Session 14: Sports Medicine II
Fredag 28. oktober
9:00-10:30
Lokale: Reykjavik
Chairmen: Nis Nissen / Per Hölmich
Lotte Drustrup, Laura Fuglsang, Helene Rovsing, Cecilie Rovsing, Carsten Mølgaard, Sten Rasmussen
Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital
Background: Meniscal tears are the most frequent pathology under the auspices of the orthopedic department. As arthroscopic partial meniscectomy increase the risk of degenerative changes in the knee, the focus of meniscal preserving techniques has increased. Yet, Studies reveals that arthroscopic meniscal repair have an increased risk of reoperation compared to arthroscopic partial meniscectomy.
Purpose / Aim of Study: This study investigated whether environmental risk factors, including Body mass index, sex, age and American society of anesthesiology score influenced the one year postoperative risk of reoperation after arthroscopic meniscal repair.
Materials and Methods: In this cohort design patients receiving arthroscopic meniscal repair were retrospectively enrolled, by reviewing medical records through 2011 to 2013. All Patients, older than 18 years of age, with an isolated meniscal tear who underwent arthroscopic meniscal repair in this period were included. Exclusion criteria were: No meniscal lesion, previous knee surgery, or concurrent treatment of injuries in the knee joint including reconstruction of cruciate, collateral or patella femoral ligaments, osteotomy, or treatment of a tibia condyle fracture.
Findings / Results: In total 289 menisci were included. A high BMI increased the risk of reoperation with in the first year from primary operation. The incidence of reoperation increased from normal weight to obese. Sex and age and ASA-score did not have a significant influence on the risk of reoperation.
Conclusions: BMI influences the risk of reoperation indicating that BMI have to be taken into account in the attempt to lower the risk of reoperation in patients receiving an AMR. In addition, ASA-score, age and sex did not have a significant influence on the risk of reoperation.
Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital
Background: Meniscal tears are the most frequent pathology under the auspices of the orthopedic department. As arthroscopic partial meniscectomy increase the risk of degenerative changes in the knee, the focus of meniscal preserving techniques has increased. Yet, Studies reveals that arthroscopic meniscal repair have an increased risk of reoperation compared to arthroscopic partial meniscectomy.
Purpose / Aim of Study: This study investigated whether environmental risk factors, including Body mass index, sex, age and American society of anesthesiology score influenced the one year postoperative risk of reoperation after arthroscopic meniscal repair.
Materials and Methods: In this cohort design patients receiving arthroscopic meniscal repair were retrospectively enrolled, by reviewing medical records through 2011 to 2013. All Patients, older than 18 years of age, with an isolated meniscal tear who underwent arthroscopic meniscal repair in this period were included. Exclusion criteria were: No meniscal lesion, previous knee surgery, or concurrent treatment of injuries in the knee joint including reconstruction of cruciate, collateral or patella femoral ligaments, osteotomy, or treatment of a tibia condyle fracture.
Findings / Results: In total 289 menisci were included. A high BMI increased the risk of reoperation with in the first year from primary operation. The incidence of reoperation increased from normal weight to obese. Sex and age and ASA-score did not have a significant influence on the risk of reoperation.
Conclusions: BMI influences the risk of reoperation indicating that BMI have to be taken into account in the attempt to lower the risk of reoperation in patients receiving an AMR. In addition, ASA-score, age and sex did not have a significant influence on the risk of reoperation.
Lars Hansen, Sepp de Raedt, Bjarne Mygind-Klavsen, Peter Bo Jørgensen, Kjeld Søballe, Bart L. Kaptein, Maiken Stilling
Orthopedic Research Unit, Department of Clinical Medicine, Aarhus University Hospital; Research and development, Nordisk Røntgen Teknik, Hasselager; Department of Orthopedic Surgery, Aarhus University Hospital; Orthopedic Research Unit, Department of Clinical Medicine, Aarhus University Hospital; Department of Orthopaedic Surgery, Orthopedic Research Unit, Aarhus University Hospital; Department of Orthopaedics, Leiden University Medical Center; Orthopedic Research Unit, Department of Clinical Medicine, Aarhus University Hospital
Background: Dynamic RSA (dRSA) can track 3D in-vivo motion and describe hip joint kinematics. The method can be used to understand the clinical pathomechanics of femoroacetabular impingement (FAI) and the biomechanical effects of arthroscopic cheilectomy and –rim trimming (ACH).
Purpose / Aim of Study: To evaluate the kinematic changes in the hip joint after ACH.
Materials and Methods: Seven non-FAI affected human cadaveric hips were CT-scanned and CT-bone models were segmented. Tantalum marker beads were placed in the femur and pelvis. dRSA recordings of the hip joints were acquired at 5 fr/sec during flexion to 90°, adduction to stop and internal rotation to stop (FADIR). ACH was performed and dRSA was repeated. dRSA images were analyzed using model-based RSA (MBM) and compared to marker-based RSA (MM) as gold standard. Hip joint kinematics before and after ACH were compared pairwise.
