| 1. |
- Danielsson, Adam, et al.
(författare)
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The mechanism of hamstring injuries - a systematic review
- 2020
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Injuries to the hamstring muscles are among the most common in sports and account for significant time loss. Despite being so common, the injury mechanism of hamstring injuries remains to be determined. Purpose To investigate the hamstring injury mechanism by conducting a systematic review. Study design A systematic review following the PRISMA statement. Methods A systematic search was conducted using PubMed, EMBASE and the Cochrane Library. Studies 1) written in English and 2) deciding on the mechanism of hamstring injury were eligible for inclusion. Literature reviews, systematic reviews, meta-analyses, conference abstracts, book chapters and editorials were excluded, as well as studies where the full text could not be obtained. Results Twenty-six of 2372 screened original studies were included and stratified to the mechanism or methods used to determine hamstring injury:stretch-related injuries, kinematic analysis, electromyography-based kinematic analysis and strength-related injuries. All studies that reported the stretch-type injury mechanism concluded that injury occurs due to extensive hip flexion with a hyperextended knee. The vast majority of studies on injuries during running proposed that these injuries occur during the late swing phase of the running gait cycle. Conclusion A stretch-type injury to the hamstrings is caused by extensive hip flexion with an extended knee. Hamstring injuries during sprinting are most likely to occur due to excessive muscle strain caused by eccentric contraction during the late swing phase of the running gait cycle.
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| 2. |
- Ascione, F., et al.
(författare)
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Experience-optimised fast track improves outcomes and decreases complications in total knee arthroplasty
- 2020
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Ingår i: Knee. - : Elsevier BV. - 0968-0160. ; 27, s. 500-508
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The aim of this study was to describe an advanced total knee arthroplasty (TKA) fast-track programme and determine discharge parameters during hospitalisation, as well as patient satisfaction, outcomes and complications within the first 12months after surgery. Methods This prospective study was based on patients selected consecutively for primary elective TKA, undergoing surgery between 2014 and 2017 in an established fast-track setting. Hospitalisation-related parameters were collected: demographics, body mass index (BMI), surgical time, ischaemia time, haemoglobin values, blood transfusions, length of stay, weight-bearing and stair-climbing time, opioid administration, preoperative and discharge loss of extension and maximum active flexion of the knee, visual analogue scale (VAS), 12-month follow-up satisfaction rate and range of motion, any complications, hospital re-admission and re-operation within the first 12months. Differences were determined using t-tests. Results A total of 704 total knee replacements implanted in 481 patients were included in the study and 223 patients had a bilateral TKA. Their mean age was 69.8years (range 57–88years). At the 12-month follow-up, 623 patients (88.5%) reported being satisfied or very satisfied and 15 (2.1%) were dissatisfied with their TKA, mean active flexion and loss of extension were 104.4° and 2.3°, respectively. A total of 15 complications occurred (two percent): five painful knees, three knee stiffness, three haematomas, two infections, one hospital re-admission and one deep venous thrombosis. No cases of pulmonary embolism and death related to surgery were reported. Conclusion The study reports on an advanced fast-track programme for TKA with a low incidence of surgery- and hospitalisation-related issues and complications and without any severe adverse events during the first year. On average, the fast-track programme had a short length of stay, an early recovery of weight-bearing, knee mobility, pain control and a high satisfaction rate, accompanied with an acceptable 12month range of motion.
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| 3. |
- Beischer, Susanne, et al.
(författare)
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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
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Ingår i: Journal of Orthopaedic & Sports Physical Therapy. - : Journal of Orthopaedic & Sports Physical Therapy (JOSPT). - 0190-6011 .- 1938-1344. ; 50:2, s. 83-90
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Tidskriftsartikel (refereegranskat)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.
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| 4. |
- Diermeier, T., et al.
(författare)
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Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group
- 2020
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 28, s. 2390-2402
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Tidskriftsartikel (refereegranskat)abstract
- Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance toward consensus opinions regarding the best available evidence on operative vs. non-operative treatment for ACL injury. The purpose of this study is to report the consensus statements on operative vs. non-operative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. Sixty-six international experts on the management of ACL injuries, representing 18 countries, were convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the Scientific Organizing Committee and Session Chairs for the three working groups. Panel participants reviewed preliminary statements prior to the meeting and provided the initial agreement and comments on the statement via an online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Eighty percent agreement was defined a-priori as consensus. A total of 11 of 13 statements on operative v. non-operative treatment of ACL injury reached the consensus during the Symposium. Nine statements achieved unanimous support, two reached strong consensus, one did not achieve consensus, and one was removed due to redundancy in the information provided. In highly active patients engaged in jumping, cutting, and pivoting sports, early anatomic ACL reconstruction is recommended due to the high risk of secondary meniscus and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight plane activities, non-operative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomic ACL reconstruction is indicated. The consensus statements derived from international leaders in the field will assist clinicians in deciding between operative and non-operative treatments with patients after an ACL injury. Level of evidence V. © 2020, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
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| 5. |
- Diermeier, Theresa, et al.
(författare)
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Treatment After Anterior Cruciate Ligament Injury: Panther Symposium ACL Treatment Consensus Group
- 2020
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Ingår i: Orthopaedic Journal of Sports Medicine. - 2325-9671. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best-practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance toward consensus opinions regarding the best available evidence on operative versus nonoperative treatment for ACL injury. The purpose of this study was to report the consensus statements on operative versus nonoperative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. There were 66 international experts on the management of ACL injuries, representing 18 countries, who were convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the scientific organizing committee and session chairs for the 3 working groups. Panel participants reviewed preliminary statements before the meeting and provided initial agreement and comments on the statement via online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Ultimately, 80% agreement was defined a priori as consensus. A total of 11 of 13 statements on operative versus nonoperative treatment of ACL injury reached consensus during the symposium. Overall, 9 statements achieved unanimous support, 2 reached strong consensus, 1 did not achieve consensus, and 1 was removed because of redundancy in the information provided. In highly active patients engaged in jumping, cutting, and pivoting sports, early anatomic ACL reconstruction is recommended because of the high risk of secondary meniscal and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight-plane activities, nonoperative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomic ACL reconstruction is indicated. The consensus statements derived from international leaders in the field will assist clinicians in deciding between operative and nonoperative treatment with patients after an ACL injury.
