Evaluation of patients with an anterior cruciate ligament rupture, before and after reconstruction, with special emphasis on the use of the KT-1000 arthrometer

The aim of the study was to analyse the outcome and function after anterior cruciate ligament(ACL) reconstruction using different evaluation systems. Special emphasis was placed on thesagittal knee laxity as measured with the KT-1000 arthrometer.The patients were operated on using bone-patellar tendon-bone autografts and rehabilitatedaccording to an individual training programme based on standardised accelerated guidelines.The post-operative outcome two years after reconstruction was analysed in 527 patients. TheKT-1000 measurement did not correlate with the subjective, objective and functionalevaluation scores that were used. Four hundred and twenty-nine patients were divided intosubgroups with increased, normal and reduced knee laxity at the post-operative follow-up.Persisting deficits in range of motion (ROM) were found more often in patients with reducedor increased knee laxity. Patients with increased post-operative knee laxity had an inferiorfunctional outcome.The inter- and intra-examiner reproducibility of the KT-1000 arthrometer was analysed. Thereproducibility between two experienced examiners was acceptable and, for the sameexaminer the reproducibility was considered good.In 45 male patients with an ACL injury, the anterior knee laxity had an inverse correlationwith the concentric peak torque (PT) of the hamstring muscles on the injured side.The KT-1000 revealed increased sagittal laxity in a group of patients with a right-sided ACLinjury compared with a group of patients with a left-sided ACL injury pre-operatively andafter ACL reconstruction. The same thing was found in healthy persons.In conclusion, the overall post-operative results after ACL reconstruction using bone-patellartendon-bone autografts were good. The laxity tests cannot be used to predict a return to highlevelactivities or the overall outcome. A persistent deficit in ROM is a common postoperativecomplication after ACL reconstruction. In clinical studies, it is recommended thatthe same examiner should perform the KT-1000 evaluations. The KT-1000 is not useful fordiagnosing an ACL injury in an individual patient. Male patients with strong hamstringmuscles displayed less anterior knee laxity in the ACL injured side compared with malepatients with weak hamstring muscles. It appears to be important to report the laxity andfunctional outcome of right and left knees separately, in studies reporting the results afterACL reconstruction

Nurses\ub4Experiences of participation in a research and development programme

Aims and objectives. To describe clinical nurses’ experience of participating in a Research and Development (R&D) programme and its influence on their research interest and ability to conduct and apply nursing research.Background. To stimulate nurses’ research interest and to overcome barriers for building research capacity in nursing, there is a need for sustainable research programmes. A two-year programme was designed for nurses, to take part in both an academic education for master and research seminars and workshops to conduct a research project from idea to publication.Design. A qualitative approach using using focus group interviews.Methods. Registered nurses (n = 12) with a bachelor’s degree in nursing, participated. Data were collected in focus group interviews, after one year and when the programme ended. Content analysis was used to analyse the data.Results. The findings consist of two themes: being a traveller in the world of nursing research, which included three categories, and experiencing professional growth as a result of nursing research training, in both cases focusing on the experienceof students involved in a cohesive programme which included four categories: discovering new dimensions of clinical nursingpractice; selected and confirmed; supported by professional others; development of professional self-concept.Conclusions. To support early career researchers, there is a need for strong leadership, an organisational and supportive infrastructure underpinning research capability building in nurses. In this context, research strategies, programmes and collaboration between leaders of academia and clinical institutions appear to be essential.Relevance to clinical practice. The R&D programme illustrates an effective way of stimulating nurses’ lifelong learning by building the capacity to conduct and apply nursing research in clinical practice. The structure of the programme can be used as a model in other contexts

Periprosthetic joint infection after total hip arthroplasty induces histological degeneration of the gluteus medius tendon

Aims: A revision for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) has a major effect on the patient’s quality of life, including walking capacity. The objective of this case control study was to investigate the histological and ultrastructural changes to the gluteus medius tendon (GMED) in patients revised due to a PJI, and to compare it with revision THAs without infection performed using the same lateral approach. Methods: A group of eight patients revised due to a PJI with a previous lateral approach was compared with a group of 21 revised THAs without infection, performed using the same approach. The primary variables of the study were the fibril diameter, as seen in transmission electron microscopy (TEM), and the total degeneration score (TDS), as seen under the light microscope. An analysis of bacteriology, classification of infection, and antibiotic treatment was also performed. Results: Biopsy samples from the GMED from infected patients revealed a larger fibril diameter than control patients, as seen in the TEM (p < 0.001). Uninfected patients were slightly older and had their revisions performed significantly later than the infected patients. Histologically, samples from infected patients revealed significantly more vascularity (p < 0.001), the presence of glycosaminoglycans (p < 0.001), and a higher TDS (p = 0.003) than the control patients. The majority of patients had staphylococcal infections of various species. Conclusion: More histological degeneration in the GMED was found in patients undergoing THA revision surgery due to PJI than in patients undergoing THA revision surgery due to other reasons. Cite this article: Bone Jt Open 2023;4(8):628–635

No significant histological or ultrastructural tendinosis changes in the hamstring tendon in patients with mild to moderate osteoarthritis of the knee?

