| 1. |
- Ahldén, Mattias, et al.
(författare)
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Knee laxity measurements after anterior cruciate ligament reconstruction, using either bone-patellar-tendon-bone or hamstring tendon autografts, with special emphasis on comparison over time
- 2009
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 1433-7347 .- 0942-2056. ; 17:9, s. 1117-24
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Tidskriftsartikel (refereegranskat)abstract
- The aims of the study were to analyse the change in knee laxity over time after anterior cruciate ligament (ACL) reconstruction, using either bone-patellar-tendon-bone (BPTB) or hamstring (HS) tendon autografts, and to compare the knee laxity measurements between the study groups both pre-operatively and on multiple follow-up occasions. Another aim was to compare the radiographic findings in terms of degenerative changes between the study groups. A randomised series of 71 patients, who underwent ACL reconstruction using BPTB or HS tendon autografts and interference screw fixation, were included in the study. Of these patients, 47/71 (66%) attended a clinical examination, including laxity measurements using the KT-1000 arthrometer, pre-operatively and on four post-operative occasions; 6 months, 1 year, 2 years and 7 years after the reconstruction. The BPTB group consisted of 22 patients, while there were 25 patients in the HS group. There were no significant differences in the mean side-to-side knee laxity between the BPTB and the HS group pre-operatively or at the follow-up examinations. There was a tendency towards a reduction in side-to-side knee laxity over time in both groups, measured with the KT-1000 arthrometer. The decrease was significant when analysing the injured and uninjured knee separately (injured side p < 0.001 (BPTB) and p = 0.005 (HS), uninjured side p = 0.008 and p = 0.042, respectively). Forty-four patients (BPTB 21, ST 23) underwent a radiographic assessment at the 7-year follow-up, which revealed no significant differences between the study groups in terms of osteoarthritic findings classified according to the Fairbank and Ahlback rating systems. In overall terms, osteoarthritis was identified in 16% (BPTB 19%; ST 13%; n.s.) according to the Ahlback rating system and 68% (BPTB 67%; ST 70%; n.s.) according to the Fairbank rating system. There were no significant differences in knee laxity measurements between the two study groups pre-operatively or at 7 years. A decrease in knee laxity over time was seen in both groups. There were no significant differences between the BPTB and ST groups in terms of osteoarthritic findings at 7 years.
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| 2. |
- Andersson, Daniel, et al.
(författare)
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Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials.
- 2009
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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. ; 25:6, s. 653-85
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Tidskriftsartikel (refereegranskat)abstract
- The primary aim was to investigate and assess the current evidence of randomized controlled trials (RCTs) on anterior cruciate ligament (ACL) injuries, with special reference to the choice of surgical techniques and aspects of rehabilitation. A secondary aim was to clarify relative strengths and weaknesses of the selected studies, resolve literature conflicts, and finally, evaluate the need for further studies.
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| 3. |
- Augustsson, Jesper, 1964, et al.
(författare)
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Single-leg hop testing following fatiguing exercise: reliability and biomechanical analysis
- 2006
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Ingår i: Scand J Med Sci Sports. - : Wiley. - 0905-7188. ; 16:2, s. 111-20
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Tidskriftsartikel (refereegranskat)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.
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| 4. |
- Bergsten, Anna
(författare)
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Population Differentiation in Solidago virgaurea along Altitudinal Gradients
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Altitudinal gradients offer attractive opportunities for studies of population differentiation in response to environmental heterogeneity. In this thesis, I examined population differentiation along altitudinal gradients by combining common-garden experiments with field studies and experiments in alpine, subalpine and boreal populations of the perennial herb Solidago virgaurea. More specifically, I determined whether leaf physiology in terms of nitrogen concentration and resorption, flowering phenology, flower production and reproductive effort vary along altitudinal gradients. Nitrogen concentration in green leaves were higher in alpine than in subalpine and boreal populations. These differences persisted when plants were grown from seeds in a common-garden experiment at two sites, suggesting that the differences have a genetic component. There was mixed support for a trade-off between maximized carbon gain through the maintenance of high nitrogen concentration, and minimized nitrogen loss through high resorption. In their natural habitats alpine populations began flowering later than subalpine populations, but this difference was reversed when plants were grown in a common environment. This suggests that genetic differences among populations counteract environmental effects and reduce phenotypic variation in flowering time among populations. Flowering time thus shows countergradient genetic variation in S. virgaurea. In a common-garden experiment, boreal populations produced more flowers and had a higher reproductive effort than subalpine and alpine populations indicating habitat-specific genetic differences in reproductive allocation. In a field study, which included three populations, seed set was close to zero in the alpine population, intermediate in the subalpine population, and high in the boreal population. Experimental flower removal showed that seed production was associated with a considerable cost in terms of reduced flowering propensity the following year, but did not support the hypothesis that a large floral display is important for pollination success.
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| 5. |
- Castagna, A., et al.
(författare)
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Minor shoulder instability
- 2007
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Ingår i: Arthroscopy. - 1526-3231. ; 23:2, s. 211-5
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Tidskriftsartikel (refereegranskat)abstract
- The wide spectrum of shoulder instability is difficult to include in 1 classification. The distinction between traumatic, unidirectional, and atraumatic multidirectional instability is still widely used, even though this classification is not sufficiently precise to include all the different pathological findings of shoulder instability. We present "minor instability," which is a pathological condition causing a dysfunction of the glenohumeral articulation, especially in combination with microtrauma, repetitive or not, or after a period of immobilization or inactivity. When "minor shoulder instability" is suspected, the patient's history and detailed clinical examination represent the most important factors when establishing the diagnosis. In particular, the apprehension test stressing the middle glenohumeral ligament (MGHL)/labral complex in the position of midabduction and external rotation may be painful and may even reveal anterior instability or subluxation. Conventional radiographs are negative in most cases, as is magnetic resonance imaging arthrography. It is only after an accurate arthroscopic assessment that the pathological lesion can be found. The major pathological process can be identified at the level of the anterior superior labrum, in particular the MGHL complex, and appears as hyperemia, fraying, stretching, loosening, thinning, hypoplasia, or even absence. It may, however, be difficult to distinguish between a normal variant and a pathological lesion. Clinical symptoms and examination should always be correlated with arthroscopic findings. Recommended treatment is to restore shoulder stability and thereby prevent shoulder pain secondary to the increase in laxity. A reduction in range of motion should be expected during the postoperative phase, at least up to six to nine months. External rotation is usually permanently reduced by a few degrees.
