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1.	Arundale, Amelia, et al. (författare) Jump performance in male and female football players 2020 Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : SPRINGER. - 0942-2056 .- 1433-7347. ; 28, s. 606-613 Tidskriftsartikel (refereegranskat)abstract Purpose To examine differences between men and women football players in clinically feasible jumping measures. Methods Female football players (N=46, ages 16-25) were matched based on age, training frequency, and playing position with 46 male players. All players performed the tuck jump and drop vertical jump (DVJ). DVJ was assessed quantitatively for valgus knee motion and probability of a high peak knee abduction moment (pKAM), as well as sagittal plane hip, knee, and ankle angles, and qualitatively with visual assessment of the players knees upon landing; graded as good, reduced, or poor control. Result Women had higher total tuck jump scores (52) (more technique flaws), than men (3 +/- 2, Pamp;lt;0.01). The quantitative analysis of the DVJ found that men had greater asymmetries between limbs, but women landed bilaterally in more knee valgus (interaction P=0.04, main effect of sex P=0.02). There was no difference in pKAM (interaction n.s.). Women also landed in less hip flexion (P=0.01) and ankle dorsiflexion (P=0.01) than men. The qualitative DVJ analysis found that more women (48%) had poor knee control compared to men (11%, Pamp;lt;0.01). Conclusions The results indicate that women perform worse on the tuck jump assessment than men. The results support previous findings that women land in more knee valgus than men, but also found that men may have larger asymmetries in knee valgus. These results from clinically feasible measures provide some suggestions for clinicians to consider during ACL reconstruction rehabilitation to enhance performance.
2.	Arundale, Amelia, 1965-, et al. (författare) Jumping performance based on duration of rehabilitation in female football players after anterior cruciate ligament reconstruction 2019 Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Berlin/Heidelberg. - 0942-2056 .- 1433-7347. ; 27:2, s. 556-563 Tidskriftsartikel (refereegranskat)abstract PurposeTo determine if female football players who had longer durations of rehabilitation, measured in months, after anterior cruciate ligament reconstruction would have lower tuck jump scores (fewer technique flaws) and smaller asymmetries during drop vertical jump landing.MethodsOne-hundred-and-seventeen female football players, aged 16ï¿œ25 years, after primary unilateral ACL reconstruction (median 16 months, range 6ï¿œ39) were included. Athletes reported the duration of rehabilitation they performed after anterior cruciate ligament reconstruction. Athletes also performed the tuck jump and drop vertical jump tests. Outcome variables were: tuck jump score, frontal plane knee motion and probability of peak knee abduction moment during drop vertical jump landing.ResultsThere was no difference in tuck jump score based on duration of rehabilitation (n.s.). No interaction (n.s.), difference between limbs (n.s.), or duration of rehabilitation (n.s.) was found for peak knee abduction moment during drop vertical jump landing. No interaction (n.s.) or difference between limbs (n.s.) was found for frontal plane knee motion, but there was a difference based on duration of rehabilitation (P?=?0.01). Athletes with >?9 months of rehabilitation had more frontal plane knee motion (medial knee displacement) than athletes with ConclusionAs there was no difference in tuck jump score or peak knee abduction moment based on duration of rehabilitation, the results of this study press upon clinicians the importance of using objective measures to progress rehabilitation and clear athletes for return to sport, rather than time alone.
3.	Arundale, Amelia, et al. (författare) TUCK JUMP SCORE IS NOT RELATED TO HOPPING PERFORMANCE OR PATIENT-REPORTED OUTCOME MEASURES IN FEMALE SOCCER PLAYERS 2020 Ingår i: INTERNATIONAL JOURNAL OF SPORTS PHYSICAL THERAPY. - : AMER PHYSICAL THERAPY ASSOC. - 2159-2896. ; 15:3, s. 395-406 Tidskriftsartikel (refereegranskat)abstract Background: The tuck jump assessment was developed to identify players at risk for anterior cruciate ligament (ACL) injuries or gauge a players progress through rehabilitation after ACL reconstruction. A tuck jump score of >= 6 out of 10 has been labeled poor and thought to identify players with high risk landing patterns. Purpose: The purpose of this exploratory study was to examine if there was a relationship between tuck jump score, particularly tuck jump scores >= 6, hopping performance, and patient-reported outcome measures in female soccer players with ACL reconstruction (ACLR) and knee-healthy controls. Study Design: Secondary analysis of prospective cohort study Methods: Female soccer players (117 after ACLR, 117 knee-healthy) performed the single hop for distance, tuck jump assessment, and drop vertical jump (DVJ). All players were categorized based on as having a total tuck jump score >= 6 or < 6. Analyzing all players together, Spearmans rank correlations assessed if there were relationships between total tuck jump score or tuck jump scores >= 6 and single-legged hop limb symmetry or DVJ measures. Players with an ACLR also filled out the International Knee Documentation Committee 2000 Subjective Knee Form and the Knee injury Osteoarthritis Outcome Score. Spearmans rank correlations assessed if there were relationships between total tuck jump score or tuck jump scores >= 6 and patient-reported outcome measures. Results: The mean tuck jump scores was 4.8 +/- 1.8 (tuck jump score >= 6, 6.7 +/- 0.9, tuck jump score < 6, 3.7 +/- 1.1) with 87 (37%) athletes having tuck jump score >= 6. There were no significant relationships between tuck jump score or tuck jump score >= 6 and hopping performance or patient-reported outcome measures. Conclusion: The results of this current study indicate that tuck jump scores, including tuck jump scores >= 6, may not be related to functional or patient-reported outcome measures. Further work is needed to examine the clinical utility of the tuck jump assessment.
