Session 9: Sports Orthopaedics
Torsdag d. 25. oktober
13:00-14:30
Lokale: Stockholm/Copenhagen
Chairmen: Simon Døssing og Ole Gade Sørensen
Kristoffer W Barfod, Emil Nielsen, Beth H Olsen, Pablo G Vinicoff, Anders Troelsen, Per Hölmich
Sports Orthopedic Research Center - Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Denmark. ; Department of Radiology, Copenhagen University Hospital Hvidovre, Denmark. ; Department of Radiology, Copenhagen University Hospital Hvidovre, Denmark. ; Department of Radiology, Copenhagen University Hospital Hvidovre, Denmark. ; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Denmark. ; Sports Orthopedic Research Center - Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Denmark.
Background: Deep vein thrombosis (DVT) following acute Achilles tendon rupture (ATR) is common (up to 34%) and potentially dangerous. Immobilization is thought to be an important factor in the pathogenesis. It has never been investigated if early controlled ankle motion (ECM) can reduce the incidence of DVT.
Purpose / Aim of Study: To investigate if ECM could reduce the incidence of DVT compared to IM in the treatment of acute Achilles tendon rupture.
Materials and Methods: The study was performed as a randomized controlled trial with patients allocated in a 1:1 ratio to one of two parallel groups. Patients aged 18 to 70 years were eligible for inclusion. Treatment was non-operative. The ECM group performed movements of the ankle 5 times a day from week 3 to 8 after rupture. The control group was IM for 8 weeks. Follow up was performed with Color Doppler ultrasound for above and below knee DVT at 2 and 8 weeks by two experienced radiologists. DVT was a secondary outcome, why a secondary power calculation was performed before analyzing the data: 124 patients were required to have a 60% chance of detecting, as significant at the 5% level, a decrease in DVT from 34% in the IM group to 17% in the ECM group.
Findings / Results: 189 patients were assessed for eligibility from February 2014 to December 2016. 130 were randomized, 69 in the ECM group and 61 in the IM group. All patients participated in the follow up. In total 60 (46%) patients were diagnosed with DVT; 31/69 (45%) in the ECM group and 29/61 (48%) in the IM group (p=0.77).
Conclusions: The incidence of asymptomatic DVT was higher than previously reported as almost half of the patients presented with DVT after acute Achilles tendon rupture. ECM revealed no benefit to IM in reducing the incidence of DVT.
Sports Orthopedic Research Center - Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Denmark. ; Department of Radiology, Copenhagen University Hospital Hvidovre, Denmark. ; Department of Radiology, Copenhagen University Hospital Hvidovre, Denmark. ; Department of Radiology, Copenhagen University Hospital Hvidovre, Denmark. ; Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Denmark. ; Sports Orthopedic Research Center - Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Denmark.
Background: Deep vein thrombosis (DVT) following acute Achilles tendon rupture (ATR) is common (up to 34%) and potentially dangerous. Immobilization is thought to be an important factor in the pathogenesis. It has never been investigated if early controlled ankle motion (ECM) can reduce the incidence of DVT.
Purpose / Aim of Study: To investigate if ECM could reduce the incidence of DVT compared to IM in the treatment of acute Achilles tendon rupture.
Materials and Methods: The study was performed as a randomized controlled trial with patients allocated in a 1:1 ratio to one of two parallel groups. Patients aged 18 to 70 years were eligible for inclusion. Treatment was non-operative. The ECM group performed movements of the ankle 5 times a day from week 3 to 8 after rupture. The control group was IM for 8 weeks. Follow up was performed with Color Doppler ultrasound for above and below knee DVT at 2 and 8 weeks by two experienced radiologists. DVT was a secondary outcome, why a secondary power calculation was performed before analyzing the data: 124 patients were required to have a 60% chance of detecting, as significant at the 5% level, a decrease in DVT from 34% in the IM group to 17% in the ECM group.
Findings / Results: 189 patients were assessed for eligibility from February 2014 to December 2016. 130 were randomized, 69 in the ECM group and 61 in the IM group. All patients participated in the follow up. In total 60 (46%) patients were diagnosed with DVT; 31/69 (45%) in the ECM group and 29/61 (48%) in the IM group (p=0.77).
Conclusions: The incidence of asymptomatic DVT was higher than previously reported as almost half of the patients presented with DVT after acute Achilles tendon rupture. ECM revealed no benefit to IM in reducing the incidence of DVT.
Salamah Belal Eljaja, Mette Tavlo, Volkert Siersma, Jørgen Tranum-Jensen, Michael Rindom Krogsgaard
Section of Sports Traumatology M51, Bispebjerg Hospital; Dep. of Cellular and Molecular Medicine, University of Copenhagen; Dep. of Public Health, University of Copenhagen; Dep. of Cellular and Molecular Medicine, University of Copenhagen; Section of Sports Traumatology M51, Bispebjerg Hospital
Background: Positioning of the graft tunnels in anterior cruciate ligament (ACL) reconstruction (r) is usually at the footprint. There is no systematic study of the consequence of tunnel malposition on both tibia and femur, regarding range of motion and stability.