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| 6. |
- Hamrin Senorski, Eric, 1989, et al.
(författare)
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Understanding limitations in sport 1 year after an Achilles tendon rupture: a multicentre analysis of 285 patients.
- 2020
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Ingår i: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 28:1, s. 233-244
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to determine patient-related and treatment-related predictors of superior and inferior function in sport and recreational activities 1year after an Achilles tendon rupture.This study is based on a multicentre cohort from 4 previous randomised controlled trials. All the patients who had responded to the Foot and Ankle Outcome Score (FAOS) at the 1-year follow-up were included. All the patients had a clinically verified Achilles tendon rupture and patients who underwent surgery were treated within 96h of the time of rupture. Patients were excluded in the event of a previous Achilles tendon rupture or the presence of other lifestyle diseases. The primary outcomes of the study were reported in the 20th and 80th percentiles of the FAOS subscale, function in sports and recreational activities.A total of 285 (84% men) patients with an average age of 40.0 (SD 8.4) years were included. Smoking increased the odds of superior self-reported FAOS sport and recreation [OR 4.59 (95% CI 1.58-13.32), p=0.005] compared with non-smoking, while being female [OR 0.38 (95% CI 0.16-0.93), p=0.035] and every increment of one unit in BMI [OR 0.89 (95% CI 0.81-0.99), p=0.029] reduced the odds. No variable was statistically significant when attempting to predict which patients report inferior FAOS sport and recreation. The recovery of symmetry in heel-rise tests had no effect on 1-year FAOS sport and recreation. Patient-reported outcomes had a good-to-excellent explanatory capacity of superior and inferior 1-year function in sport and recreational activities (AUC=0.87-0.93).BMI is a modifiable risk factor, which, when lowered, may be associated with less impairment in sports 1year after an Achilles tendon rupture. Females appear to perceive more limitations than males. Unexpectedly, smokers experience less limitations in foot and ankle function. Patients who report no functional limitation in sport are characterised by an overall perception of adequate foot, ankle and Achilles function, despite not having recovered symmetry in the heel-rise test.I.
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| 7. |
- Identeg, Fredrik, 1990, et al.
(författare)
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Poor Associations Between Radiographic Tibiofemoral Osteoarthritis and Patient-Reported Outcomes at 16 Years After Anterior Cruciate Ligament Reconstruction
- 2020
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Ingår i: Orthopaedic Journal of Sports Medicine. - : SAGE Publications. - 2325-9671. ; 8:9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Radiographic tibiofemoral (TF) osteoarthritis (OA) is common in patients after anterior cruciate ligament (ACL) reconstruction at long-term follow-up. The association between radiographic OA and patient-reported outcomes has not been thoroughly investigated. Purpose: To determine the association between radiographic TF OA and patient-reported outcome measure (PROM) scores at 16 years after ACL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: This study was based on 2 randomized controlled studies comprising 193 patients who underwent unilateral ACL reconstruction. A long-term follow-up was carried out at 16.4 +/- 1.7 years after surgery and included a radiographic examination of the knee and recording of PROM scores. Correlation analyses were performed between radiographic OA (Kellgren-Lawrence [K-L], Ahlback, and cumulative Fairbank grades) and the PROMs of the International Knee Documentation Committee (IKDC) subjective knee form, Lysholm score, and Tegner activity scale. A linear univariable regression model was used to assess how the IKDC score differed with each grade of radiographic OA. Results: Of 193 patients at baseline, 147 attended the long-term follow-up. At long-term follow-up, 44.2% of the patients had a K-L grade of >= 2 in the injured leg, compared with 6.8% in the uninjured leg. The mean IKDC score at follow-up was 71.2 +/- 19.9. Higher grades of radiographic OA were significantly correlated with lower IKDC and Lysholm scores (r= -0.36 to -0.22). Patients with a K-L grade of 3 to 4 had significantly lower IKDC scores compared with patients without radiographic OA (K-L grade 0-1). Adjusted beta values were -15.7 (95% CI, -27.5 to -4.0;P= .0093;R-2= 0.09) for K-L grade 3 and -25.2 (95% CI, -41.7 to -8.6;P= .0033;R-2= 0.09) for K-L grade 4. Conclusion: There was a poor but significant correlation between radiographic TF OA and more knee-related limitations, as measured by the IKDC form and the Lysholm score. Patients with high grades of radiographic TF OA (K-L grade 3-4) had a statistically significant decrease in IKDC scores compared with patients without radiographic TF OA at 16 years after ACL reconstruction. No associations were found between radiographic TF OA and the Tegner activity level.
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| 8. |
- Krupic, Ferid, et al.