4.	Fältström, Anne, et al. (författare) Are We Jumping to the Wrong Conclusions? Longer Jumps and More Hops in Female Football Players Who Went on to Sustain a Primary or Secondary ACL Injury Compared to Those Who Did Not 2023 Ingår i: SPORTS MEDICINE-OPEN. - : SPRINGER. - 2199-1170. ; 9:1 Tidskriftsartikel (refereegranskat)abstract BackgroundDifferent functional performance tests are used to assess patients in the clinic and before return to sport (RTS), where the rehabilitation goal is to reach good strength and jumping ability. A limb symmetry index of >= 90% is a common target in rehabilitation before RTS. The aim of this short communication is to use data from our 2-year prospective cohort study on female football players, either with or without an anterior cruciate ligament (ACL) reconstruction, to discuss whether hop performance in 3 commonly used hop tests can inform safe football participation, that is, with a low risk for ACL injury or reinjury.MethodAt baseline, 117 active female football players (mean age +/- standard deviation, 20 +/- 2 years) were included 19 +/- 9 months after ACL reconstruction as well as 119 matched female knee-healthy players (age 19 +/- 3 years). All players performed a single hop for distance test, 5-jump test and side hop test at baseline and were then prospectively followed for 2 years. Twenty-eight (24%) players sustained a second ACL injury and 8 (7%) sustained a primary ACL injury.ResultsLonger jumps in the 5-jump test (922 cm vs. 865 cm, Cohens d = - 0.60) and more hops in the side hop test for both limbs (41-42 hops vs. 33-36 hops, d = - 0.43 to - 0.60) were seen in players who sustained a second ACL injury compared with those who did not. Longer jumps in the single hop for distance test (both limbs) (139-140 cm vs. 124-125 cm, d = - 0.38 to - 0.44), in the 5-jump test (975 cm vs. 903 cm, d = -0.42) and more hops in the side hop test (both limbs) (48-49 hops vs. 37-38 hops, d = - 0.38 to - 0.47) were seen in players who sustained a primary ACL injury compared with those who did not.ConclusionsThe average hop performance, i.e. longer jumps or more hops, was greater in players who went on to sustain a primary or secondary ACL injury compared to those who did not over a two-year follow-up period. Even though hop tests are not used in isolation to evaluate readiness to RTS, their interpretation needs consideration in the decision-making process of returning to pivoting sports. center dot The average hop performance, i.e. longer jumps or more hops, was greater in female football players who went on to sustain a primary or secondary ACL injury compared to those who did not over a two-year follow-up period.center dot Even though hop tests are not used in isolation to evaluate readiness to RTS, their interpretation needs consideration in the decision-making process of returning to pivoting sports.center dot The relationship between better hop performance and risk of ACL injury is unclear. It is likely not a predictor per se, but better performance could mean more exposure to high risk activities.
5.	Fältström, Anne, et al. (författare) Clinical Risk Profile for a Second Anterior Cruciate Ligament Injury in Female Soccer Players After Anterior Cruciate Ligament Reconstruction 2021 Ingår i: American Journal of Sports Medicine. - : SAGE PUBLICATIONS INC. - 0363-5465 .- 1552-3365. ; 49:6, s. 1421-1430 Tidskriftsartikel (refereegranskat)abstract Background: The risk of a second anterior cruciate ligament (ACL) injury when participating in pivoting sports after ACL reconstruction is high. Risk factors associated with a second ACL injury are complex. Purpose: To investigate the combinations of various clinical risk factors associated with second ACL injury in female soccer players with a primary unilateral ACL reconstruction, using Classification and Regression Tree (CART) analysis. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 117 active female soccer players (mean +/- SD age, 20 +/- 2 years) were included. Athletes were enrolled 19 +/- 9 months after ACL reconstruction and were prospectively followed for 2 years. At baseline, all players underwent assessment of knee and ankle joint range of motion (ROM), participated in functional tests (postural control, hop performance, and movement asymmetries in the lower limbs and trunk), and answered questionnaires (patient-reported knee function, knee-related quality of life, psychological and personality factors). A clinical prediction model using CART was developed. Results: A total of 28 players (24%) sustained a second ACL injury (21 ipsilateral and 7 contralateral ruptures) while playing soccer. CART analysis selected 9 of 19 independent variables associated with second ACL injury: the 5-jump test, knee collapse on the non-ACL reconstructed leg in a drop vertical jump, tuck jump, limb symmetry index on side hop and the single hop for distance, side difference in ankle dorsiflexion ROM, and scores for the questionnaires ACL-Return to Sport After Injury and the Swedish Universities Scales of Personality subscales of Stress Susceptibility and Adventure Seeking. The accuracy of the model was 89%, with 100% sensitivity and 76% specificity. CART analysis indicated that the interaction of longer jumps in the 5-jump test (>916 cm) with more side difference in ankle dorsiflexion ROM (>-2.5 degrees) and more knee valgus collapse in the nonreconstructed knee (>-1.4 cm) (relative risk, 4.03; 95% CI, 2.21-7.36) best predicted an increased likelihood of a second ACL injury. Conclusion: The risk profiles selected by CART could accurately identify female soccer players at high risk for a second ACL injury. There was an interaction between functional performance, clinical assessment, and psychological factors, and it is reasonable to include these factors in return-to-sport decisions and in athlete screening after ACL injury.
6.	Fältström, Anne, et al. (författare) Factors associated with playing football after anterior cruciate ligament reconstruction in female football players. 2016 Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : Wiley-Blackwell. - 0905-7188 .- 1600-0838. ; 26:11, s. 1343-1352 Tidskriftsartikel (refereegranskat)abstract This study investigated whether player-related factors (demographic, personality, or psychological factors) or the characteristics of the anterior cruciate ligament (ACL) injury were associated with the return to playing football in females after ACL reconstruction (ACLR). We also compared current knee function, knee related quality of life and readiness to return to sport between females who returned to football and those who had not returned. Females who sustained a primary ACL rupture while playing football and underwent ACLR 6-36 months ago were eligible. Of the 460 contacted, 274 (60%) completed a battery of questionnaires, and 182 were included a median of 18 months (IQR 13) after ACLR. Of these, 94 (52%) returned to football and were currently playing, and 88 (48%) had not returned. Multiple logistic regression analysis identified two factors associated with returning to football: short time between injury and ACLR (0-3 months, OR 5.6; 3-12 months OR 4.7 vs reference group > 12 months) and high motivation. Current players showed higher ratings for current knee function, knee-related quality of life, and psychological readiness to return to sport (P < 0.001). Undergoing ACLR sooner after injury and high motivation to return to sports may impact a player's return to football after ACLR.