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| 6. |
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| 7. |
- Cornelissen, Johannes H C, et al.
(författare)
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Global negative vegetation feedback to climate warming responses of leaf litter decomposition rates in cold biomes
- 2007
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Ingår i: Ecology Letters. - : Wiley. - 1461-023X .- 1461-0248. ; 10:7, s. 619-627
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Tidskriftsartikel (refereegranskat)abstract
- Whether climate change will turn cold biomes from large long-term carbon sinks into sources is hotly debated because of the great potential for ecosystem-mediated feedbacks to global climate. Critical are the direction, magnitude and generality of climate responses of plant litter decomposition. Here, we present the first quantitative analysis of the major climate-change-related drivers of litter decomposition rates in cold northern biomes worldwide.Leaf litters collected from the predominant species in 33 global change manipulation experiments in circum-arctic-alpine ecosystems were incubated simultaneously in two contrasting arctic life zones. We demonstrate that longer-term, large-scale changes to leaf litter decomposition will be driven primarily by both direct warming effects and concomitant shifts in plant growth form composition, with a much smaller role for changes in litter quality within species. Specifically, the ongoing warming-induced expansion of shrubs with recalcitrant leaf litter across cold biomes would constitute a negative feedback to global warming. Depending on the strength of other (previously reported) positive feedbacks of shrub expansion on soil carbon turnover, this may partly counteract direct warming enhancement of litter decomposition.
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| 8. |
- Gisslén, Karl, 1967-
(författare)
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The patellar tendon in junior elite volleyball players and an Olympic elite weightlifter
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The principal aim of the present thesis was to prospectively follow (clinical status and ultrasound + Doppler findings) the patellar tendons in the young elite volleyball players at the Swedish National Centre for high school volleyball in Falköping. In an Olympic weightlifter with chronic painful jumper´s knee, the effects of treatment with sclerosing injections followed by early instituted very heavy weightlifting training, was also evaluated. First, in a prevalence study, we demonstrated that the clinical diagnosis patellar tendinopathy-jumper’s knee, together with structural tendon changes and vascularisation in the painful area of the tendon, was demonstrated in 12/114 tendons in Swedish junior elite volleyball players, but not in any tendons of individually matched (age, height and weight) not regularly sports active controls. Structural tendon changes alone was demonstrated among the volleyball players but also among the controls. In a 7 months prospective study of a total of 120 tendons, we demonstrated that the clinical diagnosis patellar tendinopathy-jumper’s knee was associated with neovessels/vascularity in the area with structural tendon changes in 17/19 tendons. Seventy tendons that at start were clinically normal, and had normal ultrasound + Doppler findings, remained clinically normal after 7 months with intensive training and playing volleyball. In a 3-year prospective study it was demonstrated that normal clinical tests and normal ultrasound + Doppler findings at school start, indicated a low risk (8%) for these players to sustain patellar tendinopathy-jumper’s knee during the 3 school years with intensive training and playing. In a case study, involving an Olympic elite weightlifter with chronic painful patellar tendinopathy-jumper’s knee, successful treatment with ultrasound and Doppler-guided injection of the sclerosing agent polidocanol, allowed for pain-free very heavy weight training two weeks after treatment. Further heavy weightlifting training on a daily basis, preparing for European Championships, was done without causing tendon rupture and/or pain. Key words: Jumper’s knee, Patellar tendinopathy, Chronic pain, Ultrasonography, Doppler, Neovascularisation, Volleyball, Weightlifting
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| 9. |
- Grävare Silbernagel, Karin, 1965, et al.
(författare)
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Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study
- 2007
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Ingår i: Am J Sports Med. - : SAGE Publications. - 0363-5465. ; 35:6, s. 897-906
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Tidskriftsartikel (refereegranskat)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.
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| 10. |
- Grävare Silbernagel, Karin, 1965, et al.
(författare)
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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
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Ingår i: BMC Musculoskelet Disord. - 1471-2474. ; 6
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Tidskriftsartikel (refereegranskat)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.
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| 11. |
- Grävare Silbernagel, Karin, 1965, et al.
(författare)
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Evaluation of lower leg function in patients with Achilles tendinopathy
- 2006
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 14:11, s. 1207-17
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Tidskriftsartikel (refereegranskat)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.
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| 12. |
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| 13. |
- Gustavsson, Alexander, et al.
(författare)
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A test battery for evaluating hop performance in patients with an ACL injury and patients who have undergone ACL reconstruction
- 2006
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 14:8, s. 778-88
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Tidskriftsartikel (refereegranskat)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.
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| 14. |
- Hultenheim Klintberg, Ingrid, 1959, et al.
(författare)
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Early activation or a more protective regime after arthroscopic subacromial decompression--a description of clinical changes with two different physiotherapy treatment protocols--a prospective, randomized pilot study with a two-year follow-up.
- 2008
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Ingår i: Clinical rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 22:10-11, s. 951-65
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To describe clinical changes with two protocols of physiotherapy following arthroscopic subacromial decompression (ASD) over two years. Reliability of Functional Index of the Shoulder was performed. DESIGN: A prospective, randomized pilot study, within-subject design. SUBJECTS: Thirty-four shoulders (13 women), mean age 46 (SD 7) years with primary shoulder impingement, listed for arthroscopic subacromial decompression. INTERVENTIONS: The traditional group (n = 20) started with active assisted range of motion exercises on the day of surgery, dynamic exercises for the rotator cuff after six weeks and strengthening exercises after eight weeks. The progressive group (n = 14) started active assisted range of motion and dynamic exercises for the rotator cuff on the day of surgery. Strengthening exercises started after six weeks. MAIN MEASURES: A clinical evaluation was made preoperatively, six weeks, three, six, 12 and 24 months after surgery. Pain, patient satisfaction, active range of motion and muscular strength were evaluated. Shoulder function was evaluated using Constant score, Hand in neck, Pour out of a pot and Functional Index of the Shoulder. RESULTS: Both groups showed significant improvements in pain during activity and at rest, in range of motion in extension and abduction, in strength of external rotation and in function. There were no clinical differences in changes between groups. Most patients were pain-free from six months. After two years, the majority of patients achieved > or = 160 degrees in flexion, > or = 175 degrees in abduction and 80 degrees in external rotation, the traditional achieved 67 and the progressive group 87 with Constant score. CONCLUSIONS: Early activation using a comprehensive, well-defined and controlled physiotherapy protocol can be used safely after arthroscopic subacromial decompression.
