with femoro-acetabular impingement (FAI) has been reported to yield good outcomes. The purpose of this study was to report on outcome following the arthroscopic treatment of patients with FAI in the presence of mild to moderate OA. Seventy-five patients undergoing arthroscopic surgery for FAI, all with preoperative radiological signs of mild to moderate OA were prospectively included in this study. A 2-year follow-up, using web-based patient-reported outcome measures, including the International Hip Outcome Tool (iHOT-12), Copenhagen Hip and Groin Outcome (HAGOS), EQ-5D, Hip Sports Activity Scale (HSAS) for physical activity level and a visual analogue scale (VAS) for overall hip function, was performed, complemented by a radiographic evaluation. At follow-up (mean 26 months, SD 5), five patients (7%) had undergone total hip arthroplasty, leaving 70 patients for the analysis. Preoperative scores compared with those obtained at the 2-year follow-up revealed significant improvements (P<0.0001) for all measured outcomes; the iHOT-12 (42 versus 65), VAS for global hip function (48 versus 68), HSAS (2.5 versus 3), EQ5D index (0.62 versus 0.76), EQ VAS (69 versus 75) and different HAGOS subscales (54 versus 72, 47 versus 67, 56 versus 75, 40 versus 61, 33 versus 56, 31 versus 55). At follow-up, 56 (82%) patients reported that they was satisfied with the outcome of surgery. Arthroscopic treatment for patients with FAI in the presence of mild to moderate OA resulted in statistically significant and clinically relevant improvements in outcome measures related to pain, symptoms, function, physical activity level and quality of life in the majority of patients.
22.	Sundemo, David, et al. (author) Generalized joint hypermobility does not influence 1-year patient satisfaction or functional outcome after ACL reconstruction 2022 In: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 30, s. 4173-4180 Journal article (peer-reviewed)abstract Purpose The purpose of this study was to evaluate whether generalized joint hypermobility (GJH) influences postoperative results, including return to sport, patientreported outcomes, functional performance (hop tests), muscular strength, and the occurrence of ACL re-injury, in patients 1 year after anterior cruciate ligament (ACL) reconstruction. Methods Data was extracted from a regional rehabilitation-specific registry containing information on patients with ACL injury. Patients between the ages of 16-50 years previously undergoing ACL reconstruction with available 1 year follow-up data were eligible for inclusion. Generalized joint hypermobility was assessed using the Beighton score (BS). Patients were examined one year postoperatively in terms of return to sport, patient-reported outcome, hop tests, muscular strength and the occurrence of reinjury. For purpose of analysis, patients were allocated into two groups, depending on the existence of GJH. The KOOS subscale of sports and recreation was considered the primary outcome. Analyses were performed both dichotomously and by using adjusted logistic regression, to consider potential confounders. Results A total of 356 patients (41% males) were included, of which 76 (24% male) were categorized as having GJH. Patients with GJH had an inferior limb symmetry index preoperatively in terms of knee extension (mean 81.6 [SD 16.4] vs. 91.4 [SD 15.9], p = 0.02) and flexion strength (mean 91.9 vs. 99.1, p = 0.047) compared to patients without GJH. There was no difference between the groups in terms of the primary outcome, nor in any of the other postoperative outcomes. Nine patients (11.8%) in the group with GJH suffered ACL re-injury, compared with 13 patients (4.6%) in the control group (n.s.). Conclusion One year after ACL reconstruction the existence of GJH did not affect postoperative patient satisfaction, strength or functional outcome. No conclusive statements can be made regarding the influence of GJH on the risk of ACL re-injury in this particular study.
23.	Svantesson, Eleonor, et al. (author) Only 10% of Patients With a Concomitant MCL Injury Return to Their Preinjury Level of Sport 1 Year After ACL Reconstruction: A Matched Comparison With Isolated ACL Reconstruction. 2023 In: Sports health. - : SAGE Publications. - 1941-0921. Journal article (peer-reviewed)abstract There is a need for an increased understanding of the way a concomitant medial collateral ligament (MCL) injury may influence outcome after anterior cruciate ligament (ACL) reconstruction.Patients with a concomitant MCL injury would have inferior clinical outcomes compared with a matched cohort of patients undergoing ACL reconstruction without an MCL injury.Matched registry-based cohort study; case-control.Level 3.Data from the Swedish National Knee Ligament Registry and a local rehabilitation outcome registry were utilized. Patients who had undergone a primary ACL reconstruction with a concomitant nonsurgically treated MCL injury (ACL + MCL group) were matched with patients who had undergone an ACL reconstruction without an MCL injury (ACL group), in a 1:3 ratio. The primary outcome was return to knee-strenuous sport, defined as a Tegner activity scale ≥6, at the 1-year follow-up. In addition, return to preinjury level of sport, muscle function tests, and patient-reported outcomes (PROs) were compared between the groups.The ACL + MCL group comprised 30 patients, matched with 90 patients in the ACL group. At the 1-year follow-up, 14 patients (46.7%) in the ACL + MCL group had return to sport (RTS) compared with 44 patients (48.9%) in the ACL group (P = 0.37). A significantly lower proportion of patients in the ACL + MCL group had returned to their preinjury level of sport compared with the ACL group (10.0% compared with 25.6%, adjusted P = 0.01). No differences were found between the groups across a battery of strength and hop tests or in any of the assessed PROs. The ACL + MCL group reported a mean 1-year ACL-RSI after injury of 59.4 (SD 21.6), whereas the ACL group reported 57.9 (SD 19.4), P = 0.60.Patients with a concomitant nonsurgically treated MCL injury did not return to their preinjury level of sport to the same extent as patients without an MCL injury 1 year after ACL reconstruction. However, there was no difference between the groups in terms of return to knee strenuous activity, muscle function, or PROs.Patients with a concomitant nonsurgically treated MCL injury may reach outcomes similar to those of patients without an MCL injury 1 year after an ACL reconstruction. However, few patients return to their preinjury level of sport at 1 year.