7.	Fältström, Anne, 1970-, et al. (författare) Female Soccer Players With Anterior Cruciate Ligament Reconstruction Have a Higher Risk of New Knee Injuries and Quit Soccer to a Higher Degree Than Knee-Healthy Controls 2019 Ingår i: American Journal of Sports Medicine. - : Sage Publications. - 0363-5465 .- 1552-3365. ; 47:1, s. 31-40 Tidskriftsartikel (refereegranskat)abstract Background:Many patients with anterior cruciate ligament (ACL) reconstruction who return to sport suffer new ACL injuries or quit sports soon after returning.Purpose:To prospectively follow a cohort of female soccer players with primary unilateral ACL reconstruction and matched knee-healthy controls from the same soccer teams to compare (1) the rate of new traumatic and nontraumatic knee injuries and other injuries, (2) the proportion of players who quit soccer, and (3) player-reported activity level and satisfaction with activity level and knee function.Study Design:Cohort study; Level of evidence, 2.Methods:A total of 117 active female soccer players (mean ± SD age, 19.9 ± 2.5 years) 18.9 ± 8.7 months after ACL reconstruction and 119 knee-healthy female soccer players (19.5 ± 2.5 years) matched from the same teams were prospectively followed for 2 years for new knee injuries, other injuries, soccer playing level, activity level according to the Tegner Activity Scale, and satisfaction with activity level and knee function.Results:Players with ACL reconstruction had a higher rate of new ACL injuries (n = 29 vs 8; 19 vs 4 per 100 player years; rate ratio [RR], 4.82; 95% CI, 2.20-10.54; P < .001), other traumatic knee injuries (29 vs 16 per 100 player years; RR, 1.84; 95% CI, 1.16-2.93; P < .01), and nontraumatic knee injuries (33 vs 9 per 100 player years; RR, 3.62; 95% CI, 2.11-6.21; P < .001) as compared with controls. There was no difference in the rate of other (not knee) injuries (43 vs 48 per 100 player years; RR, 0.90; 95% CI, 0.65-1.23; P = .494). During the 2-year follow-up, 72 (62%) players with ACL reconstruction quit soccer, as opposed to 43 (36%) controls (P = .001). The median Tegner Activity Scale score decreased in both groups (P < .001) but more for the ACL-reconstructed group (P < .015).Conclusion:Female soccer players with ACL reconstruction had nearly a 5-fold-higher rate of new ACL injuries and a 2- to 4-fold-higher rate of other new knee injuries, quit soccer to a higher degree, and reduced their activity level to a greater extent as compared with knee-healthy controls.
8.	Fältström, Anne, et al. (författare) Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls 2017 Ingår i: American Journal of Sports Medicine. - : Sage Publications. - 0363-5465 .- 1552-3365. ; 45:2, s. 377-385 Tidskriftsartikel (refereegranskat)abstract Background: Good functional performance with limb symmetry is believed to be important to minimize the risk of injury after a return to pivoting and contact sports after anterior cruciate ligament reconstruction (ACLR).Purpose: This study aimed to investigate any side-to-side limb differences in functional performance and movement asymmetries in female soccer players with a primary unilateral anterior cruciate ligament (ACL)–reconstructed knee and to compare these players with knee-healthy controls from the same soccer teams.Study Design: Cross-sectional study; Level of evidence, 3.Methods: This study included 77 active female soccer players at a median of 18 months after ACLR (interquartile range [IQR], 14.5 months; range, 7-39 months) and 77 knee-healthy female soccer players. The mean age was 20.1 ± 2.3 years for players with an ACL-reconstructed knee and 19.5 ± 2.2 years for controls. We used a battery of tests to assess postural control (Star Excursion Balance Test) and hop performance (1-legged hop for distance, 5-jump test, and side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using 2-dimensional analyses.Results: The reconstructed and uninvolved limbs did not differ in any of the tests. In the 5-jump test, players with an ACL-reconstructed knee performed worse than controls (mean 8.75 ± 1.05 m vs 9.09 ± 0.89 m; P = .034). On the drop vertical jump test, the ACL-reconstructed limb had significantly less knee valgus motion in the frontal plane (median 0.028 m [IQR, 0.049 m] vs 0.045 m [IQR, 0.043 m]; P = .004) and a lower probability of a high knee abduction moment (pKAM) (median 69.2% [IQR, 44.4%] vs 79.8% [IQR, 44.8%]; P = .043) compared with the control players’ matched limb (for leg dominance). Results showed that 9% to 49% of players in both groups performed outside recommended guidelines on the different tests. Only 14 players with an ACL-reconstructed knee (18%) and 15 controls (19%) had results that met the recommended guidelines for all 5 tests (P = .837).Conclusion: The reconstructed and uninvolved limbs did not differ, and players with an ACL-reconstructed knee and controls differed only minimally on the functional performance tests, indicating similar function. It is worth noting that many players with an ACL-reconstructed knee and controls had movement asymmetries and a high pKAM pattern, which have previously been associated with an increased risk for both primary and secondary ACL injury in female athletes.
9.	Fältström, Anne, et al. (författare) High Risk of New Knee Injuries in Female Soccer Players After Primary Anterior Cruciate Ligament Reconstruction at 5-to 10-Year Follow-up 2021 Ingår i: American Journal of Sports Medicine. - : SAGE PUBLICATIONS INC. - 0363-5465 .- 1552-3365. ; 49:13, s. 3479-3487 Tidskriftsartikel (refereegranskat)abstract Background: A new anterior cruciate ligament (ACL) injury after ACL reconstruction is a feared outcome. Purpose: To study the risk of new knee injuries in female soccer players 5 to 10 years after primary unilateral ACL reconstruction and to compare players who returned to soccer with (1) players who did not return and (2) knee-healthy soccer players (controls). Study Design: Cohort study; Level of evidence, 2. Methods: Demographic, soccer-specific, and surgical data were recorded at baseline for 317 female soccer players (mean +/- SD age, 20.1 +/- 2.7 years) 1.6 +/- 0.7 years after ACL reconstruction and for 119 matched controls (mean age, 19.5 +/- 2.5 years). Data on new knee injuries and soccer-playing status were collected 5 to 10 years after ACL reconstruction via a questionnaire. Results: Among players with ACL reconstruction, 222 (70%) responded at a mean 6.5 +/- 1.0 years after primary ACL reconstruction. We compared 3 cohorts: (1) among 163 players with ACL reconstruction who returned to soccer, 68 (42%) sustained 44 reruptures and 29 contralateral ruptures; (2) among 59 players with ACL reconstruction who did not return to soccer, 11 (19%) sustained 9 reruptures and 2 contralateral ruptures; and (3) among 113 knee-healthy controls, 12 (11%) sustained 13 ACL injuries. Players who returned had a >2-fold higher risk of a new ACL injury than players who did not return (risk ratio, 2.24; 95% CI, 1.27-3.93; P = .005) and a 4-fold higher risk than controls (risk ratio, 3.93; 95% CI, 2.23-6.91; P <.001). A new ACL, meniscal, or cartilage injury was the most frequent new knee injury. Among players who returned to soccer, 68% reported a new knee injury, and they had a 2- to 5-times higher risk of any new knee injury and knee surgery than players who did not return and controls. Conclusion: Two-thirds of female soccer players with ACL reconstruction who returned to soccer sustained a new knee injury within 5 to 10 years; 42% had a new ACL injury. Their risk of a new knee injury and knee surgery was 2 to 5 times greater than that for players who did not return and for knee-healthy controls. New injury may have negative consequences for long-term knee health and should be a critical consideration in the decision to return to play.
