Session 6: Sports/Shoulder
Torsdag den 24. oktober
13:30 – 15:00
lokale: Reykjavik
Chairmen: Ilija Ban / Uffe Jørgensen
50. Failed Osteochondral Repair by MayoRegen® Scaffolds in Patients with Ostochondritis Dissecans
Christensen Bjørn Borsøe, Foldager Casper Bindzus, Eric Bünger Cody, Lind Martin
Ortopædisk forskningslaboratorium, Aarhus Universitetshospital; Idrætssektoren, ortopædkirurgisk afdeling, Aarhus Universitetshospital
Background: Osteochondral injuries are very difficult to
treat and existing treatment options are often
expensive and relatively ineffective.
Purpose / Aim of Study: To evaluate the osteochodral repair in
patients treated with a nano-composite multi-
layered biomaterial consisting of collagen
type I and hydroxyapatite (MaioRegen®).
Materials and Methods: Ten patients with osteochondritis dissecans
(OCD) in the knee (n=6) or on the talus
(n=4) were treated with the MaioRegen®
scaffold. The patients underwent CT and
MRI 1 year postoperatively and the bone
and cartilage formation was evaluated, the
latter using MOCART.
Findings / Results: One patient was excluded due to severe
swelling of the knee and implant removal 5
days postoperatively. Two additional
patients experienced swelling of the knee,
but were treated conservatively and
recovered.
MRI: One of nine patients had complete
filling of the osteochondral defect
(Hypertrophy n=3, incomplete repair n=5),
and complete integration with adjacent tissue
was seen in two of nine patients. In all nine
patients the surface of the repair tissue was
damaged and the tissue had a
heterogeneous structure. In all nine patients
the signal intensity of the repair tissue was
hyperintense compared to native cartilage.
The subchondral lamina and the
subchondral bone were not intact in any of
the cases.
CT: No patients had complete regeneration
of the bone. In five patients there was no
evidence of bone formation in the
defect.Two patients had between 25-50%
bone filling. CT two patients were not
available.
Conclusions: Treatment of OCD with MayoRegen®
resulted in incomplete cartilage repair and a
profound lack of bone formation. Three
patients experienced postoperative swelling,
which may be attributed to the implant. This
study illustrates the importance of thorough
clinical follow-up in patients treated with
novel devices.
51. 2 years follow-up after TruFit® implantation for full thickness cartilage defects in the knee.
Lars Konradsen, Michael R. Krogsgaard
Idrætskirurgisk sektion, Ortopædkirurgisk afdeling, Bispebjerg Hospital
Background:
Purpose / Aim of Study: To present our short-term experience
with an artificial osteochondral scaffold
plug for cartilage repair in the knee.
Materials and Methods: 22 patients treated over a 2 year
period. Median patient age 37.5 years
(range 24-49). 8 women. 20 medial
femoral condyle defects. Median
defect size 1 cm2 (range 0.6 to 3). All
defects previously debrided or
microfractured. 1 plug implanted in 13
cases, 2 in 7, 3 in 1, and 4 in 1 case.
KOOS and Tegner scores and
standard MRI pre-op, and 1 and 2
years post-op. CT scans 1 and 2 years
post-op.
Findings / Results: KOOS values:
Dimensions: Symptoms; Pain;
Function in daily living; Sport; Quality
of Life.
Pre-op: 62; 39; 43; 2; 11
1 year post-op: 73; 64; 66; 25; 30
2 years post-op: 79; 69; 79; 34; 34
Normals: 89; 88; 90; 78; 80
For comparison: Normals: age-
matched subjects without knee
problems.
Tegner: pre-op: median 2; 2 years post-
op: 3.
Between 1 and 2 years post-op: plugs
removed in 3 cases; MACI performed
in one of these cases.
CT scans after 1 year: Volume with no
evidence of trabecular bone occupied
115-120% of the primary plug volume.
