Session 6: Sports Orthopedics I Papers
Onsdag den 23. oktober
11:00 - 12:00
Lokale: Vingsal 3
Chairmen: Martin Lind og Kristoffer Barfod
48. Outcome after knee dislocation. A comparison of multiligament injuries using the Schenck classification. Results from the Danish Knee ligament Reconstructions Registry
Torsten Grønbech Nielsen, Lene Lindberg Miller, Martin Lind
Orthopedic Dept, Aarhus University Hospital, Denmark ; Orthopedic Dept, Aarhus University Hospital, Denmark ; Orthopedic Dept, Aarhus University Hospital, Denmark
Background: In the Danish Knee Ligament Reconstruction Registry (DKRR) knee dislocation surgeries have been monitored since 2005. This study is the first registry study dividing knee dislocations into sub groups using Schenck classification and using patient reported outcome scores at 1 year follow-up as primary outcome.
Purpose / Aim of Study: The purpose of this study is to compare subjective clinical outcomes in patients who have undergone multiligament reconstruction after knee disclocation using the Schenck classification.
Materials and Methods: Data on multiligament surgeries in the DKRR between 2005 and 2017 were analyzed. Clinical subjective outcome and knee function was evaluated by Knee injury and Osteoarthritis Outcome Scores (KOOS) and Tegner activity scale.
Findings / Results: A total of 1,201 multiligament surgeries were registered in the DKRR between 2005 and 2017 (isolated cruciate ligament reconstructions were excluded). Mean age was 33.2 (range 9-71). Of the 1,201 patients 70% were males. Sport injuries and traffic accidents accounted for 54% and 19% of the knee dislocation injuries, respectively. Schenck KD-l and KD-lll (KD-lll-L + KD-lll-M) comprising 930 patients (77%) and 169 patients (14%), respectively. The rest was in group KD-2 and KD-4 (88 and 14). KOOS Pain, ADL, Sport, QOL and Tegner significant improved from baseline to 1 year follow-up for all groups. KD-1 group demonstrated better scores improvements than KD-III with more severe ligament lesions. Between groups significant improved were seen in ADL, Sport and Tegner in favour of group KD-1. KOOS scores at 1 year follow-up in the KD-1 group by subscale were 82 (ADL) and 47 (Sport). Scores for KD-3 were 77 (ADL) and 34 (Sports). Tegner scores were 4.1 and 3.5, respectively.
Conclusions: Surgical reconstructions after knee dislocation result in clinical relevant subjective outcome improvements. KD-1 lesions demonstrated better outcome improvements than KD-3 lesions.
Orthopedic Dept, Aarhus University Hospital, Denmark ; Orthopedic Dept, Aarhus University Hospital, Denmark ; Orthopedic Dept, Aarhus University Hospital, Denmark
Background: In the Danish Knee Ligament Reconstruction Registry (DKRR) knee dislocation surgeries have been monitored since 2005. This study is the first registry study dividing knee dislocations into sub groups using Schenck classification and using patient reported outcome scores at 1 year follow-up as primary outcome.
Purpose / Aim of Study: The purpose of this study is to compare subjective clinical outcomes in patients who have undergone multiligament reconstruction after knee disclocation using the Schenck classification.
Materials and Methods: Data on multiligament surgeries in the DKRR between 2005 and 2017 were analyzed. Clinical subjective outcome and knee function was evaluated by Knee injury and Osteoarthritis Outcome Scores (KOOS) and Tegner activity scale.
