| 1. |
- Ackermann, Paul W, et al.
(author)
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Reduced time to surgery improves patient-reported outcome after achilles tendon rupture
- 2018
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In: The American Journal of Sports Medicine. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0363-5465 .- 1552-3365.
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Journal article (peer-reviewed)abstract
- Background: Patient outcome after an acute Achilles tendon rupture (ATR) continues to be suboptimal and heterogeneous. Thus, prognostic factors are called for to optimize evidence-based ATR treatment protocols, however, the influence of delayed time from injury to surgery (TTS) on patient outcome after ATR remains largely unknown. Purpose: To determine whether patient outcomes and adverse events after surgical repair of acute ATR are related to delayed TTS. Study Design: Cohort study; Level of evidence, 3. Methods: Two hundred and twenty-eight ATR patients treated with uniform anesthetic and surgical techniques, within 10 days after injury, were retrospectively assessed. TTS depended on a free slot in the operating theatre and neither surgeon nor patient could affect TTS. Patients were assigned into three groups according to trichotomized TTS; short- (<48hours), intermediate- (48-72hours) and long TTS (>72hours). Patient-reported outcome at one-year was assessed using the validated Achilles tendon Total Rupture Score, with scores>80 on a 0- to 100-point scale indicating an overall good outcome. The incidences of adverse events (peri- and postoperative) and deep venous thrombosis were assessed. Results: Shorter TTS was significantly associated with increased rate of good outcome and reduced risk of adverse events. Seventy-one percent (95% CI, 60%-83%) of the patients with short TTS attained a good outcome compared to 44% (95% CI, 33%-56%) of the patients 3 with long TTS (p=.002), and with the intermediate TTS group in between (63%, 95% CI, 47%-78%). The incidence of adverse events was significantly reduced among patients with short TTS 1.4% (95% CI, 1%-4%) as compared to those with intermediate TTS 11% (95% CI, 2%-21%) (p=.035) and to patients with long TTS 14.8% (95% CI, 7%-23%) (p=.003). The risk of sustaining a deep venous thrombosis was not statistically significant different among the three groups (p=.15). Conclusion: Patients with acute ATR operated on within 48 hours after injury yielded better outcomes and a lower number of adverse events compared to patients operated on after 72 hours. These results conform to evidence-based recommendations from other surgical disciplines and should be used as guidelines for optimizing ATR treatment protocols.
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| 2. |
- Alim, Md Abdul, et al.
(author)
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Procollagen markers in microdialysate can predict patient outcome after Achilles tendon rupture.
- 2016
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In: BMJ open sport & exercise medicine. - London, UK : BMJ. - 2055-7647. ; 2:1
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Patients who sustain acute Achilles tendon rupture (ATR) exhibit variable and mostly impaired long-term functional, and patient-reported outcomes. However, there exists a lack of early predictive markers of long-term outcomes to facilitate the development of improved treatment methods. The aim of this study was to assess markers of tendon callus production in patients with ATR in terms of outcome, pain, and fatigue.STUDY DESIGN AND SETTING: Prospective cohort study; level of evidence 2. Outpatient orthopaedic/sports medicine department.PATIENTS: A total of 65 patients (57 men, 8 women; mean age 41±7 years) with ATR were prospectively assessed.ASSESSMENTS: Markers of tendon callus production, procollagen type I N-terminal propeptide (PINP) and procollagen type III N-terminal propeptide (PIIINP), were assessed 2 weeks postoperatively using microdialysis followed by enzymatic quantification. Normalised procollagen levels (n-PINP and n-PIIINP) were calculated as the ratio of procollagen to total protein content. Pain and fatigue were assessed at 1 year using reliable questionnaires Achilles tendon Total Rupture Score (ATRS).RESULTS: Patients exhibited fatigue (77.6%) and pain (44.1%) to some extent. Higher levels of n-PINP (R=0.38, p=0.016) and n-PIIINP (R=0.33, p=0.046) were significantly associated with less pain in the limb. Increased concentrations of PINP (R=-0.47, p=0.002) and PIIINP (R=-0.37, p=0.024) were related to more self-reported fatigue in the leg. The results were corroborated by multiple linear regression analyses.CONCLUSIONS: Assessment of procollagen markers in early tendon healing can predict long-term patient-reported outcomes after ATR. These novel findings suggest that procollagen markers could be used to facilitate the development of improved treatment methods in patients who sustain ATR.TRIAL REGISTRATION NUMBERS: NCT01317160: Results. NCT02318472: Pre-results.
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| 3. |
- Hamrin Senorski, Eric, 1989, et al.
(author)
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Understanding limitations in sport 1 year after an Achilles tendon rupture: a multicentre analysis of 285 patients.