(författare)
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Experience of Intensive Care Nurses in Assessment of Postoperative Pain in Patients with Hip Fracture and Dementia
- 2020
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Ingår i: Materia socio-medica. - : ScopeMed. - 1512-7680. ; 32:1, s. 50-56
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT Introduction: Patients with hip fracture are one of the most demanding groups in the health-care system. One of the most important tasks for nurses is to assess pain and ensure the patients are pain free. Pain assessment in patients with dementia is a well-known challenge for health-care professionals due to the patients’ difficulties in verbalising pain problems. Aim: The aim of this study was to explore the experience of intensive care nurses in assessment of pain in patients with hip fracture and dementia in the postoperative setting. Methods: Data were collected through five focus group discussions using open-ended questions and qualitative content analysis. Twenty-one intensive care nurses (6 men and 15 women) participated in the focus group interviews. Results: Analysis of the data resulted in three main categories: “Communication”, “Visual assessment of pain”, and “Practical issues” including a number of subcategories. Some of the factors which influence assessment of pain in patients with dementia are the lack of information and knowledge about the patients, which causes loss of time and increased stress. The different forms of communication and ways of assessing pain in these patients were other factors mentioned by nurses as hindrances regarding assessment of the pain. Conclusion: In order to improve assessment of pain, more knowledge and information about the patients are needed and better coordination between the pre- and postoperative departments regarding these patients. In this context, different intervention studies on patient’s hip fracture and dementia are needed to increase knowledge and awareness regarding this group of patients
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| 9. |
- Krupic, Ferid, et al.
(författare)
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Experience of nurses in assessing postoperative pain in hip fracture patients suffering from dementia in nursing homes.
- 2020
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Ingår i: Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina. - 1840-2445. ; 17:1, s. 216-223
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Tidskriftsartikel (refereegranskat)abstract
- Aim To explore the experiences of registered nurses in assessing postoperative pain in hip fracture patients suffering from dementia in nursing homes. Methods The study was designed as a qualitative study using data from a self-reported questionnaire form. Data were collected through the self-administered questionnaire with 23 questions, mainly addressing demographic and social data, information about communication and pain assessment. Results All nurses reported that large part of verbal communication with dementia patients was lost, and non-verbal communication was very important to optimize the care of these patients in postoperative situations. An assessment of pain in patients with dementia and hip fractures was a complex process because cognitive ability of these patients was reduced. Conclusion Registered nurses need to know various and different forms of evaluation and tools to assess the experience of pain in patients with dementia who had undergone surgery for hip fractures. This is a complicated task, which requires a great deal of time, and means that nurses must work together with other medical staff, using a holistic approach.
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| 10. |
- Krupic, Ferid, et al.
(författare)
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Use of the World Health Organization Checklist-Swedish Health Care Professionals' Experience: A Mixed-Method Study.
- 2020
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Ingår i: Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses. - : Elsevier BV. - 1532-8473. ; 35:3, s. 288-93
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Tidskriftsartikel (refereegranskat)abstract
- The purpose was to describe health care professionals' experience of using the World Health Organization (WHO) surgical safety checklist.A descriptive cross-sectional mixed-method study, including health care professionals from two clinics at the same university hospital in the western part of Sweden was conducted.Data were collected from one hundred ninety-six health care professionals using a self-administered questionnaire that contained 12 questions. The Mantel-Haenszel and Pearson χ2 tests were used for ordered and unordered categorical variables. The text analysis was inspired by Malterud.The most statistically significant difference between the clinics related to the responsibility for administering the checklist (P=.0010) and always using the checklist in all emergency situations (P=.045). Among the health care professionals who were educated and trained in using checklists, 63% and 65.5% stated that the checklist was adapted to the department. Sixty four percent stated that the assistant nurses were responsible for implementing the checklist. The health care professionals also mentioned a large number of positive and negative aspects of using the WHO checklist.The health care professionals had difficulties using the WHO checklist in the Swedish health care system. More research is needed to determine why specific items are overlooked and whether these items could form the basis of the further elaboration of a modified checklist. An increased understanding of why the checklist is important, as well as updated knowledge on the content could produce greater compliance and thereby increase patient safety.
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| 11. |
- Krupic, Ferid, et al.
(författare)
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Young People’s Views of Organ Donation and Transplantation as Seen by High-School and University Students in Sweden
- 2020
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Ingår i: International Journal of Health Sciences and Research. - 2249-9571. ; 10:8, s. 287-296
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Organ donation and transplantation of organs are one of the most effective ways to save lives and improve the quality of life for people with end-stage organ failure. Despite its increasing availability from the technological standpoint, the gap between the number of people waiting for transplantation and the number of donors is widening every year all over the world. Aim: To explore and elucidate high school and university students’ attitudes, knowledge and willingness regarding organ donation and transplantation. Methods: Data were collected from March 2018 to September 2019through three focus group interviews using open-ended questions, following an interview guide and qualitative content analysis according to Graneheim and Lundman and about twenty-five adult students. Results: The analysis of the interviews resulted in three main categories: “Knowledge of organ donation”, “Being informed about organ donation” and “Willingness to be a donor”, including a number of subcategories. Interest in organ donation of all the students was at an extremely low level and they were critical and emphasized that their school offered very little or no education about organ donation. The extremely low level of knowledge was also found about a donor card, who can donate their organs and who can receive organs from other people. Conclusion: In order to overcome young people’s low level of knowledge about organ donation, structured and well-considered educational programs, which provide knowledge, information and education about prejudice relating to organ donation and transplantation should be prepared for all. More programs about organ donation must be available in different media and on the Internet.
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| 12. |
- Lindman, Ida, et al.