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| 15. |
- Hultenheim Klintberg, Ingrid, 1959, et al.
(författare)
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Early loading in physiotherapy treatment after full-thickness rotator cuff repair: a prospective randomized pilot-study with a two-year follow-up.
- 2009
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Ingår i: Clinical rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 23:7, s. 622-38
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the clinical changes following two different physiotherapy treatment protocols after rotator cuff repair. DESIGN: A prospective, randomized pilot study with a two-year follow-up. SUBJECTS: Five women and nine men, 55 (40-64) years old, were included. INTERVENTION: The progressive group (n = 7) started with dynamic, specific muscle activation of the rotator cuff the day after surgery as well as passive range of motion. After four weeks of immobilization the loading to the rotator cuff increased and in a progressive manner throughout the rehabilitation. In the traditional group (n = 7) the rotator cuff was protected from loading. Patients were immobilized for six weeks and started with passive range of motion the day after surgery. No specific exercises to the rotator cuff were introduced during this period. MAIN MEASURES: A clinical evaluation was made preoperatively, 3, 6, 12 and 24 months after surgery. Pain rating during activity and at rest, patient satisfaction, active range of motion and muscle strength, Constant score, hand in neck, hand in back and pour out of a pot, as well as Functional Index of the Shoulder were used. RESULTS: At two years follow-up, the progressive group and traditional group scored pain during activity visual analogue scale (VAS) 2/0 mm and pain at rest 0/0 mm, respectively. The groups attained 170/175 degrees in active abduction in standing and 70/90 degrees in passive external rotation while lying in supine. Using Constant score, the groups attained 82/77 points respectively. CONCLUSION: The present study showed that the progressive protocol produced no adverse effects compared with the traditional protocol.
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| 16. |
- Högström, Magnus, 1956-
(författare)
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Vitamins, fatty acids, physical activity and peak bone mass
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Osteoporosis is a disease characterized by low bone mineral density, deteriorated bone microstructure and increased fracture risk. About 50% of all women and 25% of all men will have an osteoporotic fracture. Given that there is no effective cure in established osteoporosis, prevention is of high importance. Bone mineral density (BMD) is accumulated during childhood and adolescence with a peak at about 20 years of age. Peak BMD has been suggested to explain at least half of the variation in BMD up to old age. Thus, to increase peak BMD could decrease the risk of later fractures. The purpose of the present thesis was to investigate the influence of physical activity, vitamins A and D, and fatty acids on peak bone mass in men. The influence of physical activity on bone accrual was studied in two cohorts. In the first cohort 46 ice hockey players, 18 badminton players and 27 controls, all 17 years of age at baseline, were followed for four years. During the follow up the badminton players gained more bone mass at the hip compared to both the ice hockey players and controls. In the second cohort the associations between physical activity and BMD were investigated in 62 female and 62 male young medical students. The estimated high impact activity per week was associated with bone mass at all sites in the male medical students (r=0.27-0.53, p<0.05). In the female cohort different estimates of physical activity were not related to bone mass at any site. In both males and females correlations between bone mass and body constitution parameters were observed. Levels of vitamin D3, vitamin D2, retinol, retinol-binding-protein-4 (RBP-4) and fatty acids were measured in 78 young men with a mean age of 22.6 years. BMD at various sites were measured using Dual-Energy X-ray absorptiometry. Levels of vitamin D3 showed a significant positive association with all BMD sites and also lean body mass (r=0.23-0.35, p<0.05). Levels of vitamin D2, however, showed a significant negative correlation with BMD of the total body (r=-0.28, p=0.01) and spine (r=-0.27, p=0.02). There was also a significant negative relationship between levels of vitamin D3 and D2 (r=-0.31, p=0.006). Concentrations of n-3 (omega-3) fatty acids showed a positive association with BMD at the total body (r=0.27, p=0.02) and spine BMD (r=0.25, p=0.02). There was also a positive association between levels of n-3 fatty acids and changes in BMD of the spine between 16 and 22 years of age (r=0.26, p=0.02). The significant associations found seemed to be related mostly to the concentration of the n-3 fatty acid docosahexaenoic acid. Levels of retinol and RBP-4 were not related to BMD but to levels of osteocalcin, which is a marker of bone formation. This association disappeared when adjusting for the influence of abdominal fat mass. In summary, the present thesis suggests that many modifiable factors may influence the accumulation of peak bone mass in males, such as physical activity, vitamins, and fatty acids. Further studies are needed to investigate whether optimizing these factors in youth may decrease the risk of osteoporosis later in life.
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| 17. |
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| 18. |
- Isberg, Jonas, 1965, et al.
