Funksjon hos pasienter operert med bruskimplantasjon i kneet : En syv års prospektiv studie

Bakgrunn: Pasienter med alvorlige bruskskader i kneet plages med smerter og funksjonelle begrensninger i varierende grad. Det eksisterer i dag flere kirurgiske metoder for behandling av bruskskader, og det er et behov for å evaluere langtidsresultatene etter slik behandling med hensyn til smerter og fysisk funksjon. Hensikten med denne studien var å kartlegge smerter, muskelstyrke, fysisk funksjon og generell helsestatus over tid hos en gruppe pasienter operert med autolog bruskimplantasjon i kneet. Materiale og metode: 14 pasienter operert med bruskimplantasjon i kneleddet ble fortløpende inkludert i studien. Pasientene fylte ut spørreskjema etter 4 og 8 mnd, 1,2 og 7 år etter operasjon og ble isokinetisk etter 1,2 og 7 år postoperativt. Evalueringsmetodene var: Cincinatti funksjonsscore, visuell analoge skala (VAS) for smerter og pasientens tilfredshet med operasjon, Cybex 6000 isokinetisk test av mm. quadriceps og hamstrings ved 60°/sek og 240 °/sek og SF-36. De statistiske analysene som ble benyttet var Wilcoxon Signed Rank Test, one sample t-test og Spearmans korrelasjonstest. Resultater: 6 kvinner og 8 menn ble inkludert, med en gjennomsnittlig alder på 27 (fra16 til 42) år. Gjennomsnittlig tid fra skade til operasjon var 144 (fra 7 til144) måneder. Medianverdien på Cincinatti funksjonsscore var ved baseline 41 poeng (skala 0-100, 100 best). Etter 4 måneders oppfølging var det en forbedring på 18 poeng, etter to år 39 poeng og etter 7 år 36 poeng. Etter 4 måneders oppfølging var medianverdien for smerter mindre enn 5 mm (0-100, 100 verst) mens medianverdien for smerter i aktivitet 30mm, med bare små forandringer i observasjonsperioden. Forskjellene i styrke i mm. quadriceps og hamstring mellom operert og uoperert ble mindre i observasjonsperioden men etter syv år var det fortsatt signifikant forskjell mellom de to sider. Målinger med SF-36 målt 7 år postoperativt (baselinedata ikke tilgjengelig) viste at de mannlige pasientene rapporterte om signifikant dårligere fysisk funksjon enn en generell populasjon mens pasientgruppen scoret likt som den generelle populasjon med hensyn til smerter, vitalitet og mental helse. Tidsperioden fra skade til operasjon var signifikant korrelert med dårligere knefunksjon. Konklusjon: Frem til ett år postoperativt hadde pasientenes knefunksjon forbedret seg betydelig men etter syv år var pasientene fortsatt plaget med redusert fysisk funksjon målt både på Cincinatti og SF-36. Forskjellene i styrke i mm. quadriceps og hamstring mellom operert og uoperert side ble mindre i observasjonsperioden men etter syv år var det fortsatt signifikant forskjell mellom de to sider. Tid fra skade til operasjon var signifikant korrelert med dårligere knefunksjon

Autologous chondrocyte implantation to repair knee cartilage injury : ultrastructural evaluation at 2 years and long term follow up including muscle strength measurements

Autologous chondrocyte implantation (ACI) usually results in improvement in clinical scores. However, long-term isokinetic muscle strength measurements have not been reported. Biopsies from the repair tissue have shown variable proportions of hyaline-like cartilage. In this study, 21 consecutive patients were treated with autologous cartilage implantations in the knee. Mean size of the lesions was 5.5 cm2. Follow-up arthroscopy with biopsy was performed at 2 years in 19 patients. The biopsies were examined with both light microscopy and transmission electron microscopy (TEM) techniques including immunogold analysis of collagen type 1. Patient function was evaluated with modified 10-point scales of the Cincinnati knee rating system obtained preoperatively and at 1 and 8.1 years. Isokinetic quadriceps and hamstrings muscle strength testing was performed at 1, 2 and 7.4 years. Light microscopy and TEM both showed predominately fibrous cartilage. The immunogold analysis showed a high percentage of collagen type I. At 7.4 years, the total work deficits when compared with the contra-lateral leg for isokinetic extension were 19.1 and 11.4%, and for isokinetic flexion 11.8 and 8.5% for 60 and 2408/s, respectively. Mean pain score improved from 4.3 preoperatively to 6.3 at 1 year (p = 0.031) and 6.6 at 8.1 years (p = 0.013). Overall health condition score improved from 4.1 preoperatively to 6.1 at 1 year (p = 0.004) and 6.5 at 8.1 years (p = 0.008). Three patients later went through revision surgery with other resurfacing techniques and are considered failures. In summary, the formation of fibrous cartilage following ACI was confirmed by TEM with immunogold histochemistry. Although the functional scores were generally good, strength measurements demonstrated that the surgically treated leg remained significantly weaker