(författare)
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Five-Year Outcomes After Arthroscopic Surgery for Femoroacetabular Impingement Syndrome in Elite Athletes
- 2020
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Ingår i: American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 48:6, s. 1416-1422
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Tidskriftsartikel (refereegranskat)abstract
- © 2020 The Author(s). Background: Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain and disability in athletes. Arthroscopic treatment for FAIS is well-established; however, the long-term results in elite athletes are limited. Purpose: To evaluate outcomes 5 years after arthroscopic treatment for FAIS in elite athletes. Study Design: Case series; Level of evidence, 4. Methods: Elite athletes undergoing arthroscopic treatment for FAIS with a minimum 5-year follow-up were included. They were prospectively followed up with patient-reported outcome measures. An elite athlete was defined as having a Hip Sports Activity Scale (HSAS) level of 7 or 8 before the onset of symptoms. Preoperatively and 5 years after surgery, all athletes completed a web-based questionnaire, including the Copenhagen Hip and Groin Outcome Score (comprising 6 subscales), the EQ-5D and EQ-VAS (European Quality of Life–5 Dimensions Questionnaire and European Quality of Life–Visual Analog Scale), iHOT-12 (International Hip Outcome Tool), a visual analog scale for hip function, and the HSAS. Moreover, patients reported their overall satisfaction with their hip function. Preoperative measurements were compared with the 5-year follow-up. Results: A total of 64 elite athletes (52 men, 12 women) with a mean ± SD age of 24 ± 6 years were included. On average, patients reported a statistically significant and clinically relevant improvement from preoperative patient-reported outcome measures to the 5-year follow-up (P <.0003), Copenhagen Hip and Groin Outcome Score subscales (symptoms, 51.7 vs 71.9; pain, 61.0 vs 81.1; function of daily living, 67.1 vs 83.6; function in sports and recreation, 40.0 vs 71.5; participation in physical activity, 25.0 vs 67.4; hip and groin–related quality of life, 34.4 vs 68.0), EQ-5D (0.60 vs 0.83), EQ-VAS (66.1 vs 76.7), and iHOT-12 (40.0 vs 68.8). At the 5-year follow-up, 90.5% reported satisfaction with their overall hip function. In total, 54% still participated in competitive sports (HSAS, 5-8) at follow-up, while 77% had decreased their level. Older patients and patients with longer duration of symptoms reported a significantly lower level of sports activity (HSAS, 0-4; P <.009). Conclusion: Arthroscopic treatment for FAIS in elite athletes results in a statistically significant and clinically relevant improvement regarding symptoms, hip function, quality of life, and pain 5 years after surgery. Approximately half of the cohort was still in competitive sports at follow-up, yet 77% had decreased their level of sports. Nine of 10 patients were satisfied with their surgery.
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| 13. |
- Lindman, Ida, et al.
(författare)
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Loss to follow-up: initial non-responders do not differ from responders in terms of 2-year outcome in a hip arthroscopy registry.
- 2020
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Ingår i: Journal of hip preservation surgery. - : Oxford University Press (OUP). - 2054-8397. ; 7:2, s. 281-287
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Tidskriftsartikel (refereegranskat)abstract
- Loss to follow-up in registry studies is a problem due to potential selection bias. There is no consensus on the effect of response rate. The aim of this study was to compare patient-reported outcome measures (PROMs) between responders and initial non-responders (INR) in a hip arthroscopy registry and to examine whether demographics affect the response rate. Data from hip arthroscopies performed at two centres in Gothenburg were collected and the patients were followed up with PROMs. The follow-up was a minimum of 2 years after surgery. All 536 patients who underwent primary hip arthroscopies during 2015 and 2016 and had recorded pre-operative PROMs were included. A total of 396 patients completed the follow-up and were labelled 'Responders' (R) and 107 patients responded after reminders were sent and labelled 'Initial non-responders' (INR). The mean time of follow-up was 24.7±2.9 and 42.5±7.0months for the R- and INR-group, respectively. There were no differences between the two groups at the follow-up for the Copenhagen Hip and Groin Outcome Score, European Quality of life 5 dimensions questionnaire, EQ-VAS, International Hip Outcome Tool or a visual analogue scale for hip function. A larger proportion of R was satisfied after hip arthroscopy compared with INR (86% versus 70%, P=0.0003). INR were younger than responders (31.5±12.5 versus 35.6±12.7years of age). The conclusion of the study was that there were no differences between R and INR at the follow-up across the PROMs except patient satisfaction, where responders were more satisfied.
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| 14. |
- Meredith, S. J., et al.
(författare)
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Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group
- 2020
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 28, s. 2403-2414
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Tidskriftsartikel (refereegranskat)abstract
- Purpose A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS and description of the RTS continuum, as well as to provide clinical guidance on RTS testing and decision-making. Methods An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. Results Key points include that RTS is characterized by achievement of the pre-injury level of sport and involves a criteria-based progression from return to participation to return to sport, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along a RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries. Conclusion The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biologic assessment of healing and recovery.
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| 15. |
- Meredith, Sean J., et al.
(författare)
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Return to Sport After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Return to Sport Consensus Group
- 2020
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Ingår i: Orthopaedic Journal of Sports Medicine. - : SAGE Publications. - 2325-9671. ; 8:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sport and their previous activity level. Purpose: The aim of the Panther Symposium ACL Injury Return to Sport Consensus Group was to provide a clear definition of RTS after ACL injury and a description of the RTS continuum as well as provide clinical guidance on RTS testing and decision-making. Study Design: Consensus statement. Methods: An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. Results: Key points include that RTS is characterized by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS and, ultimately, return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum, with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors, and concomitant injuries. Conclusion: The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing, and methods for the biological assessment of healing and recovery.
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| 16. |
- Nilsson, Niklas, et al.
(författare)
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The economic cost and patient-reported outcomes of chronic Achilles tendon ruptures.