24.	Thomeé, Pia, 1955, et al. (author) A new instrument for measuring self-efficacy in patients with an anterior cruciate ligament injury 2006 In: Scand J Med Sci Sports. ; 16:3, s. 181-7 Journal article (peer-reviewed)abstract It has been suggested that self-efficacy belief is of major importance for rehabilitation outcome after sports-related injuries. No instruments are, however, available to evaluate perceived self-efficacy for prognostic and outcome expectations in patients with an anterior cruciate ligament (ACL) injury. Perceived self-efficacy is defined as a judgment of one's potential ability to carry out a task, rather than a measure of whether or not one actually can or does perform the task. The purpose of this study was to develop a reliable and valid instrument for measuring perceived self-efficacy in patients with an ACL injury. A total of 210 male and female patients with an ACL injury were included in this study. The items were generated by health professionals with long clinical experience of patients with an ACL injury and by discussions with patients. After item analysis and item reduction, based on the results from 88 patients, the final 22-item version of the Knee Self-Efficacy Scale (K-SES) was evaluated in 18 patients for test-retest reliability and in 104 patients for internal consistency and validity. The K-SES was compared with the Multidimensional Health Locus of Control (MHLC), Coping Strategies Questionnaire (CSQ), SF-36 and Knee Injury and Osteoarthritis Outcome Score (KOOS) instruments. A factor analysis was also performed on the K-SES. The test-retest revealed a correlation of r(s)=0.73 between test-days and an intraclass correlation coefficient of 0.75. No significant difference between test-days was found. The internal consistency was 0.94, as calculated with Cronbach's alpha. There were low correlations between the K-SES and MHLC and the K-SES and CSQ, respectively. A strong correlation was found between the K-SES and physical functioning, as measured by the SF-36 (r(s)=0.8). All the sub-scales in the KOOS correlated moderately to strongly (r(s)=0.4-0.7) to the K-SES. The factor analysis produced two factors of importance. Factor one was related to how patients perceived their present physical performance/function, while factor two was related to how patients perceived the future physical performance/prognosis of their knee. Good reliability and good face, content, construct and convergent validity were demonstrated for this new instrument (K-SES) for measuring perceived self-efficacy in patients with an ACL injury. The K-SES is recommended for studies designed to evaluate prognostic and outcome expectations of perceived self-efficacy in patients with an ACL-insufficient knee.
25.	Thomeé, Pia, 1955, et al. (author) A randomized, controlled study of a rehabilitation model to improve knee-function self-efficacy with ACL injury 2010 In: Journal of sport rehabilitation. - 1056-6716. ; 19:2, s. 200-213 Journal article (peer-reviewed)abstract CONTEXT: The Knee Self-Efficacy Scale (K-SES) has good reliability, validity, and responsiveness for patients' perceived knee-function self-efficacy during rehabilitation after an anterior cruciate ligament (ACL) injury. Preoperative knee-function self-efficacy has also been shown to have a predictive ability in terms of outcome 1 y after ACL reconstruction. OBJECTIVE: To evaluate a new clinical rehabilitation model containing strategies to enhance knee-function self-efficacy. DESIGN: A randomized, controlled study. SETTING: Rehabilitation clinic and laboratory. PATIENTS: 40 patients with ACL injuries. INTERVENTION: All patients followed a standardized rehabilitation protocol. Patients in the experimental group were treated by 1 of 3 physiotherapists who had received specific training in a clinical rehabilitation model. These physiotherapists were also given their patients' self-efficacy scores after the initial and 4-, 6-, and 12-mo follow-ups, whereas the 5 physiotherapists treating the patients in the control group were not given their patients' self-efficacy scores. MAIN OUTCOME MEASURES: The K-SES, the Tegner Activity Scale, the Physical Activity Scale, the Knee Injury and Osteoarthritis Outcome Score, and the Multidimensional Health Locus of Control. RESULTS: Twenty-four patients (12 in each group) completed all follow-ups. Current knee-function self-efficacy, knee symptoms in sports, and knee quality of life improved significantly (P = .05) in both groups during rehabilitation. Both groups had a significantly (P = .05) lower physical activity level at 12 mo than preinjury. No significant differences were found between groups. CONCLUSION: In this study there was no evidence that the clinical rehabilitation model with strategies to enhance self-efficacy resulted in a better outcome than the rehabilitation protocol used for the control group.
