| 1. |
- Abrahamson, Josefin, et al.
(author)
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Adolescent elite skiers with and without cam morphology did change their hip joint range of motion with 2 years follow-up
- 2019
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In: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 27:10, s. 3149-3157
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Journal article (peer-reviewed)abstract
- Purpose: To investigate how range of motion of the hips and the lumbar spine are affected by continued elite, alpine skiing in young subjects, with and without a magnetic resonance imaging verified cam morphology, in a 2-year follow-up study. The hypothesis is that skiers with cam morphology will show a decrease in hip joint range of motion as compared with skiers without cam, after a 2-year follow-up. Method: Thirty adolescent elite alpine skiers were examined at the baseline (mean age 17.3 ± 0.7 years) and after 2 years. All skiers were examined for the presence of cam morphology (α-angle > 55°) using magnetic resonance imaging at the baseline. Clinical examinations of range of motion in standing lumbar flexion and extension, supine hip flexion, internal rotation, FABER test and sitting internal rotation and external rotation were performed both at the baseline and after 2 years. Results: Skiers with and without cam morphology showed a significant decrease from baseline to follow-up in both hips for supine internal rotation (right: mean − 13.3° and − 10.9° [P < 0.001]; left: mean − 7.6° [P = 0.004] and − 7.9° [P = 0.02]), sitting internal rotation (right: mean − 9.6° and − 6.3° [P < 0.001]; left: mean − 7.6° [P = 0.02] and − 3.3° [P = 0.008]) and sitting external rotation (right: mean − 16.9° and − 11.4° and left: mean − 17.9° and − 14.5° [P < 0.001]) and were shown to have an increased left hip flexion (mean + 8.4° and + 4.6° [P = 0.004]). Skiers with cam were also shown to have an increased right hip flexion (mean + 6.4° [P = 0.037]). Differences were found between cam and no-cam skiers from baseline to follow-up in the sitting internal rotation in both hips (right: mean 3.25°, left: mean 4.27° [P < 0.001]), the right hip flexion (mean 6.02° [P = 0.045]) and lumbar flexion (mean − 1.21°, [P = 0.009]). Conclusion: Young, elite alpine skiers with cam morphology decreased their internal rotation in sitting position as compared with skiers without the cam morphology after 2 years of continued elite skiing. Level of evidence: II.
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| 2. |
- Abrahamson, Josefin
(author)
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Cam morphology of femoroacetabular impingement syndrome - Clinical, radiological and follow-up studies
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Femoroacetabular impingement syndrome (FAIS) leads to hip pain and reduced hip function in young athletes. Recent studies have reported high-impact sporting activities during adolescent growth as an important cause of cam morphology. However, not all athletes with cam morphology develop symptoms and dysfunction related to FAIS, nor do they require surgical treatment. The question of why some athletes with cam morphology function well at a high level of sports for years, while others do not, and possible differences between genders and different sports, remains to be answered. The aim of this thesis is to investigate the correlation between cam morphology, hip joint range of motion (ROM) and hip pain in young elite athletes and patient-reported outcome measures (PROMs) and the rate of athletes still active at elite level after arthroscopic treatment for FAIS, and to make comparisons between genders, sports types and evaluations over time. Study I is a cross-sectional study comprising young athletes (60 male football players, 40 male and 35 female skiers). The prevalence of cam morphology, hip ROM, hip pain and FAIS is studied. Football players had reduced hip rotation compared with skiers, independent of cam morphology and hip pain. Male and female skiers had a higher proportion fulfilling the diagnostic criteria for FAIS compared with football players. Study II is a cohort study comparing hip ROM over 2 years in young skiers (n=30) with and without cam morphology. All the skiers reduced their hip rotation, independent of cam morphology. A statistical, not clinically relevant, larger reduction was shown in internal rotation in skiers with cam morphology. Study III is a cohort study investigating the correlation between cam morphology, activity level and hip pain over 5 years in young skiers (n=60). Activity level and cam morphology had no, or only a low, correlation with hip pain. Study IV is a cross-sectional study comprising 919 athletes undergoing arthroscopic treatment for FAIS. Preoperative PROMs and types of sport participation between genders is studied. Females had a longer duration and a higher degree of symptoms. Horseback riding and football were equally common in females, while football was dominant in males. Study V is a cohort study comprising 551 athletes undergoing arthroscopic treatment for FAIS. The rate of continued sporting activity is evaluated and compared between sports, genders and PROMs. Only 25% were still active at pre-injury level after 2 years, with no gender difference, but with a greater improvement in PROMs.
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| 3. |
- Abrahamson, Josefin, et al.
(author)
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High prevalence of former elite ice hockey players requiring early hip arthroplasty surgery
- 2024
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In: Journal of Hip Preservation Surgery (JHPS). - : Oxford Univ Press. - 2054-8397.
