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  • 1.
    Alexandersson, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Nyköping Hosp, Dept Orthoped, Nyköping, Sweden.
    Wang, Eugen Yu-Hui
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Eriksson, Staffan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Fysioterapi. Umeå Univ, Dept Community Med & Rehabil, Physiotherapy, Umeå, Sweden.
    A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study2019Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, nr 4, s. 1035-1042Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: When a tourniquet is used during surgery on the extremities, the pressure applied to the muscles, nerves and blood vessels can cause neuromuscular damage that contributes to postoperative weakness. The hypothesis was that the rehabilitation-related results would be improved if total knee arthroplasty (TKA) is performed without the use of a tourniquet.

    Methods: 81 patients with osteoarthritis of the knee who underwent TKA surgery were randomized to surgery with or without tourniquet. Active flexion and extension of the knee, pain by visual analog scale (VAS), swelling by knee circumference, quadriceps function by straight leg raise, and timed up and go (TUG) test results were measured before and up to 3 months after surgery.

    Results: ANCOVA revealed no between-groups effect for flexion of the knee at day 3 postsurgery. Compared with the tourniquet group, the nontourniquet group experienced elevated pain at 24 h, with a mean difference of 16.6 mm, p = 0.005. The effect on mobility (TUG test) at 3 months was better in the nontourniquet group, with a mean difference of -1.1 s, p = 0.029.

    Conclusions: The hypothesis that the rehabilitation-related results would be improved without a tourniquet is not supported by the results. When the results in this study for surgery performed with and without tourniquet are compared, no clear benefit for either procedure was observed, as the more pain exhibited by the nontourniquet group was only evident for a short period and the improved mobility in this group was not at a clinically relevant level.

  • 2.
    Alim, Md Abdul
    et al.
    Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Domeij-Arverud, Erica
    Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Gunnar
    Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Edman, Gunnar
    Department of Psychiatry, Tiohundra AB, Norrtälje, Sweden.
    Ackermann, Paul W
    Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Achilles tendon rupture healing is enhanced by intermittent pneumatic compression upregulating collagen type I synthesis2018Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, nr 7, s. 2021-2029Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE AND HYPOTHESIS: Adjuvant intermittent pneumatic compression (IPC) during leg immobilization following Achilles tendon rupture (ATR) has been shown to reduce the risk of deep venous thrombosis. The purpose of this study was to investigate whether IPC can also promote tendon healing.

    METHODS: One hundred and fifty patients with surgical repair of acute ATR were post-operatively leg immobilized and prospectively randomized. Patients were allocated for 2 weeks of either adjuvant IPC treatment (n = 74) or treatment-as-usual (n = 74) in a plaster cast without IPC. The IPC group received 6 h daily bilateral calf IPC applied under an orthosis on the injured side. At 2 weeks post-operatively, tendon healing was assessed using microdialysis followed by enzymatic quantification of tendon callus production, procollagen type I (PINP) and type III (PIIINP) N-terminal propeptide, and total protein content. 14 IPC and 19 cast patients (control group) consented to undergo microdialysis. During weeks 3-6, all subjects were leg-immobilized in an orthosis without IPC. At 3 and 12 months, patient-reported outcome was assessed using reliable questionnaires (ATRS and EQ-5D). At 12 months, functional outcome was measured using the validated heel-rise test.

    RESULTS: At 2 weeks post-rupture, the IPC-treated patients exhibited 69% higher levels of PINP in the ruptured Achilles tendon (AT) compared to the control group (p = 0.001). Interestingly, the IPC-treated contralateral, intact AT also demonstrated 49% higher concentrations of PINP compared to the non-treated intact AT of the plaster cast group (p = 0.002). There were no adverse events observed associated with IPC. At 3 and 12 months, no significant (n.s.) differences between the two treatments were observed using patient-reported and functional outcome measures.

    CONCLUSIONS: Adjuvant IPC during limb immobilization in patients with ATR seems to effectively enhance the early healing response by upregulation of collagen type I synthesis, without any adverse effects. Whether prolonged IPC application during the whole immobilization period can also lead to improved long-term clinical healing response should be further investigated. The healing process during leg immobilization in patients with Achilles tendon rupture can be improved through adjuvant IPC therapy, which additionally prevents deep venous thrombosis.

    LEVEL OF EVIDENCE: Randomized controlled trial, Level I.

