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- Good, Lars, 1953-, et al.
(författare)
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Akuta knäskador
- 2007
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 104:34, s. 2322-2327
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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- Good, Lars, 1953-
(författare)
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Anterior cruciate ligament reconstruction : Anatomic and biomechanical considerations of graft placement and fixation
- 1993
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study, comprising 7 separate papers, is concerned with the mechanical causes of graft failure after intraarticular reconstruction of the anterior cruciate ligament (ACL). The study is predominantly experimental in design, but a clinical follow-up is also included to test a causal hypothesis of secondary graft elongation.Fixations of synthetic ACL substitutes with ligament staples had low security and the maximum tolerance loads were in parity with forces generated during daily activities, while screw fixations of looped ligaments had higher load to failure than a normal ACL.A stenosis, caused by osteophyte formation, was found at the intercondylar notch less than 2 years after an ACL tear, strongly suggesting impingement and wear as a possible mechanism of ACL substitute failure. The intercondylar notch was also found to be narrowed in patients with an acute tear of the ACL compared to a normal control group, thus implying causality.A standardized technique of graft placement, using a guide to aid bone drilling, was found more accurate and reproducible in achieving desired graft insertions compared to freehand drilling. This was evaluated by a new method for detennining the graft insertion locations on the femur and tibia, using a ratio related to the sagittal depth of the condyles.The ability to restore knee kinematics from an ACL deficient state, was evaluated for a drill guided graft route and an over-the-top route. The only effect of both methods, using a dacron graft tensioned in full extension, was restoring or partially restoring the increased anterior -posterior translation.A good in vitro and in vivo correlation was found between the patterns of change in dynamic fixation distance, as measured intraoperatively with an isometer, and tension in the fixed ACL substitute. The isometry measurement could not predict the magnitude of the frnal tension due to the biological variability in soft tissue compliance.Sagittal knee stability was measured at regular intervals for 2 years on patients who had an intraarticular ACL reconstruction with a patellar tendon substitute. Increasing anterior-posterior displacement was found for all patients as a group, and more for patients with an anterior femoralligament insertion location.A standardized treatment including aided bone drilling, notch plasty, isometry measurement, and restricted postoperative rehabilitation is recommended.
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- Good, Lars, 1953-, et al.
(författare)
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Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement
- 2003
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 90:5, s. 596-599
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Tidskriftsartikel (refereegranskat)abstract
- Background. Total knee arthroplasty (TKA) is often carried out using a tourniquet and shed blood is collected in drains. Tranexamic acid decreases the external blood loss. Some blood loss may be concealed, and the overall effect of tranexamic acid on the haemoglobin (Hb) balance is not known. Methods. Patients with osteoarthrosis had unilateral cemented TKA using spinal anaesthesia. In a double-blind fashion, they received either placebo (n=24) or tranexamic acid 10 mg kg-1 (n=27) i.v. just before tourniquet release and 3 h later. The decrease in circulating Hb on the fifth day after surgery, after correction for Hb transfused, was used to calculate the loss of Hb in grams. This value was then expressed as ml of blood loss. Results. The groups had similar characteristics. The median volume of drainage fluid after placebo was 845 (interquartile range 523-990) ml and after tranexamic acid was 385 (331-586) ml (P<0.001). Placebo patients received 2 (0-2) units and tranexamic acid patients 0 (0-0) units of packed red cells (P<0.001). The estimated blood loss was 1426 (1135-1977) ml and 1045 (792-1292) ml, respectively (P<0.001). The hidden loss of blood (calculated as loss minus drainage volume) was 618 (330-1347) ml and 524 (330-9620) ml, respectively (P=0.41). Two patients in each group developed deep vein thrombosis. Conclusions. Tranexamic acid decreased total blood loss by nearly 30%, drainage volume by ~50% and drastically reduced transfusion. However, concealed loss was only marginally influenced by tranexamic acid and was at least as large as the drainage volume.
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- Henriksson, M, et al.