Findings / Results: There was no systematic bias between model-based and marker-based RSA (p>0.05). 95% agreement limits were below ±0.44mm and ±0.9mm for translations, and below ±0.7° and ±0.58° for rotations in the femur and pelvis respectively. Mean hip internal rotation increased from 19.1° to 21.9° (p=0.04, Δ2.8°, CI:0.3°;5.3°) after ACH surgery. Mean adduction of 3.9° before and 2.7° after ACH surgery was unchanged (p=0.48, Δ-1.2° CI:-2.8°;5.2°). Mean flexion angles during dRSA tests were 82.4° before and 80.8° after ACH surgery which was similar (p=0.18, Δ-1.6°, CI:-4.1°; 0.9°).
Conclusions: A small increase in internal rotation, but not in adduction, was observed after arthroscopic cheilectomy and –rim trimming in cadaver hips. The hip flexion angle of the FADIR test was nicely reproduced at followup. dRSA kinematic analysis is a new and clinically applicable method for the hip joint and may have good potential for testing of FAI pathomechanics and surgical corrections.
Orthopedic Research Unit, Department of Clinical Medicine, Aarhus University Hospital; Research and development, Nordisk Røntgen Teknik, Hasselager; Department of Orthopedic Surgery, Aarhus University Hospital; Orthopedic Research Unit, Department of Clinical Medicine, Aarhus University Hospital; Department of Orthopaedic Surgery, Orthopedic Research Unit, Aarhus University Hospital; Department of Orthopaedics, Leiden University Medical Center; Orthopedic Research Unit, Department of Clinical Medicine, Aarhus University Hospital
Background: Dynamic RSA (dRSA) can track 3D in-vivo motion and describe hip joint kinematics. The method can be used to understand the clinical pathomechanics of femoroacetabular impingement (FAI) and the biomechanical effects of arthroscopic cheilectomy and –rim trimming (ACH).
Purpose / Aim of Study: To evaluate the kinematic changes in the hip joint after ACH.
Materials and Methods: Seven non-FAI affected human cadaveric hips were CT-scanned and CT-bone models were segmented. Tantalum marker beads were placed in the femur and pelvis. dRSA recordings of the hip joints were acquired at 5 fr/sec during flexion to 90°, adduction to stop and internal rotation to stop (FADIR). ACH was performed and dRSA was repeated. dRSA images were analyzed using model-based RSA (MBM) and compared to marker-based RSA (MM) as gold standard. Hip joint kinematics before and after ACH were compared pairwise.
Findings / Results: There was no systematic bias between model-based and marker-based RSA (p>0.05). 95% agreement limits were below ±0.44mm and ±0.9mm for translations, and below ±0.7° and ±0.58° for rotations in the femur and pelvis respectively. Mean hip internal rotation increased from 19.1° to 21.9° (p=0.04, Δ2.8°, CI:0.3°;5.3°) after ACH surgery. Mean adduction of 3.9° before and 2.7° after ACH surgery was unchanged (p=0.48, Δ-1.2° CI:-2.8°;5.2°). Mean flexion angles during dRSA tests were 82.4° before and 80.8° after ACH surgery which was similar (p=0.18, Δ-1.6°, CI:-4.1°; 0.9°).
Conclusions: A small increase in internal rotation, but not in adduction, was observed after arthroscopic cheilectomy and –rim trimming in cadaver hips. The hip flexion angle of the FADIR test was nicely reproduced at followup. dRSA kinematic analysis is a new and clinically applicable method for the hip joint and may have good potential for testing of FAI pathomechanics and surgical corrections.
Emilie Faunø, Ole Gade Sørensen, Claus Tvedesøe, Torsten Grønbæk Nielsen, Peter Faunø, Martin Lind
Department of Sports Traumatology, University Hospital of Aarhus; Department of Sports Traumatology, University Hospital of Aarhus; Department of Radiology, University Hospital of Aarhus; Department of Sports Traumatology, University Hospital of Aarhus; Department of Sports Traumatology, University Hospital of Aarhus; Department of Sports Traumatology, University Hospital of Aarhus
Background: Lack of healing after meniscus repair is seen in 25-30 % of patients. The role of magnetic resonance imaging (MRI) as a diagnostic tool in patients with clinical symptoms after meniscal repair, is not well described.
Purpose / Aim of Study: To compare the diagnostic value of MRI with second-look arthroscopy after meniscus repair in patients with clinical symptoms of an unhealed meniscus.
Materials and Methods: Eighty-two patients (34 women, 48 men, 83 menisci) with a mean age of 24.4 years were included. All patients had primary meniscus repair. MRI and second-look- arthroscopy were performed due to clinical symptoms of an unhealed meniscus. The MRIs were analysed for meniscal healing by a radiologist blinded for clinical data. Second-look arthroscopy recordings were equally examined and used as gold standard. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI regarding meniscal healing were calculated.