Findings / Results: A total of 1,201 multiligament surgeries were registered in the DKRR between 2005 and 2017 (isolated cruciate ligament reconstructions were excluded). Mean age was 33.2 (range 9-71). Of the 1,201 patients 70% were males. Sport injuries and traffic accidents accounted for 54% and 19% of the knee dislocation injuries, respectively. Schenck KD-l and KD-lll (KD-lll-L + KD-lll-M) comprising 930 patients (77%) and 169 patients (14%), respectively. The rest was in group KD-2 and KD-4 (88 and 14). KOOS Pain, ADL, Sport, QOL and Tegner significant improved from baseline to 1 year follow-up for all groups. KD-1 group demonstrated better scores improvements than KD-III with more severe ligament lesions. Between groups significant improved were seen in ADL, Sport and Tegner in favour of group KD-1. KOOS scores at 1 year follow-up in the KD-1 group by subscale were 82 (ADL) and 47 (Sport). Scores for KD-3 were 77 (ADL) and 34 (Sports). Tegner scores were 4.1 and 3.5, respectively.
Conclusions: Surgical reconstructions after knee dislocation result in clinical relevant subjective outcome improvements. KD-1 lesions demonstrated better outcome improvements than KD-3 lesions.
49. Practicing procedural skills in knee arthroscopy is more effective than basic psychomotor training: A randomized trial
Mads Emil Jacobsen, Amandus Gustafsson, Per Gorm Jørgensen, Lars Konge,
Dept.of Orthopedic Surgery, Slagelse Sygehus and the Copenhagen Academy for Medical Education and Simulation (CAMES); Dept.of Orthopedic Surgery, Slagelse Sygehus and the Copenhagen Academy for Medical Education and Simulation (CAMES); Dept. of Orthopedic Surgery, Arthroscopic Center, University Hospital of Hvidovre; Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark; ,
Background: Simulator-assisted arthroscopy education traditionally consists of initial training of basic psychomotor skills before advancing to more complex procedural tasks.
Purpose / Aim of Study: The purpose was to explore and compare the effects of basic psychomotor skills training and procedural skills training on novice surgeons’ subsequent knee arthroscopy performance.
Materials and Methods: 22 novice orthopedic surgeons and 11 experienced arthroscopic surgeons voluntarily participated in the study. Novices received a booklet and a standardized introductory lesson on knee arthroscopy before being randomized into a basic skills training group and a procedural skills training group. Each group performed two sessions on a knee arthroscopy simulator; the basic skills training group did one session consisting of basic psychomotor skills modules and one session of procedural modules (diagnostic knee arthroscopy and meniscal resection) whereas the procedural skills training group did two sessions of procedural modules. Performance of the novices was compared to performance of the experienced surgeons to explore evidence of validity for the basic psychomotoric training skills modules and the procedural modules. The effect of prior basic psychomotoric skills training and procedural skills training was explored by comparing pre- and post-training performances of the randomized groups using a mixed-effects regression.
Findings / Results: Validity evidence was found for the whole-procedure modules but not for basic psychomotoric skills modules. We found no statistical effect of basic psychomotor skills training compared to no training (p=0.27). We found a statistically significant effect of prior procedural skills training (p<0.001) and a significantly larger effect of procedural skills training compared to basic psychomotoric skills training (p=0.016).
Conclusions: Procedural skills training was significantly more effective than basic psychomotor skills training with regards to improved performance in diagnostic knee arthroscopy and meniscal resection on a knee arthroscopy simulator. Furthermore, the basic psychomotoric skills modules lacked validity evidence, and we suggest future competency-based training curricula to focus on training full procedures.
Dept.of Orthopedic Surgery, Slagelse Sygehus and the Copenhagen Academy for Medical Education and Simulation (CAMES); Dept.of Orthopedic Surgery, Slagelse Sygehus and the Copenhagen Academy for Medical Education and Simulation (CAMES); Dept. of Orthopedic Surgery, Arthroscopic Center, University Hospital of Hvidovre; Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark; ,
Background: Simulator-assisted arthroscopy education traditionally consists of initial training of basic psychomotor skills before advancing to more complex procedural tasks.
Purpose / Aim of Study: The purpose was to explore and compare the effects of basic psychomotor skills training and procedural skills training on novice surgeons’ subsequent knee arthroscopy performance.