26.	Thomeé, Pia, 1955, et al. (author) Determinants of self-efficacy in the rehabilitation of patients with anterior cruciate ligament injury 2007 In: J Rehabil Med. - : Medical Journals Sweden AB. - 1650-1977. ; 39:6, s. 486-92 Journal article (peer-reviewed)abstract OBJECTIVE: To explore physical and psychological measures believed to determine patients' perceived self-efficacy in the rehabilitation of patients with anterior cruciate ligament injury. DESIGN: An explorative descriptive study. PATIENTS: A total of 116 patients with an anterior cruciate ligament deficient or reconstructed knee. METHOD: At one visit; 12 months post-injury/reconstruction, patients reported their perceived self-efficacy on the Knee Self-Efficacy Scale. Thirty-nine other measures related to self-efficacy were also documented. A linear regression model was applied to identify determinants of perceived self-efficacy. RESULTS: 40% of the variance in the complete Knee Self-Efficacy Scale was explained by the Lysholm score, Knee Injury and Osteoarthritis Outcome ScoreSport/Recreation, Internal Locus of Control and Locus of Control by Chance. The variance in patients' present perceived self-efficacy was explained to 41% by the same measures. Perceived self-efficacy of future capability was explained to 38% by the variance in the Lysholm score, Knee Injury and Osteoarthritis Outcome ScoreSport/Recreation, TegnerPresent level and Internal Locus of Control. CONCLUSION: Self-reported symptoms/functions and Internal Locus of Control were the most important determinants of self-efficacy in patients with an anterior cruciate ligament injury. In order to strengthen self-efficacy, these determinants should be considered by the clinicians involved in the rehabilitation.
27.	Thomeé, Pia, 1955, et al. (author) Self-efficacy of knee function as a pre-operative predictor of outcome 1 year after anterior cruciate ligament reconstruction 2008 In: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 16:2, s. 118-27 Journal article (peer-reviewed)abstract The knee self-efficacy scale (K-SES) has been shown to have good reliability, validity and responsiveness during rehabilitation for patients' perceived self-efficacy of knee function. Determinants of self-efficacy of knee function 1 year after ACL reconstruction have been found to be the patients' internal locus of control and knee symptoms in sports and recreation. The predictive ability of perceived self-efficacy of knee function measured by the K-SES has not been studied in terms of patient outcome after an ACL reconstruction. The purpose of this study was to explore the potential for pre-operative self-efficacy of knee function measured by the K-SES to predict patient outcome in terms of physical activity, knee symptoms and muscle function 1 year after an ACL reconstruction. Thirty-eight patients were evaluated for outcome in terms of physical activity with the Tegner activity scale and the physical activity scale (PAS), knee symptoms with the Lysholm knee scoring scale and the knee injury and osteoarthritis outcome score (KOOS) and knee function with ability tests for muscle function 1 year after ACL reconstruction. Multiple regression and logistic multiple regression analysis were used to evaluate the K-SES as a possible predictor of outcome. The patients' present perceived self-efficacy of knee function (K-SES(Present)) pre-operatively was a significant predictor (P = 0.016) of the patients returning to their intensity and frequency of physical activity (PAS) 1 year after ACL reconstruction, when adjusted for age, gender and pre-injury physical activity level (Tegner(Pre-injury)) (odds ratio = 2.1). The patients' perceived future self-efficacy of knee function (K-SES(Future)) pre-operatively was a significant predictor (P = 0.045) of their self-rated knee function in sports/recreational activities (KOOS(Sports/recreation)) at the 1-year follow-up, when adjusted for age, gender and Tegner(Pre-injury )(R (2 )=0.25). The pre-operative K-SES(Future) was also a significant predictor (P = 0.023) of the patients' knee-related quality of life (KOOS(Qol)), at the 1-year follow-up, when adjusted for age, gender and Tegner(Pre-injury) (R (2 )=0.23). The pre-operative K-SES(Future) was furthermore a significant predictor of an acceptable outcome 1 year after surgery, on the Lysholm knee scoring scale (P = 0.003, odds ratio = 1.7), as well as on KOOS(Sports/recreation) (P = 0.002, odds ratio = 1.6) and knee-related quality of life (KOOS(Qol)) (P = 0.037, odds ratio = 1.4), when adjusted for age, gender and Tegner(Pre-injury). The pre-operative K-SES(Future) was also a significant predictor (P = 0.04) of an acceptable outcome 1 year after surgery, on the one-leg hop for distance (odds ratio = 2.2), when adjusted for age, gender and Tegner(Pre-injury). In conclusion, this study indicates that patients' perceived self-efficacy of knee function pre-operatively is of predictive value for their return to acceptable levels of physical activity, symptoms and muscle function 1 year after ACL reconstruction.
28.	Thomeé, Pia, 1955, et al. (author) Self-efficacy, symptoms and physical acitivity in patients with an anterior cruciate ligament injury: a prospecitve study 2006 In: Scand J Med Sci Sports. ; 17, s. 238-45 Journal article (peer-reviewed)
29.	Thomeé, Pia, 1955, et al. (author) Self-efficacy, symptoms and physical activity in patients with an anterior cruciate ligament injury: a prospective study 2007 In: Scand J Med Sci Sports. - : Wiley. - 0905-7188. ; 17:3, s. 238-45 Journal article (peer-reviewed)abstract Self-efficacy belief may be of major importance for the outcome of rehabilitation after sports-related injuries. A new instrument, the Knee Self-Efficacy Scale (K-SES), was used to evaluate the role of perceived self-efficacy in patients with an anterior cruciate ligament (ACL) injury. The purpose of this prospective exploratory study was to describe the patients' perceived self-efficacy at various times post-injury and surgery, respectively, for responsiveness of the K-SES and to correlate the K-SES score with the patients' subjective symptoms. The purpose was also to describe the influence of gender, age and physical activity on the patients' perceived self-efficacy. Thirty recently injured patients with an ACL-deficient knee and 33 patients who had undergone ACL reconstruction reported their physical activity level and their perceived self-efficacy on four test occasions during a 1-year period. The patients' subjective knee symptoms were documented on two of the test occasions. A significant increase in the K-SES score was seen after injury as well as after surgery, during the course of rehabilitation. Pre-operatively, men's perceived self-efficacy was significantly (P=0.013) higher compared with women's self-efficacy. Patients with a high baseline (pre-injury) physical activity level (Tegner 7-10) perceived their self-efficacy as being significantly (P=0.005) higher pre-operatively compared with patients with a low baseline activity level (Tegner 3-6). "Younger" (age 17-29), recently injured patients, perceived their self-efficacy as being significantly (P=0.034) higher compared with "older" patients (age 30-54). At the 12-month test, 15 of 30 patients with an ACL-deficient knee and 15 of 33 patients who had undergone ACL reconstruction reported that they had returned or nearly returned to their baseline physical activity level. The subjective knee outcome score, as measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS), improved significantly (P<0.01) during rehabilitation, apart from the KOOS subscale of "pain" (P=0.077) for patients who had undergone ACL reconstruction. There was a "low" to "strong" correlation (r(s)=0.0-0.7) between the K-SES and the five subscales in the KOOS. We conclude from the present study that K-SES has good responsiveness with significantly increased self-efficacy during the rehabilitation process for patients with an ACL-deficient knee as well as for patients who had undergone ACL reconstruction. The improvement in perceived self-efficacy could, however, only be partly explained by the improvement in subjective symptoms. Furthermore, self-efficacy differed significantly with gender, age and physical activity level early in the rehabilitation process.