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Journal article (peer-reviewed)abstract
- The high-impact nature of ice hockey puts the players at a higher risk of developing early hip osteoarthritis (OA). This study aims to evaluate the presence of cam morphology, early radiological findings of OA and total hip arthroplasty (THA) in former Swedish elite ice hockey players. Male elite ice hockey players in the highest league in Sweden seeking orthopedic consultation for hip and groin pain with restricted hip joint range of motion and subsequent radiographs (Antero/posterior view, Lauenstein view and/or Hip frontal view) were included. The radiographs were performed between 1988 and 2009 and retrospectively examined for the presence of cam morphology (evaluated by alpha-angle >= 60 degrees) and hip OA (evaluated by Tonnis classification). All players were contacted between 11 and 33 years after baseline radiograph examination for follow-up investigation of the presence of subsequent THA. A total of 44 male ice hockey players were included, of which 31 had available radiographs and 39 answered the follow-up questions. Cam morphology (alpha-angle >= 60 degrees) was present in 81% of the players. Seven players (18%) had received a THA with a mean age of 55.7 (SD 6.1) years at time of THA-surgery. Tonnis score at baseline radiographs were associated with THA later in life (P < 0.001). This study conclude that former elite Swedish ice hockey players underwent THA at a younger age than the general population. Despite confirming previous research of high prevalence of cam morphology in elite ice hockey players, no association could be established between cam morphology and the need for THA.
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| 4. |
- Abrahamson, Josefin, et al.
(author)
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Hip pain and its correlation with cam morphology in young skiers-a minimum of 5 years follow-up
- 2020
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In: Journal of Orthopaedic Surgery and Research. - : Springer Science and Business Media LLC. - 1749-799X. ; 15:1
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Journal article (peer-reviewed)abstract
- BackgroundThere is conflicting evidence regarding the association between cam morphological changes and hip pain, and it remains unclear who with cam morphology will develop hip pain and who will not. This study aimed to investigate the correlation between cam morphology, hip pain, and activity level at a 5-year follow-up in young Alpine and Mogul skiers.MethodAll students (n = 76) at angstrom re Ski National Sports High School were invited and accepted participation in this prospective study at baseline. Magnetic resonance imaging (MRI) of both hips was conducted to evaluate the presence of cam morphology (alpha -angle >= 55 degrees) and its size alongside the reporting of hip pain, type, and frequency of training by the Back and hip questionnaire, at baseline. After 5 years, the skiers were invited to complete a shortened version of the same questionnaire.ResultsA total of 60 skiers (80%) completed the follow-up questionnaire, of which 53 had concomitant MRI data. Cam morphology was present in 25 skiers (47.2%, 39 hips). Hip pain at baseline and at follow-up was reported in 17 (28.3%) and 22 (36.7%) skiers, respectively. No correlations were found between the activity level, the frequency, and the size of cam morphology and hip pain, except for the right hip alpha -angle at 1 o'clock and hip pain in skiers with cam morphology at baseline (r(s) = 0.49; P = 0.03) and at follow-up (r(s) = 0.47; P = 0.04). A total of 73.3% skiers had retired, of which 48% reported this was due to injuries.ConclusionHip pain was not shown to be correlated, or had a low correlation, with activity level and the presence and size of cam morphology in young skiers on a 5-year follow-up. Based on these results, cam morphology or activity level did not affect hip pain to develop during 5 years of follow-up in young skiers. Furthermore, this study highlights that almost 75% of young elite skiers had retired from their elite career with almost 50% reporting that this was due to injuries sustained from skiing.
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| 5. |
- Abrahamson, Josefin, et al.
(author)
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Horseback riding is common among female athletes who had arthroscopic treatment for femoroacetabular impingement syndrome
- 2021
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In: Translational Sports Medicine. - : Hindawi Limited. - 2573-8488. ; 4:4, s. 500-507
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Journal article (peer-reviewed)abstract
- The purpose was to investigate pre-operative symptoms and types of sport in competitive athletes undergoing arthroscopic treatment for femoroacetabular impingement syndrome (FAIS), and to compare between genders. Competitive athletes planned for arthroscopic treatment for FAIS were included prospectively in a hip arthroscopy registry. A total of 1548 athletes were identified and 919 were included. Sporting activity and patient-reported outcome measures (PROMs), including HSAS, iHOT-12, and HAGOS, were recorded, pre-operatively. The study comprised 738 male and 181 female athletes (median age 25; interquartile range 20-32 years) who had undergone arthroscopic treatment for FAIS. The most common sports type performed by males were football (48%) and ice hockey (19%) and in females, football (25%) and horseback riding (22%). Females reported a significantly longer duration of symptoms (median 36 vs 24 months) and lower pre-operative scores for the iHOT-12 and all the HAGOS subscales, except for physical activity. In conclusion, horseback riding and football are almost equally common in female athletes, while football is by far the most common in male athletes, who underwent arthroscopic treatment for FAIS. Females had a longer duration of symptoms and a higher degree of self-reported symptoms and dysfunction prior to the hip arthroscopy.