At 2 years: median 80% of the primary
plug volume without evidence of
trabecular bone. MRI showed partial fill
of the cartilage defects after both 1 and
2 years.
Conclusions: KOOS scores improved but were far
from normal, and Tegner activity
scores remained low for this young
and previously active group. CT
showed evidence of early bone
resorption changing into very limited
bony tissue fill of the intraosseos part
of the plug. Substantial surface defects
were still present in the plug areas
after 2 years.
Artificial scaffold plugs were believed
to be a treatment option for medium
size full thickness femoral condyle
cartilage defects. However, after 2
years we found that the effect on
patient reported outcome was marginal.
52. Incidence and clinical presentation of groin injuries in sub-elite male soccer
Per Hölmich, Kristian Thorborg, Christian Dehlendorff, Kim Krogsgaard, Christian Gluud
Artroskopisk Center Amager, Amager-Hvidovre Hospital; Danish Cancer Society Research Center, Danish Cancer Society Research Center; Copenhagen Trial Unit, Centre for Clinical Intervention Research , Rigshospitalet; Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet
Background: Groin injuries are prevalent and often long-
standing in soccer.
Purpose / Aim of Study: The aim of the present study was to
describe the occurrence and clinical
presentation of groin injuries in a cohort of
sub-elite soccer players during a season.
Materials and Methods: Physiotherapists allocated to each of the
participating 44 soccer clubs recorded
baseline characteristics and groin injuries
sustained by a cohort of 998 sub-elite male
soccer players during a full 10-month
season. All players with groin injuries were
examined using the clinical entity approach,
which utilises standardised reproducible
examination techniques to identify the
injured anatomical structures. The
exposure time and the injury time were
recorded. Injury time was analysed using
multiple regression on the log of the injury
times as the data was highly skewed.
Effects are thus reported at relative injury
time (RIT).
Findings / Results: Adductor-related groin injury was the most
common entity found followed by iliopsoas-
related and abdominal-related injuries. The
dominant leg was significantly more often
injured. Age and previous groin injury were
significant risk factors for sustaining a groin
injury. Groin injuries were generally located
in the same side as previously reported
groin injuries. Adductor-related injuries with
no abdominal pain had significantly longer
injury times compared to injuries with no
adductor and no abdominal pain (RIT 2.28,
95% CI 1.22 to 4.25, P=0.0096). Having
both adductor and abdominal pain also
increased the injury time significantly
compared to injuries with no adductor and
no abdominal pain (RIT=4.56, 95% CI 1.91
to 10.91, P=0.001).
Conclusions: Adductor-related groin injury was the most
common clinical presentation of groin
injuries in male soccer players and cause
long injury time, especially when combined
with abdominal-related injury.
53. High injury incidence in adolescent female soccer: The influence of weekly soccer exposure and playing level
Mikkel Bek Clausen, Mette Zebis, Merete Møller, Per Hölmich, Niels Wedderkopp, Kristian Thornorg
Artroskopisk Center Amager, Copenhagen University Hospital; Gait Analysis Laboratory, Hvidovre University Hospital; Department of Public Health , Aarhus University; Ortopædkirurgisk afd. SLB, Inst. for Regional Sundhedsforskning
Background: In a health-perspective, soccer has
important benefits, such as reduced risk
of obesity and diabetes, but also
includes an inherent risk of injury.
Soccer is increasingly popular among
adolescent females. Previous studies
report varying injury-rates (2.4-5.3
injuries per 1.000 hours), using
traditional medical-staff or coach
reports, methods that significantly
underestimate injury-rates when compared
to self-report via text-messaging (SMS).
Purpose / Aim of Study: The aim of this study was to investigate
the injury-incidence and the association
between soccer-exposure, playing-level
and injury-risk, using self-report via SMS.
Materials and Methods: 499 girls aged 15-18 years reported
soccer-injuries and exposure weekly, by
answering standardised SMS questions,
followed by individual
injury-interviews, during a full soccer
season (February-June, 2012).
