Session 1: Sports/
arthroscopy
Onsdag den 23. oktober
09:00 – 10:00
lokale: Stockholm/Copenhagen
Chairmen: Kristoffer Barfod / Martin Lind
1. The influence of early weight-bearing after non-operative treatment of acute Achilles tendon rupture on biomechanical properties of the plantar-flexor muscle-tendon complex. A blinded, randomized, controlled trial.
Jesper Bencke, Kristoffer W Barfod, Hanne Bloch Lauridsen , Christian Dippmann, Lars Ebskov, Anders Troelsen
Gait Analysis Laboratory, dept. of Orthopaedic surgery, Copenhagen University Hospital, Hvidovre, Denmark; Orthopaedic surgery, Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital, Hvidovre, Denmark; Copenhagen University Hospital, Bispebjerg, Denmark, Copenhagen University Hospital, Hvidovre, Denmark; Orthopaedic surgery, Copenhagen University Hospital, Hvidovre, Denmark
Background: Early weight-bearing has several potential
advantages during treatment of Achilles
tendon rupture, including better healing of
the tendon. This may affect the
biomechanical properties of the plantar-
flexor muscle-tendon complex (PMTC) with
possible consequences for functional
performance and risk of re-injury.
Purpose / Aim of Study: To compare the biomechanical properties of
the PMTC of both legs in patients randomized
to early weight-bearing (WB) or non-WB in
non-operative treatment of ATR.
Materials and Methods: The study was conducted as a RCT
randomising 60 patients into two groups. In
both groups, patients were treated non-
operatively with dynamic rehabilitation. The
intervention group was allowed full WB from
day 1 of treatment. The control group was
non-WB for 6 weeks. After 6 and 12 months
the passive torque at 20 degrees
dorsiflexion and stiffness during slow
stretching in early, medium and late
dorsiflexion (DF) were measured in both the
affected (A) and unaffected (UA) leg.
Findings / Results: There were no significant differences
between the WB and the non-WB groups
when evaluating the PMTC properties.
Compared to UA, the passive torque was
significantly lower for A only at 6 months
(91% (p=0.01) and 98% (ns.) at 6 and 12
months, respectively). Stiffness was
significantly lower for A during the early part
of DF at 6 months, and remained inferior at
12 months despite significant improvement
(p=0.019) (71% (p<0.001) and 83%
(p<0.001) at 6 and 12 months, respectively).
Conclusions: There was no effect of WB on the
biomechanical properties of PMTC compared
with non-WB. The reduced stiffness in A in
the early part of DF may have implications
for coordination of i.e. gait and running, and
the fact that the stiffness is not normalised
after 12 months may indicate a need for
prolonged physiotherapy, irrespective of
initial treatment regime.
2. Reconstruction of the medial patellofemoral ligament in adolescents with open growth plates
Ditte Enderlein, Torsten Nielsen, Peter Faunø, Svend Erik Christiansen, Martin Lind
Orthopaedic Department, division of Sports Trauma, Aarhus University Hospital
Background: Medial patellofemoral ligament
reconstruction (MPFL-R) has recently
been broadly accepted as primary surgical
treatment in adults.
Reconstruction techniques with osseous
fixation in femur cannot be used for
patients with open growth plates. Operative
treatment of patella instability in children
therefore is a challenge and requires
alternative MPFL-R techniques. Limited
knowledge exists concerning outcome
after MPFL-R in children and adolescents.
Purpose / Aim of Study: This study presents clinical outcome in a
consecutive single clinic series of children
treated with paediatric (MPFL-R) using a
soft tissue femoral fixation technique.
Materials and Methods: 23 children aged 8-16 operated with 25
MPFL-R between 2008 and 2011 are
included. Indication for surgery was two or
more patella dislocations and ADL
limitations. Surgical technique: Gracilis
tendon was looped around the adductor
magnus tendon and fixed through drillholes
in the proximal medial patella edge. Clinical
outcome were evaluated with Kujala score
and NRS pain score preoperatively and at
1 year follow-up including incidences of
recurrent instability episodes.