10.	Fältström, Anne, et al. (författare) Lifestyle characteristics in adolescent female football players : data from the Karolinska football Injury Cohort. 2022 Ingår i: BMC Sports Science, Medicine and Rehabilitation. - : BioMed Central (BMC). - 2052-1847. ; 14:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Normative values of lifestyle characteristics in adolescent female football players may be used by clinicians and coaches to take actions because the potential important for well-being, performance on the pitch, and risk of injury. The aim was to report descriptive characteristics of lifestyle factors in adolescent female football players and potential changes over 1 year.METHODS: We included 419 adolescent competitive female football players from 12 clubs and 27 teams (age 14 ± 1 years, range 12-17 years) and 286 were followed over 1 year. The players completed an extensive questionnaire regarding demographics, football-related factors, and lifestyle factors including tobacco consumption, alcohol use, medicine intake, eating and sleeping habits, well-being, stress, coping, and passion. Baseline data are presented for the total cohort and separately for 4 age groups (12, 13, 14, and 15-17 years).RESULTS: 12% skipped breakfast, 8% skipped lunch and 11% used protein supplements several days per week. 16% slept less than 8 h/night, 8% had impaired sleep with daytime consequences, and 22% stated that they were tired in daily activities several days per week. 32% experienced stress some or most days/week and 24% were classified as having psychological distress. Medicine intake (23% vs. 34%), skipping breakfast or lunch several days per week (10% vs. 47% and 20 vs. 33%), tiredness (20% vs. 27%), stress (26% vs. 40%), and psychological distress (27% vs. 37%) increased significantly (P = 0.031 to < 0.001) at the 1-year follow-up.CONCLUSION: Many adolescent female football players skip breakfast and lunch, have insufficient sleep, experience stress and are classified as having psychological distress. These factors increased over 1 year.
11.	Fältström, Anne, et al. (författare) Normative values and changes in range of motion, strength, and functional performance over 1 year in adolescent female football players : Data from 418 players in the Karolinska football Injury Cohort study. 2022 Ingår i: Physical Therapy in Sport. - : Elsevier. - 1466-853X .- 1873-1600. ; 58, s. 106-116 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To study normative values of range of motion (ROM), strength, and functional performance and investigate changes over 1 year in adolescent female football players.DESIGN: Cross-sectional.PARTICIPANTS: 418 adolescent female football players aged 12-17 years.MAIN OUTCOME MEASURES: The physical characteristic assessments included (1) ROM assessment of the trunk, hips, and ankles; (2) strength measures (maximal isometric and eccentric strength for the trunk, hips, and knees, and strength endurance for the neck, back, trunk and calves), and (3) functional performance (the one-leg long box jump test and the square hop test).RESULTS: Older players were stronger, but not when normalized to body weight. Only small differences in ROM regarding age were found. ROM increased over 1 year in most measurements with the largest change in hip external rotation, which increased by 6-7° (Cohen's d = 0.83-0.87). Hip (d = 0.28-1.07) and knee (d = 0.38-0.53) muscle strength and the square hop test (d = 0.71-0.99) improved over 1 year.CONCLUSIONS: Normative values for ROM and strength assessments of neck, back, trunk, hips, knees, calves and ankles are presented for adolescent female football players. Generally, fluctuations in ROM were small with little clinical meaning, whereas strength improved over 1 year.
12.	Fältström, Anne (författare) One ACL injury is enough! Focus on female football players : PhD Academy Award 2017 Ingår i: British Journal of Sports Medicine. - : BMJ Publishing Group Ltd. - 0306-3674 .- 1473-0480. ; 51:16, s. 1235-1236 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
13.	Fältström, Anne, 1970- (författare) One Anterior Cruciate Ligament injury is enough! : Focus on female football players 2016 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background: Anterior cruciate ligament (ACL) injury is a severe and common injury, and females have 2-4 times higher injury risk compared to men. Return to sport (RTS) is a common goal after an ACL reconstruction (ACLR), but only about two thirds of patients RTS. Young patients who RTS may have a 30-40 times increased risk of sustaining an additional ACL injury to the ipsi- or contralateral knee compared with an uninjured person.Aims: The overall aim of this thesis was to increase the knowledge about female football players with ACLR, and patients with bilateral ACL injuries, and to identify predictors for additional ipsi- and/or contralateral ACLR.Methods: This thesis comprises four studies. Study I and II were cross-sectional, including females who sustained a primary ACL rupture while playing football and underwent ACLR 6–36 months prior to study inclusion. In study I, 182 females were included at a median of 18 months (IQR 13) after ACLR. All players completed a battery of questionnaires. Ninety-four players (52%) returned to football and were playing at the time of completing the questionnaires, and 88 (48%) had not returned. In study II, 77 of the 94 active female football players (from study I) with an ACLR and 77 kneehealthy female football players were included. A battery of tests was used to assess postural control (the Star excursion balance test) and hop performance (the one-leg hop for distance, the five jump test and the side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using two-dimensional analyses. Study III, was a cohort study including all patients with a primary ACLR (n=22,429) registered in the Swedish national ACL register between January 2005 and February 2013. Data extracted from the register to identify predictors for additional ACLR were: patient age at primary ACLR, sex, activity performed at the time of ACL injury, primary injury to the right- or left knee, time between injury and primary ACLR, presence of any concomitant injuries, graft type, Knee injury and Osteoarthritis Outcome Score and Euroqol Index Five Dimensions measured pre-operatively. Study IV was cross-sectional. In this study, patient-reported knee function, quality of life and activity level in 66 patients with bilateral ACL injuries was investigated and outcomes were compared with 182 patients with unilateral ACLR.Results: Factors associated with returning to football in females were; short time between injury and ACLR (0–3 months, OR 5.6; 3–12 months OR 4.7 vs. reference group >12 months) and high motivation (study I). In all functional tests, the reconstructed and uninvolved limbs did not differ, and players with ACLR and controls differed only minimally. Nine to 49% of the players with ACLR and controls had side-to-side differences and movement asymmetries and only one fifth had results that met the recommended guidelines for successful outcome on all the different tests (study II). Main predictors for revision and contralateral ACLR were younger age (fourfold increased rate for <16 vs. >35-year-old patients), having ACLR early after the primary injury (two to threefold increased rate for ACLR within 3 months vs. >12 months), and incurring the primary injury while playing football (study III). Patients with bilateral ACL injuries reported poorer knee function and quality of life compared to those who had undergone unilateral ACLR. They had a high activity level before their first and second ACL injuries but an impaired activity level at follow-up after their second injury (study IV).Conclusions: Female football players who returned to football after an ACLR had high motivation and had undergone ACLR within one year after injury. Players with ACLR had similar functional performance to healthy controls. Movement asymmetries, which in previous studies have been associated with increased risk for primary and secondary ACL injury, occurred to a high degree in both groups. The rate of additional ACLR seemed to be increased in a selected group of young patients who desire to return to strenuous sports like football quickly after primary ACLR. Sustaining a contralateral ACL injury led to impaired knee function and activity level.