Generalized Estimating Equation with
Poisson-link was used to estimate
injury-rates and relative risks, as
players were clustered within teams. A
priori, soccer-exposure and
playing-level were chosen as independent
variables.
Findings / Results: A total of 424 soccer-injuries were
recorded. Total injury incidence was
15.3(13.1-17.8) and time-loss
injury-incidence was 9.7(8.2-11.4) per
1.000 hours of soccer-exposure. Higher
average weekly exposure in injury-free
weeks was associated with lower
injury-risk (p-value for trend<0.001),
and players with low exposure (≤1
hours/week) were up to 10 times more
likely to sustain a time-loss injury
compared to other players (p<0.01).
Playing-level was not associated with
the risk of time-loss injury (p>0.05).
Conclusions: The injury-incidence in adolescent
female soccer is high, and players with
low soccer-attendance have a
significantly increased injury-risk.
Future studies should investigate the
causal mechanism for this association.
54. Identification of the femoral attachment point for medial patellofemoral ligament (MPFL) reconstruction without the use of fluoroscopy -A cadaver study
Claus Ol Hansen, Mikkel Attrup, Per Hölmich
Artroskopisk Center Amager, Amager-Hvidovre Hospital
Background: Anatomically reconstruction of the MPFL
as suggested by Schöttle is a well
established technique. A free gracillis
graft is fixated on the proximal medial
boarder of the patella and tunnelled under
the second layer of the medial patello-
femoral soft tissue complex and fixated
at the anatomical femoral attachment
point for the native MPFL. A reproducible
anatomical and radiographic point for the
femoral attachment point has been
established in a cadaver study.
Incorrect femoral attachment can lead to
an unsuccessful result of the surgery.
The use of peroperative fluoroscopy to
identify the anatomical femoral
attachment point for the MPFL is not
routine in many centres.
Purpose / Aim of Study: Evaluation of the accuracy of identification of
the femoral MPFL insertion point without use
of fluoroscopy under standardized
conditions.
Materials and Methods: Twelve fresh frozen cadaver knees were
used in this study. Five experienced
surgeons in sports traumatology were
asked to dissect and mark the femoral
MPFL point with a nail according to the
description by Schöttle.
Fluoroscopic examination was done, in
the true lateral position. The 12 knees
with the nail markings were then
calibrated into a “standard knee size” by
means of a zooming tool, to correct for
differences in sizes of the individual
knees.
Findings / Results: Only 4 of the 12 MPFL markings were
placed within a distance from 5 mm. of the
anatomical MPFL point. Furthermore there
was a trend that the individual surgeons
placed their markings within a limited area -
even when suboptimal.
Conclusions: This study indicates that the ability to identify
the femoral MPFL attachment point without
use of fluoroscopy is low.
We recommend the use of peroperative
fluoroscopy for identification of the femoral
attachment point in MPFL reconstruction
surgery.
55. Increased medial foot-loading during drop jump and single leg squat in individuals with patellofemoral pain – a cross-sectional study
Michael Rathleff, Camilla Richter, Jesper Bencke, Thomas Bandholm, Per Hölmich, Kristian Thorborg
Orthopedic Surgery Research Unit, Aalborg Hospital; A-Physiotherapy, Solrød Strand; Gait Analysis Laboratory, Hvidovre Hospital; Physical Medicine and Rehabilitation Research (PMR-C), Orthopedic Department, Clinical Research Cent, Hvidovre Hospital; Arthroscopic Centre Amager, Orthopedic Departement, Hvidovre Hospital; Arthroscopic Centre Amager, Physical Medicine and Rehabilitation Research (PMR-C), Orthopedic Depart, Hvidovre Hospital
Background: Symptoms from patellofemoral pain (PFP)
occur during high load activities such as
jumping and squatting. The forces
imposed on the patellofemoral joint
during these activities are transmitted
from the foot and up to the
patellofemoral joint.This implies that the
pattern of foot loading is important for
the pathogenesis of PFP. No studies
have yet investigated loading of the foot
duringjumping and squatting in
individuals with PFP.