Findings / Results: Kujala score improved from 64 to 81. NRS
pain score improved from 2,9 to 0,6 in
activity. 4 patients (16%) experienced re-
dislocation within the 1st year. 5 patients
(20%) experienced subluxations. 1 patient
with a re-dislocation was re-operated with
adult MPFL technique. Cartilage injury was
seen in 5 patients. 4 out of 5 patients with
cartilage injury had recurrent instability.
Conclusions: There are clinical relevant improvements in
knee function and pain after paediatric
MPFL-R. Stability and strength of the
reconstruction though seem to be inferior
to adult MPFL-R techniques
postoperatively. Cartilage injury is
correlated to recurrent patella instability.
3. Traction related complications during hip arthroscopy.
Lone Frandsen, RN, Bent Lund, M.D, Svend Erik Christiansen, M.D, Torsten Grønbech Nielsen, PT, Martin Lind, Prof. M.D.
Dept of Sportstraumatology, Aarhus University Hospital
Background: Complications can arise from the traction
during hip arthroscopy.
Purpose / Aim of Study: The aim of this investigation was to
investigate traction related
complications. We also investigated how
the patients perceive and cope with
traction related problems.
Materials and Methods: The investigation is based on a
prospective cohort study partly
supplemented with interviews. Data
were collected by questionnaires from
patients who had undergone hip
arthroscopy as well as data from the
patients files. 100 consecutive patients
were included in the study. The
questionnaire was used 10 and 90 days
postoperatively. Questions were related
to location and duration of symptoms.
The questionnaire was supplemented
with a semi-structured interview with 6
patients, who had experienced
complications related to the traction.
Findings / Results: The results demonstrated that 74% of
the patients had minimum one
complication at the groin, knee or foot
level. 32% had complications in the groin
or perineal area in the form of swelling,
scratches/bruising or sensibility
changes. 49% had complications at knee
level in the form of swelling, laxity
feeling or sensibility changes. 37% had
complications at foot or ankle level in the
form of swelling, bruising or sensibility
changes. Generally the complications
were limited and disappeared within 2-4
weeks. Females had more complications
than males. No difference was found in
traction times between patients with and
without complications (36/39 minutes).
The interviews revealed that patients
lacked information about complications in
general the duration of complications
and what they should to do to handle
them.
Conclusions: The results are surprising as the existing
literature report much lower complication
rates related to traction than found in the
present study.
4. ACL reconstruction in children. Results from the Danish Registry for Knee Ligament Reconstruction
Peter Faunø, Lene Wagner, Martin Lind
Dept. of Sports Traumatology, Aarhus University Hospital
Background: An increasing number of ACL ruptures are
registered in children and adolescents.
More information on the fate of ACL
reconstruction is needed, since the
evidence for surgical treatment in the
young patient is low
Purpose / Aim of Study: To describe the outcome of ACL
reconstruction in children and
adolescents based on data from the
Danish ACL Registry
Materials and Methods: The data are subtracted from the Danish
national ACL registry. The analysis is
based on population of 14.806 ACL
reconstructed patients. Outcome was
evaluated by risk of ACL revision,
subjective outcome score (KOOS), Tegner
function score and objective laxity
scores. Three age groups (A: <13, B:
13-15, and C: 15-20 years) were compared
to D: patients 20 years and older
(adults). 95 patients in group A. 337 in
B, 2.888 in C and 11.496 were above 20
years (group D)
Findings / Results: We found significantly increased risk
for revision surgery in the age group B
(6,7%) and C (4,9%) compared to adults
(2,0%).
Objective laxity did not differ between
the four groups. Group A, B and C had
higher KOOS4 (79.6, 76.6, 73.1
respectively)) score compared to the
adults (69.7). Group B had higher KOOS
QOL (76.6/73.1) and sports (71.1/66.4)
scores than group C. Tegner activity
score did not differ between the four
groups. We could not detect any impact
of the use of extracortical graft
fixation in the youngest age group.
Conclusions: Patients between 13-20 years have an
increased risk of graft failure. This is
in contrast to the better subjective and
objective knee function scores in the
same age groups. These findings
indicates that young ACL patients
could benefit from a more careful
guidance in their postoperative activity.