  • 3. Baranto, Adad
    et al.
    Hellström, Mikael
    Cederlund, C-G.
    Nyman, Rickard
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi.
    Swärd, Leif
    Back pain and MRI changes in the thoraco-lumbar spine of top athletes in four different sports: a 15-year follow-up study2009Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 17, nr 9, s. 1125-1134Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A total 71 male athletes (weight lifters, wrestlers, orienteers, and ice-hockey players) and 21 non-athletes were randomly selected, for a baseline MRI study. After 15 years all the participants at baseline were invited to take part in a follow-up examination, including a questionnaire on back pain and a follow-up MRI examination. Thirty-two athletes and all non-athletes had disc height reduction at one or several disc levels. Disc degeneration was found in more than 90% of the athletes and deterioration had occurred in 88% of the athletes, with the highest frequency in weight lifters and ice-hockey players. 78% of the athletes and 38% of the non-athletes reported previous or present history of back pain at baseline and 71 and 75%, respectively at follow-up. There was no statistically significant correlation between back pain and MRI changes. In conclusion, athletes in sports with severe or moderate demands on the back run a high risk of developing disc degeneration and other abnormalities of the spine on MRI and they report high frequency of back pain. The study confirmed our hypothesis, i.e. that most of the spinal abnormalities in athletes seem to occur during the growth spurt, since the majority of the abnormalities demonstrated at follow-up MRI after the sports career were present already at baseline. The abnormalities found at young age deteriorated to a varying degree during the 15-year follow-up, probably due to a combination of continued high load sporting activities and normal ageing. Preventive measures should be considered to avoid the development of these injuries in young athletes.

  • 4. Baranto, Adad
    et al.
    Hellström, Mikael
    Nyman, Rickard
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi.
    Lundin, Olof
    Swärd, Leif
    Back pain and degenerative abnormalities in the spine of young elite divers: a 5-year follow-up magnetic resonance imaging study2006Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 14, nr 9, s. 907-914Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Several studies have been published on disc degeneration among young athletes in sports with great demands on the back, but few on competitive divers; however, there are no long-term follow-up studies. Twenty elite divers between 10 and 21 years of age, with the highest possible national ranking, were selected at random without knowledge of previous or present back injuries or symptoms for an MRI study of the thoraco-lumbar spine in a 5-year longitudinal study. The occurrence of MRI abnormalities and their correlation with back pain were evaluated. Eighty-nine percent of the divers had a history of back pain and the median age at the first episode of back pain was 15 years. Sixty-five percent of the divers had MRI abnormalities in the thoraco-lumbar spine already at baseline. Only one diver without abnormalities at baseline had developed abnormalities at follow-up. Deterioration of any type of abnormality was found in 9 of 17 (53%) divers. Including all disc levels in all divers, the total number of abnormalities increased by 29% at follow-up, as compared to baseline. The most common abnormalities were reduced disc signal, Schmorl's nodes, and disc height reduction. Since almost all divers had previous or present back pain, a differentiated analysis of the relationship between pain and MRI findings was not possible. However, the high frequency of both back pain and MRI changes suggests a causal relationship. In conclusion, elite divers had high frequency of back pain at young ages and they run a high risk of developing degenerative abnormalities of the thoraco-lumbar spine, probably due to injuries to the spine during the growth spurt.

  • 5. Hovelius, Lennart
    et al.
    Rahme, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Primary anterior dislocation of the shoulder: long-term prognosis at the age of 40 years or younger.2016Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, nr 2, s. 330-42Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: We describe the long-term prognosis in 257 first-time anterior shoulder dislocations (255 patients, aged 12-40 years) registered at 27 Swedish emergency units between 1978 and 1979.

    METHODS: Half the shoulders were immobilised for 3-4 weeks after repositioning. Follow-ups were performed after two (questionnaire), five (questionnaire), 10 (questionnaire and radiology) and 25 (questionnaire and radiology) years in 227 patients (229 shoulders). Twenty-eight patients died during the 25 years of observation.

    RESULTS: Early movement or immobilisation after the primary dislocation resulted in the same long-term prognosis. Recurrences increased up to 10 years of follow-up, but, after 25 years, 29 % of the shoulders with ≥2 recurrences appeared to have stabilised over time. Arthropathy increased from 9 % moderate to severe and 11 % mild at 10 years, to 34 % moderate to severe and 27 % mild after 25 years. Alcoholics had a poorer prognosis with respect to dislocation arthropathy (P < 0.001). Age <25 years and/or bilateral instability represent a poorer prognosis, where stabilising surgery is necessary in every second shoulder. Fracture of the greater tuberosity means a good prognosis, and we have found no evidence that athletic activity, gender, a Hill-Sachs lesion and minor rim fractures had any prognostic impact. During the 25 years in which these patients were followed, 28/255 died (11 %), representing a mortality rate (SMR) that was more than double that of the general Swedish population (P < 0.001).