- 2020
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In: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 28:1, s. 233-244
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Journal article (peer-reviewed)abstract
- The purpose of this study was to determine patient-related and treatment-related predictors of superior and inferior function in sport and recreational activities 1year after an Achilles tendon rupture.This study is based on a multicentre cohort from 4 previous randomised controlled trials. All the patients who had responded to the Foot and Ankle Outcome Score (FAOS) at the 1-year follow-up were included. All the patients had a clinically verified Achilles tendon rupture and patients who underwent surgery were treated within 96h of the time of rupture. Patients were excluded in the event of a previous Achilles tendon rupture or the presence of other lifestyle diseases. The primary outcomes of the study were reported in the 20th and 80th percentiles of the FAOS subscale, function in sports and recreational activities.A total of 285 (84% men) patients with an average age of 40.0 (SD 8.4) years were included. Smoking increased the odds of superior self-reported FAOS sport and recreation [OR 4.59 (95% CI 1.58-13.32), p=0.005] compared with non-smoking, while being female [OR 0.38 (95% CI 0.16-0.93), p=0.035] and every increment of one unit in BMI [OR 0.89 (95% CI 0.81-0.99), p=0.029] reduced the odds. No variable was statistically significant when attempting to predict which patients report inferior FAOS sport and recreation. The recovery of symmetry in heel-rise tests had no effect on 1-year FAOS sport and recreation. Patient-reported outcomes had a good-to-excellent explanatory capacity of superior and inferior 1-year function in sport and recreational activities (AUC=0.87-0.93).BMI is a modifiable risk factor, which, when lowered, may be associated with less impairment in sports 1year after an Achilles tendon rupture. Females appear to perceive more limitations than males. Unexpectedly, smokers experience less limitations in foot and ankle function. Patients who report no functional limitation in sport are characterised by an overall perception of adequate foot, ankle and Achilles function, despite not having recovered symmetry in the heel-rise test.I.
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| 4. |
- Ljungberg Silic, Linda, et al.
(author)
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Gene profiling reveals a contact allergy signature in most positive Amerchol L-101 patch-test reactions
- 2022
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In: Contact Dermatitis. - : Wiley. - 0105-1873 .- 1600-0536. ; 87:1, s. 40-52
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Journal article (peer-reviewed)abstract
- Background: Diagnosis of contact allergy (CA) to Amerchol L-101 (AL-101), a marker for lanolin allergy, is problematic. Positive patch-test reactions are frequently doubtful or weakly positive and difficult to associate with clinical relevance. Objective: To gain further insight on the allergic or irritant nature of skin reactions induced by AL-101 patch test. Methods: We re-tested in a dose–response fashion, 10 subjects with AL-101 CA and performed comprehensive transcriptomic analysis (gene arrays, quantitative real-time polymerase chain reaction [qRT-PCR]) of samples of their skin reactions. Results: Eight of the 10 CA subjects reacted positively upon re-test, whereas two did not react. Most of AL-101 positive patch tests expressed an allergy signature with strong activation of gene modules associated with adaptive immunity and downregulation of cornification pathway genes. In addition, the breadth of gene modulation correlated with the magnitude of patch-test reactions and the concentration of AL-101 applied. However, we observed that some of the positive patch-test reactions to AL-101 expressed no/few allergy biomarkers, suggesting the induction of an irritant skin inflammation in these samples. Conclusions: This study confirms that AL-101 is an allergen that can cause both contact allergy and contact irritation. Our results also highlight that molecular profiling might help to strengthen clinical diagnosis.
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| 5. |
- Svedman, Simon, et al.
(author)
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STOP leg clots-Swedish multicentre trial of outpatient prevention of leg clots : study protocol for a randomised controlled trial on the efficacy of intermittent pneumatic compression on venous thromboembolism in lower leg immobilised patients
- 2021
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:5
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Journal article (peer-reviewed)abstract
- Introduction: Leg immobilisation in a cast or an orthosis after lower limb injuries is associated with a high risk of complications of venous thromboembolism (VTE) and hampered healing. Current pharmacoprophylaxes of VTE are inefficient and associated with adverse events. Intermittent pneumatic compression (IPC) could represent a novel, efficient and safe VTE-prophylactic alternative that may enhance injury healing. The aim of STOP leg clots is to assess the efficacy of adjuvant IPC-therapy on reduction of VTE incidence and improvement of healing in lower leg immobilised outpatients.Methods and analys: STOP leg clots is a multicentre randomised controlled superiority trial. Eligible patients (700 patients/arm) with either an acute ankle fracture or Achilles tendon rupture will be randomised to either addition of IPC during lower-leg immobilisation or to treatment-as-usual. The primary outcome will be the total VTE incidence, that is, symptomatic and asymptomatic deep venous thrombosis (DVT) or symptomatic pulmonary embolism (PE), during the leg immobilisation period, approximately 6-8 weeks. DVT incidence will be assessed by screening whole leg compression duplex ultrasound at removal of leg immobilisation and/or clinically diagnosed within the time of immobilisation. Symptomatic PE will be verified by CT.Secondary outcomes will include patient-reported outcome using validated questionnaires, healing evaluated by measurements of tendon callus production and changes in VTE-prophylactic mechanisms assessed by blood flow and fibrinolysis. Data analyses will be blinded and based on the intention-to-treat.
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