(författare)
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Early active extension after anterior cruciate ligament reconstruction does not result in increased laxity of the knee
- 2006
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 14:11, s. 1108-1115
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Tidskriftsartikel (refereegranskat)abstract
- If permission of full active and passive extension immediately after an anterior cruciate ligament (ACL) reconstruction will increase the post-operative laxity of the knee has been a subject of discussion. We investigated whether a post-operative rehabilitation protocol including active and passive extension without any restrictions in extension immediately after an ACL reconstruction would increase the post-operative anterior-posterior knee laxity (A-P laxity). Our hypothesis was that full active and passive extension immediately after an ACL reconstruction would have no effect on the A-P laxity and clinical results up to 2 years after the operation. Twenty-two consecutive patients (14 men, 8 women, median age 21 years, range 17-41) were included. All the patients had a unilateral ACL rupture and no other ligament injuries or any other history of previous knee injuries. The surgical procedure was identical in all patients and one experienced surgeon operated on all the patients, using the bone-patellar tendon-bone autograft. The post-operative rehabilitation programme was identical in both groups, except for extension training during the first 4 weeks post-operatively. The patients were randomly allocated to post-operative rehabilitation programmes either allowing (Group A, n=11) or not allowing [Group B (30 to -10 degrees ), n=11] full active and passive extension immediately after the operation. They were evaluated pre-operatively and at 6 months and 2 years after the reconstruction. To evaluate the A-P knee laxity, radiostereometric analysis (RSA) and KT-1000 arthrometer (KT-1000) measurements were used, range of motion, Lysholm score, Tegner activity level, the International Knee Documentation Committee (IKDC) evaluation system and one-leg-hop test quotient were used. Pre-operatively, the RSA measurements revealed side-to-side differences in Group A of 8.6 mm (2.3-15.4), median (range) and in Group B of 7.2 mm (2.2-17.4) (n.s.). The corresponding KT-1000 values were for Group A, 2.0 mm (0-8.0) and Group B, 4.0 mm (0-10.0) (n.s.). At 2 years, the differences between the two groups were minimal, regardless of the method that had been used. The RSA measurements in Group A were 2.7 mm (0-10.7) and in Group B 2.8 (-1.8 to 9.5). The KT-1000 values were for Group A, 1.0 mm (-1.5 to 3.5), and for Group B, 0.5 mm (-1.0 to 4.0), without any significant differences between the groups. Nor did the Lysholm score, Tegner activity level, IKDC or one-leg-hop test differ. Early active and passive extension training, without any restrictions in extension, immediately after an ACL reconstruction using bone-patellar tendon-bone graft did not increase post-operative knee laxity up to 2 years after the ACL reconstruction.
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| 19. |
- Isberg, Jonas, 1965, et al.
(författare)
-
KT-1000 records smaller side-to-side differences than radiostereometric analysis before and after an ACL reconstruction
- 2006
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 14:6, s. 529-535
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Tidskriftsartikel (refereegranskat)abstract
- The KT-1000 and similar non-invasive arthrometers are used as a complement to clinical examination in the diagnosis of anterior cruciate ligament (ACL) rupture and during the follow-up after surgery. We compared the two methods, KT-1000 and Radiostereometric analysis (RSA), when used to measure anterior-posterior knee laxity (A-P laxity) in patients with ACL rupture, before and after the reconstruction of this ligament, in a prospective, comparative study. Twenty-two consecutive patients (14 men, 8 women) with a median age of 24 years (range 16-41) were studied. All the patients had a unilateral ACL rupture and an intact contralateral knee. The patients were operated on by one experienced surgeon using the bone-patellar tendon-bone (BTB) autograft. Preoperatively and 2 years after the reconstruction, all the patients were evaluated using KT-1000 and RSA measurements of A-P laxity. The side-to-side differences between the injured and the intact knees, that is, total A-P laxity for both knees, are presented. Preoperatively, the median side-to-side differences using the two methods (KT-1000/RSA) were 4.0 (0-10)/7.4 mm (2.2-17.4) (P<0.0001). The total A-P laxity on the injured side was 11.0 (6.0-18.0)/10.9 mm (6.2-19.6) (n.s), while it was 8.0 (6.0-10.0)/3.1 mm (0.2-8.6) on the intact side (P<0.0001). A side-to-side difference of more than 3.0 mm was defined as the cut-off value for indicating ACL rupture. Using the KT-1000, 11 of 22 (50%) patients had a cut-off value above 3.0 mm, while the corresponding figure for RSA was 21/22 (95%) patients. At the 2-year follow-up, the median side-to-side differences using the two methods (KT-1000/RSA) were 0.5 (-1.5 to 4.0)/2.8 mm (-1.8 to 10.7) (P<0.0001). The total A-P laxity on the operated side was 9.5 (7.5-14.0)/6.5 mm (2.4-14.1) (P<0.0001). We conclude that the KT-1000 recorded significantly smaller side-to-side differences than did the RSA, both before and after the reconstruction of the ACL using a BTB autograft. Before it was mainly an effect of larger A-P laxity recordings with KT-1000 on the intact side, and after the reconstruction, the KT-1000 still recorded larger A-P laxity on the intact side and also larger A-P laxity on the reconstructed side than RSA.
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| 20. |
- Jonzén, Niclas, et al.
(författare)
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Response to comment on "Rapid advance of spring arrival dates in long-distance migratory birds"
- 2007
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 1095-9203 .- 0036-8075. ; 315:5812, s. 598-598
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Both's comment questions our suggestion that the advanced spring arrival time of long-distance migratory birds in Scandinavia and the Mediterranean may reflect a climate-driven evolutionary change. We present additional arguments to support our hypothesis but underscore the importance of additional studies involving direct tests of evolutionary change.
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| 21. |
- Kalén, Mattias, et al.
(författare)
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Combination of reverse and chemical genetic screens reveals angiogenesis inhibitors and targets.
- 2009
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Ingår i: Chemistry & biology. - : Elsevier BV. - 1879-1301 .- 1074-5521. ; 16:4, s. 432-41
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Tidskriftsartikel (refereegranskat)abstract
- We combined reverse and chemical genetics to identify targets and compounds modulating blood vessel development. Through transcript profiling in mice, we identified 150 potentially druggable microvessel-enriched gene products. Orthologs of 50 of these were knocked down in a reverse genetic screen in zebrafish, demonstrating that 16 were necessary for developmental angiogenesis. In parallel, 1280 pharmacologically active compounds were screened in a human cell-based assay, identifying 28 compounds selectively inhibiting endothelial sprouting. Several links were revealed between the results of the reverse and chemical genetic screens, including the serine/threonine (S/T) phosphatases ppp1ca, ppp1cc, and ppp4c and an inhibitor of this gene family; Endothall. Our results suggest that the combination of reverse and chemical genetic screens, in vertebrates, is an efficient strategy for the identification of drug targets and compounds that modulate complex biological systems, such as angiogenesis.
