Session 3: Sports Orthopaedics / Shoulder
Onsdag den 24. oktober
11:00 – 12:00
Lokale: Helsinki/Oslo
Chairmen: Kristoffer Barfod og Klaus Bak
19. Endoscopic fasciotomy is a good and safe primary treatment for plantar fasciitis: A randomized controlled trial.
Finn Johannsen, Lars Konradsen, Robert Herzog, Michael Krogsgaard
Institute of sportsmedicine Copenhagen, Ortopæd kirurgisk afdeling, Bispebjerg Hospital; idrætskirurgisk enhed, ortopæd kirurgisk afdeling, Bispebjerg Hospital; fysioterapien, Bispebjerg Hospital; idrætskirurgisk enhed, Ortopæd kirurgisk afdeling, Bispebjerg Hospital
Background: Plantar fasciitis (PF) is a frequently
diagnosed condition. Lifetime incidence
10%. Operation is normally only
considered in PF that is refractory for non-
surgical treatment.
Purpose / Aim of Study: Is operation useful as primary treatment in
PF.
Materials and Methods: 30 consecutive patients with PF for
more than 3 months were randomized
to 1) conservative treatment with
training and glucocorticoid injection; 2)
endoscopic 2-incision technique of
partial fasciotomy and heel spur
removal. Patients were evaluated at
entry, 3,6,12,24 months with the Foot
Function Index (FFI, range 0-230) and
pain during activity on a 100 mm VAS
score (VAS-activity). FFI at 6 and 12
months were defined a-priory as
primary endpoints.
Findings / Results: We found no intergroup difference at
baseline, 3 and 6 months. Endoscopic
operation were significantly better for
the primary endpoints at 12 months in
FFI (p=0.033) compared to non-
surgical treatment, and at 24 months
there were still a strong tendency in
favor of operation in FFI (p=0.06).
VAS-activity were without intergroup
differences at 12 month, but at 24
months we found a significant
intergroup difference (p=0.001) in favor
of operation. Both groups improved
significantly over time. From entry to 3
months, 6 months, 12 months and 24
months mean FFI in the surgery group
was 107, 67, 25, 16 and 4 and mean
VAS pain during function was 50, 31,
11, 10 and 1. For the non-surgery
group mean FFI changed from 118 to
48, 32, 33 and 9, and mean VAS pain
during function changed from 67 to 44,
24, 10 and 13. No severe
complications were observed.
Conclusions: We found a beneficial effect in the long
term (1 and 2 years) of operation for
plantar fasciitis compared to best
conservative practice in a randomized
controlled trial. Endoscopic fasciotomy is a
good and safe alternative as primary
treatment for plantar fasciitis.
20. Sterno-clavicular arthroscopy – technique and experience with 57 procedures.
Michael Rindom Krogsgaard, Martin Rathcke
Section for sportstraumatology M51, Bispebjerg and Frederiksberg Hospital; Section for sportstraumatology M51, Bispebjerg and Frederiksberg Hospital
Background: There are only few, small treatment
series on arthroscopic treatment of the
sternoclavicular joint (SCJ) in
literature. This procedure may provide
better visualization of the joint and
have lower morbidity than open
procedures.
Purpose / Aim of Study: To report the technique of SCJ-
arthroscopy and experience from a
prospective, consecutive series of
patients.
Materials and Methods: We established an operative technique
on cadavers, and treated 57 patients
with unilateral painful conditions by
SCJ arthroscopy. DASH and Oxford
Shoulder Score (OSS) were filled in
before the operation and at 1, 2 and 5
years. Findings and complications
were recorded.
Findings / Results: In 10 cases it was not possible to
insert the scope: 2 joints were
anchylotic, in 1 the subcutaneous fat
was extensive, and in 7 osteophytes
blocked. The majority had discus
resection and cartilage
debridement/medial clavicle end
resection. In 2 the disc was sutured
and in 2 loose bodies were removed.
There were no infections or bleedings
and no case of penetration of the
posterior capsule. In one case
instability occurred after resection of
osteophytes and in another an
interposition plasty with a gracilis
tendon was performed for persisting
pain despite resection of the medial
clavicle end.