5. Outcome after posterior cruciate ligament (PCL) reconstruction.
Bjarne Mygind-Klavsen, Svend Erik Christiansen, Bent Lund, Peter Faunø, Mads Uldum Roesgaard, Martin Lind
Division of Sports Trauma, Department of Orthopedic Surgery, Aarhus University Hospital
Background: PCL reconstruction are rarely performed
compared to anterior cruciate ligament
reconstruction.
Purpose / Aim of Study: The purpose of this study was to evaluate
the clinical and functional outcome after PCL
reconstruction either isolated or as
multiligament reconstruction.
Materials and Methods: 197 patients who underwent PCL
reconstruction during the period 2005 to
2010 were included. We performed a
standardized follow-up in 2012/2013
consisting of subjective scores (Tegner
activity score, KOOS and subjective IKDC)
and objective measures including knee laxity
(KT1000, 70 dgr), extension strength and
overall IKDC score. We compared these
follow-up data with data from the Danish
Registry for Knee Ligament Reconstruction.
Findings / Results: 100 patients were available for follow-up,
42% with isolated PCL and 58% with
multiligament injury. Mean follow up time was
60 month (37-99). KOOS scores at follow-
up in the isolated PCL group was
respectively: sympt. (73), pain (77), ADL
(83), sport (57) and QOL (58). And in the
multiligament group: sympt. (75), pain (81),
ADL (86), sport (60) and QOL (58). Tegner
scores was respectively 4.9 and 5.6 and
subjective IKDC was 68 and 65.
Comparison with data from the Danish
Registry for Knee Ligament Reconstruction
shows only minor differences in subjective
outcome between Primary ACL
reconstruction KOOS data and PCL
reconstruction patients from this study.
The average side to side difference in knee
laxity was in the isolated PCL group 2.2 mm
compared to 3.2 mm in the multiligament
group.
Conclusions: Although the average side to side knee laxity
between the two groups is 1 mm the
functional outcome score is almost identical.
Regarding KOOS scores after primary ACL
reconstruction versus isolated or combined
PCL reconstruction surgery there is only a
minor difference in subjective outcome.
6. Clinical outcome after PCL support bracing treatment for patients with acute posterior cruciate ligament injury
Sinan Said, Martin Lind, Torsten Grønbech Nielsen, Christina Mikkelsen, Bjørn Engstrøm
orthopedic , Aalborg University Hospital; orthopedic, Aarhus University Hospital; , capio artro clinic in stockholm
Background: Posterior cruciate ligament (PCL) injury
occurs typically due to high energy
trauma. Patients with grade 3 injuries are
often treated operatively while those
with grade 1 & 2 can be managed
conservatively by bracing.
Purpose / Aim of Study: The aim of the study is to evaluate the
outcome of non-operative management
of acute isolated PCL injuries.
Materials and Methods: From March 2004 to April 2012, 36
patients with isolated acute (< 4 weeks)
PCL injury were treated with PCL
support brace (Jack brace). A brace
with tibial supporters designed to
prevent posterior displacement at the
knee. 29 ptt were from Capio Arthro
Clinic in Stockholm and 7 ptt from Aarhus
University hospital. 23 pt were present
for a median follow up of 43 months.
Functional outcomes were evaluated
with Lysholm score, International Knee
Documentation Committee subjective
(IKDC), KOOS, Tegner, Werner scores
as well as one leg hop test and
anterior/posterior knee stability
measured with KT-1000 arthrometer.
Findings / Results: There were 10 females and 13 males.
Average age at the time of injury was 23
yrs. Mean Lysholm score was 86,
median Tegner was 7, objective IKDC
2000 score showed 57% were nearly
normal and 43% abnormal, KOOS
scores for pain, symptoms, ADL, sport,
QOL was 90,86,93,76,74 respectively.
Average Werner score was 43,
Average knee function (one leg hop)
compared to non-injured knee was 96%.
Average side-to-side difference at 70
degrees of knee flexion was 1mm.
Conclusions: PCL support bracing with attached tibial
supporters designed to prevent
posterior displacement at the knee
yielded satisfactory clinical and
functional results in the majority of the
cohort study group.
