Long-Term Follow-Up of Nonoperatively and Operatively Treated Acute Primary Patellar Dislocation in Skeletally Immature Patients

Purpose. The present study reports a long-term follow-up of acute primary patellar dislocation in patients with open physes. The purpose of the study was to evaluate knee function and recurrence rates after surgical and nonsurgical treatment of patellar dislocation. Methods. A total of 51 patients, including 29 girls and 22 boys, who were 9–14 years of age at the time of injury, were retrospectively evaluated. The minimum follow-up time was 5 years. Thigh muscle torque, range of motion, the squat test, the knee injury and osteoarthritis outcome score (KOOS), the Kujala score, and the recurrence rate were registered. Radiological predisposing factors at the time of injury were determined. Results. Quality of life and sports/recreation were the most affected subscales, according to KOOS, and a reduced Kujala score was also observed in all treatment groups. The surgically treated patients had a significantly lower recurrence rate. Those patients also exhibited reduced muscle performance, with a hamstring to quadriceps ratio (H/Q) of 1.03. The recurrence rate was not correlated with knee function. Conclusions. Patellar dislocation in children influences subjective knee function in the long term. Surgery appears to reduce the recurrence rate, but subjective knee function was not restored

Femur shaft fracture at a young age and the risk of subsequent severe injuries during childhood: a cohort study

Background: A child who suffers a fracture or a soft-tissue injury at a young age faces an increased risk of subsequent injuries during childhood. This risk could be related to personal and family characteristics or to lower-than-average bone-mineral density. The purpose of this nationwide cohort study was to estimate the association between a femur shaft fracture at a young age and the subsequent risk of hospitalization for injuries during childhood. Methods: We compared the subsequent risk of hospitalization for injuries during childhood among 1,404 children (exposed) who were one to three years of age when they suffered a femur shaft fracture with the risk among 13,814 randomly selected, gender- and age-matched femur fracture–free children (unexposed). Hazard ratios (HRs) and 95% confidence intervals (CIs) for severe injuries defined as fractures or soft-tissue injuries requiring hospital admission were estimated in a Cox proportional hazards model. Results: Exposed children exhibited no significantly increased risk of upper-extremity fractures or soft-tissue injuries during childhood, regardless of sex and follow-up time. Boys exhibited a 162% increased risk of suffering a lower leg fracture requiring hospital admission (HR?=?2.62, 95% CI: 1.45–4.71), but the refracture risk was not significant for girls 2.02 (0.58–6.97). Conclusions: We found an increased risk for subsequent fractures in the lower leg that requires inpatient care during childhood for boys, but not for girls, who were one to three years of age when they first suffered a femur shaft fracture. This increased fracture risk is probably not simply the result of greater risk-taking among boys. The explanation might relate to factors affecting the bone quality of the lower leg

The International Olympic Committee consensus statement on age determination in high-level young athletes

I Brage finner du siste tekst-versjon av artikkelen, og den kan inneholde ubetydelige forskjeller fra forlagets pdf-versjon. Forlagets pdf-versjon finner du på bjsm.bjm.com: http://dx.doi.org/10.1136/bjsm.2010.073122 / In Brage you'll find the final text version of the article, and it may contain insignificant differences from the journal's pdf version. The original publication is available at bjsm.bjm.com: http://dx.doi.org/10.1136/bjsm.2010.07312

Anterior cruciate ligament injuries in children

The thesis discusses the two most common injuries to the anterior cruciate ligament (ACL) in children: The rupture in the substance of the ACL and the anterior tibial spine (ATS) fracture. The latter is an avulsion fracture of the tibial attachment of the ACL. The injuries and their treatment are studied in two clinical papers. Two experimental studies in rabbits are connected to the clinical studies and focuses on two fields of evident interest in the treatment of the injuries: * The limitations of ACL reconstruction in children, with respect to drilling and tendon grafting across a growth plate (physis), and the risk of growth disturbances. * The influence of growth on knee laxity after an ATS fracture. Twenty-eight consecutive children with ACL ruptures were followed for 3 - 5 years in order to describe the outcome of nonoperative treatment, to identify variables relevant to failure of nonoperative treatment, and to evaluate an over-the-top procedure for ACL reconstruction avoiding drill holes across the physes. 68% of the patients in whom nonoperative treatment was attempted had been operated on at follow-up, i.e. the injury has a marked impact on knee function in children. The patients not operated on were younger at the time of injury and had a lower activity level at follow-up. The surgical procedure improved knee function, but there was a correlation between high activity level and low subjective knee function indicating that the knee function was not completely restored. A controlled and measurable drill injury was made across the distal femoral physis in rabbits. The relative size of the drill injury necessary to cause growth disturbance was found to be 7 - 9%. A transphyseally placed tendon, even as a free graft, prevented solid bone bridge formation in the drill hole and growth disturbance. The results are of possible clinical significance when discussing improvement of ACL reconstruction in children. The long-term course of ATS fractures sustained in childhood was evaluated 10 - 39 years after injury in 61 adults. Age at injury, residual fracture displacement after healing, and the type of ATS fracture according to Meyers & McKeever were compared with objective and subjective knee function. The injury appears to be a relatively benign injury in the long term. The subjective knee function was excellent or good in 87% of the subjects. Age at injury did not influence the outcome. Only in patients with a totally avulsed ATS fragment (type 111), was there a correlation between residual fracture displacement and knee laxity, which in turn was correlated to subjective knee function. A method to measure anterior knee laxity in rabbits was developed using a materials testing machine. The results of the subsequent experimental study on the influence of growth on knee laxity after healing of a displaced ATS fracture type Ill, support the theory that further growth may reduce the functional elongation of the ACL caused by the fracture