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| 22. |
- Karlsson, Jón, 1953, et al.
(författare)
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Akut hälseneruptur
- 2007
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Ingår i: Idrottsskador. Frontlinjen inom behandling och rehabilitering. - Stockholm : Centrum för Idrottsforskning. ; , s. 241-248
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 23. |
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| 24. |
- Karlsson, Jón, 1953, et al.
(författare)
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Ankle ligaments and prevention
- 2007
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Ingår i: IOC Book on Prevention of Sports Injuries. - : IOC (International Olympic Committee).
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 25. |
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| 26. |
- Karlsson, Jón, 1953
(författare)
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Axelproblem i vardagen
- 2007
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Ingår i: Incitament. ; :16, s. 297-300
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 27. |
- Karlsson, Jón, 1953, et al.
(författare)
-
Back to the future: thank you for 2009
- 2009
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 17:12, s. 1401-1403
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 28. |
- Karlsson, Jón, 1953, et al.
(författare)
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Fotfrakturer
- 2005
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Ingår i: Fotkirurgi. - Stockholm : Liber AB. ; , s. 101-119
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 29. |
- Karlsson, Jón, 1953
(författare)
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Functional treatment of ankle sprain; Early motion
- 2005
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Ingår i: ISAKOS-FIMS World Consensus on Ankle Instability. - : International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine and International. ; , s. 34-36
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 30. |
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| 31. |
- Karlsson, Jón, 1953
(författare)
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Imaging of the Ankle joint; Stress X-rays
- 2005
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Ingår i: ISAKOS-FIMS World Consensus on Ankle Instability. - : International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine and Internation F. ; , s. 23-25
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 32. |
- Karlsson, Jón, 1953
(författare)
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Ligamentskador i fotleden
- 2007
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Ingår i: Svensk Idrottsforskning. - Stockholm : Centrum för Idrottsforskning. ; :16, s. 33-37, s. 241-248
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 33. |
- Karlsson, Jón, 1953, et al.
(författare)
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Management of acute ligament injuries of the ankle
- 2006
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Ingår i: Foot Ankle Clin. - 1083-7515. ; 11:3, s. 521-30
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Tidskriftsartikel (refereegranskat)abstract
- Ligament injuries of the ankle are common and troublesome. Management may seem easy, but residual symptoms ae common. Grade III injuries still generate controversy in terms of the best management available, and more studies are needed when it comes to early mobilization, cast immobilization, or surgery. Even the three Cohrane reviews published to date are not conclusive.
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| 34. |
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| 35. |
- Karlsson, Karl-Göran, 1959-
(författare)
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The use of a satellite-derived cloud climatology for studying cloud-aerosol processes and the performance of regional cloud climate simulations
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The entry of satellite-derived decadal cloud datasets with homogeneous coverage in time and space enables studies not possible before. This thesis presents two such applications. The first study deals with cloud-aerosol processes and the second with an evaluation of cloud simulations from a regional climate model.The first part of the thesis describes the used satellite-derived dataset based on imagery from the Advanced Very High Resolution Radiometer (AVHRR) on the polar orbiting NOAA satellites. A method for cloud retrieval and the compilation of a 1991-2000 Scandinavian cloud climatology are described.The second part reveals an intriguing anti-correlation between monthly mean satellite-derived cloudiness and the concentration of the cosmogenetic isotope Beryllium-7 in near-surface aerosol samples for three measurement sites in Sweden. Large-scale transport processes are suggested as the most likely physical mechanism for this behaviour but more complex relations to cloud microphysical processes are not ruled out.The final part presents a thorough evaluation of cloud simulations of the SMHI Rossby Centre regional atmospheric model (RCA3). Several model-to-satellite adaptations are applied to avoid artificial biases of results. The study stresses the necessity to account for initial differences between observed and modelled clouds caused by satellite cloud detection limitations. Results show good agreement of modelled and observed cloud amounts while the vertical distribution of clouds appears largely different. RCA3 underestimates medium-level clouds while overestimating low- and high-level clouds. Also, the current use of the Maximum cloud overlap approach in the radiation scheme and an indicated excess of cloud condensate in modelled clouds appear to create excessive cloud optical thicknesses with serious implications for the surface radiation budget.Future applications are outlined based on greatly enhanced satellite-derived cloud and radiation budget datasets.
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| 36. |
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| 37. |
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| 38. |
- Laxdal, Gauti, 1966, et al.
(författare)
-
A prospective comparison of bone-patellar tendon-bone and hamstring tendon grafts for anterior cruciate ligament reconstruction in male patients
- 2007
-
Ingår i: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 15:2, s. 115-25
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BPTB Group) (n = 45) and four-strand semitendinosus/gracilis (ST/G Group) (n = 78) autografts in male patients. The type of study is non-randomised, prospective consecutive series. A consecutive series of 126 male patients, all with unilateral ACL ruptures, was included in the study. In both groups, interference screw fixation of the graft was used at both ends and 123/126 (97%) of the patients returned for the follow-up examination after a period of 25 (23-33) months. The pre-operative assessments in both groups were similar in terms of the Tegner activity level, the Lysholm knee scoring scale, KT-1000 measurements, one-leg-hop test and knee-walking test. A significant reduction in knee laxity as measured with the KT-1000 arthrometer, compared with the pre-operative assessments, was found in both groups (P < 0.001). No significant differences in the post-operative knee-laxity measurements were found between the groups. Both groups had a significantly improved functional outcome at follow-up in terms of the Lysholm knee scoring scale, Tegner activity level and one-leg-hop test. The BPTB Group had a significantly higher Tegner activity level at follow-up, compared with the ST/G Group (P = 0.02). Moreover, the patients in the BPTB Group were significantly more likely to have a Tegner activity level of 6 or above (P = 0.03). Otherwise, no significant differences were found between the two study groups at the 2-year follow-up. Two years after an ACL reconstruction, the two groups displayed no significant differences in terms of functional outcome and knee laxity. However, more patients in the BPTB Group returned to a higher Tegner activity level than that in the ST/G Group.