- 2020
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Ingår i: Journal of experimental orthopaedics. - : Springer Science and Business Media LLC. - 2197-1153. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- While most Achilles tendon ruptures are dramatic and diagnosed quickly, some are missed, with a risk of becoming chronic. A chronic Achilles tendon rupture is defined as a rupture that has been left untreated for more than 4 weeks. By mapping the health economic cost of chronic Achilles tendon ruptures the health-care system might be able to better distribute resources to detect these ruptures at an earlier time.All patients with a chronic Achilles tendon rupture who were treated surgically at Sahlgrenska University Hospital or Kungsbacka Hospital between 2013 and 2018 were invited to participate in the study. The patients were evaluated postoperatively using the validated Achilles tendon Total Rupture Score (ATRS). The health-care costs were assessed using clinical records. The production-loss costs were extracted from the Swedish Social Insurance Agency. The cost of chronic Achilles tendon ruptures was then compared with the cost of acute ruptures in a previous study by Westin et.al.Forty patients with a median (range) age of 66 (28-86) were included in the study. The mean total cost (± SD) for the patients with a chronic Achilles tendon rupture was 6494 EUR±6508, which is 1276 EUR higher than the mean total cost of acute ruptures. Patients with chronic Achilles tendon ruptures reported a mean (min-max) postoperative ATRS of 73 (14-100).Missing an Achilles tendon rupture will entail higher health-care costs compared with acute ruptures. Health-care resources can be saved if Achilles tendon ruptures are detected at an early stage.
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| 17. |
- Piussi, R., et al.
(författare)
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Hop tests and psychological PROs provide a demanding and clinician-friendly RTS assessment of patients after ACL reconstruction, a registry study
- 2020
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Ingår i: Bmc Sports Science Medicine and Rehabilitation. - : Springer Science and Business Media LLC. - 2052-1847. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Background There is growing interest in assessing psychological well-being in patients after anterior cruciate ligament (ACL) reconstruction. It is unknown whether an assessment of psychological outcome in addition to tests of muscle function can facilitate decisions on return to sport (RTS). Therefore, the aim of this study was to evaluate passing rates in different physical RTS test batteries, with and without the inclusion of psychological outcome measures 1 year after ACL reconstruction. Method In this cross-sectional cohort study a total of 320 patients (51% men) aged 18-65 years were included 1 year after ACL reconstruction. Passing rates on different muscle function (MF) test batteries (with results presented as Limb Symmetry Index (LSI)), consisting of knee extension and flexion strength tests, 3 hop tests, and 2 psychological patient-reported outcomes (PROs); Quality of Life subscale from the Knee injury and Osteoarthritis Outcome Score (KOOS QoL) and ACL Return to Sport after Injury (ACL-RSI), were evaluated 1 year after ACL reconstruction. Muscle function test batteries comprised: 2 MF tests (vertical hop and hop for distance; pass = 90% LSI); 2 MF tests and 2 PRO (pass = 90% LSI, 62.5 points on KOOS QoL and 76.6 points on ACL-RSI), 5 MF tests (2 strength and 3 hop tests, pass = 90% LSI), and 5 MF tests and 2 PRO (pass = 90% LSI, 62.5 points on KOOS QoL and 76.6 points on ACL-RSI). Results Passing rates in the different test batteries were 47% for 2 MF tests, 19% for 2 MF tests and 2 PROs, 29% for 5 MF tests and 13% for 5 MF tests and 2 PROs. The use of psychological PROs together with tests of muscle function gave the lowest passing rate (13%). There was a very strong correlation between passing 2 hop tests and 2 PROs and passing 5 MF tests (r phi = 0.41) as well as passing 5 MF tests and 2 PROs (r phi = 0.79). Conclusion The use of hop tests together with psychological PROs provides a clinician-friendly RTS test battery for assessment 1 year after ACL reconstruction as the passing rate was 19% when using 2 hop-tests combined with 2 PROs, compared with 29% when using 5 tests of MF requiring advanced testing equipment.
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| 18. |
- Piussi, R., et al.
(författare)
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Recovery of preoperative absolute knee extension and flexion strength after ACL reconstruction
- 2020
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Ingår i: BMC Sports Science, Medicine and Rehabilitation. - : Springer Science and Business Media LLC. - 2052-1847. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The recovery of muscle function after an Anterior Cruciate Ligament (ACL) reconstruction is most commonly reported as limb-to-limb differences using the Limb Symmetry Index (LSI), which is not free from limitations. The purpose of this study was to compare the proportion of patients who recover their Preoperative Absolute Muscle Strength (PAMS) 8 and 12 months after ACL reconstruction with the proportion of patients who recover their symmetrical knee strength. A secondary aim was to assess the relationship between psychological Patient-Reported Outcomes (PROs) and recovering PAMS at 8 and 12 months after ACL reconstruction and rehabilitation. Method: Preoperative, 8- and 12-month results from quadriceps and hamstring strength tests and PROs for 117 patients were extracted from a rehabilitation registry. Individual preoperative peak torques from strength tests were compared with results from the 8- and 12-month follow-ups respectively. Patients were defined as having recovered their PAMS upon reaching 90% of their preoperative peak torque for both quadriceps and hamstring strength. Patients were defined as having recovered their LSI upon reaching a value ≥90% when comparing the results for their injured knee with those of their healthy knee. Correlations between the recovery of PAMS and PROs at 8 and 12 months were analyzed. Results: There was no difference in the proportion of patients who recovered their PAMS compared with patients who recovered their LSI. In all, 30% and 32% of the patients who recovered their LSI had not recovered their PAMS at 8 months and 12 months respectively. In the patients who had recovered their PAMS, 24% and 31% had not recovered their symmetrical LSI at 8 months and 12 months respectively. There was no significant correlation between the recovery of PAMS and psychological PROs. Conclusion: The use of both PAMS and LSI provides more detailed information on the recovery of muscle strength after ACL reconstruction. The recovery of PAMS was not correlated with psychological traits, which implies that both PROs and PAMS are important when evaluating patients after ACL reconstruction. Trial registration: This trial was not registered. © 2020, The Author(s).
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| 19. |
- Piussi, Ramana, et al.