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| 6. |
- Abrahamson, Josefin, et al.
(author)
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Low rate of high-level athletes maintained a return to pre-injury sports two years after arthroscopic treatment for femoroacetabular impingement syndrome
- 2020
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In: Journal of Experimental Orthopaedics. - : Springer Science and Business Media LLC. - 2197-1153. ; 7:1
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Journal article (peer-reviewed)abstract
- Purpose: The aim was to investigate the rate of athletes still active at their pre-injury sports level two years after arthroscopic treatment for femoroacetabular impingement syndrome (FAIS), and examine this between different sports and gender, and its correlation to patient-reported outcome measures (PROMs). Method: High-level athletes planned for arthroscopic treatment for FAIS were included prospectively in a Swedish hip arthroscopy registry between 2011 and 2017, and 717 met the inclusion criteria. Self-reported sporting activity was recorded preoperatively. The subjects answered PROMs, including the HSAS, iHOT-12 and HAGOS pre- and postoperatively. Results: A total of 551 athletes (median age 26, interquartile range 20–34 years; 23% women) had completed follow-up PROMs, at mean 23.4 ± 7.2 months postoperatively. In total, 135 (24.5%) were active at their pre-injury level of sports at follow-up (RTSpre). Athletes ≤30 years at time of surgery (n = 366; median age 22 years) had higher rate of RTSpre (31.4%) compared with athletes > 30 years (n = 185; median age 40 years) (10.8%; p < 0.001). All athletes had improvements in iHOT-12 and HAGOS, two years postoperatively (p < 0.001), while RTSpre athletes reported significantly better PROMs, pre- and postoperatively, and had greater improvements two years postoperatively, compared with athletes not active at pre-injury level. Conclusion: Only 25% of all high-level athletes and 31% of athletes ≤30 years were still active at their pre-injury sports level two years after arthroscopic treatment for FAIS. Athletes still active had significantly and clinically greater improvement regarding hip symptoms, function and quality of life, as compared with athletes not active at pre-injury level, two years postoperatively. © 2020, The Author(s).
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| 7. |
- Ekström, Lars, 1959, et al.
(author)
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A model for evaluation of the electric activity and oxygenation in the erector spinae muscle during isometric loading adapted for spine patients
- 2020
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In: Journal of Orthopaedic Surgery and Research. - : Springer Science and Business Media LLC. - 1749-799X. ; 15:1
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Journal article (peer-reviewed)abstract
- Background Simultaneous measurement of electromyography (EMG) and local muscle oxygenation is proposed in an isometric loading model adjusted for patients that have undergone spinal surgery. Methods Twelve patients with degenerative lumbar spinal stenosis (DLSS) were included. They were subjected to a test protocol before and after surgery. The protocol consisted of two parts, a dynamic and an isometric Ito loading with a time frame of 60 s and accompanying rest of 120 s. The Ito test was repeated three times. EMG was measured bilaterally at the L4 level and L2 and was recorded using surface electrodes and collected (Biopac Systems Inc.). EMG signal was expressed as RMS and median frequency (MF). Muscle tissue oxygen saturation (MrSO(2)) was monitored using a near-infrared spectroscopy (NIRS) device (INVOS (R) 5100C Oxymeter). Two NIRS sensors were positioned bilaterally at the L4 level. The intensity of the leg and back pain and perceived exertion before, during, and after the test was evaluated with a visual analogue scale (VAS) and Borg RPE-scale, respectively. Results All patients were able to perform and complete the test protocol pre- and postoperatively. A consistency of lower median and range values was noted in the sensors of EMG1 (15.3 mu V, range 4.5-30.7 mu V) and EMG2 (13.6 mu V, range 4.0-46.5 mu V) that were positioned lateral to NIRS sensors at L4 compared with EMG3 (18.9 mu V, range 6.5-50.0 mu V) and EMG4 (20.4 mu V, range 7.5-49.0 mu V) at L2. Right and left side of the erector spinae exhibited a similar electrical activity behaviour over time during Ito test (60 s). Regional MrSO(2) decreased over time during loading and returned to the baseline level during recovery on both left and right side. Both low back and leg pain was significantly reduced postoperatively. Conclusion Simultaneous measurement of surface EMG and NIRS seems to be a promising tool for objective assessment of paraspinal muscle function in terms of muscular activity and local muscle oxygenation changes in response to isometric trunk extension in patients that have undergone laminectomy for spinal stenosis.