Findings / Results: MRI analysis found 22 (26.5 %) healed menisci and 61 (73.5%) unhealed, whereas second-look arthroscopy found 15 (18.1%) healed menisci and 68 (81.9%) unhealed menisci. Sensivity, specificity, PPV and NPV respectively were calculated for MRI overall: 0.85, 0.80, 0.95, 0.55 and the five most frequently used MRI sequences: sagittal STIR: 0.69, 0.75, 0.95, 0.30; sagittal pd: 0.29, 0.83, 0.89, 0.20; sagittal T2*: 0.33, 1.00, 1.00, 0.26; coronal T1: 0.26, 1.00, 1.00, 0.25; axial STIR: 0.15, 0.88, 0.88, 0.15.
Conclusions: MRI provides an acceptable sensitivity and PPV in diagnosing an unhealed meniscus after repair. Sagittal STIR has the highest sensivity and NPV, whereas sagittal T2* and coronal T1 have the highest PPV.
Department of Sports Traumatology, University Hospital of Aarhus; Department of Sports Traumatology, University Hospital of Aarhus; Department of Radiology, University Hospital of Aarhus; Department of Sports Traumatology, University Hospital of Aarhus; Department of Sports Traumatology, University Hospital of Aarhus; Department of Sports Traumatology, University Hospital of Aarhus
Background: Lack of healing after meniscus repair is seen in 25-30 % of patients. The role of magnetic resonance imaging (MRI) as a diagnostic tool in patients with clinical symptoms after meniscal repair, is not well described.
Purpose / Aim of Study: To compare the diagnostic value of MRI with second-look arthroscopy after meniscus repair in patients with clinical symptoms of an unhealed meniscus.
Materials and Methods: Eighty-two patients (34 women, 48 men, 83 menisci) with a mean age of 24.4 years were included. All patients had primary meniscus repair. MRI and second-look- arthroscopy were performed due to clinical symptoms of an unhealed meniscus. The MRIs were analysed for meniscal healing by a radiologist blinded for clinical data. Second-look arthroscopy recordings were equally examined and used as gold standard. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI regarding meniscal healing were calculated.
Findings / Results: MRI analysis found 22 (26.5 %) healed menisci and 61 (73.5%) unhealed, whereas second-look arthroscopy found 15 (18.1%) healed menisci and 68 (81.9%) unhealed menisci. Sensivity, specificity, PPV and NPV respectively were calculated for MRI overall: 0.85, 0.80, 0.95, 0.55 and the five most frequently used MRI sequences: sagittal STIR: 0.69, 0.75, 0.95, 0.30; sagittal pd: 0.29, 0.83, 0.89, 0.20; sagittal T2*: 0.33, 1.00, 1.00, 0.26; coronal T1: 0.26, 1.00, 1.00, 0.25; axial STIR: 0.15, 0.88, 0.88, 0.15.
Conclusions: MRI provides an acceptable sensitivity and PPV in diagnosing an unhealed meniscus after repair. Sagittal STIR has the highest sensivity and NPV, whereas sagittal T2* and coronal T1 have the highest PPV.
Signe Wisbech Vange
Dept. of Cellular and Molecular Medicine, The Panum Institute
Background: Sensory loss in the saphenous nerve domain occurs in up to 74% of patients undergoing ACL reconstruction using medial hamstring autografts. It is well described that the nerve can be damaged during incision. The risk of proximal nerve injury during tendon stripping has received less attention.
Purpose / Aim of Study: The purpose was to examine where the saphenous nerve is at risk during gracilis tendon harvesting. Semitendinosus tendon harvesting was not a focus due to the tendon`s distance from the saphenous nerve.
Materials and Methods: In 17 cadaver limbs donated to the University of Copenhagen the gracilis tendon was harvested according to standard routine. The limbs were then carefully dissected exposing the saphenous nerve and its branches to identify any injuries.
Findings / Results: Dissections revealed a fascia separating the nerve from the gracilis tendon. Lesions in the fascia were detected proximally to the incision in 7 cases (41 %). Nerve injuries in relation to these lesions were observed in 5 cases (29 %). All were partial injuries on the main stem of the saphenous nerve located superficially to the fascia, at the posterior border of the sartorius. Partial or complete incisional injuries to the infrapatellar or medial cutaneous branches were observed in 13 cases (76 %).
Conclusions: The saphenous nerve is at risk in the incision area, but also in an area proximally to the incision. The location of the proximal injuries suggests they occurred during stripping of the tendon, and that they were caused either by the Metzenbaum scissor used to release vinculae of the tendon or by the stripper. We hypothesize that the Metzenbaum scissor is most likely to have caused the observed injuries, and that blunt release of vinculae might lower the risk of nerve injury.
Dept. of Cellular and Molecular Medicine, The Panum Institute
Background: Sensory loss in the saphenous nerve domain occurs in up to 74% of patients undergoing ACL reconstruction using medial hamstring autografts. It is well described that the nerve can be damaged during incision. The risk of proximal nerve injury during tendon stripping has received less attention.
Purpose / Aim of Study: The purpose was to examine where the saphenous nerve is at risk during gracilis tendon harvesting. Semitendinosus tendon harvesting was not a focus due to the tendon`s distance from the saphenous nerve.
Materials and Methods: In 17 cadaver limbs donated to the University of Copenhagen the gracilis tendon was harvested according to standard routine. The limbs were then carefully dissected exposing the saphenous nerve and its branches to identify any injuries.