(författare)
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Superior knee self-efficacy and quality of life throughout the first year in patients who recover symmetrical muscle function after ACL reconstruction
- 2020
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 28, s. 555-567
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Tidskriftsartikel (refereegranskat)abstract
- © 2019, The Author(s). Purpose: The aim of this study was to (1) describe psychological outcomes during the first year after an anterior cruciate ligament (ACL) reconstruction and (2) compare psychological outcomes in patients who recover symmetrical muscle function with patients who do not. Methods: The included patients had undergone a unilateral ACL reconstruction. Patients with a re-rupture and contralateral ACL injury were excluded. Three groups, based on the results from 5 tests of muscle function 12months after reconstruction, were created. Three validated questionnaires (the Knee Self-Efficacy Scale; the Knee injury and Osteoarthritis Outcome Score subscale “Quality of Life”; the ACL Return to Sport after Injury scale) and a single question “Have you achieved your goal with rehabilitation?” were analysed in 4 different follow-ups after ACL reconstruction (10weeks, 4, 8 and 12months). Means and standard deviations were analysed with standard t tests and reported with 95% confidence intervals. Results: A total of 328 patients (120 men, 37%), mean age 27.8 ± 10years, were included. Patients who did not recover symmetrical muscle function (n = 56; 17%) at the 12-month follow-up reported inferior knee-related self-efficacy and quality of life than patients who recovered symmetrical muscle function (n = 96; 29%) at all follow-ups, except quality of life at 4months. The proportion of patients who stated they achieved their rehabilitation goal at 12months was 17% for the entire cohort, 24% for patients who recovered muscle function and 5% for patients who did not recover muscle function. Conclusion: Patients who recovered strength and hop symmetry 12months after ACL reconstruction had superior knee-related self-efficacy and greater quality of life during the whole first year after ACL reconstruction. These results can aid clinicians in the decision-making process by providing knowledge of patients who might need further attention during rehabilitation. Level of evidence: III.
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| 20. |
- Seffo, Nail, et al.
(författare)
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Communication and assessment of pain in hip fracture patients with dementia - experiences of healthcare professionals at an accident and emergency department in Sweden.
- 2020
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Ingår i: Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina. - 1840-2445. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Aim To describe the experience of healthcare professionals in assessing pain and communication in patients with hip fractures and dementia in an emergency department. Methods Data were collected through focus group interviews using open-ended questions, following an interview guide and qualitative content analysis. Twenty one registered nurses participated in the interviews, five male and 16 female, aged 26 to 55 years. Results The analysis of the interviews resulted in three main categories: "Arrival at the emergency department", "Hip track" and "Handover to the ward", including a number of subcategories. All nurses reported that the assessment of pain and communication with patients with dementia and hip fractures was a complex process. A great deal of stress, fast and brief communication, quick decisions and quick treatments in assessment of pain were only some of the difficulties the nurses emphasized. They also suggested a whole series of improvements for those patients. Conclusion The situation of patients with hip fracture and dementia on the emergency department and healthcare professionals who communicate and assess their pain can be said to be untenable. The care environment in the emergency department is not adapted to patients and can of course depend on several factors. To meet the needs of the future and increased numbers of those patients, some improvements such as more extensive research and more studies on the experiences of both the patients and healthcare professionals are required.
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| 21. |
- Spennacchio, P., et al.
(författare)
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Evaluation modalities for the anatomical repair of chronic ankle instability
- 2020
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 28, s. 163-176
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Several evaluation modalities are reported in the literature dealing with the operative treatment of chronic ankle instability (CAI) both to establish the CAI diagnosis leading to the surgical indication and to assess the effectiveness of ankle stabilisation procedure. The purpose of this study is to present an overview of the pre- and postoperative evaluation modalities reported in the literature dealing with CAI operative treatment. The comprehensive analysis of the different modalities chosen by researchers is expected to suggest critical points in current evaluation ability of CAI surgical treatment. Methods Systematic review of the literature on surgical treatment of CAI through anatomic procedures. Pubmed, Embase and Cochrane electronic databases were analysed, from 2004 to 2018. Results One-hundred-and-four studies met inclusion in this systematic review. 88 out of 104 studies analysed preoperative mechanical laxity of the ankle to depict the ligamentous insufficiency related to the subjective feeling of functional instability. Stress radiographs and manual stress examination of the ankle were the two most common modalities to evaluate joint laxity, reported in 67 and 53 studies, respectively. Clinical Outcome Measurement Scales (COMs) is the most common evaluation modality (102 out of 104 studies) to assess CAI surgical outcome. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale (AOFAS) and the Karlsson score are the most frequent COMs, reported in the 66% and 33%, respectively of the included literature. The radiographic analysis of ankle laxity after stabilisation procedures is the second most frequent postoperative evaluation modality, reported in 55 out 104 studies. Conclusions There is a lack of standardization among researchers related to both the criteria to establish the CAI diagnosis leading to the surgical indication and the modality chosen to evaluate the effectiveness of surgical treatment. Future standardization of evaluation modalities in the CAI population is desirable to increase consistency of reported data.
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| 22. |
- Svantesson, Eleonor, et al.
(författare)
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Clinical outcomes after anterior cruciate ligament injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group
- 2020
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Ingår i: Journal of ISAKOS. - : Elsevier BV. - 2059-7754. ; 5, s. 281-294
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Forskningsöversikt (refereegranskat)abstract
- Purpose: A stringent outcome assessment is a key aspect for establishing evidence-based clinical guidelines for anterior cruciate ligament (ACL) injury treatment. The aim of this consensus statement was to establish what data should be reported when conducting an ACL outcome study, what specific outcome measurements should be used and at what follow-up time those outcomes should be assessed. Methods: To establish a standardised assessment of clinical outcome after ACL treatment, a consensus meeting including a multidisciplinary group of ACL experts was held at the ACL Consensus Meeting Panther Symposium, Pittsburgh, PA, USA, in June 2019. The group reached consensus on nine statements by using a modified Delphi method. Results: In general, outcomes after ACL treatment can be divided into four robust categories - early adverse events, patient-reported outcomes, ACL graft failure/recurrent ligament disruption, and clinical measures of knee function and structure. A comprehensive assessment following ACL treatment should aim to provide a complete overview of the treatment result, optimally including the various aspects of outcome categories. For most research questions, a minimum follow-up of 2 years with an optimal follow-up rate of 80% is necessary to achieve a comprehensive assessment. This should include clinical examination, any sustained re-injuries, validated knee-specific patient-reported outcomes and Health-Related Quality of Life questionnaires. In the mid-term to long-term follow-up, the presence of osteoarthritis should be evaluated. Conclusion: This consensus paper provides practical guidelines for how the aforementioned entities of outcomes should be reported and suggests the preferred tools for a reliable and valid assessment of outcome after ACL treatment. Level of Evidence: Level V. © International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.