30.	Thomeé, Pia, 1955, et al. (author) Tilltron till den egna förmågan stark prediktor vid ortopedisk skada. Att tro på sig själv – grund för lyckad rehabilitering : Self-belief--basis for successful rehabilitation. Confidence in one's own ability a strong predictor in orthopedic injury 2009 In: Lakartidningen. - 0023-7205. ; 106:32-33, s. 1975-7 Journal article (peer-reviewed)
31.	Thomeé, Roland, 1954, et al. (author) Cross-cultural adaptation to Swedish and validation of the Copenhagen Hip and Groin Outcome Score (HAGOS) for pain, symptoms and physical function in patients with hip and groin disability due to femoro-acetabular impingement. 2014 In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 22:4, s. 826-834 Journal article (peer-reviewed)abstract There is a lack of standardised outcome measures in Swedish for active, young and middle-aged patients with hip and groin disability. The purpose of this study was to adapt the Danish version of the Copenhagen Hip and Groin Outcome Score (HAGOS) patient-reported outcome instrument for use in Swedish patients and evaluate the adaptation according to the Consensus-Based Standards for the Selection of Health Status Measurement Instruments checklist.
32.	Thomeé, Roland, 1954, et al. (author) Variability in leg muscle power and hop performance after anterior cruciate ligament reconstruction. 2012 In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347 .- 0942-2056. ; 20:6, s. 1143-1151 Journal article (peer-reviewed)abstract PURPOSE: The purpose of this prospective study was to describe the variability in leg muscle power and hop performance up to 2years among patients following ACL reconstruction and specifically to illustrate the effects of various criteria for an acceptable level of muscle function. METHODS: Eighty-two patients (56 men and 26 women) with a mean age of 28years, who underwent ACL reconstruction using either hamstring tendons (n=46) or a patellar tendon (n=36), were assessed pre-operatively and 3, 6, 12 and 24months post-surgery with a battery of three lower extremity muscle power tests and a battery of three hop tests. RESULTS: Leg symmetry index (LSI) values at group level ranged between 73 and 100% at all follow-ups. When the tests were evaluated individually, patients reached an average LSI of ≥90% at 24months. The success rate at 24months for the muscle power test battery, that is, patients with an LSI of ≥90% in all three tests, was 48 and 44% for the hop test battery. The success rate at 24months for both test batteries on all six muscle function tests was 22%. The criterion of an LSI of ≥80% resulted in 53% of the patients having an acceptable level on all six tests, while with a criterion of an LSI of ≥100%, none of the patients reached an acceptable level. CONCLUSION: At group level and in single muscle function tests, the muscle function outcome 1 and 2years after ACL reconstruction is satisfactory in the present study and on a par with the results presented in the literature. However, when using more demanding criteria for a successful muscle function outcome, using batteries of tests or increasing the acceptable LSI level from ≥90% to ≥95% or ≥100%, the results are considered to be poor. It is suggested that this should be taken into consideration when presenting results after ACL rehabilitation, deciding on the criteria for a safe return to sports, or designing rehabilitation programmes after ACL reconstruction. LEVEL OF EVIDENCE: Prognostic prospective cohort study, Level I.
33.	Ageberg, Eva, et al. (author) 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 In: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 1433-7347 .- 0942-2056. ; 17:2, s. 162-9 Journal article (peer-reviewed)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.
34.	Ageberg, Eva, et al. (author) Muscle strength and functional performance in patients with anterior cruciate ligament injury treated with training and surgical reconstruction or training only: a two to five-year followup. 2008 In: Arthritis and rheumatism. - : Wiley. - 0004-3591 .- 1529-0131. ; 59:12, s. 1773-9 Journal article (peer-reviewed)abstract To study muscle strength and functional performance in patients with anterior cruciate ligament (ACL) injury with or without surgical reconstruction 2 to 5 years after injury. Good muscle function is important in preventing early-onset osteoarthritis (OA), but the role of reconstructive surgery in restoring muscle function is unclear.