Purpose / Aim of Study: To compare medial-to-lateral plantar
forces during drop jump and single leg
squat in patients with PFP and healthy
controls.
Materials and Methods: 23 young adults with PFP were
compared to 20 age and gender
matched individuals without knee pain.
Foot loading (plantar pressure
distribution) was collected during drop
jump and single leg squat using pressure
sensitive Pedar insoles. Plantar pressure
data from the most pain-full side was
used in individuals with PFP, including an
identical proportion of right and left feet
among pain-free individuals. Primary
outcome was medial-to-lateral peak
force calculated as the peak force under
the medial forefoot in percent of the total
peak force under the entireforefoot
during drop jump. Mean forces under the
forefoot were analysed using the same
approach. Both measures were found to
have high test-retest reliability (Limits of
Agreement mean ± 15%).
Findings / Results: On average, individuals with PFP had a
22-32% higher medial-to-lateral peak
force during drop jump and single leg
squat, p<0.03, and 19-23% higher
medial-to-lateral mean force, during the
same activities, p<0.04.
Conclusions: Individuals with PFP have a more
medially directed foot loading compared
to healthy controls during high load
activities. This may influence the
distribution of forces transmitted
proximally to the knee, and be an
important factor in the development of
PFP.
56. Patient reported outcome, revision rate and reason for revision following resurfacing hemiarthroplasty in patients diagnosed with osteoarthritis: 837 operations reported to the Danish Shoulder Arthroplasty Registry.
Jeppe Rasmussen, Anne Polk, Sørensen Anne Kathrine , Stig Brorson, Bo S Olsen
Department of Orthopaedic Surgery, Herlev University Hospital
Background: Resurfacing hemiarthroplasties in the
shoulder for the treatment of
osteoarthritis is commonly used but
previous studies have not been able to
adequately describe revision rates and
reasons for revision.
Purpose / Aim of Study: The primary aim was to evaluate patient
reported outcome, revision rate and
reasons for revision following
resurfacing hemiarthroplasty in patients
diagnosed with osteoarthritis. The
secondary aims were to compare
arthroplasty designs and to evaluate age
as a possible risk factor.
Materials and Methods: We included all patients reported to the
Danish Shoulder Arthroplasty Registry
between 2006 and 2010 diagnosed with
osteoarthritis and treated with
resurfacing hemiarthroplasty. 837
arthroplasties in 772 patients were
eligible. Western Ontario Osteoarthritis
of the Shoulder index (WOOS) was
used to evaluate outcome 1 year
postoperatively. Revision rates were
calculated by checking reported
revisions to DSR until December 2011
and by checking deaths with the Danish
National Register of Persons.
Findings / Results: 82.2 % returned a complete
questionnaire. Mean WOOS was 67.4
range 0.0-100.0. Patients aged 55 years
or younger had a statistically and
clinically significant worse adjusted
WOOS compared to older patients (mean
difference 14.2 [8.8; 19.6 CI 95%],
P<0.001). There was no significant
difference in WOOS between
resurfacing hemiarthroplasty designs.
Sixty three (7.5 %) of the arthroplasties
were revised. The most common reason
for revision was glenoid attrition (n=18).
There were no differences in revision
rates or adjusted risk of revision with
regard to age or resurfacing
hemiarthroplasty design.
Conclusions: Resurfacing hemiarthroplasty for the
treatment of osteoarthritis of the
shoulder joint is, at the short term,
associated with a good patient reported
outcome but a relatively high revision
rate.