Purpose / Aim of Study: Investigating how positioning of graft tunnels affects knee range of motion (ROM) and stability.
Materials and Methods: Sixty cadaveric knees had ACL removed and reconstructed. There were 5 different placements of the femoral tunnel: by anteromedial (AM) technique at the native femoral attachment and 5 mm anterior(+) or posterior(-) to this, and posterior by transtibial (TT) technique and +12 mm(anterior) to this. There were 3 different tibial positions: Anatomic at the native attachment and -5 mm(posterior) or +5 mm(anterior) to this. ROM, anterior translation(AT) and rotational stability(RS) were measured before and after ACL resection, and after each ACLr.
Findings / Results: The tunnel combination that best restored ROM and stability was anatomical tibia combined with a femoral AM-5mm. Increased AT was found with femur TT+12mm. Transtibial positioning of the femoral tunnel caused flexion deficiency, when combined with any tibial tunnel. AM positioning on femur combined with +5mm /-5mm on tibia caused flexion deficiency. When combined with tibia -5mm most femoral drill tunnels showed decreased RS and increased AT. Tibia +5mm especially caused extension deficiency.
Conclusions: Tunnel combinations with the most oblique (frontal) and least steep (sagittal) grafts, restored ROM and stability best. Combinations with a steeper and/or less oblique graft caused increased AT and decreased RS. Transtibial positioning of the femoral tunnel caused flexion deficiency. A posterior tibial tunnel caused decreased RS and higher AT. An anterior tibial tunnel caused extension deficiency.
Section of Sports Traumatology M51, Bispebjerg Hospital; Dep. of Cellular and Molecular Medicine, University of Copenhagen; Dep. of Public Health, University of Copenhagen; Dep. of Cellular and Molecular Medicine, University of Copenhagen; Section of Sports Traumatology M51, Bispebjerg Hospital
Background: Positioning of the graft tunnels in anterior cruciate ligament (ACL) reconstruction (r) is usually at the footprint. There is no systematic study of the consequence of tunnel malposition on both tibia and femur, regarding range of motion and stability.
Purpose / Aim of Study: Investigating how positioning of graft tunnels affects knee range of motion (ROM) and stability.
Materials and Methods: Sixty cadaveric knees had ACL removed and reconstructed. There were 5 different placements of the femoral tunnel: by anteromedial (AM) technique at the native femoral attachment and 5 mm anterior(+) or posterior(-) to this, and posterior by transtibial (TT) technique and +12 mm(anterior) to this. There were 3 different tibial positions: Anatomic at the native attachment and -5 mm(posterior) or +5 mm(anterior) to this. ROM, anterior translation(AT) and rotational stability(RS) were measured before and after ACL resection, and after each ACLr.
Findings / Results: The tunnel combination that best restored ROM and stability was anatomical tibia combined with a femoral AM-5mm. Increased AT was found with femur TT+12mm. Transtibial positioning of the femoral tunnel caused flexion deficiency, when combined with any tibial tunnel. AM positioning on femur combined with +5mm /-5mm on tibia caused flexion deficiency. When combined with tibia -5mm most femoral drill tunnels showed decreased RS and increased AT. Tibia +5mm especially caused extension deficiency.
Conclusions: Tunnel combinations with the most oblique (frontal) and least steep (sagittal) grafts, restored ROM and stability best. Combinations with a steeper and/or less oblique graft caused increased AT and decreased RS. Transtibial positioning of the femoral tunnel caused flexion deficiency. A posterior tibial tunnel caused decreased RS and higher AT. An anterior tibial tunnel caused extension deficiency.
Signe Kierkegaard, Bent Lund, Ulrik Dalgas, Kjeld Søballe, Inger Mechleburg
Orthopaedic Surgery, Horsens Hospital; Orthopaedic Surgery, Horsens Hospital; Section for Sport Science, Department of Public Health, Aarhus University; Orthopaedic Surgery, Aarhus University Hospital; Orthopaedic Surgery, Aarhus Unviersity Hospital
Background: The dominant symptom in patients with femoroacetabular impingement syndrome is pain. Patients undergo hip arthroscopic surgery to reduce pain and improve function, but at follow up, many patients are not free of pain. However, patients with FAIS undergoing surgery are heterogeneous and presenting mean outcome values may not provide the full picture.
Purpose / Aim of Study: The aim of this study was to investigate which pre- operative parameters that describe patients with persistent pain one year after hip arthroscopic surgery.
Materials and Methods: In a consecutively recruited group of 60 patients with FAI syndrome undergoing hip arthroscopic surgery pre-operative parameters were investigated in subgroups based on one-year post-surgery Copenhagen Hip and Going Outcome Score (HAGOS) pain ratings: Moderate to Severe Pain (< 50), Mild pain (HAGOS pain 50- <90) and Almost pain free (> 90). Baseline measures included; age and gender, HAGOS questionnaire and maximal isometric hip flexion and extension strength tested in an isokinetic dynamometer.