    CONCLUSION: Almost half of all first-time dislocations at the age of <25 years will have stabilising surgery and two-thirds will develop different stages of arthropathy within 25 years.

  • 6.
    Rahme, Hans
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Vikerfors, Ola
    Ludvigsson, Lena
    Elvèn, Maria
    Michaëlsson, Karl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Loss of external rotation after open Bankart repair: an important prognostic factor for patient satisfaction2010Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 18, nr 3, s. 404-408Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The repair of the capsuloligamentous complex during shoulder stabilisation procedures can be followed by a persistent restricted capacity of external rotation. The prognostic importance of this loss in external rotation for patient satisfaction has not previously been evaluated. We therefore followed 68 consecutive patients operated for recurrent traumatic unidirectional anterior instability of the glenohumeral joint to assess the association between loss of external rotation and patient satisfaction. All patients underwent open Bankart repair. Two independent observers carried out a follow-up (5 years on average) after surgery. At follow-up, recurrent dislocation had developed in four of the 68 patients (6%). The median pre-operative Rowe score was 65 (range 42-87), which can be compared with 92 (range 46-100) at the follow-up. Three patients rated their outcome as poor, 13 as fair, 23 as good and 29 as excellent. There was a five-fold increased risk for a poor or fair outcome among patients with loss of external rotation in 0 degrees of abduction (age- and gender-adjusted odds ratio [OR] 5.3; 95% confidence interval [CI] 1.3-22.0, P = 0.0007). A linear association between the degree of loss in external rotation and patient dissatisfaction was found. The risk of being dissatisfied, independent of recurrent dislocation, occasional pain, positive apprehension test, age and gender, more than doubled (OR 2.6; 95% CI 1.4-4.8, P = 0.002) for every 10 degrees of post-operative loss of external rotation. Loss of external rotation almost explained all of the variation in patient satisfaction with a population attributable risk of 0.85 (95% CI 0.20-0.94). We conclude that open Bankart repair with a modified Rowe procedure is an excellent surgical option regarding stability, but restriction in external rotation reduces the likelihood of a satisfied patient.

  • 7.
    Robinson, Yohan
    et al.
    Department of Orthopaedic and Trauma Surgery, Klinik fu¨ r Unfall- und Wiederherstellungschirurgie, Charite´—Campus Benjamin Franklin, Berlin.
    Reinke, Marcus
    Heyde, Christoph E
    Ertel, Wolfgang
    Oberholzer, Andreas
    Traumatic proximal tibiofibular joint dislocation treated by open reduction and temporary fixation: a case report2007Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 15, nr 2, s. 199-201Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Isolated dislocations of the proximal tibiofibular joint are a rare condition. Missed diagnosis can lead to chronic knee pain and disability. Early recognition should be followed by immediate closed reduction or open reduction and joint transfixation. We present a young athlete with this injury which was treated successfully by open reduction.

  • 8.
    Sonesson, Sofi
    et al.
    Linkoping Univ, Div Physiotherapy, S-58183 Linkoping, Sweden.
    Kvist, Joanna
    Linkoping Univ, Div Physiotherapy, S-58183 Linkoping, Sweden.
    Ardern, Clare
    Linkoping Univ, Div Physiotherapy, S-58183 Linkoping, Sweden.; La Trobe Univ, Sch Allied Hlth, Fac Hlth Sci, Melbourne, Vic, Australia.; Aspetar Orthopaed & Sports Med Hosp, Doha, Qatar.
    Österberg, Annika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Div Physiotherapy, S-58183 Linkoping, Sweden.
    Silbernagel, Karin Grävare
    Univ Delaware, Dept Phys Therapy, Newark, DE USA.
    Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy.2017Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 25, nr 5, s. 1375-1384Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: To describe individuals' expectations, motivation, and satisfaction before, during, and after rehabilitation for ACL reconstruction and to explore how these factors were associated with return to pre-injury sport activity at 1-year follow-up.

    METHODS: Sixty-five individuals (34 males), median age 22 (15-45) years, scheduled for ACL reconstruction participated. Participants completed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and questions about expectations, satisfaction, and motivation pre-operatively and at 16 and 52 weeks after surgery.