7. A validation study of the Danish Knee Ligament Reconstruction Registry.
Lene Rahr-Wagner, Theis Thillemann, Martin Lind, Alma Pedersen
Orthopedic, Aarhus University Hospital; Clinical Epidemiology, Aarhus University Hospital
Background: The Danish Knee Ligament
Reconstruction Registry (DKRR) is a
population-based database. The
validity of the database is not known. It
is of crucial importance to evaluate the
registration completeness and to
validate the data quality in such a
database in order to be able to draw
valid and reliable conclusions.
Purpose / Aim of Study: The aim of this study was to validate
the DKRR by assessing the
registration completeness of the ACL
reconstruction (ACLr) code and
detecting the validity of important key
variables. Furthermore, we assessed
data quality of patient-related outcome
scores
Materials and Methods: All operation codes for ACLr from 2005
to 2011 were identified in the Danish
National Registry of Patients and
compared with the cases registered in
the DKRR to compute the
completeness of registration in the
DKRR. We also assessed the validity
of key variables using medical records
as a gold standard to compute the
positive predictive value (PPV). Finally,
we assessed potential differences
between responders and non-
responders to subjective patient-
related outcome scores (KOOS and
Tegner scores) one year after surgery.
Findings / Results: The completeness of registration of
patients in the DKRR rose from 60%
(2005) to 86% (2011). Large-volume
hospitals had a significantly higher
completeness than small-volume
hospitals. With a PPV between 85%
and 100%, the validity of key variables
was good. KOOS vs. Tegner scores
for responders and non-responders
were comparable.
Conclusions: The results show a good registration of
ACLr procedures in the DKRR, but
there is room for improvement mainly
at small-volume hospitals. Overall, the
validity of the key variables in the
DKRR was good and no difference
was found in KOOS and Tegner
scores for responders vs. non-
responders.
Therefore, we conclude that the DKRR
is a valid source for future research.
8. Patient reported outcomes are strongly associated by lower limb loading pattern, mechanical muscle strength and functional performance in acl-patients-a cross-sectional study
Anders Holsgaard-Larsen, Carsten Jensen, Per Aagaard
Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark; Institute of Sports Science and Clinical Biomechanics, Muscle Research Cluster (SMRC), University of Southern Denmark
Background: Despite, being considered as two
distinct constructs, associations
between objective measures and self-
reported outcomes (i.e. Knee Injury
and Osteoarthritis Outcome Score
(KOOS)) may specify focus areas in
the rehabilitation of ACL-patients.
Purpose / Aim of Study: To investigate the extent to which a
test-battery of 15 objective outcome
measures of physical function are
associated with KOOS-subscales in
ACL-reconstructed patients, with the
perspective of identifying areas of
intervention that potentially could
facilitate rehabilitation in this patient-
group.
Materials and Methods: This cross sectional study was
performed in 23 ACL-reconstructed
men (mean age: 27.2±7.5 years and
BMI: 25.4±3.2) 18-30 month post-
surgery. KOOS-questionnaire was
filled out and subsequently, patients
performed a test-battery composed by:
(i) bilateral and (ii) unilateral maximal
counter movement jumps (CMJ).
Kinematic data were synchronously
recorded by a 6-camera Vicon MX
system. Furthermore, patients
performed (iii) one-leg maximal jump
for distance and (iv) maximal isometric
knee extensor and flexor strength
(MVC). Backward multiple stepwise
linear regression analysis was
conducted using each of the 5 KOOS-
subscales as the depended variables,
and the 15 objective outcomes from
the test-battery as independed
variables.
Findings / Results: Strong associations between objective
outcomes and KOOS subscales were
observed: QOL (r2=0.89, p < 0.001),
Pain (r2=0.74, p < 0.002), Sport/Rec
(r2=0.71, p < 0.001) and ADL (r2=0.57,
p < 0.001) along with a moderate
association for Symptoms (r2=0.18, p
< 0.05).
Conclusions: A very large proportion (57-89%) of the
variation in KOOS (QOL, Pain,
Sport/Rec, and ADL) was explained by
the current objective test-battery. Thus,
future research on ACL-rehabilitation
should emphasise areas of
intervention evaluated by the current
test-battery.