Poorer patient-reported outcome and increased risk of revision at a 5-year follow-up among patients with septic arthritis following anterior cruciate ligament reconstruction: a register-based cohort study of 23,075 primary anterior cruciate ligament reconstructions

PurposeThe primary aim of this study is to analyse the patient-reported outcomes after ACLR complicated by septic arthritis. The secondary aim is to examine the 5-year risk of revision surgery after primary ACLR complicated by septic arthritis. The hypothesis was that patients with septic arthritis after ACLR are more likely to have lower PROMs scores and an increased risk of revision, compared with patients without septic arthritis.Materials and methodsAll primary ACLRs, with a hamstring or patellar tendon autograft (n = 23,075), in the Swedish Knee Ligament Register (SKLR) between 2006 and 2013 were linked with data from the Swedish National Board of Health and Welfare to identify patients with postoperative septic arthritis. These patients were verified in a nationwide medical records analysis and compared with patients without infection in the SKLR. The patient-reported outcome was measured using the Knee injury and Osteoarthritis Index Score (KOOS) and the European Quality of Life Five Dimensions Index (EQ-5D) at 1, 2 and 5 years postoperatively and the 5-year risk of revision surgery was calculated.ResultsThere were 268 events of septic arthritis (1.2%). The mean scores on the KOOS and EQ-5D index were significantly lower for patients with septic arthritis on all subscales on all follow-up occasions compared with patients without septic arthritis. Patients with septic arthritis had a revision rate of 8.2% compared with 4.2% in patients without septic arthritis (adjusted hazard ratio 2.04; confidence interval 1.34-3.12).ConclusionPatients suffering from septic arthritis following ACLR are associated with poorer patient-reported outcomes at 1-, 2- and 5-year follow-ups compared with patients without septic arthritis. The risk of revision ACL reconstruction within 5 years of the primary operation for patients with septic arthritis following ACLR is almost twice as high, compared with patients without septic arthritis.Funding Agencies|Karolinska Institute</p

Pre- and postcontrast T1 and T2 mapping of patellar cartilage in young adults with recurrent patellar dislocation

PurposeTo examine the cartilage quality in young adults with recurrent patellar dislocation in childhood using different magnetic resonance imaging parameters. MethodsSixteen young adults with unilateral recurrent patellar dislocation were investigated 5 y (mean, 8.5 y) after the first dislocation. Pre- and postcontrast T1 and precontrast T2 relaxation times were analyzed in four superficial and four deep patellar cartilage regions of both knees. Two hours after intravenous injection of 0.2 mM/kg Gd-DTPA(2-), postcontrast T1 [T1(Gd)] and R1 [1/T1 (precontrast)-1/T1 (postcontrast)] were analyzed in the regions. Muscle performance and patient-reported outcome were evaluated. ResultsWhen comparing the injured side with the noninjured side, differences were seen in the superficial half but not the deep half of the cartilage. T1(Gd) was shorter in the central part, whereas T2 was shorter in the periphery of the patellar cartilage (P<0.05). R1 demonstrated similar differences between healthy and diseased cartilage as T1(Gd) alone. The knee function was not correlated to the degenerative changes. ConclusionThe short T1(Gd) centrally indicates degenerative cartilage changes consistent with loss of glycosaminoglycans. Precontrast and R1 calculations may be excluded in clinical dGEMRIC, which simplifies the procedure. A decrease in T2 may be a very early sign of joint pathology but warrants further investigation. Magn Reson Med 74:1363-1369, 2015. (c) 2014 Wiley Periodicals, Inc

T2 mapping and post-contrast T1 (dGEMRIC) of the patellar cartilage:12-year follow-up after patellar stabilizing surgery in childhood

Abstract Background: Cartilage degeneration has been reported after recurrent patellar dislocation. However, effects of surgical stabilization in childhood have not yet been described. Purpose: To examine the cartilage quality in very young adults operated with a patellar stabilizing procedure due to recurrent patellar dislocation in childhood, and evaluate if cartilage quality correlates with clinical parameters and patient-reported outcomes. Material and Methods: Seventeen patients were investigated ≥ 5 years (mean = 11.6 years) after patellar stabilizing surgery in childhood. Pre-contrast T2 relaxation times were analyzed in four superficial and four deep patellar cartilage regions of both knees. Two hours after 0.2 mM/kg Gd-DTPA² i.v., post-contrast T1 (T1(Gd)) was analyzed in the same regions. Patient-reported outcomes (KOOS, Kujala, and Tegner scores) and recurrence rates were evaluated. Results: Comparing operated to healthy side, neither T2 nor dGEMRIC differed between the operated and the reference knee regarding the superficial half of the cartilage. In the deep half of the cartilage, T1(Gd) was shorter in the central part of the cartilage, whereas T2 was longer medially (P &lt; 0.05). A low score in the KOOS subscales Symptom and Sports and Recreation, was correlated to the degenerative changes detected by T1(Gd) (r = 0.5, P = 0.041). Conclusion: In general, our findings demonstrate good cartilage quality 12 years after patellar stabilizing surgery during childhood. The subtle changes in T2 and T1(Gd) in the deep cartilage layer may be a result of altered biomechanics, although very early degenerative changes cannot be excluded. The short T1(Gd) centrally may reflect lower glycosaminoglycan content, whereas the increase in T2 medially indicates increased cartilage hydration