(författare)
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Range of motion training in brace vs. plaster immobilization after anterior cruciate ligament reconstruction : A prospective randomized comparison with a 2-year follow-up
- 2002
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Ingår i: Scandinavian Journal of Medicine and Science in Sports. - 0905-7188 .- 1600-0838. ; 12:2, s. 73-80
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this prospective and randomized study was to compare rehabilitation with early range of motion (ROM) training vs immobilization following anterior cruciate ligament (ACL) reconstruction. Fifty patients, undergoing an ACL reconstruction with a bone-patellar tendon-bone graft, were postoperatively allocated randomly to either a plaster cast or a brace for 5 weeks. The brace group had ROM exercises from post-operative day 7. The commencement of ROM exercises was postponed 4 weeks for the plaster group compared to the brace group, but progressed subsequently with equal speed. There was no difference between the groups in the ROM of flexion or extension 20 weeks after the ACL reconstruction and later. Twenty-four months after surgery, the muscle strength deficit in the hamstring muscles (isokinetic measurements, percent difference, injured vs uninjured) was significantly larger in the brace group (mean +/- SD: 5.9 +/- 7.8%, P < 0.01) than in the plaster group (-0.9 +/- 11.8%, NS) (brace vs plaster group, P <0.05). Furthermore, there was also a tendency in the brace group to a larger strength deficit in the quadriceps muscle (brace: 11.1 +/- 13.2%, P <0.001, plaster: 3.8 +/- 12.9%, NS) (brace vs plaster group, P = 0.07). There was no difference between the groups in the total sagittal knee laxity, as measured with an arthrometer, or in the subjective knee function or activity level (Lysholm score together with the Tegner activity level) between the groups. It is concluded that the postoperative treatment with early range of motion training after ACL reconstruction gave as good ROM, knee stability, subjective knee function and activity level as the treatment with immobilization. It is hypothesized that the larger strength deficit observed after rehabilitation with early range of motion training is secondary to the more intensive training and physical therapist involvement that was demanded in order to achieve full ROM following immobilization.
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- Kvist, Joanna, 1967-, et al.
(författare)
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Changes in knee motion pattern after anterior cruciate ligament injury - A case report
- 2007
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Ingår i: Clinical Biomechanics. - : Pergamon Press. - 0268-0033 .- 1879-1271. ; 22:5, s. 551-556
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Tidskriftsartikel (refereegranskat)abstract
- Background: After an anterior cruciate ligament injury, the contra-lateral non-injured leg has been found to adapt towards the injured leg. Accordingly, in order to study changes in knee motion pattern after an anterior cruciate ligament injury, the ideal is to compare the same leg prior to and after the injury. However, this is very seldom possible. The purpose of the present study was to describe changes in static and dynamic sagittal tibial translation, electromyographic activity and muscle torque relevant to an anterior cruciate ligament tear in one patient evaluated both before and after the injury.Methods: A male soccer player was examined 11 weeks before and eight weeks after an anterior cruciate ligament injury. Sagittal tibial translation was measured with the CA-4000 electrogoniometer, statically during Lachman's test, and dynamically during isokinetic muscle testing, one-legged squat and level walking. The electromyographic activity of mm. quadriceps and hamstrings, was registered simultaneously during the one-legged squat test.Findings: Static tibial translation was increased by ∼2 mm, while dynamic tibial translation was decreased by 0.4 mm at isokinetic testing, 0.9 mm at one-legged squat and 2.4 mm during level walking compared to before the injury. Muscle torque decreased 30% and 35% for the quadriceps and the hamstrings muscle, respectively. The electromyographic activity revealed similar activation levels in quadriceps and a doubled level of activation in hamstring compared to before the injury.Interpretation: In spite of an increase in static tibial translation eight weeks after an anterior cruciate ligament injury, the tibial translation decreased during activity, thus indicating that the patient could stiffen the knee in order to protect it against increased shear forces.
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| 9. |
- Kvist, Joanna, 1967-, et al.
(författare)
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Fear of re-injury : A hindrance for returning to sports after anterior cruciate ligament reconstruction
- 2005
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 13:5, s. 393-397
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Tidskriftsartikel (refereegranskat)abstract
- Unrestricted participation in sports activities and return to the pre-injury level is often reported as an indicator of the success of ACL reconstruction. The athletes' choice not to return to their pre-injury level may depend on the knee function, but some times, social reasons or psychological hindrances such as fear of re-injury may influence their return to sports. The aim of this study was to investigate whether fear of re-injury due to movement is of significance for returning to previous level of activity in patients who have undergone anterior cruciate ligament reconstruction. The Tampa Scale of Kinesiophobia (TSK), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and some general questions were mailed to 87 patients who underwent ACL reconstruction 3-4 years before the study was conducted. Sixty-two patients (74%) answered the questionnaires (34 men and 28 women). Fifty-three percent of the patients returned to their pre-injury activity level. The patients who did not return to their pre-injury activity level had more fear of re-injury, which was reflected in the TSK. In addition, high fear of re-injury was correlated with low knee-related quality of life. Fear of re-injury must be considered in the rehabilitation and evaluation of the effects of an ACL reconstruction. © Springer-Verlag 2005.
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