35.	Ageberg, Eva, et al. (author) Treatment after anterior cruciate ligament injury: comment on the article by Ageberg et al Reply 2009 In: ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH. - : Wiley. - 0004-3591. ; 61:6, s. 854-854 Journal article (peer-reviewed)
36.	Augustsson, Jesper, 1964, et al. (author) Ability of a new hop test to determine functional deficits after anterior cruciate ligament reconstruction 2004 In: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 12:5, s. 350-6 Journal article (peer-reviewed)abstract The aim of this study was to investigate the ability of a new hop test to determine functional deficits after anterior cruciate ligament (ACL) reconstruction. The test consists of a pre-exhaustion exercise protocol combined with a single-leg hop. Nineteen male patients with ACL reconstruction (mean time after operation 11 months) who exhibited normal single-leg hop symmetry values (> or =90% compared with the non-involved extremity) were tested for one-repetition maximum (1 RM) strength of a knee-extension exercise. The patients then performed single-leg hops following a standardised pre-exhaustion exercise protocol, which consisted of unilateral weight machine knee-extensions until failure at 50% of 1 RM. Although no patients displayed abnormal hop symmetry when non-fatigued, 68% of the patients showed abnormal hop symmetry for the fatigued test condition. Sixty-three per cent exhibited 1 RM strength scores of below 90% of the non-involved leg. Eighty-four percent of the patients exhibited abnormal symmetry in at least one of the tests. Our findings indicate that patients are not fully rehabilitated 11 months after ACL reconstruction. It is concluded that the pre-exhaustion exercise protocol, combined with the single-leg hop test, improved testing sensitivity when evaluating lower-extremity function after ACL reconstruction. For a more comprehensive evaluation of lower-extremity function after ACL reconstruction, it is therefore suggested that functional testing should be performed both under non-fatigued and fatigued test conditions.
37.	Augustsson, Jesper, 1964, et al. (author) Single-leg hop testing following fatiguing exercise: reliability and biomechanical analysis 2006 In: Scand J Med Sci Sports. - : Wiley. - 0905-7188. ; 16:2, s. 111-20 Journal article (peer-reviewed)abstract A fatiguing exercise protocol was combined with single-leg hop testing to improve the possibilities of evaluating the effects of training or rehabilitation interventions. In the first test-retest experiment, 11 healthy male subjects performed two trials of single-leg hops under three different test conditions: non-fatigued and following fatiguing exercise, which consisted of unilateral weight machine knee extensions at 80% and 50%, respectively, of 1 repetition maximum (1 RM) strength. Intraclass correlation coefficients ranged from 0.75 to 0.98 for different hop test conditions, indicating that all tests were reliable. For the second experiment, eight healthy male subjects performed the fatiguing exercise protocol to investigate how fatigue influences lower-extremity joint kinematics and kinetics during single-leg hops. Hip, knee and ankle joint angles, moments and powers, as well as ground-reaction forces were recorded with a six-camera, motion-capture system and a force platform. Recovery of hop performance following the fatiguing exercise was also measured. During the take-off for the single-leg hops, hip and knee flexion angles, generated powers for the knee and ankle joints, and ground-reaction forces decreased for the fatigued hop conditions compared with the non-fatigued condition (P<0.05). Compared with landing during the non-fatigued condition, hip moments and ground-reaction forces were lower for the fatigued hop conditions (P<0.05). The negative joint power was two to three times greater for the knee than for the hip and five to 10 times greater for the knee than for the ankle during landing for all test conditions (P<0.05). Most measured variables had recovered three minutes post-exercise. It is concluded that the fatiguing exercise protocol combined with single-leg hop testing was a reliable method for investigating functional performance under fatigued test conditions. Further, subjects utilized an adapted hop strategy, which employed less hip and knee flexion and generated powers for the knee and ankle joints during take-off, and less hip joint moments during landing under fatigued conditions. The large negative power values observed at the knee joint during the landing phase of the single-leg hop, during which the quadriceps muscle activates eccentrically, indicate that not only hop distance but also the ability to perform successful landings should be investigated when assessing dynamic knee function.
38.	Augustsson Ryman, Sofia, 1975, et al. (author) Performance Enhancement Following a Strength and Injury Prevention Program: A 26-Week Individualized and Supervised Intervention in Adolescent Female Volleyball Players 2011 In: INTERNATIONAL JOURNAL OF SPORTS SCIENCE & COACHING. - : SAGE Publications. - 1747-9541 .- 2048-397X. ; 6:3, s. 399-417 Journal article (peer-reviewed)abstract Abstract: The aim of this study was to evaluate the effects of a 26-week individualized and supervised strength and injury prevention program on performance enhancement in young female volleyball players who completed resistance training with either a supervised and individualized training program (experimental group, n=10) or an unsupervised non-individualized training program (control group, n=17). Exposure and injury data were collected during the 2006-2007 season (baseline season) and the 26-week program was conducted during the 2007-2008 season (intervention season). All players were tested for physical performance. At post-test, the players in the experimental group had improved significantly more than the players in the control group for squat (p<0.0001), bench press (p=0.048), push-ups (p=0.02) and sit-ups (p<0.0001) but not for the vertical jump test. Thirty-five percent (6/17) of the players from the control group and 80% (8/10) of the players in the experimental group completed the resistance training with compliance of no less than 50%. The present study shows the importance of individualization and supervision for resistance training in young female athletes when it comes to compliance, strength gains and performance.