Findings / Results: Dissections revealed a fascia separating the nerve from the gracilis tendon. Lesions in the fascia were detected proximally to the incision in 7 cases (41 %). Nerve injuries in relation to these lesions were observed in 5 cases (29 %). All were partial injuries on the main stem of the saphenous nerve located superficially to the fascia, at the posterior border of the sartorius. Partial or complete incisional injuries to the infrapatellar or medial cutaneous branches were observed in 13 cases (76 %).
Conclusions: The saphenous nerve is at risk in the incision area, but also in an area proximally to the incision. The location of the proximal injuries suggests they occurred during stripping of the tendon, and that they were caused either by the Metzenbaum scissor used to release vinculae of the tendon or by the stripper. We hypothesize that the Metzenbaum scissor is most likely to have caused the observed injuries, and that blunt release of vinculae might lower the risk of nerve injury.
Steffen Sauer, Martin Lind
Sportstraumatology, Aarhus University Hospital; Sportstraumatology, Aarhus University Hospital
Background: Bone tunnel enlargement is a well- established phenomenon following ACL reconstruction. Tunnel enlargement is related to soft tissue grafts, suspension fixation devices and resorbable implants. Severe tunnel widening can lead to reconstruction failure. The correlation between bone tunnel enlargement following ACL reconstruction and original bone tunnel diameter has not been elucidated.
Purpose / Aim of Study: The purpose of the present study was to determine whether bone tunnel enlargement after ACL reconstruction with hamstring autograft is dependent on original tunnel diameter established during primary ACL reconstruction.
Materials and Methods: A retrospective review was conducted on 52 patients scheduled for ACL revision surgery who had CT scanning performed as part of their preoperative evaluation. All patients had previous hamstring ACL reconstruction. Patients were divided into three groups according to the original femoral and tibial bone tunnel diameter created during primary ACL reconstruction. Femoral and tibial bone tunnel enlargement was assessed on CT serial sections. Mean values were calculated and analysis of the correlation between original tunnel diameter and bone tunnel enlargement was investigated.
Findings / Results: Mean tibial bone tunnel enlargement is significantly more distinct in original 6-7 mm bone tunnels (+2.07 mm 1,03) compared to original 8,5-9 mm bone tunnels (+0,85 mm 1,03; p=.001).
Conclusions: The results of this study indicate that bone tunnel enlargement following ACL reconstruction is dependent on original bone tunnel diameter with smaller diameter tunnels developing more tunnel enlargement than larger tunnels. The contributing factors remain unclear and need to be further investigated.
Sportstraumatology, Aarhus University Hospital; Sportstraumatology, Aarhus University Hospital
Background: Bone tunnel enlargement is a well- established phenomenon following ACL reconstruction. Tunnel enlargement is related to soft tissue grafts, suspension fixation devices and resorbable implants. Severe tunnel widening can lead to reconstruction failure. The correlation between bone tunnel enlargement following ACL reconstruction and original bone tunnel diameter has not been elucidated.
Purpose / Aim of Study: The purpose of the present study was to determine whether bone tunnel enlargement after ACL reconstruction with hamstring autograft is dependent on original tunnel diameter established during primary ACL reconstruction.
Materials and Methods: A retrospective review was conducted on 52 patients scheduled for ACL revision surgery who had CT scanning performed as part of their preoperative evaluation. All patients had previous hamstring ACL reconstruction. Patients were divided into three groups according to the original femoral and tibial bone tunnel diameter created during primary ACL reconstruction. Femoral and tibial bone tunnel enlargement was assessed on CT serial sections. Mean values were calculated and analysis of the correlation between original tunnel diameter and bone tunnel enlargement was investigated.
Findings / Results: Mean tibial bone tunnel enlargement is significantly more distinct in original 6-7 mm bone tunnels (+2.07 mm 1,03) compared to original 8,5-9 mm bone tunnels (+0,85 mm 1,03; p=.001).
Conclusions: The results of this study indicate that bone tunnel enlargement following ACL reconstruction is dependent on original bone tunnel diameter with smaller diameter tunnels developing more tunnel enlargement than larger tunnels. The contributing factors remain unclear and need to be further investigated.
Emil T. Nielsen, Michael S. Andersen, Ole G.Sørensen, Sepp de Raedt, Maiken Stilling
Orthopedic Research Department, Aarhus University Hospital; Department of Mechanical Engineering and Manufacturing, Aalborg University; Department of Sportstraumatology, Aarhus University Hospital; , Nordisk Røntgen Teknik; Department of Clinical Medicine, University of Aarhus
Background: Anterior cruciate ligament (ACL) injury may be complicated with extrinsic ligament injury such as injury to the anterolateral ligament (ALL), which may increase rotational instability. The pivot-shift (PS) test dynamically reproduces knee rotational instability, and positive tests correlate with patients’ subjective experience of knee stability, reduced sports activity, and risk of early gonarthritis. However, the PS grading is poorly repeatable between clinicians.
Purpose / Aim of Study: To develop an objective grading system for the PS test that screened for human errors.