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| 39. |
- Laxdal, Gauti, 1966, et al.
(författare)
-
A prospective randomized comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction
- 2005
-
Ingår i: Arthroscopy. - 1526-3231. ; 21:1, s. 34-42
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BPTB group), 3-strand semitendinosus (ST group), or 4-strand semitendinosus/gracilis (ST/G group) autografts. TYPE OF STUDY: Prospective randomized trial. METHODS: A randomized series of 134 patients, all with unilateral ACL rupture was included in the study. In all 3 groups, interference screw fixation of the graft was used at both ends and 125 of 134 (93%) of the patients returned for the follow-up examination after 26 months (range, 20 to 43 months). The preoperative assessments in all 3 groups were similar in terms of gender, Tegner activity level, Lysholm score, KT-1000 measurements, 1-leg hop test, and the knee-walking test. RESULTS: At follow-up, the knee-walking test was significantly worse in the BPTB group than in the ST group (P = .0004) and ST/G group (P < .0001). Furthermore, the knee-walking test was significantly worse at follow-up than preoperatively in the BPTB group (P < .0001). The corresponding findings were not made in the other 2 groups. A significant reduction in knee laxity and an increase in activity level compared with the preoperative assessments were found in all 3 groups, without any significant differences between the groups. CONCLUSIONS: Two years after ACL reconstruction, the use of ST and ST/G autografts rendered significantly less discomfort during the knee-walking test than the use of BPTB autografts. However, in terms of functional outcome and knee laxity, the groups displayed no significant differences. LEVEL OF EVIDENCE: Level I.
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| 40. |
- Laxdal, Gauti, 1966, et al.
(författare)
-
Biodegradable and metallic interference screws in anterior cruciate ligament reconstruction surgery using hamstring tendon grafts: prospective randomized study of radiographic results and clinical outcome
- 2006
-
Ingår i: The American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 34:10, s. 1574-80
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The use of biodegradable screws in anterior cruciate ligament reconstruction has grown in popularity. PURPOSE: To compare the clinical and radiographic results in arthroscopically assisted anterior cruciate ligament reconstruction using 4-strand hamstring tendon grafts and either metallic (metal group) or biodegradable (PLLA group) interference screw fixation. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A randomized series of 77 patients, all with a unilateral anterior cruciate ligament rupture, was included in the study. The preoperative assessments in both groups were similar in gender, Tegner activity level, Lysholm score, KT-1000 arthrometer measurements, and single-legged hop test results. In both groups, interference screw fixation of the graft was used at both ends, and 68 of 77 (88%) patients returned for a radiographic examination at 6 and 24 months, respectively. RESULTS: At follow-up, no significant differences were found between the 2 groups in KT-1000 arthrometer laxity measurements, Tegner activity level, or Lysholm score. The PLLA group had a significantly better outcome in the single-legged hop test and the final International Knee Documentation Committee classification (P = .007 and P = .03, respectively). At 6 and 24 months after the index operation, the PLLA group displayed significantly larger drill holes on the radiographs than did the metal group on both the tibial (8.1 vs 6.6 mm at 6 months [P = .0007]; 6.0 vs 3.2 mm at 24 months [P < .0001]) and femoral sides (7.8 vs 5.6 mm at 6 months [P < .0001]; 6.3 vs 1.9 mm at 24 months [P < .0001]). CONCLUSION: There were significantly larger radiographically visible drill holes on both the tibial and femoral sides in the PLLA group compared with the metal group at 6 and 24 months. Clinical examination at 2 years revealed no major differences between the groups. The larger drill holes in the PLLA group did not correlate with inferior clinical results.
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| 41. |
- Laxdal, Gauti, 1966, et al.
(författare)
-
Outcome and risk factors after anterior cruciate ligament reconstruction: a follow-up study of 948 patients
- 2005
-
Ingår i: Arthroscopy. - : Elsevier BV. - 1526-3231. ; 21:8, s. 958-964
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of the study was to assess the outcome and risk factors after anterior cruciate ligament (ACL) reconstruction in a large group of patients. TYPE OF STUDY: Case series. METHODS: Included in this retrospective study were 948 patients (323 female, 625 male) with a symptomatic unilateral ACL rupture, who underwent arthroscopic reconstruction using patellar tendon autograft and interference screw fixation at 3 Swedish hospitals. The median age of the patients at the time of the index operation was 26 years (range, 14 to 53 years). The patients underwent surgery at a median of 12 months (range, 0.5 to 360 months) after their injury. Independent physiotherapists performed the follow-up examinations at a median of 32 months (range, 21 to 117 months) postoperatively. RESULTS: Of the 948 patients, 550 (58%) underwent meniscal surgery before, during, or after the ACL reconstruction. The median Tegner activity level was 8 (range, 2-10) before injury, 3 (range, 0-9) preoperatively, and 6 (range, 1-10) at follow-up (P < .0001 preoperative v follow-up). At follow-up, the median Lysholm score was 90 points (range, 14-100), the median KT-1000 anterior side-to-side laxity difference was 1.5 mm (range, -6 to 13 mm), and the median 1-leg hop test quotient was 95% (0% to 167%) compared with the contralateral normal side. At follow-up, 69.3% of the patients were classified as normal or nearly normal according to the International Knee Documentation Committee evaluation system. However, 36% of the patients were unable to or had severe problems performing the knee-walking test. Inferior results correlated with increased time period between the index injury and reconstruction and concomitant joint damage found at the index operation. CONCLUSIONS: Overall, the results were good after ACL reconstruction using patellar tendon autograft and interference screw fixation. Concomitant joint damage and a long time period between the injury and reconstruction are major risk factors for inferior outcome after ACL reconstruction. LEVEL OF EVIDENCE: Level IV, case series.
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| 42. |
- Lidén, Mattias, 1973, et al.