14.	Fältström, Anne, et al. (författare) Patient-Reported Knee Function, Quality of Life, and Activity Level After Bilateral Anterior Cruciate Ligament Injuries 2013 Ingår i: American Journal of Sports Medicine. - : SAGE Publications (UK and US): No SAGE Choice. - 0363-5465 .- 1552-3365. ; 41:12, s. 2805-2813 Tidskriftsartikel (refereegranskat)abstract Background: About 12% of patients who have undergone primary anterior cruciate ligament (ACL) reconstruction sustain a contralateral ACL injury within 5 years. less thanbrgreater than less thanbrgreater thanPurpose: To investigate patient-reported knee function, quality of life, and activity level in patients with bilateral ACL injuries. less thanbrgreater than less thanbrgreater thanStudy Design: Cohort study; Level of evidence, 3. less thanbrgreater than less thanbrgreater thanMethods: A search of hospital records identified 147 patients, aged 18 to 45 years, with bilateral ACL injuries. Of these, 83 met the inclusion criteria, having had their first ACL injury up to 12 years ago with no other major injuries to the knee joint. Sixty-six of these patients (80% of total; 47% female; mean age, 29.1 7.2 years) answered a questionnaire packet. Patients who had undergone unilateral ACL reconstruction (n = 182) were used for comparison. less thanbrgreater than less thanbrgreater thanResults: Patients with bilateral ACL injuries had a median Lysholm knee score of 82 (range, 34-100). The mean EuroQol index (EQ-5D) score of the overall health status was 0.77 +/- 0.22, and the mean EQ-5D visual analog scale score was 75.5 +/- 17.6. The median Tegner activity level was 9 (range, 1-9) before any injuries, 7 (range, 1-9) before the second ACL injury, and 4 (range, 1-9) at the time of follow-up. The activity level before the second injury was higher compared with the follow-up for patients who had undergone unilateral ACL reconstruction. At follow-up, 23% of the patients with bilateral ACL injuries returned to their previous activity, and 12% of patients returned to the same level as before their injuries compared with 43% (P = .004) and 28% (P = .01) in patients who had undergone unilateral ACL reconstruction, respectively. Patients with bilateral ACL injuries had significantly lower values in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for pain, function in sports and recreation, and knee-related quality of life as well as the ACL Deficiency Quality of Life (ACL-QOL) score compared with patients who had undergone unilateral ACL reconstruction. less thanbrgreater than less thanbrgreater thanConclusion: Patients with bilateral ACL injuries reported poorer knee function and quality of life compared with those who had undergone unilateral ACL reconstruction. Their activities had changed, and they were dissatisfied with their current activity level. They had a high activity level before their first and second ACL injuries but an impaired activity level after their contralateral injury at follow-up.
15.	Fältström, Anne, et al. (författare) Poor Validity of Functional Performance Tests to Predict Knee Injury in Female Soccer Players With or Without Anterior Cruciate Ligament Reconstruction 2021 Ingår i: American Journal of Sports Medicine. - : SAGE PUBLICATIONS INC. - 0363-5465 .- 1552-3365. ; 49:6, s. 1441-1450 Tidskriftsartikel (refereegranskat)abstract Background: Various tests have been developed to evaluate athletes functional performance and for use as screening tools for injury prediction. Further validation of their accuracy to predict injury is needed. Purpose: To investigate the validity of predetermined cutoffs used to differentiate between high- and low-risk players in different functional performance tests to predict (1) anterior cruciate ligament (ACL) injury or (2) severe traumatic knee injury in a cohort of female soccer players with a primary unilateral ACL reconstruction and a cohort of knee-healthy players. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 117 active female soccer players (mean age +/- SD, 20 +/- 2 years) an average of 19 +/- 9 months after ACL reconstruction and 119 knee-healthy players (age, 19 +/- 3 years) were prospectively followed up for 2 years for new knee injuries. At baseline, all players underwent tests to assess postural control (Star Excursion Balance Test), hop performance (single-leg hop for distance, side hop), and movement asymmetries in the lower limbs and trunk (drop vertical jump [DVJ], tuck jump). The predictive validity of the test cutoffs to identify players who would sustain an ACL injury or a severe traumatic knee injury (absence from soccer play, >28 days) was assessed. The risk ratio (RR), area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated. Results: A total of 46 players (39%) with ACL reconstruction sustained 48 severe knee injuries, including 28 ACL ruptures. Of the knee-healthy players, 13 (11%) sustained 14 severe knee injuries, including 8 ACL ruptures. No association was found between the predetermined functional performance test cutoffs and the risk of a new ACL injury or severe knee injury in players with ACL reconstruction. In knee-healthy players, the only variable associated with future ACL injury was >= 6.5 cm knee valgus in the frontal plane (any knee) in the DVJ (RR, 4.93; 95% CI, 1.04-23.40; P = .045), but with only fair predictive validity (AUC, 0.7; sensitivity, 0.75; specificity, 0.65). Conclusion: In our cohorts of female soccer players, the validity of commonly used functional performance tests to predict new knee injuries was poor. Only knee valgus during the DVJ was associated with new ACL injuries in knee-healthy players, but with only fair predictive validity.
16.	Fältström, Anne, et al. (författare) Predictors for additional anterior cruciate ligament reconstruction : data from the Swedish national ACL register. 2016 Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 24:3, s. 885-894 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To identify predictors for additional anterior cruciate ligament (ACL) reconstruction.METHODS: Patients from the Swedish national ACL register who underwent ACL reconstruction between January 2005 and February 2013 (follow-up duration 6-104 months) were included. Cox regression analyses included the following independent variables regarding primary injury: age, sex, time between injury and primary ACL reconstruction, activity at primary injury, concomitant injuries, injury side, graft type, and pre-surgery KOOS and EQ-5D scores.RESULTS: Among ACL reconstruction procedures, 93 % involved hamstring tendon (HT) autografts. Graft type did not predict additional ACL reconstruction. Final regression models only included patients with HT autograft (n = 20,824). Of these, 702 had revision and 591 contralateral ACL reconstructions. The 5-year post-operative rates of revision and contralateral ACL reconstruction were 4.3 and 3.8 %, respectively. Significant predictors for additional ACL reconstruction were age (fourfold increased rate for <16-year-old patients vs. >35-year-old patients), time between injury and primary surgery (two to threefold increased rate for ACL reconstruction within 0-90 days vs. >365 days), and playing football at primary injury.CONCLUSION: This study identified younger age, having ACL reconstruction early after the primary injury, and incurring the primary injury while playing football as the main predictors for revision and contralateral ACL reconstruction. This suggests that the rate of additional ACL reconstruction is increased in a selected group of young patients aiming to return to strenuous sports after primary surgery and should be taken into consideration when discussing primary ACL reconstruction, return to sports, and during post-surgery rehabilitation. LEVEL OF EVIDENCE: II.
