35 research outputs found
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
Menisk- och korsbandsskador
The treatment of meniscus tears and anterior cruciate ligament (ACL) injuries are mainly considered as symptomatic. Meniscus tears can be divided into traumatic and degenerative tears, with different outcomes. A displaced meniscus with a locked knee constitutes an acute indication for arthroscopic surgery. A degenerative tear with mechanical symptoms also represents an indication for surgery. The main principle for treating an acute ACL injury is non-surgical treatment with a well-controlled muscular rehabilitation program for 3-4 months. If symptomatic instability remains, ACL reconstruction is considered. In highly active patients and also if there is a repairable associated meniscus tear, a subacute ACL reconstruction is recommended. Both meniscus tears and ACL injuries increase the risk of developing early osteoarthritis. Surgical procedures such as meniscus fixation or ACL reconstruction have not been shown to reduce the risk of osteoarthritis. Thus, prevention of osteoarthritis does not constitute an indication for surgical treatment of these injuries
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
Increased occurrence of ACL injuries for football players in teams changing coach and for players going to a higher division
Purpose To identify football-specific factors associated with ACL injuries that can be targeted for sport-specific injury prevention. Methods A study-specific questionnaire was developed to study the characteristics of ACL injuries in football including intrinsic, extrinsic, and injury specific factors. The questionnaire was available at the Swedish national knee ligament registry's website for the football players to voluntarily fill out. Data are presented on group level for all football players in total and for females and males separate to examine gender-specific differences. The results are based on answers collected over a 3-year period from 2875 football players, 1762 (61%) males and 1113 (39%) females. Results ACL were more frequently sustained during games 66% than during practices 25%. The injury mechanism was non-contact in 59% and contact in 41%. For the contact injuries during games, no action was taken by the referee in 63% of the situation and a red card was shown in 0.5%. The risk of ACL injury was highest early in the football game with 47% sustained during the first 30 min and 24% in the first 15 min. Players changing to a higher level of play 15% had a higher rate of ACL injuries than players changing to a lower level 8%. This difference was especially seen in female football players with 20% of ACL injuries being sustained by players going to a higher division compared to 7% for those going to a lower division. 15% of the male and 21% of the female ACL injuries occurred in teams with a coach change during the season. Knee control exercises to warm up was used by 31% of the female players and 16% of the males. 40% of the players reported that they did not plan on returning to football. Conclusion Neuromuscular training programs have proven to reduce ACL injuries, but greater adherence to these remains a challenge as only 1 in 5 of the ACL-injured football players report using them. Teams changing coach and players going to a higher division appear to have an increased risk of ACL injury warranting attention and further investigations
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
Gender differences in patient-reported outcomes after ACL reconstruction – Data from the Swedish knee ligament Register
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 (&gt; 28 ACLRs/year) surgeons (68.1%), surgeons with a caseload of &gt;= 50 ACLRs (85.1%) and surgeons with the ability to use &gt;= two autograft types (85.9%) (all p &lt; 0.001). Most patients underwent ACLR at high-volume (&gt; 55 ACLRs/year) clinics (72.2%) and at clinics capable of using &gt;= two autograft types (93.1%) (both p &lt; 0.001). Significantly increased odds of receiving PT/QT autografts were found for ACLR by surgeons with a caseload of &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