DASH was median 53 (range 30-94)
preoperatively, 38.5 (25-108) (p<0.05)
at 1 year and 37 (24-102) at 2 years.
Worst pain item from OSS was mean
2,6 preoperatively, 1,9 at 1 year
(p<0.05) and 1,7 at 2 years. Usual pain-
item was 2,15 preoperatively, 1,4 at 1
year (p < 0.05) and 1,1 at 2 years. Pain
at night was 2,4 preoperatively, 1,3 at
1 year (p<0,05) and 1,4 at 2 years.
Conclusions: SCJ arthroscopy is safe and clinical
results are comparable to or better
than after similar open procedures.
Patients should be prepared for
conversion to open surgery, if
osteophytes block the way.
21. Restoration of knee laxity in combined ACL plus ALL deficiency -Comparison of Intra-articular Hamstrings Tendons Graft versus the Modified intra- and extra-articular Iliotibial Tract Graft: A Cadaveric Study
Salamah Belal Eljaja, Lars Konradsen, Volkert Siersma, Kiron Athwal, Andre Arthur Amis, Michael Rindom Krogsgaard
Section of Sports Traumatology M51, Bispebjerg Hospital; Section of Sports Traumatology M51, Bispebjerg Hospital; Dep. of Public Health, University of Copenhagen; Dep. of Biomechanical Engineering, Imperial College London; Dep. of Biomechanical Engineering, Imperial College London; Section of Sports Traumatology M51, Bispebjerg Hospital
Background: The strength of a double stranded iliotibial tract graft
is comparable to the strength of the natural anterior
cruciate ligament (ACL) and with its attachment to
Gerdy’s tubercle it might restore knee stability better
in the ACL + anterolateral ligament (ALL) insufficient
knee, compared to standard intraarticular
techniques for ACL reconstruction (ACLr).
Purpose / Aim of Study: The aim of this study was to measure and compare
knee kinematics before and after ACL resection,
ALL resection and ACL reconstruction using
hamstring graft (HG) and modified iliotibial tract
(MIT) graft, respectively.
Materials and Methods: Fourteen cadaveric knees were tested in a 6 degree
of freedom kinematics rig. An optical tracking
system recorded kinematics of the knee from 0° to
80° of flexion applying no load, internal rotation (IR),
external rotation, valgus rotation, varus rotation
(VRR), simulated pivot shift (SPS), anterior
translation (AT) and posterior translation loads. Test
in following states: Intact, after ACL resection, after
ALL resection, after HG-ACLr and MIT-ACLr. Grafts
were fixed at 20° of flexion. Results were compared
to intact.
Findings / Results: P-value<0,05
ACL resection increased AT in all degrees of flexion,
peak at 20°, mean diff. 6.6±2.25 mm. ACLr with HG-
ACL and MIT-ACL restored AT. Resection of the ALL
increased IR in the fully extended knee, mean diff.
2.4±2.1°. MIT-ACLr, reduced IR and SPS compared
to HG-ACLr and the intact knee in deep flexion
angles (60-80°), peak at 80°, mean diff. -6.2±2.1°
and -5.4±2.2° for IR and SPS, respectively. The MIT-
ACLr caused less VRR at 80° flexion, mean diff.
-2.7±1.9°.
Conclusions: MIT-ACLr restored AT equally to the HG-ACLr. The
MIT-ACLr had a restraining influence on IR and SPS
in deep flexion. This may be protective against re-
rupture, though it could have an overconstraining
effect on knee.
22. Discus preserving reconstruction of recurrent anterior sterno-clavicular instability in young persons: a 1-5 years follow-up.
Martin Rathcke, Rikke Høffner, Michael Rindom Krogsgaard
Section for sportstraumatology M51, Bispebjerg and Frederiksberg Hospital; Department of physiotherapy, Bispebjerg and Frederiksberg Hospital; Section for sportstraumatology M51, Bispebjerg and Frederiksberg Hospital
Background: Non-traumatic recurrent anterior
instability of the sternoclavicular joint
(SCJ) is a disabling condition in young
persons. If physiotherapy fails, surgical
treatment is indicated. Traditionally the
discus is resected, but in young
persons it should be saved. We
introduce a stabilizing procedure that is
preserving the discus. It uses a gracilis
autograft to form a triangular
reconstruction of the anterior SCJ
capsule, anchoring the graft to
manubrium and the medial clavicle.