Materials and Methods: One examiner graded PS tests performed on eight cadavers exposed to five successive ligament situations: intact, ACL lesion, ACL+ALL lesion, ACL reconstruction, and ACL+ALL reconstruction. Tibial kinematics were assessed using an inertial measurement unit (IMU) and dynamic radiostereometry (dRSA) to evaluate the accuracy of the IMU. An automatic screening algorithm using IMU-features approved 95 PS tests (training: n=76, evaluation: n=19). Based on IMU-features, four different artificial neural networks (ANNs) were developed and trained to grade individual PS tests using the clinical grades (0,1,2,3) given by the examiner as a gold standard.
Findings / Results: The RMSE comparison of the IMU and dRSA showed no difference (p>0.61) between rejected (n=18) and approved (n=14) PS tests. The automatic screening algorithm correctly categorized 97% of these 32 PS tests. The two ANNs that used a combined-average strategy had the best accuracy of 84% for grading the 19 PS tests.
Conclusions: ANNs have a great potential for objective individual grading of PS tests, and further it is a low-cost and user-friendly method. Following ongoing in-vivo testing and calibration, it may be used for clinical individual rotation instability grading in patients with knee injuries.
Orthopedic Research Department, Aarhus University Hospital; Department of Mechanical Engineering and Manufacturing, Aalborg University; Department of Sportstraumatology, Aarhus University Hospital; , Nordisk Røntgen Teknik; Department of Clinical Medicine, University of Aarhus
Background: Anterior cruciate ligament (ACL) injury may be complicated with extrinsic ligament injury such as injury to the anterolateral ligament (ALL), which may increase rotational instability. The pivot-shift (PS) test dynamically reproduces knee rotational instability, and positive tests correlate with patients’ subjective experience of knee stability, reduced sports activity, and risk of early gonarthritis. However, the PS grading is poorly repeatable between clinicians.
Purpose / Aim of Study: To develop an objective grading system for the PS test that screened for human errors.
Materials and Methods: One examiner graded PS tests performed on eight cadavers exposed to five successive ligament situations: intact, ACL lesion, ACL+ALL lesion, ACL reconstruction, and ACL+ALL reconstruction. Tibial kinematics were assessed using an inertial measurement unit (IMU) and dynamic radiostereometry (dRSA) to evaluate the accuracy of the IMU. An automatic screening algorithm using IMU-features approved 95 PS tests (training: n=76, evaluation: n=19). Based on IMU-features, four different artificial neural networks (ANNs) were developed and trained to grade individual PS tests using the clinical grades (0,1,2,3) given by the examiner as a gold standard.
Findings / Results: The RMSE comparison of the IMU and dRSA showed no difference (p>0.61) between rejected (n=18) and approved (n=14) PS tests. The automatic screening algorithm correctly categorized 97% of these 32 PS tests. The two ANNs that used a combined-average strategy had the best accuracy of 84% for grading the 19 PS tests.
Conclusions: ANNs have a great potential for objective individual grading of PS tests, and further it is a low-cost and user-friendly method. Following ongoing in-vivo testing and calibration, it may be used for clinical individual rotation instability grading in patients with knee injuries.
Helene Rovsing, Cecilie Rovsing, Laura Drustrup, Carsten Mølgaard, Sten Rasmussen
Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg university Hospital
Background: Previous studies have observed a correlation between arthroscopic meniscectomy (APM) and accelerated progression on osteoarthritis, as well as limited benefits of APM compared to arthroscopic meniscal repair (AMR) and physiotherapy. Thus, the incitement for choosing APM as treatment for meniscal lesions is questionable.
Purpose / Aim of Study: To identify the distribution of AMR and APM over a 3-year period. In addition, the association between surgical procedure and the following factors was investigated: age, gender, and traumatic or degenerative lesion.
Materials and Methods: In this Cohort Study medical records of patients who had an APM or an AMR between 2011 and 2013 were evaluated retrospectively. The total number of medical records was 1938 (56.1% men and 43.9% women). Age ranged from 18 to 88 years, mean age 48.6 ± 15.5. The following indicators were extracted from the medical records: age, gender, and whether the lesion was traumatic or degenerative.
Findings / Results: The incidence of AMRs has increased every year from 11.2% in 2011 to 18.1% in 2013. The mean age within the AMR group was 30.3 ± 10.4 and 51.8 ± 13.9 years within the APM group. Both groups were male- dominant, however, the proportion of men were higher in the AMR group compared to the APM group. The majority of the lesions in the AMR group was traumatic (66.7%), whereas the majority of the lesions in the APM group was degenerative (65.5%).
Conclusions: APM is the most dominant surgical approach to meniscal lesions, but the number of AMRs seems to increase every year. However, it remains unclear exactly how certain meniscal lesions should be treated in terms of harms and functional outcome. In conclusion, the long-term outcome and predictors to the outcome need to be evaluated further.
Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg University Hospital; Orthopaedic Surgery, Aalborg university Hospital
Background: Previous studies have observed a correlation between arthroscopic meniscectomy (APM) and accelerated progression on osteoarthritis, as well as limited benefits of APM compared to arthroscopic meniscal repair (AMR) and physiotherapy. Thus, the incitement for choosing APM as treatment for meniscal lesions is questionable.
