| 1. |
- Hamrin Senorski, Eric, 1989, et al.
(author)
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Concomitant injuries may not reduce the likelihood of achieving symmetrical muscle function oneyear after anterior cruciate ligament reconstruction: a prospective observational study based on 263 patients.
- 2018
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In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 26:10, s. 2966-2977
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Journal article (peer-reviewed)abstract
- A better understanding of patient characteristics and the way common concomitant injuries affect the recovery of muscle function after surgery should help providers to treat patients with anterior cruciate ligament (ACL) injuries. The aim of this study was to determine whether patient characteristics, concomitant injuries and graft choice at ACL reconstruction were associated with symmetrical knee muscle function at one year. The hypothesis was that the presence of concomitant injuries would negatively influence the opportunity to achieve symmetrical knee function at the one-year follow-up.Data was extracted from the Swedish National Knee Ligament Register and a rehabilitation outcome register between August 2012 and December 2016. The patients had been evaluated with a battery of tests comprising knee extension and flexion strength, vertical jump, hop for distance and the side-hop test one year after ACL reconstruction. Univariable and multivariable logistic regression analyses were performed with achieving a limb symmetry index (LSI) of ≥90% in all tests of muscle function as primary outcome.A total of 263 patients with a mean age of 26.7±10.3years were included in the study (47% females). No patient demographic or intra-operative predictors were found to be significant when attempting to predict the achievement of a symmetrical muscle function. Lateral meniscus injury and a patellar tendon autograft reduced the odds of achieving an LSI of ≥90% in knee extension strength, OR=0.49 [(95% CI 0.25-0.97), p=0.039] and OR=0.30 [(95% CI 0.14-0.67), p=0.0033] respectively. In addition, reduced odds of recovering knee extension strength were found in older patients, OR=0.76 [(95% CI 0.60-0.98), p=0.034]. A higher pre-injury level of physical activity increased the odds of recovering knee flexion strength, OR=1.14 [(95% CI 1.01-1.29), p=0.037].Intra-operatively identified concomitant injuries or graft choice did not affect the likelihood of recovering symmetrical performance in five different tests of muscle function one year after ACL reconstruction. However, fewer than one in four patients achieved an LSI of ≥90% in all tests.Prospective observational study: Level 2.
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| 2. |
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| 3. |
- Hamrin Senorski, Eric, 1989, et al.
(author)
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Factors that affect patient reported outcome after anterior cruciate ligament reconstruction-a systematic review of the Scandinavian knee ligament registers.
- 2019
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In: British journal of sports medicine. - : BMJ. - 1473-0480 .- 0306-3674. ; 53:7
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Journal article (peer-reviewed)abstract
- To perform a systematic review of findings from the Scandinavian knee ligament registers with regard to factors that affect patient reported outcome after anterior cruciate ligament (ACL) reconstruction.Systematic review.Four electronic databases: PubMed, EMBASE, the Cochrane Library and AMED were searched, and 157 studies were identified. Two reviewers independently screened the titles, abstracts and full text articles for eligibility. A modified version of the Downs and Black checklist was applied for quality appraisal.Studies published from the Scandinavian registers from their establishment in 2004 and onwards that documented patient reported outcome and provided information on concomitant injuries were eligible.A total of 35 studies were included. Younger age at ACL reconstruction, male sex, not smoking and receiving a hamstring tendon autograft positively influenced patient reported outcome. Patients with concomitant cartilage and meniscal injuries reported inferior subjective knee function compared with patients with an isolated ACL tear. One study reported that patients treated non-reconstructively reported inferior knee function compared with patients who had ACL reconstruction.Younger age, male sex, not smoking, receiving a hamstring tendon autograft and the absence of concomitant injuries were associated with superior patient reported outcomes after ACL reconstruction.
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| 4. |
- Hamrin Senorski, Eric, 1989, et al.