Purpose / Aim of Study: To present the 1-5 year-result of this
discus preserving SCJ reconstruction
for recurrent anterior dislocation in a
prospective cohort.
Materials and Methods: 30 SCJs (16 right /14 Left) in 25
patients (5 had bilateral instability)
were operated for recurrent dislocation
of the SCJ during the period 2010-17.
Two patients had a re-operation due to
recurrence of the SCJ instability.
Allografts were used in two patients,
one primary and one re-operation.
All patients filled in the DASH
questionnaire before the operation and
at 1, 2 and 5-year follow-up. Stability,
pain and satisfaction were also
registered.
Findings / Results: Mean age at operation was 19 years
(13-30). In 5 patients, the procedure
was bilateral.
At 1-year follow-up there was 4 re-
instabilities, and two of these were re-
operated. 26 SCJ = 87 % were
considered stable. One patient had
suture of a torn disc. Two patients
complained of donor pain, and 3
patients had keloid formation in their
scar. DASH was significantly better at
follow-up (p<0.05).
Conclusions: The 1 – 5 year results of this
procedure were satisfactory. As it
preserves the discus- and joint, we
suggest it is used in young patients
with SCJ instability who needs surgery.
23. Revision hip arthroscopy, indications and outcomes: a follow-up study of 269 femoroacetabular impingement (FAI) patients. Results from the Danish Hip Arthroscopy Registry (DHAR).
Andreas Chatterton, Torsten Grønbech Nielsen, Bent Lund, Ole Gade Sørensen, Bjarne Mygind-Klavsen, Martin Lind
Department of Sports Traumatology, Aarhus University Hospital; Department of Sports Traumatology, Aarhus University Hospital; Department of Orthopaedic Surgery, The Regional Hospital in Horsens; Department of Sports Traumatology, Aarhus University Hospital; Department of Sports Traumatology, Aarhus University Hospital; Department of Sports Traumatology, Aarhus University Hospital
Background: Hip arthroscopy is the standard surgical intervention
for intraarticular hip pathologies such as cam, pincer
and labral tears. However, limited knowledge exists
concerning the causes for failure, and outcomes
after revision hip arthroscopy.
Purpose / Aim of Study: The purpose of this study is to evaluate the causes
of failure after primary hip arthroscopy and clinical
outcomes after revision hip arthroscopy. Moreover,
the study aims to compare primary and revision hip
arthroscopy outcome scores.
Materials and Methods: 269 FAI patients (90 males and 179 females)
were included from DHAR, with failed primary hip
arthroscopic procedure and performed revision
procedure. The mean age was 39.3 (SD 10.1).
Patient related outcome measures consisting of
Copenhagen Hip and Groin Outcome Score
(HAGOS), quality of life (EQ-5D), Hip Sports
Activity Scale (HSAS), International Hip Outcome
Score (IHOT12) and Numeric Rating Scale
(NRS) pain scores were assessed prior to
surgery, 1 and 2 years post-operatively. Clinical
outcomes were compared with a primary hip
arthroscopic patient cohort.
Findings / Results: Females had a median relative risk of undergoing
revision hip arthroscopy of 1.71 compared to males.
At 2-year follow-up after revision hip arthroscopy we
observed significant improvements in all outcome
scores.
Primary hip arthroscopic outcomes in FAI patients
were significantly better than after FAI revision hip
arthroscopy, in all scores.
Conclusions: Females have an increased risk of revision after FAI
arthroscopic treatment. Revision hip arthroscopy in
FAI patients improves subjective outcomes
significantly, although they are poorer than after
primary hip arthroscopy. The clinical relevance of
this study is that revision hip arthroscopy is a
valuable treatment option in cases of failed primary
hip arthroscopy in FAI patients.