(författare)
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The course of the patellar tendon after reharvesting its central third for ACL revision surgery: a long-term clinical and radiographic study
- 2006
-
Ingår i: Knee Surg Sports Traumatol Arthrosc. - 0942-2056. ; 14:11, s. 1130-8
-
Tidskriftsartikel (refereegranskat)abstract
- The choice of the optimal graft for anterior cruciate ligament (ACL) revision surgery is still controversial. Reharvesting the patellar tendon has been suggested as one graft alternative. Our hypothesis was that in the long-term, ACL revision surgery using reharvested patellar tendon autografts would render a good clinical outcome and a normal patellar tendon at the donor site as seen on magnetic resonance imaging (MRI). Fourteen consecutive patients (five women, nine men), who underwent ACL revision surgery using reharvested ipsilateral patellar tendon grafts, were included in the study. They underwent bilateral MRI evaluations of the patellar tendon and were tested for clinical outcome 26 (20-35) and 115 months (102-127) after the revision procedure. On the second occasion, they also underwent standard weight-bearing X-ray examinations.The serial MRI evaluations revealed that the thickness of the patellar tendon at the donor site was significantly increased compared with the non-harvested, normal contralateral side and that the donor-site gap was still visible after 10 years. No significant differences were seen between the 2- and 10-year MRI evaluations. Standard weight-bearing X-ray examinations revealed signs of mild degenerative changes in all patients. Clinical results in terms of the Lysholm score, IKDC evaluation system, one-leg-hop test, KT-1000 laxity test and the knee-walking test revealed no significant differences between the 2- and 10-year assessments. In overall terms, the clinical results were considered to be poor on both occasions. The patellar tendon at the donor site had not normalised 10 years after the reharvesting procedure, as seen on MRI. Furthermore, the clinical results were poor after ACL revision surgery using reharvested patellar tendon autograft.
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| 43. |
- Magnusson, Lennart, 1959, et al.
(författare)
-
A prospective, randomized, clinical and radiographic study after arthroscopic Bankart reconstruction using 2 different types of absorbable tacks
- 2006
-
Ingår i: Arthroscopy. - 1526-3231. ; 22:2, s. 143-51
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of the study was to compare the clinical and radiographic results after arthroscopic Bankart reconstruction using 2 different types of absorbable implant. TYPE OF STUDY: Randomized controlled trial. METHODS: A randomized series of 40 patients who had recurrent, unidirectional, post-traumatic shoulder instability were included in the study. All patients underwent an arthroscopic Bankart reconstruction involving either polygluconate co-polymer (PGACP group, n = 20) or self-reinforced poly-L-lactic acid polymer (PLLA group, n = 20) tack implants. The patients underwent clinical and radiographic assessments preoperatively and at 2 years. Additional radiographic assessments were performed at 6 months. RESULTS: Preoperatively, the study groups were comparable in terms of demographics as well as clinical parameters. One patient in each group had a redislocation (5%) during the follow-up period of 2 years. No subluxations were registered. No statistically significant differences were found between the study groups in terms of strength in abduction, range of motion, and Rowe or Constant scores. There was a significant increase in degenerative changes during the follow-up period in both study groups (P = .004). However, no significant differences in degenerative changes were registered between the study groups either preoperatively or at the 2-year follow-up. There were no significant differences in the radiographic visibility of the drill holes used for the absorbable implants between the study groups at the 6-month assessment. However, at the 2-year assessment, the radiographic visibility of the drill holes was significantly greater (P = .004) in the patients in the PLLA group than those in the PGACP group. At the 2-year assessment, no correlation was found between the appearance of the drill holes and the degenerative findings (PGACP group, rho = 0.44; PLLA group, rho = 0.42). CONCLUSIONS: Two years after arthroscopic Bankart reconstruction using either PGA polymer or PLA polymer implants, the overall clinical results were comparable. Radiographic assessments revealed that the degenerative changes increased in both study groups during the follow-up period. Furthermore, the visibility of the drill holes on the 2-year radiographs was greater after using PLLA implants than after using PGACP implants. LEVEL OF EVIDENCE: Level I.
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| 44. |
- Magnusson, Lennart, 1959, et al.
(författare)
-
The value of ultrasonography in the preoperative diagnostic evaluation of patients with recurrent anterior shoulder dislocation: a prospective study of 44 patients.
- 2007
-
Ingår i: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 0942-2056. ; 15:5, s. 649-53
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to investigate the value of ultrasonography in the pre-operative assessment of patients with recurrent post-traumatic, anterior shoulder instability. Forty-four consecutive patients, 44 men and 12 women, with unilateral, post-traumatic, recurrent instability of the shoulder were included in the study. One experienced radiologist examined all patients, using a 5.0 or 7.5 MHz linear-array transducer, with the arm in different positions, one of which was used to provoke apprehension of the shoulder. Special attention was paid to the evaluation of the joint capsule, the anterior labrum, especially in terms of the presence of a Bankart lesion. All patients were subsequently treated surgically. After a diagnostic arthroscopy either an open or arthroscopic stabilisation of the shoulder was performed. Ultrasonography disclosed an unstable anterior labrum (equivalent to a Bankart lesion) in 36 shoulders; the lesion was verified in all 36 shoulders during arthroscopy. In three shoulders, arthroscopy disclosed an injured labrum, which had healed in an anterio-medial position on the scapular neck. In these three shoulders, ultrasonography failed to show any lesion. In five shoulders no Bankart lesion was found at arthroscopy. All these patients had increased shoulder laxity, and ultrasonography did not show any Bankart lesion. Furthermore a judgement of the joint capsule was not possible either. A bony Bankart lesion was found in four shoulders, using both arthroscopy and ultrasonography. The sensitivity of the ultrasonographic evaluation was 92%, and the specificity 100%. The positive predictive value was 100%, and the negative predictive value 63%. Ultrasonography showed a high correlation with the arthroscopic findings, with a high sensitivity and specificity. Therefore, we conclude that US can give important pre-operative information in patients with recurrent, unilateral, post-traumatic, anterior shoulder instability.
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| 45. |
- Magnusson, Mattias, et al.