Findings / Results: Patients with FAI syndrome experiencing moderate to severe pain after surgery were, compared to patients with almost no pain, characterized by low pre-op scores on HAGOS (pain 33 vs. 70, symptoms 29 vs. 64, activities of daily living 30 vs. 75, sport 19 vs. 50, physical activity 0 vs. 13 and quality of life 15 vs. 40). Furthermore, lower pre-operative hip flexion (-45%) and extension (-46%) muscle strength were observed in the moderate to severe pain group.
Conclusions: Patients with FAI syndrome experiencing moderate to severe pain one year after hip arthroscopic surgery were pre-operatively characterized by having low HAGOS scores and low hip muscle strength.
Orthopaedic Surgery, Horsens Hospital; Orthopaedic Surgery, Horsens Hospital; Section for Sport Science, Department of Public Health, Aarhus University; Orthopaedic Surgery, Aarhus University Hospital; Orthopaedic Surgery, Aarhus Unviersity Hospital
Background: The dominant symptom in patients with femoroacetabular impingement syndrome is pain. Patients undergo hip arthroscopic surgery to reduce pain and improve function, but at follow up, many patients are not free of pain. However, patients with FAIS undergoing surgery are heterogeneous and presenting mean outcome values may not provide the full picture.
Purpose / Aim of Study: The aim of this study was to investigate which pre- operative parameters that describe patients with persistent pain one year after hip arthroscopic surgery.
Materials and Methods: In a consecutively recruited group of 60 patients with FAI syndrome undergoing hip arthroscopic surgery pre-operative parameters were investigated in subgroups based on one-year post-surgery Copenhagen Hip and Going Outcome Score (HAGOS) pain ratings: Moderate to Severe Pain (< 50), Mild pain (HAGOS pain 50- <90) and Almost pain free (> 90). Baseline measures included; age and gender, HAGOS questionnaire and maximal isometric hip flexion and extension strength tested in an isokinetic dynamometer.
Findings / Results: Patients with FAI syndrome experiencing moderate to severe pain after surgery were, compared to patients with almost no pain, characterized by low pre-op scores on HAGOS (pain 33 vs. 70, symptoms 29 vs. 64, activities of daily living 30 vs. 75, sport 19 vs. 50, physical activity 0 vs. 13 and quality of life 15 vs. 40). Furthermore, lower pre-operative hip flexion (-45%) and extension (-46%) muscle strength were observed in the moderate to severe pain group.
Conclusions: Patients with FAI syndrome experiencing moderate to severe pain one year after hip arthroscopic surgery were pre-operatively characterized by having low HAGOS scores and low hip muscle strength.
Winge Søren, Dippmann Christian, Winge Sophie , Kraemer Otto, Holmich Per
Section of orthopaedic surgery, CAPIO CFR Hospitals, Hellerup; Section of sporttraumatology, , Bispebjerg Hospital, Copenhagen University Hospita; Medical Student, Syddansk universitet; Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre; Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre
Background: The treatment of FAIS in adolescent is a somewhat controversial subject and the literature is sparse.
Purpose / Aim of Study: The purpose was to report the 5 year outcome after hip arthroscopy with labral repair in adolescents
Materials and Methods: From September 2010 to October 2013, 29 consecutive patients with a mean age 16.3 (range 12,7-19,8). underwent hip arthroscopy with treatment of FAIS at CAPIO CFR Hospital. Patient related outcome measures (PROM) including modified Harris Hip Score (mHHS), Visual Analogue Score (VAS) for pain, and Copenhagen Hip and Groin Outcome Score (HAGOS) were for used as evaluation tools preoperatively and at follow up (FU). Mean FU was 4,7 years (range 3,5-7,1) Data was prospectively recorded and analyzed using non–parametric statistics.
Findings / Results: Significant clinical improvements were seen for all outcome tools (p < 0,001) at FU with VAS pain (n=27) score improving from mean 63 to 9, mHHS (n=27)from 58 to 93 and HAGOS (n=19) as shown in the table. HAGOS Pain Symptoms Adl Sport/rec PA QOL Pre 57 62 51 22 18 26 Post 96 87 99 92 89 87 Revision Hip Arthroscopy was required in 1 patients. Periacetabular osteotomy was performed in 2 patients at a later stage.
Conclusions: These are the first medium term results after hip arthroscopy for adolescents in a Danish cohort . The results are equal to those described in the literature for active, non-arthritic adults with clinically relevant improvements in all out-come scores. Although 3 patients underwent additional surgery overall results are promising.
Section of orthopaedic surgery, CAPIO CFR Hospitals, Hellerup; Section of sporttraumatology, , Bispebjerg Hospital, Copenhagen University Hospita; Medical Student, Syddansk universitet; Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre; Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre
Background: The treatment of FAIS in adolescent is a somewhat controversial subject and the literature is sparse.