Purpose / Aim of Study: To identify the distribution of AMR and APM over a 3-year period. In addition, the association between surgical procedure and the following factors was investigated: age, gender, and traumatic or degenerative lesion.
Materials and Methods: In this Cohort Study medical records of patients who had an APM or an AMR between 2011 and 2013 were evaluated retrospectively. The total number of medical records was 1938 (56.1% men and 43.9% women). Age ranged from 18 to 88 years, mean age 48.6 ± 15.5. The following indicators were extracted from the medical records: age, gender, and whether the lesion was traumatic or degenerative.
Findings / Results: The incidence of AMRs has increased every year from 11.2% in 2011 to 18.1% in 2013. The mean age within the AMR group was 30.3 ± 10.4 and 51.8 ± 13.9 years within the APM group. Both groups were male- dominant, however, the proportion of men were higher in the AMR group compared to the APM group. The majority of the lesions in the AMR group was traumatic (66.7%), whereas the majority of the lesions in the APM group was degenerative (65.5%).
Conclusions: APM is the most dominant surgical approach to meniscal lesions, but the number of AMRs seems to increase every year. However, it remains unclear exactly how certain meniscal lesions should be treated in terms of harms and functional outcome. In conclusion, the long-term outcome and predictors to the outcome need to be evaluated further.
Christian Dippmann, Torsten Warming, Line Dahl
Section for Sports Traumatology M51, Department of Orthopedic Surgery , Bispebjerg Hospital, Denmark
Background: The amount of patients referred with longstanding, non-arthritic hip pain is increasing. Hip arthroscopy (HA) can be considered the gold standard in treating intraarticular pathologies of the hip not related to hip dysplasia, acetabular retroversion or osteoarthritis.
Purpose / Aim of Study: In this prospective, cohort study all patients undergoing HA with labral rapair were followed 3 and 12 months after surgery. The purpose of this study was to document the clinical outcome using a standardized clinical algorithm for patient selection
Materials and Methods: From January 2014 to July 2015 39 consecutive patients (19 males, 20 females), average age 35yr (m) and 37yr (f) underwent HA with labral repair. Contraindication for HA was osteoarthritis, hip dysplasia and total acetabular retroversion. The patients were followed prospectively filling out the Copenhagen hip and groin score (HAGOS) with its 6 subdomains symptoms, pain, function in daily living (ADL), function in sport and recreation (Sports/Rec), participation in physical activities (PA) and hip and/or groin- related quality of life (QOL). pre- operatively and again 3 and 12 months after surgery. The data was analyzed in SPSS using paired t-test.
Findings / Results: Both 3 and 12 months after HA with labral repair clinically and statistically significant improvements could be seen in all subdomains of the HAGOS, compared with the preoperative baseline.
Conclusions: Using a standardized clinical algorithm for patient selection we could show significant improvement after hip arthroscopy with labral repair both 3 and 12 months after surgery.
Section for Sports Traumatology M51, Department of Orthopedic Surgery , Bispebjerg Hospital, Denmark
Background: The amount of patients referred with longstanding, non-arthritic hip pain is increasing. Hip arthroscopy (HA) can be considered the gold standard in treating intraarticular pathologies of the hip not related to hip dysplasia, acetabular retroversion or osteoarthritis.
Purpose / Aim of Study: In this prospective, cohort study all patients undergoing HA with labral rapair were followed 3 and 12 months after surgery. The purpose of this study was to document the clinical outcome using a standardized clinical algorithm for patient selection
Materials and Methods: From January 2014 to July 2015 39 consecutive patients (19 males, 20 females), average age 35yr (m) and 37yr (f) underwent HA with labral repair. Contraindication for HA was osteoarthritis, hip dysplasia and total acetabular retroversion. The patients were followed prospectively filling out the Copenhagen hip and groin score (HAGOS) with its 6 subdomains symptoms, pain, function in daily living (ADL), function in sport and recreation (Sports/Rec), participation in physical activities (PA) and hip and/or groin- related quality of life (QOL). pre- operatively and again 3 and 12 months after surgery. The data was analyzed in SPSS using paired t-test.
Findings / Results: Both 3 and 12 months after HA with labral repair clinically and statistically significant improvements could be seen in all subdomains of the HAGOS, compared with the preoperative baseline.
Conclusions: Using a standardized clinical algorithm for patient selection we could show significant improvement after hip arthroscopy with labral repair both 3 and 12 months after surgery.
Jonathan Comins, Michael Krogsgaard, Svend Kreiner, John Brodersen
Department of Rheumatology , Copenhagen University, Institute of Public Health /University Hospital Zeeland; Copenhagen University Hospital Bispebjerg; Copenhagen University, Institute of Public Health; Copenhagen University, Institute of Public Health
Background: Patient-Reported Outcome Measures (PROMs) in the form of clinical questionnaires have become a fundamental component of healthcare assessment today. Also in the realm of sports medicine and orthopedics, clinicians and researchers besiege their patients with PROMs, only to be burdened with the extensive administration and interpretation of these measures. From a clinical standpoint, PROMs are important because they measure health from the perspective of the patient. However, in order to understand how a sum score (a number), which has been derived from the responses to a group of questions can be considered a measure of anything, it is necessary to consider the basic principles of what measurement in fact is. Clinicians and clinical researchers using PROMs need to have a basic understanding of the purpose and application of PROMs as measurement scales.