57. Implant survival after total elbow arthroplasty: A retrospective study of 324 procedures performed from 1980 to 2008
Hans Christian Plaschke, Theis Thillemann, Stig Brorson, Bo Olsen
Shoulder and Elbow Department, Herlev University Hospital; Orthopaedic Department, Horsen Hospital
Background: Total elbow arthroplasty (TEA) is an
established treatment for late stage arthritis
of the elbow. Recent literature advocates
TEA in comminute distal humeral fractures in
the elderly. However, information on implant
survival and risk factors for revision is
sparse.
Purpose / Aim of Study: The aim of this retrospective study was to
evaluate the survival and risk factors for
revision of TEAs inserted in eastern part of
Denmark in the period from 1980 till 2008.
Materials and Methods: The Danish National Patient Registry, (NPR)
provided social security numbers on
patients, who underwent TEA procedures in
the period from 1980 till 2008. Based on
review of medical reports and linkage to the
NPR we calculated revision rates and
evaluated potential risk factors for revision
including, age, gender, indication for TEA,
and implant design.
Findings / Results: 324 primary TEA procedures performed on
234 patients were evaluated at a mean
follow up of 8.8 years (range 3-27 years).
The overall 5- and 10-year survival rates
were 90% (95 % CI = 88-94) and 81% (95%
CI= 76-86), respectively.
TEAs performed due to fracture were
associated with an increased RR of revision
of 2.28 (95% CI=1.19-4.36) compared to
rheumatoid arthritis (RA). Furthermore, age
above 60 years was associated with an
increased RR for revision of 2,2 (95% CI =
1.4-4.0) There were no differences in
revision rates related to gender or implant
design.
Conclusions: We found acceptable implant survival after 5
and 10 years. There were no significant
differences in revision rates between linked
and unlinked design. However, primary TEA
due to fracture and advanced age at time of
surgery was associated with an increased
risk for revision.
58. The effective analgesic dose of dexamethasone after outpatient shoulder surgery: a randomized, blinded trial.
Karen Toftdahl Bjørnholdt, Peter Nørgaard Mønsted, Lone Nikolajsen, Kjeld Søballe
Department of Orthopaedics, Horsens Regional Hospital; Department of Orthopaedics , Horsens Regional Hospital; Department of Anaesthesiology, Danish Pain Research Centre, Aarhus University Hospital
Background: It is well established that
dexamethasone, given in a single dose
of 4-16 mg preoperatively, prevents
postoperative nausea and vomiting.
Dexamethasone has also been shown
to reduce pain after surgery, but the
optimal dose is unknown.
Purpose / Aim of Study: We hypothesized that a higher dose of
dexamethasone could provide or
improve an analgesic effect, and
therefore compared the current
(antiemetic) dose of 8 mg to a high dose
of 40 mg.
Materials and Methods: This was a GCP-monitored, blind, parallel
group, placebo-controlled, randomized
clinical trial conducted at Horsens
Regional Hospital. Seventyfive patients
undergoing arthroscopic subacromial
decompression and/or acromioclavicular
joint resection as outpatient surgery
were randomized to receive either
dexamethasone 8 mg (D8),
dexamethasone 40 mg (D40) or placebo
(D0) intravenously before surgery.
Primary outcome was pain intensity
(numeric rating scale 0-10) 8 hours after
surgery. Secondary outcomes were
average and worst pain during the first
night and on the following morning, and
analgesic consumption in the recovery
room. Pain intensity, analgesic
consumption and side effects were
recorded by patients for four days after
discharge, and a final follow-up
regarding side effects was made after
two months.
Findings / Results: There was no difference in pain
intensity after 8 hours between D8 and
D40 (median (IQR): D40: 2 (1-4), D8: 2(1-
3), p=0.60). For D0 results were (median
(IQR)) 4 (2-7). D40 was significantly
different from D0 (p=0.02), also during
the first night and on the following
morning. No difference was found in
use of analgesics. No serious side
effects were observed.
Conclusions: Dexamethasone 40 mg has a significant
analgesic effect continuing into the day
after surgery, but does not significantly
reduce pain intensity compared to
dexamethasone 8 mg.