39.	Beischer, Susanne, et al. (author) Patients that maintain their pre-injury level of physical activity 3-5 years after ACL reconstruction are, 18months after surgery, characterised by higher levels of readiness to return to sport. 2023 In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 31:2, s. 596-607 Journal article (peer-reviewed)abstract To characterise patients who had returned to their pre-injury physical activity (PA) or higher at 18 months and maintained that level of PA 3-5 years after the primary ACL reconstruction and to describe the level, frequency, and type of PA participation during the first 5 years after ACL reconstruction METHOD: Data, from follow-ups at 18 months and 3-5 years after an ACL reconstruction, were extracted from a rehabilitation-specific register. Patients, 15-65 years of age, were included. The data comprised patient-reported outcomes and the results from two questions with respect to the level, frequency, and type of PA. Comparisonswere made betweenpatients who had and had not maintained their pre-injury level of PA at the follow-up 3-5 years after an ACL reconstruction.A total of 272 patients met the inclusion criteria. The mean follow-up time was 3.8 years (min-max: 2.9-5.1) after the ACL reconstruction. Of patients who had returned to their pre-injury or a higher level of PA at the 18month follow-up (n = 114), 68% (n = 78) maintained that level at the 3- to 5-year follow-up after ACL reconstruction. These patients reported a higher level of psychological readiness to return to sport (98 versus 79; p = 0.013). Moreover, these patients were 6.0 years older (p = 0.016) and were characterised by male sex (56% versus 44%; p = 0.028) and a lower level of pre-injury PA (p = 0.013). At the follow-up 3-5 years after the ACL reconstruction, more than 90% met the recommendations for PA. However, the prevalence of physical inactivity had increased and the involvement in organised PA had decreased compared with the 18-month follow-up.Two out of three patients who have returned to their previous level of PA at 18 months can be expected to maintain that level, 3-5 years following ACL reconstruction. These patients were mainly characterised by a higher level of psychological readiness, especially in patients who participated in knee-strenuous sport and were younger than 20 years of age. The results of this study suggest that patients become more physically inactive over time, implicating the importance of clinicians helping patients find a suitable PA that may help patients maintain an active lifestyle.
40.	Broman, D., et al. (author) A clinician-friendly test battery with a passing rate similar to a ‘gold standard’ return-to-sport test battery 1 year after ACL reconstruction: Results from a rehabilitation outcome registry 2023 In: Physical Therapy in Sport. - : Elsevier BV. - 1466-853X. ; 59, s. 144-150 Journal article (peer-reviewed)abstract Objectives: To 1) present passing rates for different clinician-friendly (CF) test batteries and 2) determine the relationship between passing CF test batteries and passing gold standard (GS) return-to-sport (RTS) muscle function testing, 1 year after ACL reconstruction. Study design: Cross-sectional registry study, level of evidence: 3. Setting: Primary care. Participants: Data from 588 patients (52% women, mean age 29.3 ± 9.8 years) were extracted from the Project ACL registry. Main outcome measures: The passing rates for the different test batteries. Results: The passing rate for GS test battery was 28% (95% CI, 24–32%) and the passing rate for the CF test battery with the lowest passing rate was 27% (95% CI 24–31%). The two CF test batteries with the strongest relationships with passing GS test battery showed that 51% (95% CI 43–59%) and 49% (95% CI 44–55%) of the patients who passed the respective CF test battery also passed the GS test battery. Conclusion: A CF test battery can be as demanding to pass as a GS test battery, 1 year after ACL reconstruction. However, passing a CF test battery only gives patients a chance similar to a “coin flip” of also passing a GS RTS test battery.
41.	Grävare Silbernagel, Karin, 1965, et al. (author) A new measurement of heel-rise endurance with the ability to detect functional deficits in patients with Achilles tendon rupture. 2010 In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 18:2, s. 258-64 Journal article (peer-reviewed)abstract Studies evaluating treatment effects on muscle function after an Achilles tendon rupture often use various tests for evaluating calf muscle strength. However, these tests rarely demonstrate the difference between treatment groups; therefore, new tests with a higher ability to detect possible differences in outcome are needed. The purpose of this study was to evaluate the validity and ability to detect differences in outcome of a heel-rise work test that would measure both the height of each heel-rise and the number of repetitions. Seventy-eight patients (65 men and 13 women) at a mean (standard deviation) age of 42 (9) years with Achilles tendon ruptures were included. The patients were evaluated with the new heel-rise test at 6 and 12 months after injury. The limb symmetry index (LSI = involved/uninvolved x 100) was calculated to determine the size of the difference in function between the injured and the uninjured side. The heel-rise height differed significantly between the injured and uninjured sides at the 6- and 12-month evaluations (P < 0.001). At the 6-month evaluation, the patients had achieved a mean LSI of 84% on the number of repetitions parameter but only a mean LSI of 61% on the work parameter. At the 12-month evaluation the mean, LSI of the heel-rise repetition parameter was 95%, indicating that the patients had fully recovered function, but on the work parameter the mean LSI was only 76%. The heel-rise work test in the present study has good validity and greater ability to detect differences between the injured and the uninjured sides than a test that measures only the number of heel-rise repetitions in patients with Achilles tendon rupture.