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| 23. |
- Svantesson, Eleonor, et al.
(författare)
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Clinical Outcomes After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group.
- 2020
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Ingår i: Orthopaedic journal of sports medicine. - 2325-9671. ; 8:7
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Tidskriftsartikel (refereegranskat)abstract
- A stringent outcome assessment is a key aspect of establishing evidence-based clinical guidelines for anterior cruciate ligament (ACL) injury treatment. To establish a standardized assessment of clinical outcome after ACL treatment, a consensus meeting including a multidisciplinary group of ACL experts was held at the ACL Consensus Meeting Panther Symposium, Pittsburgh, Pennsylvania, USA, in June 2019. The aim was to establish a consensus on what data should be reported when conducting an ACL outcome study, what specific outcome measurements should be used, and at what follow-up time those outcomes should be assessed. The group reached consensus on 9 statements by using a modified Delphi method. In general, outcomes after ACL treatment can be divided into 4 robust categories: early adverse events, patient-reported outcomes (PROs), ACL graft failure/recurrent ligament disruption, and clinical measures of knee function and structure. A comprehensive assessment after ACL treatment should aim to provide a complete overview of the treatment result, optimally including the various aspects of outcome categories. For most research questions, a minimum follow-up of 2 years with an optimal follow-up rate of 80% is necessary to achieve a comprehensive assessment. This should include clinical examination, any sustained reinjuries, validated knee-specific PROs, and health-related quality of life questionnaires. In the midterm to long-term follow-up, the presence of osteoarthritis should be evaluated. This consensus paper provides practical guidelines for how the aforementioned entities of outcomes should be reported and suggests the preferred tools for a reliable and valid assessment of outcome after ACL treatment.
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| 24. |
- Svantesson, Eleonor, et al.
(författare)
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Clinical outcomes after anterior cruciate ligament injury: panther symposium ACL injuryclinical outcomes consensus group.
- 2020
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Ingår i: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 28:8, s. 2415-2434
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Tidskriftsartikel (refereegranskat)abstract
- A stringent outcome assessment is a key aspect for establishing evidence-based clinical guidelines for anterior cruciate ligament (ACL) injury treatment. The aim of this consensus statement was to establish what data should be reported when conducting an ACL outcome study, what specific outcome measurements should be used and at what follow-up time those outcomes should be assessed.To establish a standardized approach to assessment of clinical outcome after ACL treatment, a consensus meeting including a multidisciplinary group of ACL experts was held at the ACL Consensus Meeting Panther Symposium, Pittsburgh, PA; USA, in June 2019. The group reached consensus on nine statements by using a modified Delphi method.In general, outcomes after ACL treatment can be divided into four robust categories-early adverse events, patient-reported outcomes, ACL graft failure/recurrent ligament disruption and clinical measures of knee function and structure. A comprehensive assessment following ACL treatment should aim to provide a complete overview of the treatment result, optimally including the various aspects of outcome categories. For most research questions, a minimum follow-up of 2 years with an optimal follow-up rate of 80% is necessary to achieve a comprehensive assessment. This should include clinical examination, any sustained re-injuries, validated knee-specific PROs and Health-Related Quality of Life questionnaires. In the mid- to long-term follow-up, the presence of osteoarthritis should be evaluated.This consensus paper provides practical guidelines for how the aforementioned entities of outcomes should be reported and suggests the preferred tools for a reliable and valid assessment of outcome after ACL treatment.V.
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| 25. |
- Svantesson, Eleonor, et al.
(författare)
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Comparison of concomitant injuries and patient-reported outcome in patients that have undergone both primary and revision ACL reconstruction-a national registry study
- 2020
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Ingår i: Journal of Orthopaedic Surgery and Research. - : Springer Science and Business Media LLC. - 1749-799X. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Anterior cruciate ligament (ACL) revision surgery has been associated with inferior outcome compared with primary ACL reconstruction. However, this has rarely been investigated in a consecutive cohort limited to patients that have undergone both primary and revision ACL reconstruction. This study aimed to assess differences in outcome and concomitant injuries between primary and revision ACL reconstruction in such a cohort, and to identify predictors of the patient-reported outcome after ACL revision. Methods Patients who had undergone both primary and revision ACL reconstruction were identified in the Swedish National Knee Ligament Registry. Patients aged 13-49 years with hamstring tendon primary ACL reconstruction and data on the Knee Injury and Osteoarthritis Outcome Score (KOOS) on at least one occasion (preoperative or one year postoperatively) at both surgeries were eligible. Concomitant injuries and the KOOS were compared between each patient's primary and revision ACL reconstruction. Linear regression analyses were performed to determine predictors of the one-year KOOS after ACL revision. Results A total of 1014 patients were included. Cartilage injuries increased at ACL revision (p < 0.001), as 23.0% had a cartilage injury at ACL revision that was not present at primary ACL reconstruction. The 1-year KOOS was lower after ACL revision compared with primary ACL reconstruction, with the largest difference in the KOOS sports and recreation (5.2 points, SD 32.2, p = 0.002). A posterolateral corner (PLC) injury at ACL revision was a negative predictor of KOOS, with the largest effect on the sports and recreation subscale (beta = - 29.20 [95% CI - 50.71; - 6.69], p = 0.011). The use of allograft for ACL revision was an independent predictor of a poorer KOOS QoL (beta = - 12.69 [95% CI - 21.84; - 3.55], p = 0.0066) and KOOS4 (beta = - 11.40 [95% CI - 19.24; - 3.57], p = 0.0044). Conclusion Patients undergoing ACL revision reported a 1-year outcome that was slightly inferior to the 1-year outcome after their primary ACL reconstruction. An ACL revision was associated with an increase in cartilage injuries. A PLC injury at ACL revision and the use of allograft for ACL revision predicted a clinically relevant poorer KOOS one year after ACL revision.