59. Primary total elbow arthroplasty in complex fractures of the distal humerus: a retrospective study of 24 consecutive cases
Brian Weng Sørensen, Stig Brorson, Bo Sanderhoff Olsen
Orthopaedic surgery, Hillerød Hospital; Orthopaedicsurgery, Herlev University Hospital
Background: Osteoporotic fractures of the distal
humerus has increased within the last 40
years. The results of osteosynthesis on
distal humerus fractures in elderly are
variable and studies show up to 42
percent less-than-good results according
to Mayo Elbow Performance score (MEPS).
Total Elbow Arthroplasty (TEA) has
gained popularity in the treatment of
complicated distal humerus fractures in
elderly, but only few results have been
reported.
Purpose / Aim of Study: To evaluate short- to medium term
outcome of TEA in complex fractures of
the distal humerus.
Materials and Methods: A consecutive series of 24 complex
distal humerus fractures operated with
TEA at Herlev Hospital in the period
2006-2012 was evaluated with the MEPS,
plain radiographs, complications and
overall satisfaction.
Findings / Results: 18 patients were followed up. 6
patients, of which 3 had died, were lost
to follow up. AO classification: 15 C3,
1 B2 and 2 A2 fractures. Mean follow-up
was 20 months (range 4-54). Mean MEPS
was 94 (range 65-100). Mean flexion was
109 degrees (range 90-140). According to
MEPS there were 14 excellent, 3 good and
1 fair result. Patient satisfaction: 7
excellent, 9 good, 2 fair and 1 poor.
There was one revision due to infection
treated successfully with revision and
three months of antibiotics. In two
patients the locking split had loosened.
One was referred to re-insertion and one
chose yearly controls. Two patients had
persistent dysaesthesia of their 5th
finger, but were able to discriminate
between sharp and blunt. 5/24 (21%)
presented complications to the surgery
of which 3 (12,5%) were severe.
Conclusions: Our study suggests that TEA in complex
fractures of the distal humerus in
elderly patients can result in
acceptable short- to medium term
outcome. However, the optimal treatment
for complex fractures of the distal
humerus has yet to be determined.
60. Short term reults after arthroscopic resection of synovial plicae in the radiohumeral joint: a case series of 68 procedures.
Jens Brahe Pedersen
Ortopædkirurgisk Afdeling , Regionshospitalet Horsens
Background: Synovial plica in the posterolateral
corner of the radiohumeral joint has
previously been described as a
differential diagnosis to lateral
epicondylitis of the elbow. Small case
series have shown promising results
after artrhoscopic resection of these
plicae.
Purpose / Aim of Study: The aim of this study was to evaluate
the short term results after plica
resection of the elbow.
Materials and Methods: In this follow-up study, we included a
consecutive series of 68 arthroscopies
(62 patients) with arthroscopic plica
resection of the elbow . Inclusion
criteria were 6 months of lateral elbow
pain and unsuccessful conservative
treatment. Patients had either
ultrasonography verified plicae or pain
on palpation of the plica.
Patients were evaluated with an Oxford
Elbow Score (OES) preoperatively, after
3 months and after mean 22 months
(range:12-31) of follow-up.
Furthermore, baseline characteristics
were recorded including, gender, age,
BMI, occupation, smoking and cartilage
damage.
Findings / Results: Mean age was 44 years (range:18-66). In
13 elbows, International Cartilage
Repair Society (ICRS) grade 1 lesions
were present in association with the plica.
Preoperatively mean OES was 18
(95%CI:17-20). At 3 and 22 month
followup OES increased to 34 (95%CI:
31-36) and 35 (95%CI 32-38),
respectively (p<0,01). Cartilage injury
and gender did not affect the outcome.
We reported no complications.
Conclusions: Arthroscopic plica resection of the
elbow indicates an improved OES after 3
and 22 months. A randomized prospective
trial is needed to validate the effect
of arthroscopic treatment of synnovial
elbow plicae.