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| 8. |
- Lindman, Ida, et al.
(author)
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Self-Reported Level of Sports Compared With Objective Data in Athletes With Femoroacetabular Impingement Syndrome
- 2024
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In: AMERICAN JOURNAL OF SPORTS MEDICINE. - 0363-5465 .- 1552-3365.
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Journal article (peer-reviewed)abstract
- Background: Femoroacetabular impingement syndrome (FAIS) is common among ice hockey and soccer players. To evaluate the prevalence of return to sports after hip arthroscopy or level of sports before surgery, self-reported questionnaires such as the Hip Sports Activity Scale (HSAS) are frequently used. There is a risk of self-reporting bias when using these tools.Purpose: To evaluate how self-reported levels of sports using HSAS correspond to objective data.Study Design: Cohort study, Level of evidence: 3.Method: Ice hockey and soccer players undergoing hip arthroscopy for FAIS between 2011 and 2019 and included in the local hip arthroscopy registry in Gothenburg, Sweden, aged >= 18 years at the time of surgery, with a self-reported HSAS level of 7 or 8 before onset of symptoms, were included. Objective data on level of sports were collected through sports-specific sources (https://football.instatscout.com, https://hockey.instatscout.com, https://www.eliteprospects.com, and Swedish Football Association). Objective data were collected for the corresponding season when the athletes reported their symptom onset. Agreement between subjective and objective data was described using descriptive statistics, and comparison between subgroups was made.Results: A total of 483 athletes met the inclusion criteria: 80 ice hockey and 403 soccer players. The majority were men (90%). The mean age was 26.5 years (SD, 8.3 years). When comparing HSAS level with objective data, 112 athletes (23%) had a correct self-reported HSAS level. Of 251 athletes with a self-reported HSAS level of 8, 76 (30%) had a matching objective HSAS level, and 36 of 232 (16%) athletes with a self-reported HSAS level of 7 had a matching objective HSAS level. Of the erroneous subjective ratings, 98% were higher than the objective data. Athletes reporting a correct HSAS level were younger (24.6 vs 26.4 years; P = .04) and had a shorter symptom duration (18 vs 24 months; P < .001). Ice hockey players scored themselves correctly more often than soccer players (P < .001).Conclusion: Only 23% of athletes undergoing hip arthroscopy for FAIS self-reported an HSAS level before onset of symptoms that was accurate according to the objectively recorded data. The majority self-reported an HSAS level above their correct level of sports. Ice hockey players, younger age, and shorter symptom duration were associated with correct self-assessment.
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| 9. |
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| 10. |
- Witwit, Wisam, et al.
(author)
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No Significant Change in MRI Abnormalities or Back Pain Prevalence in the Thoraco-Lumbar Spine of Young Elite Skiers Over a 2-Year Follow-Up
- 2022
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In: Open Access Journal of Sports Medicine. - 1179-1543. ; 13, s. 69-76
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Journal article (peer-reviewed)abstract
- Background: Young athletes are at increasing risk for spinal column injuries due to overloading the spine with excessive sports activities, with potential development of complications later in life.Purpose: The purpose of this 2-year follow-up study of young elite skiers and non-athletes was to investigate any potential change in the thoraco-lumbar findings on MIRI and to outline any change in back pain prevalence with continuing sporting activity and age. Study Design: Longitudinal cross-sectional study.Methods: MIRI of the thoraco-lumbar spine was performed on 30 skiers (mean age 20 years, female 43%) and 16 non-athletes (mean age 19, female 75%), available for the 2-year follow-up. The intervertebral discs were evaluated for signal, height, bulge/herniation, and additionally according to Pfirrmann classification, and the endplates were graded according to endplate defect score. Any of the following disc findings was defined as disc degenerative change: reduced signal, reduced height, bulge, or herniation. All participants answered a specific back pain questionnaire.Results: No significant difference in spinal column abnormalities, nor back pain, was found between baseline and 2-year follow-up in neither skiers nor controls. There was significantly higher prevalence of disc degenerative changes in skiers (73%) than in non-athletes (44%, p=0.05). Skiers (63%) had significantly more Pfirrmann grade >= 3 discs compared to non-athletes (25%) (p=0.03). There was no significant difference in number of endplates with score >= 4 between skiers and non-athletes (50% vs 38%, p=0.40) nor in lifetime prevalence of back pain between skiers (46%) and non-athletes (40%).Conclusion: There was no significant change over time of the spinal column MIRI abnormalities, nor back pain prevalence, during a 2-year follow-up of skiers and non-athletes. Young skiers had significantly higher prevalence of spine abnormalities compared with non-athletes. There was no significant difference of the back pain lifetime prevalence in skiers compared with non-athletes.
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