Purpose / Aim of Study: The purpose was to report the 5 year outcome after hip arthroscopy with labral repair in adolescents
Materials and Methods: From September 2010 to October 2013, 29 consecutive patients with a mean age 16.3 (range 12,7-19,8). underwent hip arthroscopy with treatment of FAIS at CAPIO CFR Hospital. Patient related outcome measures (PROM) including modified Harris Hip Score (mHHS), Visual Analogue Score (VAS) for pain, and Copenhagen Hip and Groin Outcome Score (HAGOS) were for used as evaluation tools preoperatively and at follow up (FU). Mean FU was 4,7 years (range 3,5-7,1) Data was prospectively recorded and analyzed using non–parametric statistics.
Findings / Results: Significant clinical improvements were seen for all outcome tools (p < 0,001) at FU with VAS pain (n=27) score improving from mean 63 to 9, mHHS (n=27)from 58 to 93 and HAGOS (n=19) as shown in the table. HAGOS Pain Symptoms Adl Sport/rec PA QOL Pre 57 62 51 22 18 26 Post 96 87 99 92 89 87 Revision Hip Arthroscopy was required in 1 patients. Periacetabular osteotomy was performed in 2 patients at a later stage.
Conclusions: These are the first medium term results after hip arthroscopy for adolescents in a Danish cohort . The results are equal to those described in the literature for active, non-arthritic adults with clinically relevant improvements in all out-come scores. Although 3 patients underwent additional surgery overall results are promising.
Lene Lindberg Miller, Torsten Grønbech Nielsen, Bjarne Mygind-Klavsen, Martin Lind
Div. of Sports Trauma, Orthopedic Dept. , Aarhus University Hospital, Denmark; Div. of Sports Trauma, Orthopedic Dept. , Aarhus University Hospital, Denmark; Div. of Sports Trauma, Orthopedic Dept. , Aarhus University Hospital, Denmark; Div. of Sports Trauma, Orthopedic Dept. , Aarhus University Hospital, Denmark
Background: Intraarticular local anaesthesia (LA) is used in patients with hip symptoms to determine whether symptoms such as pain are of intraarticular origin. There is a lacking knowledge to what degree a positive LA test is related to MRA findings of hip joint pathology.
Purpose / Aim of Study: The purpose of this study is to determine whether there is a correlation between MRA and reduction of pain during two specific manual hip tests: Flexion, ADduction, and Internal Rotation (FADIR) test, Flexion ABduction External Rotation (FABER) test after LA in potential hip arthroscopy candidates.
Materials and Methods: Subjects with hip pain were evaluated by an orthopedic surgeon or a physiotherapist and were prospectively enrolled in the study. Clinical examination results were recorded. In patients with MRA verified intraarticular pathology and positive specific hip tests, intraarticular symptom origin was tested by pain reduction after ultrasound guided intraarticular LA injection. The diagnostic test procedure: FADIR and FABER tests were performed prior to injection of LA and 30 minutes after LA injection. Patients evaluated their pain by the Numeric Rating Scale (NRS). A larger than 30 % reduction in NRS score was considered as a positive LA response.
Findings / Results: This present study included 40 patients (28 women (76%)) with a MRA verified labral tear. Mean age 32 (range 17-69). Thirtytwo of these patients (80%) had a positive LA response when re-tested with FADIR-test and 31 patients (78%) with the FABER-test.
Conclusions: A high proportion of patients with MRA diagnosed hip labrum pathology respond with reduction in pain after LA diagnostic injection indicating intraarticular origin of pain.
Div. of Sports Trauma, Orthopedic Dept. , Aarhus University Hospital, Denmark; Div. of Sports Trauma, Orthopedic Dept. , Aarhus University Hospital, Denmark; Div. of Sports Trauma, Orthopedic Dept. , Aarhus University Hospital, Denmark; Div. of Sports Trauma, Orthopedic Dept. , Aarhus University Hospital, Denmark
Background: Intraarticular local anaesthesia (LA) is used in patients with hip symptoms to determine whether symptoms such as pain are of intraarticular origin. There is a lacking knowledge to what degree a positive LA test is related to MRA findings of hip joint pathology.
Purpose / Aim of Study: The purpose of this study is to determine whether there is a correlation between MRA and reduction of pain during two specific manual hip tests: Flexion, ADduction, and Internal Rotation (FADIR) test, Flexion ABduction External Rotation (FABER) test after LA in potential hip arthroscopy candidates.
Materials and Methods: Subjects with hip pain were evaluated by an orthopedic surgeon or a physiotherapist and were prospectively enrolled in the study. Clinical examination results were recorded. In patients with MRA verified intraarticular pathology and positive specific hip tests, intraarticular symptom origin was tested by pain reduction after ultrasound guided intraarticular LA injection. The diagnostic test procedure: FADIR and FABER tests were performed prior to injection of LA and 30 minutes after LA injection. Patients evaluated their pain by the Numeric Rating Scale (NRS). A larger than 30 % reduction in NRS score was considered as a positive LA response.
Findings / Results: This present study included 40 patients (28 women (76%)) with a MRA verified labral tear. Mean age 32 (range 17-69). Thirtytwo of these patients (80%) had a positive LA response when re-tested with FADIR-test and 31 patients (78%) with the FABER-test.