17.	Fältström, Anne, et al. (författare) Risk Factors for Sustaining a Second ACL Injury after Primary ACL Reconstruction in Female Football Players: A Study Investigating the Effects of Follow-Up Time and the Statistical Approach 2023 Ingår i: SPORTS MEDICINE-OPEN. - : SPRINGER. - 2199-1170. ; 9:1 Tidskriftsartikel (refereegranskat)abstract BackgroundStudies evaluating risk factors for sustaining an anterior cruciate ligament (ACL) injury have different, sometimes contrasting, results. Different follow-up times and statistical approaches may be a reason for these differences. The aim of this study was to explore if different follow-up times and statistical approaches, classification and regression tree (CART) analysis and Cox regression, would impact on the association between various candidate risk factors and ACL injury in female football players. In total, 112 active female football players, 18 +/- 8 months after ACL reconstruction (mean age +/- SD, 20 +/- 2 years), were included and followed for at least 36 months. At baseline, all players underwent assessment of range of motion of knee and ankle joints, functional tests, and answered questionnaires regarding knee function, psychological and personality traits. Nineteen independent variables were included for the CART analysis and for univariable Cox regression and compared using four different follow-up times: 0-12, 0-24, 0-36, and 0->36 months.ResultsForty-three (38%) players sustained a second ACL injury. The identified risk factors varied depending on follow-up time both with CART analysis and with Cox regression. CART identified 12 of the 19 independent variables and selected between 5 and 6 of the variables in the four different follow-up times associated with second ACL injury. The accuracy of the different follow-up times for the CART varied between 86 and 93% with 77-96% sensitivity and 70-81% specificity. Cox regression identified two risk factors: knee extension at 0-36 months and 0->36 months, and time between primary injury and surgery at 0->36 months. The accuracy varied between 54 and 64% with 44-88% sensitivity and 32-71% specificity.ConclusionsThe identified risk factors associated with a second ACL injury varied depending on the follow-up time and statistical approach used. Thus, in future research on risk factors, the time athletes are followed up and the type of statistical methods used are important to discuss.
18.	Fältström, Anne, et al. (författare) Self-reported knee function and activity level are reduced after primary or additional anterior cruciate ligament injury in female football players: a five-year follow-up study 2023 Ingår i: Revista Brasileira de Fisioterapia. - : ASSOCIACAO BRASILEIRA PESQUISA POS-GRADUACAO FISIOTERAPIA-ABRAPG-FT. - 1413-3555 .- 1809-9246. ; 27:6 Tidskriftsartikel (refereegranskat)abstract Background: Playing football involves a high risk of anterior cruciate ligament (ACL) injuries and these may affect knee function and activity level. Objectives: To measure changes in self-reported knee function, activity level, and satisfaction with knee function and activity level in female football players with or without an ACL-recon-structed knee. Methods: Female football players, age 19.9 (SD 2.6) years, with either a primary ACL-recon-struction 1.6 (SD 0.7) years after ACL-reconstruction (n = 186) or no ACL injury (n = 113) were fol-lowed prospectively for five years. Self-reported data collected at baseline and follow-up included knee function (International Knee Documentation Committee Subjective Knee Form [IKDC-SKF]), activity level (Tegner Activity Scale), and satisfaction with knee function (Likert scale 1=happy; 7=unhappy) and activity level (1-10 scale). Information on any new ACL injury during the follow-up period was collected. Results: Players with ACL-reconstruction at baseline who either did (n = 56) or did not (n = 130) sustain an additional ACL injury, and players with no injury at baseline who remained injury free (n = 101) had a lower Tegner score at follow-up. Players with additional ACL injury had lower IKDC-SKF score (mean difference:-11.4, 95% CI:-16.0,-6.7), and satisfaction with activity level (mean difference:-1.5, 95% CI:-2.3,-0.7) at follow-up. Players with no additional ACL injury had higher satisfaction with knee function (mean difference: 0.6, 95% CI: 0.3, 0.9) at fol-low-up. Players with no ACL injury had lower satisfaction with activity level (mean difference:-0.7, 95% CI:-1.1,-0.3) at follow-up. Players with additional ACL injury had larger decreases in all variables measured compared to the two other groups. Conclusion: Primary, and even more so additional, ACL injuries decreased self-reported knee function, activity level, and satisfaction with knee function and activity level in female football players. (c) 2023 The Author(s). Published by Elsevier Espana, S.L.U. on behalf of Associacao Brasileira de Pesquisa e Pos-Graduacao em Fisioterapia. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
19.	Fältström, Anne, et al. (författare) The side hop test: Validity, reliability, and quality aspects in relation to sex, age and anterior cruciate ligament reconstruction, in soccer players 2023 Ingår i: Physical Therapy in Sport. - : CHURCHILL LIVINGSTONE. - 1466-853X .- 1873-1600. ; 62, s. 39-45 Tidskriftsartikel (refereegranskat)abstract Objective: To study the side hop test regarding validity, reliability, and quality in relation to sex, age and ACL-reconstruction in soccer players.Design: Cohort study. Participants: 117 females with a primary ACL-reconstruction, and 119 females, 46 males (age 16-26 years), 49 girls and 66 boys (age 13-16 years) without injury.Main outcome measures: For convergent validity, one physiotherapist analysed side hops live and later on video. One physiotherapist and two physiotherapy students analysed side hops from 92 players for interrater reliability (video). For intrarater reliability, side hops from 35 players were analysed twice (video). Quality aspects (flaws), i.e. number of times the hopping limb touched the strips, the nonhopping limb touched the floor, and double hops/foot turns with the hopping limb, were registered (video).Results: Convergent validity was excellent; the intraclass correlation coefficient (ICC) was 0.93-1.0. All reliability measures were excellent (ICC 0.92-1.0). Adult male players had fewest and girls had most flaws, especially double hops/foot turns with the hopping limb, compared with all other players (mean, 11-12 vs 1-6, h2 = 0.18, large effect size). No differences were reported between knee-healthy and ACLreconstructed females.Conclusion: The side hop test is valid and reliable. Quality aspects differ between sexes and ages.& COPY; 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
20.	Gustafsson, Kristin, 1976-, et al. (författare) Written instructions versus physiotherapist-supervised rehabilitation after acute ankle sprain 2017 Ingår i: European Journal of Physiotherapy. - : Taylor & Francis Group. - 2167-9169 .- 2167-9177. ; 19:2, s. 76-83 Tidskriftsartikel (refereegranskat)abstract The aim of this study was to compare the effects of written instructions (WIs) versus physiotherapist-supervised rehabilitation on patient-rated ankle function, satisfaction and physical activity ability after an acute ankle sprain. Thirty-nine patients with an acute ankle sprain, recruited from an emergency department, received WIs on functional rehabilitation (WI group). The patients were evaluated six weeks and three months after their injury with the disease-specific Foot and Ankle Outcome Score (FAOS). The patients also rated how satisfied they were with their ankle and physical activity ability using visual analogue scales. The results from the WI group were compared with a group of patients (n ¼ 33) who received physiotherapist-supervised rehabilitation in a previous study (PT group). We found that compared with the PT group, the WI group had significantly worse scores in all of the FAOS subscales six weeks after the injury, and in three of five subscales three months after the injury. They also rated significantly lower satisfaction and significantly lower physical activity ability at both follow-ups. In conclusion, physiotherapist-supervised rehabilitation was more effective than WIs on improving patient-rated ankle function, satisfaction and physical activity ability after an acute ankle sprain.
