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

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

Sex Differences in Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: Data From the Swedish Knee Ligament Register.

BACKGROUND: Female gender is a risk factor for sustaining anterior cruciate ligament (ACL) injury. However, little is known about possible sex differences in patients with ACL injury/reconstruction. PURPOSE: To study sex differences in patient-reported outcomes before and at 1 and 2 years after ACL reconstruction and to present reference values. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Between 2005 and 2008, 10 164 patients (mean age, 27 years; SD, 9.8; 42% females) with primary ACL reconstruction were registered in the Swedish national knee ligament register. There were 4438 (44%) of these patients (42% females) who had completed the knee-specific questionnaire, Knee injury and Osteoarthritis Outcome Score (KOOS), and 5255 (52%) who had completed the generic score of health status, EQ-5D, before surgery and were included in this study. Independent t tests were used to study sex differences in KOOS and EQ-5D preoperatively, 1 and 2 years postoperatively, and over time. RESULTS: Preoperatively, female patients reported worse scores than male patients in 4 KOOS subscales (pain, symptoms, sport/recreation, quality of life) and EQ-5D, with the largest difference seen in KOOS sport/recreation (mean difference, 4.7; 95% confidence interval [CI], 3.0-6.3). At 1 year postoperatively, female patients reported worse scores than male patients in KOOS pain (mean difference, 1.4; 95% CI, 0.4-2.4) and KOOS sport/recreation (mean difference, 2.7; 95% CI, 0.9-4.4) and at 2 years postoperatively in KOOS sport/recreation (mean difference, 4.4; 95% CI, 2.1-6.7) and KOOS quality of life (mean difference, 2.4; 95% CI, 0.4-4.4). Female patients reported less improvement from 1 to 2 years postoperatively than male patients in KOOS sport/recreation (mean difference, 3.2; 95% CI, 0.3-6.1). In some age groups, female patients reported a clinically relevant worse KOOS sport/recreation score than male patients (mean difference >/=8). CONCLUSION: Female patients reported statistically significant worse outcomes than male patients before and at 1 and 2 years after ACL reconstruction. In some age groups, this difference was also clinically relevant. There were no clinically relevant sex differences in improvements over time. We suggest that possible sex differences be analyzed in future studies on evaluation after ACL injury/reconstruction

Results From the Swedish National Anterior Cruciate Ligament Register

PURPOSE: The purpose of the study was to analyze the baseline variables and clinical outcomes for almost 24,000 patients entered into the Swedish National ACL Register between January 2005 and December 2012. METHODS: The register consists of 2 parts: 1 section in which surgeons report baseline and surgical data and 1 section in which patients report the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the EQ-5D score before and 1, 2, and 5 years after surgery. RESULTS: By December 2012, 23,744 patients had been entered into the surgeons' part of the register. The female-male ratio in the register is 42:58. The mean age at primary anterior cruciate ligament (ACL) reconstruction was 26 years (SD, 11 years) and 28 years (SD, 9 years) for the female and male patients, respectively. The ACL injury occurred during soccer in 36% of the female patients and 49% of the male patients. In 2012, 95% of the primary ACL reconstructions were performed using hamstring tendon autografts. For patients who had a minimum of 5 years' follow-up, the revision rate was 3.3% and the contralateral reconstruction rate was 3.8%. On all follow-up occasions up to 5 years, patients who had undergone revision had a significantly (P < .001) poorer outcome than those who had undergone primary unilateral ACL reconstructions in all KOOS and EQ-5D dimensions. On all follow-up occasions, smokers obtained significantly poorer scores than nonsmokers in terms of both the KOOS (P < .008) and the EQ-5D (P < .024). CONCLUSIONS: Soccer is the most common cause of injury in both female and male patients, and patients undergoing revisions fare less well than those undergoing primary unilateral ACL reconstructions, as well as bilateral reconstructions. Furthermore, smokers fare less well than nonsmokers. The cumulative risk of an ACL revision or contralateral ACL reconstruction during a 5-year period is approximately 7%. For patients aged younger than 19 years, the cumulative risk is significantly higher. LEVEL OF EVIDENCE: Level II, retrospective prognostic study

Surgeons experience, sports participation and a concomitant MCL injury increase the use of patellar and quadriceps tendon grafts in primary ACL reconstruction : a nationwide registry study of 39,964 surgeries