Conclusions: A high proportion of patients with MRA diagnosed hip labrum pathology respond with reduction in pain after LA diagnostic injection indicating intraarticular origin of pain.
Signe Kierkegaard, Bent Lund, Ulrik Dalgas, Kjeld Søballe, Inger Mechlenburg
Ortopaedic Surgery, Horsens Hospital; Orthopaedic Surgery, Horsens Hospital; Section for Sport Science, Department of Public Health, Aarhus University; Orthopaedic Surgery, Aarhus University Hospital; Orthopaedic Surgery, Aarhus University Hospital
Background: Most patients with femoroacetabular impingement (FAI) syndrome are young and middle-aged persons living physically active lives including sports activities.
Purpose / Aim of Study: However, it remains to be investigated 1) if the self-reported and objectively measured physical activity level is impacted by hip arthroscopy for FAI syndrome, 2) if self-reported and objectively measured physical activity levels differ from a reference group with healthy hips.
Materials and Methods: Sixty patients with FAI syndrome eligible for hip arthroscopy were consecutively included in a prospective cohort study together with 30 reference persons reporting no hip problems. Participants completed the Copenhagen Hip and Groin Outcome Score (HAGOS) together with questions regarding their sports activities. Furthermore, participants wore a 3-axial accelerometer for five consecutive days during waking hours. The accelerometer-based data was analyzed and presented as total activity and type, frequency and duration of activities.
Findings / Results: Patients experienced significant and clinically relevant changes in all HAGOS scores. 88% of patients participated in some kind of sports activity one year after surgery. Overall, objectively measured physical activity did not change from before to one year after surgery. Compared to reference persons, patients performed less bicycling and running and there was an overall trend towards less physical activity among patients.
Conclusions: Despite clinically relevant changes in self- reported outcomes, patients did not increase their overall physical activity level one year after surgery. 88% patients participated in some kind of physical activity, but the performance level was lower than in references.
Ortopaedic Surgery, Horsens Hospital; Orthopaedic Surgery, Horsens Hospital; Section for Sport Science, Department of Public Health, Aarhus University; Orthopaedic Surgery, Aarhus University Hospital; Orthopaedic Surgery, Aarhus University Hospital
Background: Most patients with femoroacetabular impingement (FAI) syndrome are young and middle-aged persons living physically active lives including sports activities.
Purpose / Aim of Study: However, it remains to be investigated 1) if the self-reported and objectively measured physical activity level is impacted by hip arthroscopy for FAI syndrome, 2) if self-reported and objectively measured physical activity levels differ from a reference group with healthy hips.
Materials and Methods: Sixty patients with FAI syndrome eligible for hip arthroscopy were consecutively included in a prospective cohort study together with 30 reference persons reporting no hip problems. Participants completed the Copenhagen Hip and Groin Outcome Score (HAGOS) together with questions regarding their sports activities. Furthermore, participants wore a 3-axial accelerometer for five consecutive days during waking hours. The accelerometer-based data was analyzed and presented as total activity and type, frequency and duration of activities.
Findings / Results: Patients experienced significant and clinically relevant changes in all HAGOS scores. 88% of patients participated in some kind of sports activity one year after surgery. Overall, objectively measured physical activity did not change from before to one year after surgery. Compared to reference persons, patients performed less bicycling and running and there was an overall trend towards less physical activity among patients.
Conclusions: Despite clinically relevant changes in self- reported outcomes, patients did not increase their overall physical activity level one year after surgery. 88% patients participated in some kind of physical activity, but the performance level was lower than in references.
Hanne Bloch Lauridsen, Mette Kreutzfeldt Zebis, Erland Magnussen, Per Hölmich
Human Movement Analysis Laboratory, Amager-Hvidovre Hospitaler; Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, University College Copenhagen; Danish Research Centre for Magnetic Resonance, Amager-Hvidovre Hospitaler; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre Hospitaler
Background: In Scandinavia, the most common way to reconstruct the Anterior Cruciate Ligament (ACL) is to replace the remains of the native ACL by an autologous tendon graft. In Denmark, the semitendinosus (ST) tendon is used as graft in 85% of all ACL-reconstructions. Since the ST muscle serves as an important ACL synergist, concern arises whether the muscle length is retained or shortens after harvesting. Muscle shortening after harvesting will change knee joint biomechanics and thereby potentially impair the protective mechanism of the new ACL.
Purpose / Aim of Study: The purpose of this study was to measure the muscle length of the ST in individuals with previous ACL-reconstruction using a ST-graft.
Materials and Methods: Eleven subjects (two men and nine women) aged 30.7±3.5 years who had undergone unilateral ACL reconstruction with ST-graft 6.8±5.0 years previously (all in combination with a gracilis tendon), underwent bilateral magnetic resonance imaging (MRI). MRI-scans consisted of two axial sequences performed in a 1.5T magnet (Avanto, Siemens, Berlin, Germany) with a slice thickness of 5mm with 5mm gap. Hence, the smallest detectable muscle length change was 10 mm. The muscle length of the ST was measured bilaterally and the difference in mm between legs was calculated. In addition, 10 control subjects (five men and five women) aged 30.5±3.9 years with no previous knee surgery were MRI scanned bilaterally.