21.	Hultman, Kristin, 1976-, et al. (författare) The effect of early physiotherapy after an acute ankle sprain 2010 Ingår i: Advances in Physiotherapy. - : Taylor & Francis. - 1403-8196 .- 1651-1948. ; 12:2, s. 65-73 Tidskriftsartikel (refereegranskat)abstract Ankle sprain is one of the most common injuries treated in emergency departments (ED). In clinical practice, these injuries are expected to heal by themselves, often without any treatment other than short information about the RICE regime (rest, ice, compression and elevation). Still, remaining symptoms are reported to occur in 30% of the cases. The aim of this study was to evaluate the effect of early physiotherapy intervention after an acute ankle sprain. Sixty-five patients were recruited from the ED at a general hospital in Sweden (mean age 35 years; 30 women), and allocated into an intervention group with early physiotherapy or a control group. Both groups were evaluated 6 weeks and 3 months after their injury. As primary outcome, the disease-specific Foot and Ankle Outcome Score (FAOS) was used. The patients also rated their physical activity ability and how satisfied they were with their ankle on a visual analogue scale (VAS). The intervention group made significant improvements compared with the control group at both evaluations measured with FAOS and the VAS questions. These findings indicate that early physiotherapy intervention has a positive effect on patient-focused foot and ankle function after an acute ankle sprain. © 2010 Informa UK Ltd.
22.	Häger, Charlotte, Professor, 1962-, et al. (författare) Svenskt nationellt nätverk för forskning om främre korsbandsskador 2023 Ingår i: Idrottsmedicin. - Järna : Svensk förening för fysisk aktivitet och idrottsmedicin. - 1103-7652. ; :4, s. 36-43 Tidskriftsartikel (populärvet., debatt m.m.)abstract Det har nyligen bildats ett svenskt nationellt och tvärprofessionellt nätverk för forskningom främre korsbandsskada med fokus på hur och varför man får skadan, vilkakonsekvenserna blir och hur personer med främre korsbandsskada ska behandlas. Enmålsättning är att diskutera och nå en gemensam syn i Sverige om viktiga nyckelfrågorsom exempelvis hur man med bästa evidens dels bör utvärdera funktion efter skada påett tillförlitligt och adekvat sätt och vilka tester som ska användas både i forskning ochklinik, samt vilka rekommendationer som ska ges för behandling/träning. Vi ger här enövergripande presentation av nätverket och dess verksamhet och vilken betydelse detkan ha.
23.	Koca, Firathan, et al. (författare) Comparison of Knee Function and Activity Level Between Bilateral and Unilateral ACL Reconstruction : A Matched-Group Analysis With Minimum 5-Year Follow-up 2022 Ingår i: The Orthopaedic Journal of Sports Medicine. - : Sage Publications Inc. - 2325-9671. ; 10:4 Tidskriftsartikel (refereegranskat)abstract Background: There is a lack of knowledge regarding knee function and activity level after bilateral anterior cruciate ligament reconstruction (ACLR) at midterm follow-up. Purpose: To compare activity level, patient-reported knee function, and quality of life in patients with bilateral ACLR and matched controls with unilateral ACLR at a minimum 5-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with bilateral ACLR who were aged <= 40 years and had a second ACLR performed between 2010 and 2015 were identified in the authors local database. Surgical data and preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) were extracted. The patients were sent a letter with questionnaires including the KOOS, EuroQol 5-Dimensions (EQ-5D), and EuroQol visual analog scale (EQ-VAS) and were asked study-specific questions by telephone regarding activity level and knee function at a minimum 5-year follow-up. For every patient with bilateral ACLR, a control matched for age +/- 2 years, sex, year ACLR was performed, and preinjury activity level or sport at the time of injury were identified in the database. Results: A total of 98 patients (mean age +/- SD, 33.3 +/- 7.3 years) with bilateral ACLR and 98 patients with unilateral ACLR (mean age +/- SD, 33.1 +/- 7.7 years) were included. The mean postoperative follow-up was 7.6 +/- 1.8 years (from the second ACLR) for patients with bilateral ACLR and 7.8 +/- 1.7 years for patients with unilateral ACLR. Patients with bilateral ACLR reported lower scores on all KOOS subscales, the EQ-5D, and the EQ-VAS at follow-up (P < .05). There was no difference in activity level between the groups at follow-up, but patients with bilateral ACLR were less satisfied with their activity level and knee function (P < .05). Conclusion: Patient-reported knee function and health-related quality of life were inferior in patients with bilateral ACLR compared with patients with unilateral ACLR. Patients with bilateral ACLR cannot expect the same knee function and quality of life as patients with unilateral ACLR.
24.	Koca, Firathan, et al. (författare) Poorer patient-reported knee function and quality of life, but not activity level, after revision ACL reconstruction compared with primary ACL reconstruction : a matched-pair analysis with a minimum 5-year follow-up. 2023 Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central (BMC). - 1471-2474. ; 24:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: An appropriate method for comparing knee function and activity level between patients with primary and revision anterior cruciate ligament reconstruction (ACLR) is to perform a matched-group analysis. The aim was to assess and compare knee function, knee-related quality of life and activity level between patients with revision ACLR and primary ACLR at a minimum of 5 years of follow-up.METHODS: Patients aged ≤ 40 years old who underwent revision ACLR between 2010 and 2015 and a matched control group (primary ACLR) (1:1) with age ± 2 years, year of ACLR, sex, and pre-injury sport and Tegner Activity Scale (TAS) were retrospectively identified in our clinic database. The preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) and surgical data were extracted and analyzed. Patients were mailed KOOS and EQ-5D questionnaires at a minimum of 5-years after revision ACLR. Study-specific questions about knee function, limitation in sport, satisfaction, and activity level according to the TAS (all scales of 1-10, 10 best) were also asked by telephone.RESULTS: Seventy-eight patients with a revision ACLR (mean age ± SD, 29.9 ± 6.0 years) matched with seventy-eight patients with a primary ACLR (30.2 ± 5.8 years) were included. The follow-up for the revision ACLR group was 7.0 ± 1.5 years and for the primary ACLR group 7.7 ± 1.6 years. The revision ACLR group reported poorer KOOS scores in all subscales (p < 0.05) except the Symptoms subscale, poorer EQ-5D VAS (mean 79.2 ± 20.1 vs 86.0 ± 20.1, p = 0.012), and less satisfaction with current knee function (median 7 (6-8) vs 8 (7-9), p < 0.001). Patients with revision ACLR also experienced greater limitation in sports (median 7 (4-8) vs 8 (6-9), p < 0.001). There were no significant differences in the EQ-5D (mean 0.86 ± 0.17 vs 0.89 ± 0.11, p = 0.427), activity level (median 2 (2-5) vs 4 (2-7), p = 0.229), or satisfaction with activity level (median 8 (5-9) vs 8 (6-10), p = 0.281) between the groups.CONCLUSIONS: At a minimum 5-year follow-up, the revision ACLR group reported poorer knee function and quality of life, less satisfaction with knee function and a greater limitation in sports but no differences in activity level and satisfaction with activity level compared with the primary ACLR group.