(author)
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Preoperative knee laxity measurements predict the achievement of a patient-acceptable symptom state after ACL reconstruction: a prospective multicenter study
- 2017
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In: Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine. - : Elsevier BV. - 2059-7754 .- 2059-7762. ; 3:1
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Journal article (peer-reviewed)abstract
- Objective To determine whether patient-related factors, concomitant injuries and preoperative knee laxity could predict a patient acceptable symptom state (PASS) in the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) at 1 and 2 years follow-up after anterior cruciate ligament (ACL) reconstruction in a multicentre cohort. Methods Patients between 14 and 50 years of age who underwent single-bundle ACL reconstruction with hamstring tendon autograft within 1 year from the index injury were eligible. Additionally, only patients who completed the IKDC-SKF questionnaire at 1 or 2 years of follow-ups were included. Preoperative knee laxity assessment of patients in the awake state was performed using rolimeter, the Lachman and the pivot-shift test. The pivot shift was graded according to the IKDC criteria and also quantified by the use of non-invasive technology for (1) lateral tibial translation and (2) tibial acceleration. The quantitative pivot shift (QPS) was examined in the awake state and under anaesthesia (EUA). Univariable logistic regression models were performed with achieving PASS in the IKDC as the dependent variable. Results A total of 86 patients had complete data on the IKDC-SKF score at 1-year follow-up, of which 67 patients (77.9%) achieved PASS (age 24.8±9.3 years, 43% females). Two-year data were available for 50 patients, of which 39 patients (78.9%) achieved PASS (age 23.9±9.2 years, 42.0% females). A low-grade manual pivot shift according to IKDC grading had increased odds of achieving PASS at 1 year (OR=2.96 (95% CI 1.01 to 8.66), P<0.05) compared with patients who displayed a high-grade pivot shift preoperatively. However, this was not confirmed by the preoperative QPS measures (awake: tibial translation; OR=0.99,(95% CI 0.72 to 1.35), (n.s.), acceleration; OR=1.04,(95% CI 0.68 to 1.59), (n.s.) EUA: tibial translation; OR=1.02 (95% CI 0.78 to 1.31), (n.s.), acceleration; OR=1.14 (95% CI 0.93 to 1.40), (n.s.)). None of the studied variables of patient characteristics, concomitant injuries or knee joint laxity predicted PASS at the 2-year follow-up. Conclusion Almost four in every five patients were able to achieve PASS 1 and 2 years after anatomic single-bundle ACL reconstruction. The presence of preoperative low-grade pivot shift increased the odds of achieving an acceptable level of knee function 1 year after ACL reconstruction compared with high-grade pivot shift; however, QPS did not confirm achievement of PASS in this study. Level of evidence Level III, prospective cohort.
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| 6. |
- Kvist, Joanna, et al.
(author)
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Results From the Swedish National Anterior Cruciate Ligament Register.
- 2014
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In: 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 .- 0749-8063. ; 30:7, s. 803-810
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Journal article (peer-reviewed)abstract
- The purpose of the study was to analyze the baseline variables and clinical outcomes for almost 24,000 patients entered into the Swedish National ACL Register between January 2005 and December 2012.
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| 7. |
- Nordenholm, Anna, et al.
(author)
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Disappointment and frustration, but long-term satisfaction: patient experiences undergoing treatment for a chronic Achilles tendon rupture-a qualitative study.
- 2022
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In: Journal of orthopaedic surgery and research. - : Springer Science and Business Media LLC. - 1749-799X. ; 17:1
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Journal article (peer-reviewed)abstract
- Delayed treatment of Achilles tendon ruptures is generally due to either misdiagnosis or patient delay. When the treatment is delayed more than 4weeks, the rupture is defined as "chronic", and almost always requires more invasive surgery and longer rehabilitation time compared with acute Achilles tendon ruptures. There is insufficient knowledge of patient experiences of sustaining and recovering from a chronic Achilles tendon rupture.To evaluate patients' experiences of suffering a chronic Achilles tendon rupture, semi-structured group interviews were conducted 4-6years after surgical treatment using a semi-structured interview guide. The data were analyzed using qualitative content analysis described by Graneheim and Lundman.The experiences of ten patients (65±14years, 7 males and 3 females) were summarized into four main categories: (1) "The injury", where the patients described immediate functional impairments, following either traumatic or non-traumatic injury mechanisms that were misinterpreted by themselves or the health-care system; (2) "The diagnosis", where the patients expressed relief in receiving the diagnosis, but also disappointment and/or frustration related to the prior misdiagnosis and delay; (3) "The treatment", where the patients expressed high expectations, consistent satisfaction with the surgical treatment, and addressed the importance of the physical therapist having the right expertise; and (4) "The outcomes", where the patients expressed an overall satisfaction with the long-term outcome and no obvious limitations in physical activity, although some fear of re-injury emerged.An Achilles tendon rupture can occur during both major and minor trauma and be misinterpreted by both the assessing health-care professional as well as the patient themselves. Surgical treatment and postoperative rehabilitation for chronic Achilles tendon rupture results in overall patient satisfaction in terms of the long-term outcomes. We emphasize the need for increased awareness of the occurrence of Achilles tendon rupture in patients with an atypical patient history.
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| 8. |
- Persson, Kajsa, et al.
(author)
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Greater proportion of patients report an acceptable symptom state after ACL reconstruction compared with non-surgical treatment: a 10-year follow-up from the Swedish National Knee Ligament Registry.