Purpose / Aim of Study: The objective of this paper is to illustrate how Rasch Item Response Theory (IRT) is the most appropriate method for constructing and validating PROMs.
Materials and Methods: We present an in-depth description of how questions that are confirmed to be relevant and comprehensive for the targeted patient group should be generated, and we show how the Rasch model is used to confirm statistically the measurement/scaling properties of these questions.
Findings / Results: Rasch IRT is the only statistical method used to validate PROMs, which satisfies the fundamental mathematical constraints of measurement.
Conclusions: If we are to use instruments to measure non-physical attributes such as pain, self perceived function, or psychosocial consequences as primary outcome measures in comparative studies, then the validation methods must be as stringent as possible and should include Rasch IRT analyses.
Department of Rheumatology , Copenhagen University, Institute of Public Health /University Hospital Zeeland; Copenhagen University Hospital Bispebjerg; Copenhagen University, Institute of Public Health; Copenhagen University, Institute of Public Health
Background: Patient-Reported Outcome Measures (PROMs) in the form of clinical questionnaires have become a fundamental component of healthcare assessment today. Also in the realm of sports medicine and orthopedics, clinicians and researchers besiege their patients with PROMs, only to be burdened with the extensive administration and interpretation of these measures. From a clinical standpoint, PROMs are important because they measure health from the perspective of the patient. However, in order to understand how a sum score (a number), which has been derived from the responses to a group of questions can be considered a measure of anything, it is necessary to consider the basic principles of what measurement in fact is. Clinicians and clinical researchers using PROMs need to have a basic understanding of the purpose and application of PROMs as measurement scales.
Purpose / Aim of Study: The objective of this paper is to illustrate how Rasch Item Response Theory (IRT) is the most appropriate method for constructing and validating PROMs.
Materials and Methods: We present an in-depth description of how questions that are confirmed to be relevant and comprehensive for the targeted patient group should be generated, and we show how the Rasch model is used to confirm statistically the measurement/scaling properties of these questions.
Findings / Results: Rasch IRT is the only statistical method used to validate PROMs, which satisfies the fundamental mathematical constraints of measurement.
Conclusions: If we are to use instruments to measure non-physical attributes such as pain, self perceived function, or psychosocial consequences as primary outcome measures in comparative studies, then the validation methods must be as stringent as possible and should include Rasch IRT analyses.
Mathias Paiva, Lars Blønd, Per Hölmich, Robert N. Steensen, Gerd Diederichs, Julian A Feller, Kristoffer Weisskirchner Barfod
Sports Orthopedic Research Center Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre; Zealand University Hospital, Køge and Aleris-Hamlet Parken; Sports Orthopaedic Research Center Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Orthopedic Surgery Residency, Mount Carmel Health System, Columbus, Ohio; Department of Radiology, Charite – Universitaetsmedizin Berlin, Campus Charite Mitte, Berlin, Germany; OrthoSport Victoria Research Unit, Epworth Healthcare and Deakin University, Melbourne, Australia; Sports Orthopedic Research Center Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre
Background: A large number of measurements describing trochlear dysplasia have been proposed in the literature.
Purpose / Aim of Study: To make a systematic review with quality assessments of the known measurements used to describe trochlear dysplasia.
Materials and Methods: A systematic literature search was conducted in the databases PubMed and Embase using the search string “trochlea dysplasia OR trochlear dysplasia”. Papers were screened for their relevance based on predefined parameters and all measurements showing a statistical association between trochlear dysplasia and patellar instability were presented. Four experts evaluated the quality of the measures using a purpose-made quality scale.
Findings / Results: The search generated 484 papers of which seven were chosen for review. 33 unique measurements were identified and described in order of their date of publication. The lateral trochlear inclination was rated highest by the expert panel. The crossing sign, the trochlear bump, the TT-TG distance, the trochlear depth and the ventral trochlear prominence also had high ratings.
Conclusions: The lateral trochlear inclination was rated highest by the expert panel and is recommended for use in assessment of trochlear dysplasia. The crossing sign, the trochlear bump, the TT-TG, the trochlear depth and the ventral trochlear prominence were also rated well and can be recommended for use. Due to the small size of the expert panel further research and evaluation is warranted.
Sports Orthopedic Research Center Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre; Zealand University Hospital, Køge and Aleris-Hamlet Parken; Sports Orthopaedic Research Center Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre; Orthopedic Surgery Residency, Mount Carmel Health System, Columbus, Ohio; Department of Radiology, Charite – Universitaetsmedizin Berlin, Campus Charite Mitte, Berlin, Germany; OrthoSport Victoria Research Unit, Epworth Healthcare and Deakin University, Melbourne, Australia; Sports Orthopedic Research Center Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre
Background: A large number of measurements describing trochlear dysplasia have been proposed in the literature.