25.	Sonesson, Sofi, 1977-, et al. (författare) Neuromuscular control and hop performance in youth and adult male and female football players 2022 Ingår i: Physical Therapy in Sport. - : Churchill Livingstone. - 1466-853X .- 1873-1600. ; 55, s. 189-195 Tidskriftsartikel (refereegranskat)abstract Objectives: To compare neuromuscular control and hop performance between youth and adult male and female football players. Design: Cross-sectional study. Participants: 119 youth players (13-16 years; 68 males) and 88 adult players (17-26 years; 44 males). Main outcome measures: Neuromuscular control assessed with drop vertical jump (DVJ) and tuck jump assessment (TJA). Hop performance assessed with single-leg hop for distance and side hop. Results: Adult females had smaller normalized knee separation distances (NKSD) during DVJ at initial contact (77.9 +/- 18.5 vs. 86.1 +/- 11.0, p = 0.010) and at maximum knee flexion (59.7 +/- 23.4 vs.74.1 +/- 18.1, p = 0.001) compared to youth females. TJA revealed more technique errors in youths compared to adults (males 10 (8-11) vs. 8 (7-10); females 11 (9-12) vs. 9 (8-11), p < 0.05). Youths demonstrated inferior hop performance (males single-leg hop 142 +/- 18 vs. 163 +/- 17, side hop 41 +/- 12 vs. 52 +/- 12, p < 0.001; females side hop 32 +/- 10 vs. 38 +/- 14, p < 0.05). Conclusions: Youth players demonstrated reduced neuromuscular control during TJA and inferior hop performance compared to adult players. Adult female players demonstrated greater knee valgus during DVJ compared to youth female players.
26.	Tigerstrand Grevnerts, Hanna, 1981-, et al. (författare) Activity demands and instability are the most important factors for recommending to treat ACL injuries with reconstruction 2018 Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : SPRINGER. - 0942-2056 .- 1433-7347. ; 26:8, s. 2401-2409 Tidskriftsartikel (refereegranskat)abstract The purpose of the study was to (1) study and compare the factors that Swedish orthopaedic surgeons and physical therapists consider important for recommending ACL reconstruction and, (2) to assess how orthopaedic surgeons and physical therapists consider their own and each others, as well as patients, roles are in the treatment decision. A web-based survey assessing the relevance of 21 predetermined factors, in the choice to recommend ACL reconstruction, was sent to orthopaedic surgeons and physical therapists. Respondents were also asked to rate the importance of the assessment made by themselves, the other clinician (physical therapists rated the importance of surgeons, surgeons rated the importance of physical therapists), and the patients preferences. Orthopaedic surgeons agreed of eight, and physical therapists of seven factors as important in the choice to recommend ACL reconstruction. The factors both groups reported as important were; "patients wishes to return to contact/pivoting sports", "instability in physical activity", "instability in activities of daily living despite adequate rehabilitation", "physically demanding occupation", and "young age". Both professions rated their own and each others assessments as well as patients wishes as important for the decision to recommend ACL reconstruction. Orthopaedic surgeons and physical therapists agree about factors that are important for their decision to recommend ACL reconstruction, showing that both professions share a common ground in perceptions of factors that are important in recommending ACL reconstruction. Diagnostic study: Level III.
27.	Tigerstrand Grevnerts, Hanna, et al. (författare) PATIENTS FOCUS ON PERFORMANCE OF PHYSICAL ACTIVITY, KNEE STABILITY AND ADVICE FROM CLINICIANS WHEN MAKING DECISIONS CONCERNING THE TREATMENT OF THEIR ANTERIOR CRUCIATE LIGAMENT INJURY 2020 Ingår i: INTERNATIONAL JOURNAL OF SPORTS PHYSICAL THERAPY. - : AMER PHYSICAL THERAPY ASSOC. - 2159-2896. ; 15:3, s. 441-450 Tidskriftsartikel (refereegranskat)abstract Background: When deciding medical treatment, patients perspectives are important. There is limited knowledge about patients views when choosing non-operative treatment or anterior cruciate ligament (ACL) reconstruction (ACLR) after ACL injury. Purpose: To describe reasons that influenced patients decisions for non-operative treatment or ACLR after ACL injury. Study Design: Cross-sectional study. Methods: This study recruited a total of 223 patients (50% men), aged 28 +/- 8 years who had sustained ACL injury, either unilateral or bilateral. Subjects were, at different time points after injury, asked to fill out a questionnaire about their choice of treatment, where an ACLR treatment decision was made, some responded before and some after the ACLR treatment. A rating of the strength of 10 predetermined reasons in their choice of treatment graded as 0 (no reason) to 3 (very strong reason), was done. Results: Patients with unilateral ACL injury treated with ACLR (110 patients) rated "inability to perform physical activity at the same level as before the injury due to impaired knee function" (96%), "fear of increased symptoms during activity" (87%) and "giving way episodes" (83%) as strong or very strong reasons in their treatment decision. Patients with bilateral ACL injury treated with ACLR (109 knees) rated similar reasons as patients with unilateral ACLR and also "low confidence in the ability to perform at the preinjury activity level without ACLR" (80%) as strong or very strong reasons. Patients with unilateral ACL injury treated non-operatively (96 patients) rated "advice from clinician" (69%) as a strong or very strong reason. Patients with bilateral ACL injury treated non-operatively (25 knees) rated "absence of giving way episodes" (62%), and "no feeling of instability" (62%) as strong or very strong reasons. Conclusion: Inability to perform physical activity, fear of increased symptoms, and giving way episodes were reasons that patients with ACL injury considered when making decisions about ACLR. When choosing non-operative treatment, patients considered the absence of instability or giving way symptoms, being able to perform physical activity, and advice from clinicians.

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