(författare)
-
HOXA10 is a critical regulator for hematopoietic stem cells and erythroid/megakaryocyte development
- 2007
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Ingår i: Blood. - : American Society of Hematology. - 0006-4971 .- 1528-0020. ; 109:9, s. 3687-3696
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Tidskriftsartikel (refereegranskat)abstract
- The Homeobox (Hox) transcription factors are important regulators of normal and malignant hematopoiesis because they control proliferation, differentiation, and self-renewal of hematopoietic cells at different levels of the hematopoietic hierarchy. In transgenic mice we show that the expression of HOXA10 is tightly regulated by doxycycline. Intermediate concentrations of HOXA10 induced a 15-fold increase in the repopulating capacity of hematopoietic stem cells (HSCs) after 13 days of in vitro culture. Notably, the proliferation induction of HSC by HOXA10 was dependent on the HOXA10 concentration, because high levels of HOXA10 had no effect on HSC proliferation. Furthermore, high levels of HOXA10 blocked erythroid and megakaryocyte development, demonstrating that tight regulation of HOXA10 is critical for normal development of the erythroid and megakaryocytic lineages. The HOXA10-mediated effects on hematopoietic cells were associated with altered expression of genes that govern stem-cell self-renewal and lineage commitment (eg, hepatic leukemia factor [HlF], Dickkopf-1 [Dkk-1], growth factor independent-1 [Gfi-1], and Gata-1). Interestingly, binding sites for HOXA10 were found in HLF, Dkk-1, and Gata-1, and Dkk-1 and Gfi-1 were transcriptionally activated by HOXA10. These findings reveal novel molecular pathways that act downstream of HOXA10 and identify HOXA10 as a master regulator of postnatal hematopoietic development.
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| 46. |
- Mann, G., et al.
(författare)
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Scoring systems for evaluating ankle function
- 2006
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Ingår i: Foot Ankle Clin. - 1083-7515. ; 11:3, s. 509-19
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Tidskriftsartikel (refereegranskat)abstract
- Each of the seven systems described has advantages and drawbacks that consist of ease or difficulty of application, accuracy, validity, and availability. This article should contribute to make these systems better known and easier to apply, and thus, will encourage their use in clinical practice. [Fig.: see text].
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| 47. |
- Marx, R. G., et al.
(författare)
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Clinical decision making based on evidence
- 2009
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Ingår i: Arthroscopy: The Journal of Arthroscopic & Related Surgery. - : Elsevier BV. - 0749-8063. ; 25:3
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 48. |
- Möller, Michael, 1957, et al.
(författare)
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The reliability of isokinetic testing of the ankle joint and a heel-raise test for endurance
- 2005
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - 0942-2056. ; 13:1, s. 60-71
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to investigate the reliability of different methods used for isokinetic testing of calf muscle strength and endurance. The detailed evaluation of test-retest reliability serves the purpose of establishing reliable research tools when evaluating patients who have sustained an Achilles tendon rupture. The test-retest reliability of isokinetic measurements at the ankle for eccentric and concentric muscle action was calculated in ten healthy male volunteers using intra-class correlation (ICC) and coefficient of variation (CV). Three different positions were compared at the angular velocities of 30 degrees /s and 180 degrees /s for right and left ankles. The ICC for plantar flexion was 0.37-0.95, whilst it was 0.00-0.96 for dorsiflexion. The corresponding CVs were 4.0-19.9 and 2.4-19.8 respectively. The test-retest reliability of standardised heel-raises, Achilles tendon width, calf circumference and ankle range of motion revealed ICC values of 0.71-0.98 and CVs of 0.67-19.1. The test-retest interval was 5 to 7 days. We conclude that all three positions studied for the isokinetic evaluation of calf muscle function are equally reliable concerning plantar flexion at the ankle joint. The same level of reliability was also found in the evaluation of the standing heel-raise test and the isokinetic dorsiflexion test, except for dorsiflexion in the supine position. The reliability of the investigated methods was only fair despite the use of a detailed and standardised test protocol.
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| 49. |
- Neeter, Camille, 1968, et al.
(författare)
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Development of a strength test battery for evaluating leg muscle power after anterior cruciate ligament injury and reconstruction
- 2006
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 14:6, s. 571-80
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Tidskriftsartikel (refereegranskat)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.
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| 50. |
- Nilsson-Helander, Katarina, 1957, et al.
(författare)
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A new surgical method to treat chronic ruptures and reruptures of the Achilles tendon
- 2008
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 16:6, s. 614-20
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Tidskriftsartikel (refereegranskat)abstract
- In patients with a chronic rupture or rerupture of the Achilles tendon, the recommended treatment is surgical. Various surgical techniques have been reported in the literature; however, the outcome is rarely evaluated with a sufficiently long follow-up, using appropriate end-points. The purpose of this study was to evaluate the subjective and objective outcome following a new surgical treatment for chronic rupture or rerupture of the Achilles tendon using augmentation with a free gastrocnemius aponeurosis flap. A total of 28 consecutive patients (22 male and 6 female) with a mean (SD) age of 46 (10.4) years were evaluated at a median (range) of 29 (12-117) months after surgery. The surgical technique involved making a single incision and then using a free gastrocnemius aponeurosis flap to cover the tendon gap after an end-to-end suture. The patients were evaluated using the Achilles tendon rupture score (ATRS) and a detailed questionnaire relating to symptoms, physical activity and satisfaction with treatment. The functional evaluation consisted of a validated test battery measuring different aspects of muscle/tendon function of the gastrocnemius/soleus and Achilles tendon complex. The median (range) ATRS was 83 (24-100). There were no reruptures. In terms of surgical complications, there was one deep infection, three wound closure complications and deep venous thrombosis in two patients. All but one patient returned to work within 6 months of surgery. Sixteen (57%) patients were satisfied with the treatment. There was a significant decrease in the level of physical activity after the injury compared with before the injury (p = 0.004). Of the 25 patients who participated in recreational sports prior to injury, 13 (52%) returned to the same activity level after treatment. In terms of jump performance, no significant differences were found between the healthy and injured sides. There was, however, a significant decrease in strength, in terms of both concentric and eccentric-concentric toe raises and the toe-raise test for endurance compared with the healthy side. The use of a free gastrocnemius aponeurosis flap to treat chronic ruptures and reruptures of the Achilles tendon rendered a good overall subjective and objective outcome in the majority of patients. The use of a single incision in combination with a free flap augmentation produced favourable results.
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