42.	Grävare Silbernagel, Karin, 1965, et al. (author) Akilles tendinopati – Hälsenebesvär 2006 In: Svensk Idrottsforskning. ; :3 Journal article (other academic/artistic)
43.	Grävare Silbernagel, Karin, 1965, et al. (author) Akillestendinopati – Hälsenebesvär 2007 In: Incitament. ; :4 Journal article (other academic/artistic)
44.	Grävare Silbernagel, Karin, 1965, et al. (author) Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study 2007 In: Am J Sports Med. - : SAGE Publications. - 0363-5465. ; 35:6, s. 897-906 Journal article (peer-reviewed)abstract BACKGROUND: Achilles tendinopathy is a common overuse injury, especially among athletes involved in activities that include running and jumping. Often an initial period of rest from the pain-provoking activity is recommended. PURPOSE: To prospectively evaluate if continued running and jumping during treatment with an Achilles tendon-loading strengthening program has an effect on the outcome. STUDY DESIGN: Randomized clinical control trial; Level of evidence, 1. METHODS: Thirty-eight patients with Achilles tendinopathy were randomly allocated to 2 different treatment groups. The exercise training group (n = 19) was allowed, with the use of a pain-monitoring model, to continue Achilles tendon-loading activity, such as running and jumping, whereas the active rest group (n = 19) had to stop such activities during the first 6 weeks. All patients were rehabilitated according to an identical rehabilitation program. The primary outcome measures were the Swedish version of the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A-S) and the pain level during tendon-loading activity. RESULTS: No significant differences in the rate of improvements were found between the groups. Both groups showed, however, significant (P < .01) improvements, compared with baseline, on the primary outcome measure at all the evaluations. The exercise training group had a mean (standard deviation) VISA-A-S score of 57 (15.8) at baseline and 85 (12.7) at the 12-month follow-up (P < .01). The active rest group had a mean (standard deviation) VISA-A-S score of 57 (15.7) at baseline and 91 (8.2) at the 12-month follow-up (P < .01). CONCLUSIONS: No negative effects could be demonstrated from continuing Achilles tendon-loading activity, such as running and jumping, with the use of a pain-monitoring model, during treatment. Our treatment protocol for patients with Achilles tendinopathy, which gradually increases the load on the Achilles tendon and calf muscle, demonstrated significant improvements. A training regimen of continued, pain-monitored, tendon-loading physical activity might therefore represent a valuable option for patients with Achilles tendinopathy.
45.	Grävare Silbernagel, Karin, 1965, et al. (author) Cross-cultural adaptation of the VISA-A questionnaire, an index of clinical severity for patients with Achilles tendinopathy, with reliability, validity and structure evaluations 2005 In: BMC Musculoskelet Disord. - 1471-2474. ; 6 Journal article (peer-reviewed)abstract BACKGROUND: Achilles tendinopathy is considered to be one of the most common overuse injuries in elite and recreational athletes and the recommended treatment varies. One factor that has been stressed in the literature is the lack of standardized outcome measures that can be used in all countries. One such standardized outcome measure is the Victorian Institute of Sports Assessment - Achilles (VISA-A) questionnaire, which is designed to evaluate the clinical severity for patients with Achilles tendinopathy. The purpose of this study was to cross-culturally adapt the VISA-A questionnaire to Swedish, and to perform reliability, validity and structure evaluations. METHODS: Cross-cultural adaptation was performed in several steps including translations, synthesis of translations, back translations, expert committee review and pre-testing. The final Swedish version, the VISA-A Swedish version (VISA-A-S) was tested for reliability on healthy individuals (n = 15), and patients (n = 22). Tests for internal consistency, validity and structure were performed on 51 patients. RESULTS: The VISA-A-S had good reliability for patients (r = 0.89, ICC = 0.89) and healthy individuals (r = 0.89-0.99, ICC = 0.88-0.99). The internal consistency was 0.77 (Cronbach's alpha). The mean [95% confidence interval] VISA-A-S score in the 51 patients (50 [44-56]) was significantly lower than in the healthy individuals (96 [94-99]). The VISA-A-S score correlated significantly (Spearman's r = -0.68) with another tendon grading system. Criterion validity was considered good when comparing the scores of the Swedish version with the English version in both healthy individuals and patients. The factor analysis gave the factors pain/symptoms and physical activity CONCLUSION: The VISA-A-S questionnaire is a reliable and valid instrument and comparable to the original version. It measures two factors: pain/symptoms and physical activity, and can be used in both research and the clinical setting.
46.	Grävare Silbernagel, Karin, 1965, et al. (author) Evaluation of lower leg function in patients with Achilles tendinopathy 2006 In: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 14:11, s. 1207-17 Journal article (peer-reviewed)abstract Achilles tendinopathy is considered to be one of the most common overuse injuries in elite and recreational athletes. However, the effect that the Achilles tendinopathy has on patients' physical performance is still unclear. The purpose of this study was to evaluate if Achilles tendinopathy caused functional deficits on the injured side compared with the non-injured side in patients. A test battery comprised of tests for different aspects of muscle-tendon function of the gastrocnemius, soleus and Achilles tendon complex was developed to evaluate lower leg function. The test battery's test-retest reliability and sensitivity (the percent probability that the tests would demonstrate abnormal lower limb symmetry index in patients) were also evaluated. The test battery consisted of three jump tests, a counter movements jump (CMJ), a drop counter movement jump (drop CMJ) and hopping, and two strength tests, concentric toe-raises, eccentric-concentric toe-raises and toe-raises for endurance. The reliability was evaluated through a test-retest design on 15 healthy subjects. The test battery's sensitivity and possible functional deficits in patients with Achilles tendinopathy were evaluated on 42 patients (19 women and 23 men). An excellent reliability was found between test days 1-2 and 2-3 for all tests (ICC = 0.76-0.94) except for concentric toe-raise, test 2-3, which had fair reliability (ICC = 0.73). The methodological error ranged from 8 to 17%. There were significant differences (P = 0.001-0.049) between the non-injured (or least symptomatic) side and injured (most symptomatic) side for hopping, drop CMJ, concentric and eccentric-concentric toe-raises, and significant differences (P = 0.000-0.012) in the level of pain during CMJ, hopping, and drop CMJ. The sensitivity of the test battery at a 90% capacity was 88. Achilles tendinopathy causes not only pain and symptoms in patients but also apparent impairments in various aspects of lower leg muscle-tendon function as measured with the test battery. This test battery is reliable and able to detect differences in lower leg function between the injured or "most symptomatic" and non-injured or "least symptomatic" side in patients with Achilles tendinopathy. The test battery has higher demand on patients' function compared with each individual test.