Purpose - To investigate the periarticular degenerative changes of the knee joint in association with osteoarthritis (OA). More tendinosis was expected to be found in the semitendinosus tendon in patients with knee OA than in patients without knee OA. Methods - Samples from 41 patients were included between January 2016 and October 2017. Twenty-one patients median age 53 (33–63) years with mild to moderate OA underwent high tibial osteotomy (HTO) and 20 patients median age 38 (31–57) years without OA underwent anterior cruciate ligament reconstruction (ACLR). Biopsies from the semitendinosus tendon were obtained at the time of surgery and examined histologically, morphologically and ultrastructurally using light and electron microscope. Results - The histological evaluation of the semitendinosus tendon revealed the presence of more hemosiderin in the ACLR group. No significant morphological or ultrastructural differences were shown between patients in the HTO and ACLR group. Conclusion - Patients with mild and moderate medial compartment knee OA displayed no more degenerative changes in their semitendinosus tendon than patients without OA, as seen in both the light and the electron microscope

Histological and ultrastructural degenerative findings in the gluteus medius tendon after hip arthroplasty

Background - Despite gluteus medius (GMED) tendinosis being relatively common, its presence in association with hip osteoarthritis (OA) or total hip arthroplasty (THA) is not well studied. It was hypothesized that more tendon degeneration would be found in patients with OA of the hip and in those that had undergone THA than that in a control group. Methods - One hundred patients were included between 2016 and 2019 and were included into 4 groups; the patients were undergoing revision surgery in two groups and primary THA in the other two groups; 22 patients had previously undergone primary THA through a direct lateral approach (involving sectioning of the GMED tendon), 24 patients had previously undergone primary THA through a posterior approach (leaving the GMED tendon intact), 29 patients had primary hip OA, and 25 patients who suffered a femoral neck fracture served as controls. Biopsies from the GMED tendon were obtained at the time of the primary THA or the hip revision surgery. The tendon biopsies were examined ultrastructurally and histologically. Results - Ultrastructurally, the direct lateral and posterior revision groups had statistically significantly more collagen fibrils with smaller diameters compared with the fracture and primary THA groups. Moreover, the direct lateral revision group had more collagen fibrils with smaller diameters compared with the posterior revision group. Histologically, the direct lateral revision group had a higher total degeneration score (TDS) compared with the primary hip OA group. Conclusions - The GMED tendon shows more ultrastructural degeneration in patients who undergo hip revision arthroplasty than in patients with primary OA of the hip and control patients, who had suffered a femoral neck fracture. Furthermore, patients who had previously undergone primary THA through a direct lateral approach revealed more histological GMED tendon degeneration than patients who suffer primary hip OA

FOU-kompetensf\uf6rs\uf6rjningsprogram f\uf6r sjuksk\uf6terskor i Fyrbodal

SammanfattningBetydelsen av FoU-kompetensf\uf6rs\uf6rjningsprogrammet som varit en medveten och strategisk satsning inom FoU-omr\ue5det kan sammanfattas p\ue5 f\uf6ljande s\ue4tt:Deltagarnas beh\ue5llning och f\uf6reskriven akademisk utveckling har haft en n\ue4rmast hundraprocentig m\ue5luppfyllelse och gett kliniskt verksamma sjuksk\uf6terskor en bra start p\ue5 sin akademiska karri\ue4r.Programmet illustrerar ett effektivt s\ue4tt att stimulera sjuksk\uf6terskors livsl\ue5nga l\ue4rande genom att bygga upp f\uf6rm\ue5gan att genomf\uf6ra och till\ue4mpa omv\ue5rdnadsforskning i klinisk praktik.Programmet har ocks\ue5 bidragit till utvecklingen av kompetenta handledare f\uf6r studenter under utbildning.Flertalet av deltagarna har utvecklat b\ue5de en \uf6nskan om och kompetens f\uf6r att ta p\ue5 sig ledande uppdrag s\ue5v\ue4l inom den egna verksamheten som i gr\ue4ns\uf6verskridande projekt b\ue5de inom Fyrbodal och nationellt.Programmet har medverkat till att bryta revirt\ue4nkande och kan bidra till en mer \uf6ppen och gr\ue4ns\uf6verskridande kultur inom Fyrbodalomr\ue5dets h\ue4lso- och sjukv\ue5rd. Det har \ue4ven medverkat till att deltagarna skaffat sig en helhetssyn p\ue5 och f\uf6rst\ue5else f\uf6r olika v\ue5rdverksamheter.Programmets design kan anv\ue4ndas f\uf6r att utveckla s\ue5v\ue4l professionell som vetenskaplig kompetens och kan med f\uf6rdel anv\ue4ndas inom andra yrkesgrupper med medell\ue5ng v\ue5rdutbildning, eller f\uf6r en tv\ue4rprofessionell grupp