24. Combined Bone Marrow Aspirate and Platelet-rich Plasma for Cartilage Repair – Results at Two-Year Follow-Up
Kris Tvilum Chadwick Hede, Bjørn Borsøe Christensen, Jonas Jensen, Casper Bindzus Foldager, Martin Carøe Lind
Orthopedic Research Laboratory, Aarhus University Hospital; Orthopedic Research Laboratory, Aarhus University Hospital; Department of Radiology, Aarhus University Hospital; Orthopedic Research Laboratory, Aarhus University Hospital; Sports Trauma Clinic, Aarhus University Hospital
Background: Cell-based cartilage repair treatments are
limited due to high costs of cell expansion
prior to implantation. The use of autologous
bone marrow aspirate concentrate (BMAC)
has been proposed as an alternative one-
step strategy. Platelet-rich plasma (PRP) is
an increasingly popular endogenous source
of concentrated growth factors.
Purpose / Aim of Study: To evaluate the clinical use of combined
BMAC and PRP on a collagen I/III scaffold
for treating cartilage lesions in the knee.
Materials and Methods: Ten patients (Mean age: 29.4 years, range
18-36) suffering from large full-thickness
cartilage lesions on patella (n=7) or the
femoral condyles (n=3) were treated with
BMAC and PRP from January 2015 to
December 2016. Bone marrow was
aspirated from the iliac crest and was
prepared using centrifugation to yield
BMAC. PRP was prepared using whole
blood. BMAC and PRP was then seeded
onto a collagen I/III scaffold and sutured into
the debrided defect.
Patients were evaluated by clinical outcome
scores (IKDC, KOOS and VAS) pre-
operatively, after three months, one and two
years and through MRI pre-operatively and
after one year, evaluated using MOCART
score.
Findings / Results: At one-year follow-up a significant
improvement was found in IKDC (35.5 to
58.4, p = 0.003), VAS activity (7.3 to 4.9, p =
0.006), KOOS symptoms (60.5 to 77.5, p =
0.026) and KOOS QOL (23.2 to 41.9, p =
0.026). MOCART score improved from 19.5
to 36.5 (p = 0.015).
At two years follow-up (n=8) improvements
were seen in all scores, but none were
statistically significant.
Conclusions: Treatment of cartilage injuries using
combined BMAC and PRP resulted in
improvements in subjective outcome and
MOCART scores one year postoperative,
which were non-significant after two years.
25. Quadriceps tendon (QT) graft has higher revision rates than hamstring and patellatendon grafts for anterior cruciate ligament (ACL) reconstruction. Results from the Danish Knee Ligament Reconstruction (DKRR)
Martin Lind, Marc Strauss, Torsten Nielsen
Orthopedics, Aarhus University Hospital; Orthopedics, Ullevaal Hospital, Oslo, Norway; Orthopedics, Aarhus University
Background: Quadriceps tendon (QT) has recently
gained increase interest as ACL
reconstruction graft due to introduction of
minimal invasive harvesting techniques and
low donor site morbidity. There is a lack of
data on failures and revision rates from
large sized cohorts.
Purpose / Aim of Study: The aim of this study is to present objective
knee stability, subjective outcome in
patients after ACL reconstruction with QT
graft and compared these with hamstring
(HS) and patellatendon (PT) grafts based
on results from DKRR. We hypothesized
similar stability, subjective outcome and
revision rates as hamstring and patella
tendon grafts.
Materials and Methods: Respectively 425, 2639 and 18709 of QT,
PT and HS tendon ACL reconstructions
were registered in the DKRR between 2005
and 2016. Objective outcomes of sagittal
knee laxity, positive pivot shift, patient-
reported outcome (KOOS) at one-year
follow-up and revision rates at 2 years was
used to compare the outcome of the 3 graft
cohorts.
Findings / Results: QT graft usage was associated with more
knee laxity than HS and PT grafts of 1,7, 1.6
and 1,5 mm respectively. Also a higher rate
of positive pivot shift (21 %) was found for
QT grafts versus PT (18 %) and HS tendon
(17 %).
KOOS outcome demonstrated improvement
for all graft types from pre- to postoperative
with no difference between graft types.
Revision rates after 2 years were 4,9, 1,6
and 2,3 % for QT, PT and HS tendon ACL
reconstructions
Conclusions: QT graft for ACL reconstruction
demonstrated excellent improvements in
knee laxity and subjective outcome similar
to PT and HS tendon grafts. However QT
graft was associated with a concerning high
rate of revision within two years and more
knee laxity. We do not conclude similar
outcome for QT, PT and HS tendon ACL
reconstructions as hypothesized.