47.	Grävare Silbernagel, Karin, 1965, et al. (author) Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy 2007 In: BRITISH JOURNAL OF SPORTS MEDICINE. - : BMJ. - 0306-3674. ; 41:4, s. 276-280 Journal article (peer-reviewed)
48.	Hamrin Senorski, Eric, 1989, et al. (author) Factors Affecting the Achievement of a Patient-Acceptable Symptom State 1 Year After Anterior Cruciate Ligament Reconstruction: A Cohort Study of 343 Patients From 2 Registries. 2018 In: Orthopaedic journal of sports medicine. - : SAGE Publications. - 2325-9671. ; 6:4 Journal article (peer-reviewed)abstract There is insufficient knowledge regarding the influence of concomitant injuries on the recovery of short-term subjective knee function after anterior cruciate ligament (ACL) reconstruction.To determine whether patient characteristics, concomitant injuries, and graft choice during ACL reconstruction can predict which patients achieve acceptable knee function 1 year after reconstruction.Case-control study; Level of evidence, 3.Data from 1 physical therapist-specific and 1 surgeon-specific register were used. Patients who had completed the Knee injury and Osteoarthritis Outcome Score (KOOS) at 1-year follow-up were included. Additional intraoperative information was extracted from a database. The primary outcome was achieving a patient-acceptable symptom state (PASS) for each subscale of the KOOS. Univariable and multivariable logistic regression models were used, with patient sex, age, and preinjury level of physical activity as covariates.A total of 343 patients (51% females) were included. The proportion of patients achieving PASS 1 year after ACL reconstruction varied between 40% and 85% among the KOOS subscales. Younger age at reconstruction and male sex provided favorable odds of achieving acceptable knee function across the KOOS subscales. Patients without cartilage injury had increased odds of achieving PASS in the KOOS sport and recreation subscale; the increase was 1.63-fold (95% CI, 1.01-2.64; P = .045). Patients receiving patellar tendon autograft had a 0.41-fold (95% CI, 0.19-0.85; P = .017) decrease in odds of achieving PASS on the KOOS quality of life (QoL) subscale. In the multivariable analysis, increased odds of achieving PASS on the KOOS QoL subscale were associated with the absence of meniscal injury (odds ratio, 1.62; 95% CI, 1.04-2.54; P = .035), and increased odds were found for hamstring tendon autograft (OR, 2.63; 95% CI, 1.25-5.56; P = .011).More than half of the patients reported an acceptable symptom state on 4 of the 5 KOOS subscales 1 year after ACL reconstruction. A lack of consistency was noted related to the effect of concomitant knee injuries and graft choice on acceptable knee function. However, younger age and male sex were favorable, nonmodifiable characteristics that increased the odds of early acceptable function.
49.	Hägglund, Martin, et al. (author) Should patients reach certain knee function benchmarks before anterior cruciate ligament reconstruction? Does intense 'prehabilitation' before anterior cruciate ligament reconstruction influence outcome and return to sports? 2015 In: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 49:22, s. 1423-4 Journal article (other academic/artistic)
50.	Högberg, Johan, 1994, et al. (author) Is absolute or relative knee flexor strength related to patient- reported outcomes in patients treated with ACL reconstruction with a hamstring tendon autograft? An analysis of eccentric Nordic hamstring strength and seated concentric isokinetic strength 2023 In: Knee. - : Elsevier BV. - 0968-0160. ; 41, s. 161-170 Journal article (peer-reviewed)abstract Background: There is a need for better understanding of how knee flexor strength influence patient-reported outcomes (PROs) after anterior cruciate ligament (ACL) reconstruction. Our aim was to investigate the relationship between the eccentric NordBord test and the seated concentric Biodex test with PROs, during the first year of rehabilitation after ACL reconstruction with hamstring tendon (HT) autograft.Methods: Patients with an index ACL reconstruction with an HT autograft participating in a rehabilitation registry were screened for inclusion. Outcomes of interest were the correla-tion between absolute (N/kg or Nm/kg) and relative (limb symmetry index) knee flexor strength measured in the NordBord and Biodex with the results of PROs. The significance level was set at p < 0.05 and Pearson's correlation coefficient was used.Results: 137 patients were included (47% women) with a mean age of 24.8 +/- 8.4 years. There were non-significant and weak correlations between relative strength for all PROs. Significant and weak correlations between absolute strength in the Biodex with the Knee Self-Efficacy Scale18 (K-SES18) present at 4 and 8 months, and for the ACL-Return to Sport after Injury scale (ACL-RSI) at 12 months was observed, accounting for 8.4-15.7% of the variance. Significant and weak correlations between absolute strength in the Nordbord with the Knee injury and Osteoarthritis Outcome Scale subscale Sports and Recreation at 4 months, the K-SES18 present and the ACL-RSI at 8 months were observed, accounting for 9.4-14.4% of the variance.

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