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| 26. |
- Svantesson, Eleonor, et al.
(författare)
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Graft Choice for Anterior Cruciate Ligament Reconstruction With a Concomitant Non-surgically Treated Medial Collateral Ligament Injury Does Not Influence the Risk of Revision.
- 2020
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Ingår i: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. - : Elsevier BV. - 1526-3231. ; 31:1, s. 199-211
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Tidskriftsartikel (refereegranskat)abstract
- To compare the risk of anterior cruciate ligament (ACL) revision and the patient-reported outcome after ACL reconstruction with a concomitant non-surgically treated medial collateral ligament (MCL) injury with regard to 3 ACL graft choices; the use of semitendinosus (ST), the use of semitendinosus-gracilis (ST-G), and the use of patellar tendon (PT) autograft. It was hypothesized that the use of ST-G would be associated with a greater risk of ACL revision and poorer patient-reported knee function.Patients older than 15years of age registered for a primary ACL reconstruction with a concomitant non-surgically treated MCL injury in the Swedish National Knee Ligament Registry were assessed for eligibility. Three groups were created according to ACL autograft choice; the ST, the ST-G, and the PT group. The primary outcomes were ACL revision and the 1- and 2-year Knee injury and Osteoarthritis Outcome Score (KOOS), including the KOOS patient acceptable symptom state (PASS). Cox regression analysis was applied to determine the proportional hazard ratio (HR) of primary ACL reconstruction survival. The KOOS was compared using the Mann-Whitney U test and Fisher exact test.A total of 622 patients (mean age 29.7years, 42.4% women) were included. There was no difference in the risk of ACL revision for either the ST group (HR 1.354; 95% confidence interval [CI] 0.678-2.702 or the PT group (HR0.837; 95% CI 0.334-2.100), compared with the ST-G group. The ST group reported a greater mean 2-year KOOS sports and recreation (68.5, standard deviation [SD] 28.5) than the ST-G group (57.4 [SD 27.6], P= .010) and the PT group (54.1 [SD30.3], P= .006). The ST group was superior in terms of achieving PASS in sports and recreation (55.3%; 95% CI 44.1-66.1%) compared with both the ST-G (37.4%; 95% CI 29.8-45.5%; P= .014) and the PT group (33.9%; 95% CI 22.1-47.4%; P= .009).The risk of ACL revision did not differ between HT and PTautografts in patients undergoing ACL reconstruction with a non-surgically treated MCL injury. However, the use of ST-Gwas associated with poorer 2-year patient-reported knee function compared with the ST.Retrospective comparative trial, Level III.
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| 27. |
- Svantesson, Eleonor, et al.
(författare)
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Strength in numbers? The fragility index of studies from the Scandinavian knee ligament registries
- 2020
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 28, s. 339-352
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The fragility index (FI) is a metric to evaluate the robustness of statistically significant results. It describes the number of patients who would need to change from a non-event to an event to change a result from significant to non-significant. This systematic survey aimed to evaluate the feasibility of applying the FI to findings related to anterior cruciate ligament (ACL) reconstruction in the Scandinavian knee ligament registries. Methods: The PubMed, EMBASE, Cochrane Library and AMED databases were searched. Studies from the Scandinavian knee ligament registers were eligible if they reported a statistically significant result (p < 0.05) for any of the following dichotomous outcomes; ACL revision, contralateral ACL reconstruction or the presence of postoperative knee laxity. Only studies with a two-arm comparative analysis were included. Eligibility assessment, data extraction and quality assessment were performed by two independent reviewers. The dichotomous analyses were stratified according to the grouping variable for the two comparative arms as follows; age, patient sex, activity at injury, graft choice, drilling technique, graft fixation, single- versus double-bundle, concomitant cartilage injury and country. The two-sided Fisher’s exact test was used to calculate the FI of all statistically significant analyses. Results: From 158 identified studies, 13 studies were included. They reported statistical significance for a total of 56 dichotomous analyses, of which all but two had been determined by a time-to-event analysis. The median sample size for the arms was 5540 (range 92–38,666). The mean FI for all 56 dichotomous analyses was 80.6 (median 34.5), which means that a mean of 80.6 patients were needed to change outcome status to generate a non-significant result instead of a significant one. Seventeen analyses (30.4%) immediately became non-significant when performing the two-sided Fisher’s exact test and, therefore, had an FI of 0. The analyses related to age were the most robust, with a mean FI of 178.5 (median 116, range 1–1089). The mean FI of the other grouping variables ranged from 0.5 to 48.0. Conclusion: There was large variability in the FI in analyses from the Scandinavian knee ligament registries and almost one third of the analyses had an FI of zero. The FI is a rough measurement of robustness when applied to registry studies, however, future studies are needed to determine the most appropriate metric for robustness in registry studies. The use of the FI can provide clinicians with a deeper understanding of significant study results and promotes an evidence-based approach in the clinical care of patients. Level of evidence: Systematic review of prospective cohort studies, Level II. © 2019, The Author(s).
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