Findings / Results: The ST muscle of the harvested leg was 81±50mm shorter compared to the non-harvested leg (p=0.003). The control group showed no difference in ST muscle length between legs (<10mm).
Conclusions: Harvesting tendon from the ST shortens the muscle and thereby changes the muscle-tendon properties of the muscle. This finding indicates that the muscle’s ability to produce force and thereby the ability to protect the ACL is impaired.
Human Movement Analysis Laboratory, Amager-Hvidovre Hospitaler; Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, University College Copenhagen; Danish Research Centre for Magnetic Resonance, Amager-Hvidovre Hospitaler; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre Hospitaler
Background: In Scandinavia, the most common way to reconstruct the Anterior Cruciate Ligament (ACL) is to replace the remains of the native ACL by an autologous tendon graft. In Denmark, the semitendinosus (ST) tendon is used as graft in 85% of all ACL-reconstructions. Since the ST muscle serves as an important ACL synergist, concern arises whether the muscle length is retained or shortens after harvesting. Muscle shortening after harvesting will change knee joint biomechanics and thereby potentially impair the protective mechanism of the new ACL.
Purpose / Aim of Study: The purpose of this study was to measure the muscle length of the ST in individuals with previous ACL-reconstruction using a ST-graft.
Materials and Methods: Eleven subjects (two men and nine women) aged 30.7±3.5 years who had undergone unilateral ACL reconstruction with ST-graft 6.8±5.0 years previously (all in combination with a gracilis tendon), underwent bilateral magnetic resonance imaging (MRI). MRI-scans consisted of two axial sequences performed in a 1.5T magnet (Avanto, Siemens, Berlin, Germany) with a slice thickness of 5mm with 5mm gap. Hence, the smallest detectable muscle length change was 10 mm. The muscle length of the ST was measured bilaterally and the difference in mm between legs was calculated. In addition, 10 control subjects (five men and five women) aged 30.5±3.9 years with no previous knee surgery were MRI scanned bilaterally.
Findings / Results: The ST muscle of the harvested leg was 81±50mm shorter compared to the non-harvested leg (p=0.003). The control group showed no difference in ST muscle length between legs (<10mm).
Conclusions: Harvesting tendon from the ST shortens the muscle and thereby changes the muscle-tendon properties of the muscle. This finding indicates that the muscle’s ability to produce force and thereby the ability to protect the ACL is impaired.
Lasse Ishøi, Kristian Thorborg, Otto Kraemer, Bent Lund, Bjarne Mygind-Klavsen, Per Hölmich
Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Copenhagen University Hospital, Amager-Hvidovre, Denmark; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Copenhagen University Hospital, Amager-Hvidovre, Denmark; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Copenhagen University Hospital, Amager-Hvidovre, Denmark; Department of Orthopedics, Horsens Regional Hospital, Denmark; Division of Sports Traumatology, Department of Orthopedics, Aarhus University Hospital, Denmark; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Copenhagen University Hospital, Amager-Hvidovre, Denmark
Background: Hip arthroscopy is an effective treatment for femoroacetabular impingement syndrome. However, severe hip joint cartilage damage (modified Beck and ICRS grade 3-4) may affect post-operative outcomes.
Purpose / Aim of Study: This cross-sectional study aimed to investigate if pre-surgical demographic and radiological data were associated with hip joint cartilage status identified during surgery.
Materials and Methods: Subjects were identified in the Danish Hip Arthroscopy Registry. The outcome variables were acetabular cartilage status (modified Beck grade 0-2 vs. 3-4) and femoral head cartilage status (ICRS grade 0-2 vs. 3-4). Logistic regression was applied to assess the association with: Age; gender; Lateral Center Edge Angle (LCEA) assessed as normal (25°≤LCEA≤39°), pincer (LCEA>39°), or dysplasia (LCEA<25°); Alpha Angle (AA) assessed as normal (AA<55°), cam (55°≤AA<78°), or severe cam (AA≥78°); joint space width (JSW) assessed as normal (JSW>4.0), mild reduction (3.1≤JSW≤4.0), or severe reduction (JSW≤3.0).
Findings / Results: 1550 subjects (mean age pre-surgery: 34.4±10.0 y) were included in the analyses. For acetabular cartilage status, increasing age (odds ratio (OR) 1.03), male gender (OR 4.32), reduced JSW (mild: OR 1.87; severe: OR 3.74) and increased AA (cam: OR 2.18; severe cam: OR 4.36) was associated (p<0.05) with Beck grade 3-4, whereas pincer morphology (OR 0.65) was protective (p=0.07). For femoral head cartilage status, decreased JSW (mild: OR 1.94; severe: OR 3.88) and dysplasia (OR 2.96) was associated (p<0.05) with ICRS grade 3-4.
Conclusions: Several factors were associated with severe hip joint cartilage damage, most notably male gender, reduced joint space width, cam morphology, and dysplasia. On the contrary, pincer morphology was protective. These factors may be important for patient selection and surgical planning.
Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Copenhagen University Hospital, Amager-Hvidovre, Denmark; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Copenhagen University Hospital, Amager-Hvidovre, Denmark; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Copenhagen University Hospital, Amager-Hvidovre, Denmark; Department of Orthopedics, Horsens Regional Hospital, Denmark; Division of Sports Traumatology, Department of Orthopedics, Aarhus University Hospital, Denmark; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Copenhagen University Hospital, Amager-Hvidovre, Denmark
Background: Hip arthroscopy is an effective treatment for femoroacetabular impingement syndrome. However, severe hip joint cartilage damage (modified Beck and ICRS grade 3-4) may affect post-operative outcomes.
Purpose / Aim of Study: This cross-sectional study aimed to investigate if pre-surgical demographic and radiological data were associated with hip joint cartilage status identified during surgery.
Materials and Methods: Subjects were identified in the Danish Hip Arthroscopy Registry. The outcome variables were acetabular cartilage status (modified Beck grade 0-2 vs. 3-4) and femoral head cartilage status (ICRS grade 0-2 vs. 3-4). Logistic regression was applied to assess the association with: Age; gender; Lateral Center Edge Angle (LCEA) assessed as normal (25°≤LCEA≤39°), pincer (LCEA>39°), or dysplasia (LCEA<25°); Alpha Angle (AA) assessed as normal (AA<55°), cam (55°≤AA<78°), or severe cam (AA≥78°); joint space width (JSW) assessed as normal (JSW>4.0), mild reduction (3.1≤JSW≤4.0), or severe reduction (JSW≤3.0).
Findings / Results: 1550 subjects (mean age pre-surgery: 34.4±10.0 y) were included in the analyses. For acetabular cartilage status, increasing age (odds ratio (OR) 1.03), male gender (OR 4.32), reduced JSW (mild: OR 1.87; severe: OR 3.74) and increased AA (cam: OR 2.18; severe cam: OR 4.36) was associated (p<0.05) with Beck grade 3-4, whereas pincer morphology (OR 0.65) was protective (p=0.07). For femoral head cartilage status, decreased JSW (mild: OR 1.94; severe: OR 3.88) and dysplasia (OR 2.96) was associated (p<0.05) with ICRS grade 3-4.
Conclusions: Several factors were associated with severe hip joint cartilage damage, most notably male gender, reduced joint space width, cam morphology, and dysplasia. On the contrary, pincer morphology was protective. These factors may be important for patient selection and surgical planning.
Bjørn Borsøe Christensen, Casper Bindzus Foldager, Morten Lykke Olesen, Jonas Jensen, Martin Lind
Orthopedics, Horsens Regional Hospital; Orthopedics, Aarhus University Hospital; Orthopedics, Hospital of Southern Jutland; Radiology, Aarhus University Hospital; Orthopedics, Aarhus University Hospital
Background: Treatment of osteochondral injuries is challenging, and no gold standard treatment has been established. Cell-free scaffolds provide an appealing inexpensive, one-step solution and previous clinical studies have shown promising results.
Purpose / Aim of Study: This study evaluated the clinical and biological osteochondral repair in patients treated with the MaioRegen® scaffold, a cell-free, biomimetic, type I collagen and hydroxyapatite scaffold.
Materials and Methods: Eight patients with osteochondral lesions in the knee (n = 6) or in the talus (n = 2) were consecutively included. Clinical evaluation was performed preoperatively, at 1 year, 2.5 years and at 6 years. Using patient reported outcome scores. Evaluation of biological osteochondral healing was performed using MRI and CT preoperatively and at one, and 2.5 years.
Findings / Results: Three patients had complete treatment failure after 6 days, three months and 4 years. All patients but one, experienced improvements after 2.5 years. In two patients, the improvements persisted at 6 years. Three patients experienced clinically significant deteriorations at 6 years. CT scans showed that 5/6 patients had no or very limited (<10 %) bone formation in the defects and 1/6 had 50–75 % bone formation in the treated defect after 2.5 years. MRI showed no improvement in the MOCART score at any time-point.
Conclusions: Treatment of osteochondral defects in the ankle and knee joint with a biomimetic scaffold resulted in incomplete cartilage repair and poor biological subchondral bone repair at 1- and 2.5-year follow- up. Clinical improvements were observed, but deterioration of the clinical scores was seen at 6 years. Despite the small size of the study, these results raise concerns about the long-term repair potential of the MaioRegen® scaffold, and we advise to use the MaioRegen® scaffold with caution.
Orthopedics, Horsens Regional Hospital; Orthopedics, Aarhus University Hospital; Orthopedics, Hospital of Southern Jutland; Radiology, Aarhus University Hospital; Orthopedics, Aarhus University Hospital
Background: Treatment of osteochondral injuries is challenging, and no gold standard treatment has been established. Cell-free scaffolds provide an appealing inexpensive, one-step solution and previous clinical studies have shown promising results.