Purpose / Aim of Study: To make a systematic review with quality assessments of the known measurements used to describe trochlear dysplasia.
Materials and Methods: A systematic literature search was conducted in the databases PubMed and Embase using the search string “trochlea dysplasia OR trochlear dysplasia”. Papers were screened for their relevance based on predefined parameters and all measurements showing a statistical association between trochlear dysplasia and patellar instability were presented. Four experts evaluated the quality of the measures using a purpose-made quality scale.
Findings / Results: The search generated 484 papers of which seven were chosen for review. 33 unique measurements were identified and described in order of their date of publication. The lateral trochlear inclination was rated highest by the expert panel. The crossing sign, the trochlear bump, the TT-TG distance, the trochlear depth and the ventral trochlear prominence also had high ratings.
Conclusions: The lateral trochlear inclination was rated highest by the expert panel and is recommended for use in assessment of trochlear dysplasia. The crossing sign, the trochlear bump, the TT-TG, the trochlear depth and the ventral trochlear prominence were also rated well and can be recommended for use. Due to the small size of the expert panel further research and evaluation is warranted.
Kasper Staghøj Sinding, Torsten Grønbech Nielsen, Ulrik Dalgas, Martin Lind
Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Public Health, Section of Sport Science, Aarhus University; Department of Orthopaedic Surgery, Aarhus University Hospital
Background: Muscle strength asymmetry of the knee extensors (KE) and flexors (KF) is seen after anterior cruciate ligament (ACL) reconstruction, which may affect physical performance and risk of re-injury. The effect of different autografts (i.e. quadriceps-autograft (QTB) vs. semitendinosus-gracilis autograft (StG)) on thigh muscle strength symmetry is unclear.
Purpose / Aim of Study: To compare muscle strength symmetry of the KE and KF in patients following ACL reconstruction with either QTB or StG.
Materials and Methods: 49 ACL patients were included and randomized to either StG (n=20) or QTB (n=29) reconstruction. Muscle strength testing was performed one year postoperative to determine maximum voluntary contraction of the KE and KF of both legs using isokinetic dynamometry. Isometric testing was performed at knee angels of 70 and 20 degrees knee flexion for KE and KF, respectively. Isokinetic testing was done at 60 and 180 degrees/s for concentric contractions, and 60 degrees/s for eccentric contractions. Deficits are expressed as limb symmetry index (LSI; operated leg/contralateral leg).
Findings / Results: Both StG- and QTB showed significant (p<0.05) strength deficits in KE (LSI 0.82-0.93 and LSI 0.71-0,84, respectively). For StG a significant deficit was seen for KF (LSI 0,83-0,87), while QTB only had strength deficits for eccentric KF (LSI 0.92). A group comparison showed that QTB had significantly lower LSI for all KE outcomes except eccentric KE, while StG had significantly lower LSI for concentric KF.
Conclusions: The StG-group showed muscle strength deficits in both KE and KF, whereas the QTB-group showed deficits in all KE but a deficit only in the eccentric muscle strength of the KF. Comparing LSI between grafttypes QTB had overall lower KE LSI and higher KF LSI than StG.
Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Public Health, Section of Sport Science, Aarhus University; Department of Orthopaedic Surgery, Aarhus University Hospital
Background: Muscle strength asymmetry of the knee extensors (KE) and flexors (KF) is seen after anterior cruciate ligament (ACL) reconstruction, which may affect physical performance and risk of re-injury. The effect of different autografts (i.e. quadriceps-autograft (QTB) vs. semitendinosus-gracilis autograft (StG)) on thigh muscle strength symmetry is unclear.
Purpose / Aim of Study: To compare muscle strength symmetry of the KE and KF in patients following ACL reconstruction with either QTB or StG.
Materials and Methods: 49 ACL patients were included and randomized to either StG (n=20) or QTB (n=29) reconstruction. Muscle strength testing was performed one year postoperative to determine maximum voluntary contraction of the KE and KF of both legs using isokinetic dynamometry. Isometric testing was performed at knee angels of 70 and 20 degrees knee flexion for KE and KF, respectively. Isokinetic testing was done at 60 and 180 degrees/s for concentric contractions, and 60 degrees/s for eccentric contractions. Deficits are expressed as limb symmetry index (LSI; operated leg/contralateral leg).
Findings / Results: Both StG- and QTB showed significant (p<0.05) strength deficits in KE (LSI 0.82-0.93 and LSI 0.71-0,84, respectively). For StG a significant deficit was seen for KF (LSI 0,83-0,87), while QTB only had strength deficits for eccentric KF (LSI 0.92). A group comparison showed that QTB had significantly lower LSI for all KE outcomes except eccentric KE, while StG had significantly lower LSI for concentric KF.
Conclusions: The StG-group showed muscle strength deficits in both KE and KF, whereas the QTB-group showed deficits in all KE but a deficit only in the eccentric muscle strength of the KF. Comparing LSI between grafttypes QTB had overall lower KE LSI and higher KF LSI than StG.