Purpose To investigate the influence of surgeon-related factors and clinic routines on autograft choice in primary anterior cruciate ligament reconstruction (ACLR). Methods Data from the Swedish National Knee Ligament Registry (SNKLR), 2008-2019, were used to study autograft choice (hamstring; HT, patellar; PT, or quadriceps tendon; QT) in primary ACLR. Patient/injury characteristics (sex, age at surgery, activity at time of injury and associated injuries) and surgeon-/clinic-related factors (operating volume, caseload and graft type use) were analyzed. Surgeon/clinic volume was divided into tertiles (low-, mid- and high-volume categories). Multivariable logistic regression was performed to assess variables influencing autograft choice in 2015-2019, presented as the odds ratio (OR) with a 95% confidence interval (CI). Results 39,964 primary ACLRs performed by 299 knee surgeons in 91 clinics were included. Most patients received HT (93.7%), followed by PT (4.2%) and QT (2.1%) grafts. Patients were mostly operated on by high-volume (&amp;gt; 28 ACLRs/year) surgeons (68.1%), surgeons with a caseload of &amp;gt;= 50 ACLRs (85.1%) and surgeons with the ability to use &amp;gt;= two autograft types (85.9%) (all p &amp;lt; 0.001). Most patients underwent ACLR at high-volume (&amp;gt; 55 ACLRs/year) clinics (72.2%) and at clinics capable of using &amp;gt;= two autograft types (93.1%) (both p &amp;lt; 0.001). Significantly increased odds of receiving PT/QT autografts were found for ACLR by surgeons with a caseload of &amp;gt;= 50 ACLRs (OR 1.41, 95% CI 1.11-1.79), but also for injury during handball (OR 1.31, 95% CI 1.02-1.67), various other pivoting sports (basketball, hockey, rugby and American football) (OR 1.59, 95% CI 1.24-2.03) and a concomitant medial collateral ligament (MCL) injury (OR 4.93, 95% CI 4.18-5.80). In contrast, female sex (OR 0.87, 95% CI 0.77-0.97), injury during floorball (OR 0.71, 95% CI 0.55-0.91) and ACLR by mid-volume relative to high-volume surgeons (OR 0.62, 95% CI 0.53-0.73) had significantly reduced odds of receiving PT/QT autografts. Conclusion An HT autograft was used in the vast majority of cases, but PT/QT autografts were used more frequently by experienced surgeons. Prior research has demonstrated significant differences in autograft characteristics. For this reason, patients might benefit if surgery is performed by more experienced surgeons.Funding Agencies|Karolinska Institute</p

Predictors for additional anterior cruciate ligament reconstruction : data from the Swedish national ACL register.

PURPOSE: To identify predictors for additional anterior cruciate ligament (ACL) reconstruction. METHODS: Patients from the Swedish national ACL register who underwent ACL reconstruction between January 2005 and February 2013 (follow-up duration 6-104 months) were included. Cox regression analyses included the following independent variables regarding primary injury: age, sex, time between injury and primary ACL reconstruction, activity at primary injury, concomitant injuries, injury side, graft type, and pre-surgery KOOS and EQ-5D scores. RESULTS: Among ACL reconstruction procedures, 93 % involved hamstring tendon (HT) autografts. Graft type did not predict additional ACL reconstruction. Final regression models only included patients with HT autograft (n = 20,824). Of these, 702 had revision and 591 contralateral ACL reconstructions. The 5-year post-operative rates of revision and contralateral ACL reconstruction were 4.3 and 3.8 %, respectively. Significant predictors for additional ACL reconstruction were age (fourfold increased rate for &lt;16-year-old patients vs. &gt;35-year-old patients), time between injury and primary surgery (two to threefold increased rate for ACL reconstruction within 0-90 days vs. &gt;365 days), and playing football at primary injury. CONCLUSION: This study identified younger age, having ACL reconstruction early after the primary injury, and incurring the primary injury while playing football as the main predictors for revision and contralateral ACL reconstruction. This suggests that the rate of additional ACL reconstruction is increased in a selected group of young patients aiming to return to strenuous sports after primary surgery and should be taken into consideration when discussing primary ACL reconstruction, return to sports, and during post-surgery rehabilitation. LEVEL OF EVIDENCE: II.Funding agencies:The study was financially supported by Futurum-the academy for healthcare, County Council, Jonkoping, the Faculty of Health Sciences at Linkoping University, and the Swedish National Centre for Research in Sports (CIF).</p