Purpose / Aim of Study: This study evaluated the clinical and biological osteochondral repair in patients treated with the MaioRegen® scaffold, a cell-free, biomimetic, type I collagen and hydroxyapatite scaffold.
Materials and Methods: Eight patients with osteochondral lesions in the knee (n = 6) or in the talus (n = 2) were consecutively included. Clinical evaluation was performed preoperatively, at 1 year, 2.5 years and at 6 years. Using patient reported outcome scores. Evaluation of biological osteochondral healing was performed using MRI and CT preoperatively and at one, and 2.5 years.
Findings / Results: Three patients had complete treatment failure after 6 days, three months and 4 years. All patients but one, experienced improvements after 2.5 years. In two patients, the improvements persisted at 6 years. Three patients experienced clinically significant deteriorations at 6 years. CT scans showed that 5/6 patients had no or very limited (<10 %) bone formation in the defects and 1/6 had 50–75 % bone formation in the treated defect after 2.5 years. MRI showed no improvement in the MOCART score at any time-point.
Conclusions: Treatment of osteochondral defects in the ankle and knee joint with a biomimetic scaffold resulted in incomplete cartilage repair and poor biological subchondral bone repair at 1- and 2.5-year follow- up. Clinical improvements were observed, but deterioration of the clinical scores was seen at 6 years. Despite the small size of the study, these results raise concerns about the long-term repair potential of the MaioRegen® scaffold, and we advise to use the MaioRegen® scaffold with caution.
Lasse Ishøi, Kristian Thorborg, Otto Kraemer, Per Hölmich
Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Copenhagen University Hospital, Amager-Hvidovre, Denmark; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Copenhagen University Hospital, Amager-Hvidovre, Denmark; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Copenhagen University Hospital, Amager-Hvidovre, Denmark; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery
Background: A recent systematic review found that 87% return to sport following hip surgery for femoroacetabular impingement syndrome. However, data is lacking on athletes using a clear definition of return to sport.
Purpose / Aim of Study: This cross-sectional study aimed to determine the return to sport rate and self-reported sport performance following hip arthroscopy for FAIS, according to return to sport consensus definitions.
Materials and Methods: Subjects were identified in the Danish Hip Arthroscopy Registry. A self-report return to sport questionnaire regarding preinjury and present sport and level was used to collect data following hip arthroscopy for FAIS. Return to sport was defined as playing the preinjury sport at preinjury level at follow- up. If return to sport was successful, the associated self-reported sports performance was assessed as: 1) optimal sport performance including full sport participation, 2) impaired sport performance, but full sport participation, and 3) impaired sport performance including restricted sport participation.
Findings / Results: 189 athletes (mean age: 26.9±3.4 y) were included at a mean follow-up of 33.1±16.3 months post- surgery. At follow-up 108 athletes (57.1%) were playing preinjury sport at preinjury level. Of those, 32 athletes (29.6%) reported optimal sports performance including full sports participation, corresponding to 16.9% of the study sample.
Conclusions: Fifty-seven percent of athletes return to preinjury sport at preinjury level. This is considerably lower than a previously reported return to sport rate of 87%, and may reflect that the present study used a clear and strict definition of return to sport. Noteworthy, only 1/3 of athletes who returned to preinjury sport at preinjury level reported their sports performance to be optimal, corresponding to 16.9% of the study sample.
Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Copenhagen University Hospital, Amager-Hvidovre, Denmark; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Copenhagen University Hospital, Amager-Hvidovre, Denmark; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Copenhagen University Hospital, Amager-Hvidovre, Denmark; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery , Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery
Background: A recent systematic review found that 87% return to sport following hip surgery for femoroacetabular impingement syndrome. However, data is lacking on athletes using a clear definition of return to sport.
Purpose / Aim of Study: This cross-sectional study aimed to determine the return to sport rate and self-reported sport performance following hip arthroscopy for FAIS, according to return to sport consensus definitions.
Materials and Methods: Subjects were identified in the Danish Hip Arthroscopy Registry. A self-report return to sport questionnaire regarding preinjury and present sport and level was used to collect data following hip arthroscopy for FAIS. Return to sport was defined as playing the preinjury sport at preinjury level at follow- up. If return to sport was successful, the associated self-reported sports performance was assessed as: 1) optimal sport performance including full sport participation, 2) impaired sport performance, but full sport participation, and 3) impaired sport performance including restricted sport participation.
Findings / Results: 189 athletes (mean age: 26.9±3.4 y) were included at a mean follow-up of 33.1±16.3 months post- surgery. At follow-up 108 athletes (57.1%) were playing preinjury sport at preinjury level. Of those, 32 athletes (29.6%) reported optimal sports performance including full sports participation, corresponding to 16.9% of the study sample.
Conclusions: Fifty-seven percent of athletes return to preinjury sport at preinjury level. This is considerably lower than a previously reported return to sport rate of 87%, and may reflect that the present study used a clear and strict definition of return to sport. Noteworthy, only 1/3 of athletes who returned to preinjury sport at preinjury level reported their sports performance to be optimal, corresponding to 16.9% of the study sample.