- 2022
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In: British journal of sports medicine. - : BMJ. - 1473-0480 .- 0306-3674. ; 56:15, s. 862-869
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Journal article (peer-reviewed)abstract
- To compare the proportion of patients with anterior cruciate ligament (ACL) injury reporting an acceptable symptom state, between non-surgical and surgical treatment during a 10-year follow-up.Data were extracted from the Swedish National Knee Ligament Registry. Exceeding the Patient Acceptable Symptom State (PASS) for the Knee injury and Osteoarthritis Outcome Score (KOOS) was the primary outcome. The PASS and KOOS4 (aggregated KOOS without the activities of daily living (ADL) subscale) were compared cross-sectionally at baseline and 1, 2, 5 and 10 years after ACL injury, where patients treated non-surgically were matched with the maximum number of patients with ACL reconstruction for age, sex and activity at injury.The non-surgical group consisted of 982 patients, who were each matched against 9 patients treated with ACL reconstruction (n=8,838). A greater proportion of patients treated with ACL reconstruction exceeded the PASS in KOOS pain, ADL, sports and recreation, and quality of life compared with patients treated non-surgically at all follow-ups. With respect to quality of life, significantly more patients undergoing ACL reconstruction achieved a PASS compared with patients receiving non-surgical treatment at all follow-ups except at baseline, with differences ranging between 11% and 25%; 1year -25.4 (-29.1; -21.7), 2 years -16.9 (-21.2; -12.5), 5 years -11.0 (-16.9; -5.1) and 10 years -24.8 (-36.0; -13.6). The ACL-reconstructed group also reported statistically greater KOOS4 at all follow-ups.A greater proportion of patients treated with ACL reconstruction report acceptable knee function, including higher quality of life than patients treated non-surgically at cross-sectional follow-ups up to 10 years after the treatment of an ACL injury.
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| 9. |
- Svantesson, Eleonor, et al.
(author)
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Factors associated with additional anterior cruciate ligament reconstruction and register comparison: a systematic review on the Scandinavian knee ligament registers.
- 2019
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In: British journal of sports medicine. - : BMJ. - 1473-0480 .- 0306-3674. ; 53:7
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Journal article (peer-reviewed)abstract
- To present an overview of the Scandinavian knee ligament registers with regard to factors associated with additional ACL reconstruction, and studies comparing the Scandinavian registers with other knee ligament registers.Systematic review.Four electronic databases: PubMed, EMBASE, the Cochrane Library and AMED were searched, and 157 studies were identified. Two reviewers independently screened titles, abstracts and full-text studies for eligibility. A modified version of the Downs and Black checklist was applied for quality appraisal.Eligible studies were those published since the establishment of the Scandinavian registers in 2004, which reported factors associated with additional ACL reconstruction and compared data from other registers.Thirty-one studies met the inclusion criteria and generally displayed good reporting quality. Adolescent age (<20 years) was the most common factor associated with additional ACL reconstruction. The choice of hamstring tendon graft compared with patella tendon, transportal femoral tunnel drilling, smaller graft diameter and utilisation of suspensory fixation devices were associated with additional ACL reconstruction. Concomitant cartilage injury decreased the likelihood of additional ACL reconstruction. Patient sex alone did not influence the likelihood. The demographics of patients undergoing ACL reconstruction in the Scandinavian registers are comparable to registers in other geographical settings. However, there are differences in surgical factors including the presence of intra-articular pathology and graft choice.The studies published from the Scandinavian registers in general have a high reporting quality when regarded as cohort studies. Several factors are associated with undergoing additional ACL reconstruction. The results from the registers may help facilitate treatment decisions.
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| 10. |
- Svantesson, Eleonor, et al.
(author)
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Static anteroposterior knee laxity tests are poorly correlated to quantitative pivot shift in the ACL-deficient knee: a prospective multicentre study
- 2018
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In: Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine. - : Elsevier BV. - 2059-7762. ; 3:2, s. 83-88
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Journal article (peer-reviewed)abstract
- Objective To determine the relationship between preoperative static knee joint laxity and non-invasive quantitative pivot shift (QPS) in patients with anterior cruciate ligament (ACL) rupture. Methods Patients with an ACL injury participating in a multicentre trial were analysed if they had complete preoperative data on the following laxity tests: the rolimeter, the KT-1000 (134N and manual maximum force), the Lachman, the anterior drawer and QPS. The QPS was assessed via a non-invasive inertial sensor system and an image analysis system for tibial acceleration and lateral tibial translation, respectively. Awake examination and examination under anaesthesia (EUA) were performed. Correlation between absolute values of static laxity and the QPS for each leg was assessed by Spearman’s rho. The Lachman and the anterior drawer were dichotomised into low- and high-grade, and differences between the groups in terms of continuous values of QPS were assessed. Results A total of 58 patients were included (41.4% women, mean age 27.1±9.8 years). Awake static laxity and QPS acceleration were negatively correlated in the ACL-deficient knee, meaning that a greater acceleration correlated to a lesser static tibial translation, and vice versa. The mean QPS acceleration correlated with the static tests as follows: the rolimeter r=−0.30 (P=0.024), the KT-1000 134N r=−0.25 (P=0.06) and the KT-1000 manual maximum r=−0.37 (P=0.004). A negative correlation between awake QPS acceleration and the static tests was also shown for the non-involved knee. Patients with a high-grade Lachman’s test in the EUA had significantly greater QPS acceleration (P=0.0002) and QPS translation (P<0.001) compared with patients with a low-grade. The corresponding analysis for the anterior drawer showed a significantly greater QPS translation in the high-grade group (P=0.01), while no differences were found in the QPS acceleration. Conclusion Static anteroposterior and dynamic knee laxities, as presented by QPS, are poorly correlated in the ACL-deficient knee and should therefore be considered as separate entities of the knee examination. These findings strengthen the implementation of non-invasive technology for quantification of the pivot shift when establishing treatment algorithms for ACL reconstruction.
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