    RESULTS: Prior to surgery, 86 % of participants stated that their goal was to return to their pre-injury sport activity. Those who had returned to their pre-injury sport activity at 52 weeks were more motivated during rehabilitation to return to their pre-injury activity level, more satisfied with their activity level and knee function at 52 weeks, and scored significantly higher on the IKDC-SKF [median 92.0 (range 66.7-100.0)] at 52 weeks, compared to those who had not returned [median 77.6 (range 50.6-97.7)].

    CONCLUSION: Prior to ACL reconstruction, most participants expected to return to their pre-injury activity level. Higher motivation during rehabilitation was associated with returning to the pre-injury sport activity. The participants who had returned to their pre-injury sport activity were more satisfied with their activity level and knee function 1 year after the ACL reconstruction. Facilitating motivation might be important to support individuals in achieving their participation goals after ACL reconstruction.

    LEVEL OF EVIDENCE: Prospective cohort study, Level II.

  • 9.
    Wahlstedt, Charlotta
    et al.
    Uppsala Univ, S-75312 Uppsala, Sweden.;Taby Rehab Ctr, S-18379 Taby, Sweden..
    Rasmussen-Barr, Eva
    Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, S-14183 Huddinge, Sweden..
    Anterior cruciate ligament injury and ankle dorsiflexion2015Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 23, nr 11, s. 3202-3207Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim was to study whether the degree of ankle dorsiflexion differs between subjects with an anterior cruciate ligament (ACL) injury and uninjured controls. Another aim was to study ankle dorsiflexion between the injured and the uninjured leg and in addition between women and men with an ACL injury. Sixty subjects (ACL injury, n = 30 and controls, n = 30) were enroled consecutively at two physical therapy settings. Ankle dorsiflexion was measured with a goniometer in a standardized way in a weight-bearing lunge position. Repeated-measures ANOVA revealed a significant difference (p < 0.001) in ankle dorsiflexion between subjects with an ACL injury (mean 41.1A degrees SD 5.7) and those without (mean 46.6A degrees SD 5.3). No difference in ankle dorsiflexion was found between the injured leg and the uninjured or between women and men with ACL injury. The present findings suggest lower degree of ankle dorsiflexion in subjects with an ACL injury than in uninjured controls. A functional test measuring ankle dorsiflexion with a goniometer may be one way of identifying individuals at increased risk of ACL injury. Comparative study, Level II.

  • 10.
    Wintzell, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Haglund-Åkerlind, Y.
    Tengvar, M.
    Johansson, L.
    Eriksson, E.
    MRI examination of the glenohumeral joint after traumatic primary anterior dislocation: A descriptive evaluation of the acute lesion and at 6-month follow-up1996Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 4, nr 4, s. 232-6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Primary traumatic anterior dislocation of the shoulder in young patients has a high recurrency rate. There are varying opinions on the pathology behind the recurrences. The aim of this study was to describe the MRI characteristics of the acute lesion, and at 6-month follow-up. Thirty patients aged 18-30 years with primary traumatic anterior dislocation of the shoulder were randomized into two groups. One group was treated with acute arthroscopic lavage within 10 days. The control group was treated with traditional non-operative therapy. All patients underwent acute MRI within 10 days and before the arthroscopic lavage, and again at the 6-month follow-up, for evaluation of the lesions. The acute MRI verified Hill-Sachs lesions in all patients. At the 6-month follow-up MRI, there was no change in the size of the Hill-Sachs lesion. This was also the case with the six patients in the control group with recurrent dislocations during the first 6 months. Twenty-nine patients (97%) had joint effusion at the acute MRI, which was very useful for evaluation of the soft tissue pathology. The glenohumeral ligaments were detached in 20/30 patients (66%), and the labrum in 22/30 patients (70%). A capsulolabral detachment classified as a Baker 3 lesion was seen in 16/30 (53%) of the patients, including all six patients with recurrent dislocation. At the 6-month control only 3/30 (10%) of the patients had joint effusion for adequate evaluation of the labrum and ligamentous pathology. A Hill-Sachs lesion was found in 100% of the patients after primary dislocation, and recurrent dislocations did not change the size of the lesion. The study supports the opinion that this lesion is overlooked in the clinical situation. The joint effusion at the acute MRI was of utmost importance for evaluation of the soft tissue pathology. The 6-month MRI control was therefore considered inconclusive when evaluating capsulolabral lesions, due to lack of effusion. MRI arthrography with contrast administration would have been very helpful at the 6-month examination.

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