The feasibility of a 3-month active rehabilitation program for patients with knee full-thickness articular cartilage lesions: The Oslo Cartilage Active Rehabilitation and Education Study

Study Design Case series. Objectives To evaluate the feasibility of an active rehabilitation program for patients with knee full-thickness articular cartilage lesions. Background No studies have yet evaluated the effect of active rehabilitation in patients with knee full-thickness articular cartilage lesions or compared the effects of active rehabilitation to those of surgical interventions. As an initial step, the feasibility of such a program needs to be described. Methods Forty-eight patients with a knee full-thickness articular cartilage lesion and a Lysholm score below 75 participated in a 3-month active rehabilitation program consisting of cardiovascular training, knee and hip progressive resistance training, and neuromuscular training. Feasibility was determined by monitoring adherence to the program, clinical changes in knee function, load progression, and adverse events. Patients were tested before and after completing the rehabilitation program by using patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee Subjective Knee Evaluation Form 2000) and isokinetic muscle strength and hop tests. To monitor adherence, load progression, and adverse events, patients responded to an online survey and kept training diaries. Results The average adherence rate to the rehabilitation program was 83%. Four patients (9%) showed adverse events, as they could not perform the exercises due to pain and effusion. Significant and clinically meaningful improvement was found, based on changes on the International Knee Documentation Committee Subjective Knee Evaluation Form 2000, the Knee injury and Osteoarthritis Outcome Score quality of life subscale, isokinetic muscle strength, and hop performance (P<.05), with small to large effect sizes (standardized response mean, 0.3–1.22). Conclusion The combination of a high adherence rate, clinically meaningful changes, and positive load progression and the occurrence of only a few adverse events support the potential usefulness of this program for patients with knee full-thickness cartilage lesions. This study was registered with the public trial registry Clinical Trials.gov (NCT00885729)

The Animated Activity Questionnaire: Validation of an innovative method for assessing activity limitations in patients with osteoarthritis

The development of the Animated Activity Questionnaire is a European project including Denmark, France, Italy, the Netherlands, Spain, England and Norway. This paper is based on data from the Norwegian part. Objective: To test a computer-animated Questionnaire (AAQ), an innovative method for assessing function in patients with hip and/or knee osteoarthritis (OA). The new method is compared with established methods for measuring function. Design: The study is a European collaborative project and has a cross-sectional design. The Norwegian part is implemented as part of the research program FYSIOPRIM. Material and methods: Patients with hip and/or knee OA and relatives were recruited from four physiotherapy clinics. Patients answered questionnaires (HOOS/KOOS ADL and AAQ) and completed performance tests. Relatives rated patient’s function using the AAQ. Five a priori hypotheses were defined for validation of AAQ (construct validity). Results: 60 patients with hip and/or knee OA and 29 relatives participated. The correlation between AAQ scores for patients and relatives was very strong (r = .80). Patients AAQ-scores correlated strong/very strong with both H/KOOS ADL (r = .74, p < .001) and with performance tests (r = - .63 to - .66, p < .001). The correlation between pain and AAQ was weaker than between pain and H/KOOS ADL, but stronger than between pain and performance tests. Conclusion: Four out of five hypotheses were met, and it is concluded that AAQ is comparable with established methods of function in patients with hip and/or knee OA (construct validity). The standardized and readily available data-animated tool AAQ may be suitable for use in clinical physiotherapy practice