The Scandinavian ACL registries 2004–2007: baseline epidemiology

Background and purpose No prospective surveillance systems have been available for monitoring the outcome of cruciate ligament surgery in Scandinavia (Denmark, Norway, and Sweden). In the present paper we describe the Scandinavian ACL registries including their main function, similarities, and preliminary baseline results

Biomechanics and anterior cruciate ligament reconstruction

For years, bioengineers and orthopaedic surgeons have applied the principles of mechanics to gain valuable information about the complex function of the anterior cruciate ligament (ACL). The results of these investigations have provided scientific data for surgeons to improve methods of ACL reconstruction and postoperative rehabilitation. This review paper will present specific examples of how the field of biomechanics has impacted the evolution of ACL research. The anatomy and biomechanics of the ACL as well as the discovery of new tools in ACL-related biomechanical study are first introduced. Some important factors affecting the surgical outcome of ACL reconstruction, including graft selection, tunnel placement, initial graft tension, graft fixation, graft tunnel motion and healing, are then discussed. The scientific basis for the new surgical procedure, i.e., anatomic double bundle ACL reconstruction, designed to regain rotatory stability of the knee, is presented. To conclude, the future role of biomechanics in gaining valuable in-vivo data that can further advance the understanding of the ACL and ACL graft function in order to improve the patient outcome following ACL reconstruction is suggested

A concept for treatment of sports related knee injuries

The aim of the present thesis was, to evaluate local anaesthesia as an anaesthetic technique when performing knee arthroscopies, from a clinical and economical point of view, and to describe the total costs for surgery of knee injuries caused by sport activities in Stockholm. In a retrospective study of 6519 arthroscopies, we tried to estimate the failure rate for knee arthroscopy in local anaesthesia compared to the same procedure in general anaesthesia. Failure was defined as a rearthroscopy within 180 days due to persisting clinical symptoms. Encouraged by the comparable results between local and general anaesthesia in this study a prospective, randomized study including 400 patients was designed. Two hundred patients were randomized to local anaesthesia, 100 patients to general anaesthesia and 100 to spinal anaesthesia. Ninety percent of the patients who had local anaesthesia were satisfied with the procedure. From the surgeon s point of view, technical problems were experienced in 5% of the procedures in local anaesthesia. Arthroscopy in local anaesthesia should be avoided if the patient has excessive synovitis. The results of the study led to the conclusion that elective knee arthroscopy can be performed under local anaesthesia in the majority of the patients. Furthermore the cost saving for an arthroscopy in local anaesthesia was SEK 1 011 per procedure compared to an arthroscopy in general or spinal anaesthesia with our described setup. The total hospital stay for patients was significantly lower for patients with local anaesthesia compared to both general and spinal anaesthesia. To determine health care costs for sports related knee surgery, we used data from three different databases an insurance company database including all players in the studied sports (football, floor ball, European team handball and ice hockey), the hospital patient record database and data from a county database containing information about all surgical procedures performed in Stockholm. The average knee surgery cost for all studied players in the population was SEK 108 in 1997. In conclusion, arthroscopy with local anaesthesia was an anaesthetic technique with clinical results comparable to other methods like general or spinal anaesthesia. Furthermore local anaesthesia was more cost and time effective. The total health costs for the community was low for players in football, floor ball, European team handball and ice hockey when their knee injuries were surgically treated