Materials and Methods: 22 novice orthopedic surgeons and 11 experienced arthroscopic surgeons voluntarily participated in the study. Novices received a booklet and a standardized introductory lesson on knee arthroscopy before being randomized into a basic skills training group and a procedural skills training group. Each group performed two sessions on a knee arthroscopy simulator; the basic skills training group did one session consisting of basic psychomotor skills modules and one session of procedural modules (diagnostic knee arthroscopy and meniscal resection) whereas the procedural skills training group did two sessions of procedural modules. Performance of the novices was compared to performance of the experienced surgeons to explore evidence of validity for the basic psychomotoric training skills modules and the procedural modules. The effect of prior basic psychomotoric skills training and procedural skills training was explored by comparing pre- and post-training performances of the randomized groups using a mixed-effects regression.
Findings / Results: Validity evidence was found for the whole-procedure modules but not for basic psychomotoric skills modules. We found no statistical effect of basic psychomotor skills training compared to no training (p=0.27). We found a statistically significant effect of prior procedural skills training (p<0.001) and a significantly larger effect of procedural skills training compared to basic psychomotoric skills training (p=0.016).
Conclusions: Procedural skills training was significantly more effective than basic psychomotor skills training with regards to improved performance in diagnostic knee arthroscopy and meniscal resection on a knee arthroscopy simulator. Furthermore, the basic psychomotoric skills modules lacked validity evidence, and we suggest future competency-based training curricula to focus on training full procedures.
50. Surgical versus nonsurgical treatment of anterior cruciate ligament rupture with at least 10 years of follow-up: a systematic review and meta-analysis
Daniel Barklin Morgan, Teodor Lien-Iversen, Carsten Jensen, May Arna Risberg, Lars Engebretsen, Bjarke Viberg
Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark; Department of Orthopedic Surgery, Oslo University Hospital, Norway, Norwegian School Sport Sciences, Oslo, Norway; Department of Orthopedic Surgery, Oslo University Hospital, Norway, Institute of Clinical Medicine, University of Oslo, Norway; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark
Background: The evidence on surgical versus nonsurgical treatment of anterior cruciate ligament (ACL) rupture, with at least 10 years follow-up, is scarce. Existing systematic reviews include studies with open surgery, thereby limiting the generalizability to modern clinical practice.
Purpose / Aim of Study: To compare the long-term effects of surgical versus nonsurgical treatment of ACL-rupture on radiographic knee osteoarthritis (OA), secondary intervention, knee laxity, and patient-reported outcome measures (PROMs).
Materials and Methods: Studies comparing minimally invasive surgical treatment (arthroscopy/mini-arthrotomy) with nonsurgical treatment of ACL rupture at 10+ years, in adults, were included. Embase, Medline, CINAHL, and Cochrane Library databases were used for the literature search. Covidence was used for the study selection. Study selection and data collection was performed by two independent reviewers. Risk of bias was assessed using the Downs and Black Checklist. Meta-analysis was performed by comparing the risk of knee OA, secondary meniscal surgery and secondary intervention; graft rupture/secondary reconstruction for surgical group and reconstruction for non-surgical.
Findings / Results: The results from five studies were analysed. The meta-analysis revealed higher risk of radiographic knee OA: RR 1.42 [95% CI: 1.09 to 1.85], and lower risk of secondary meniscal surgery: RR 0.34 [95% CI: 0.20 to 0.58] in those patients who received surgical treatment. In four studies, knee laxity was reduced in the patients, who had surgical treatment. The risk of secondary intervention was independent of treatment: RR 0.90 [95% CI: 0.49 to 1.66] and so was PROM scores (i.e., International Knee Documentation Committee, Tegner, Knee Injury and Osteoarthritis Outcome, and Lysholm scores).
Conclusions: The risk of radiographic knee OA was higher while the risk of secondary meniscal injury was lower, and the risk of secondary intervention was equal in patients who had surgical treatment of their ACL rupture 10+ years ago. However, due to the methodological challenges encountered in this systematic review, the findings must be interpreted with caution.
Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark; Department of Orthopedic Surgery, Oslo University Hospital, Norway, Norwegian School Sport Sciences, Oslo, Norway; Department of Orthopedic Surgery, Oslo University Hospital, Norway, Institute of Clinical Medicine, University of Oslo, Norway; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark
Background: The evidence on surgical versus nonsurgical treatment of anterior cruciate ligament (ACL) rupture, with at least 10 years follow-up, is scarce. Existing systematic reviews include studies with open surgery, thereby limiting the generalizability to modern clinical practice.
Purpose / Aim of Study: To compare the long-term effects of surgical versus nonsurgical treatment of ACL-rupture on radiographic knee osteoarthritis (OA), secondary intervention, knee laxity, and patient-reported outcome measures (PROMs).
Materials and Methods: Studies comparing minimally invasive surgical treatment (arthroscopy/mini-arthrotomy) with nonsurgical treatment of ACL rupture at 10+ years, in adults, were included. Embase, Medline, CINAHL, and Cochrane Library databases were used for the literature search. Covidence was used for the study selection. Study selection and data collection was performed by two independent reviewers. Risk of bias was assessed using the Downs and Black Checklist. Meta-analysis was performed by comparing the risk of knee OA, secondary meniscal surgery and secondary intervention; graft rupture/secondary reconstruction for surgical group and reconstruction for non-surgical.
Findings / Results: The results from five studies were analysed. The meta-analysis revealed higher risk of radiographic knee OA: RR 1.42 [95% CI: 1.09 to 1.85], and lower risk of secondary meniscal surgery: RR 0.34 [95% CI: 0.20 to 0.58] in those patients who received surgical treatment. In four studies, knee laxity was reduced in the patients, who had surgical treatment. The risk of secondary intervention was independent of treatment: RR 0.90 [95% CI: 0.49 to 1.66] and so was PROM scores (i.e., International Knee Documentation Committee, Tegner, Knee Injury and Osteoarthritis Outcome, and Lysholm scores).
Conclusions: The risk of radiographic knee OA was higher while the risk of secondary meniscal injury was lower, and the risk of secondary intervention was equal in patients who had surgical treatment of their ACL rupture 10+ years ago. However, due to the methodological challenges encountered in this systematic review, the findings must be interpreted with caution.
51. Five Year Follow-up of Patients Treated with Arthroscopic Partial Meniscectomy
Mathias Gregersen , Rasmus Wejnold Jørgensen , Claus Hjorth Jensen , Anders Odgaard
Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark; Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark; Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark; Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark
Background: The number of arthroscopic partial meniscectomies (APM) has declined since 2010, however, it is still one of the most common orthopaedic surgeries in Denmark. Results have been debated as well as predictors of the outcome.
Purpose / Aim of Study: The purpose of this study was to evaluate Patient Reported Outcome Measures (PROM) five years following APM.
Materials and Methods: Oxford Knee Score 0-100 (OKS) and questions on patient satisfaction and further postoperative treatment were prospectively collected from patients treated with APM in 2013 and 2014. Patients treated with chondrectomy, murectomy or micro fracture were excluded. 113 eligible patients completed the questions (73,9%). Improvements in OKS and differences in gender was analyzed by t-tests. Correlation analysis between age and the improvement in OKS was performed with Pearson’s correlation coefficient. Significance level was set at p < 0.05.
Findings / Results: At 5 year after surgery (mean 61.2 months) OKS had improved 27.9 ± 18.5 points on average, p<0.001. Preoperative scores were 55.1 (SD 17.3), at 3 months scores were 74.6 (SD 19.4), and at 5 years 83.0 (SD 19.1) Patients with no further treatment had a mean score of 87.1 (SD 16.9) and patients with any further treatment had a mean of 70.2 (SD 20.1), p < 0.001. There was no significant difference in the improvement in OKS between these groups (p = 0.085). Four patients had an arthroplasty at follow-up (three TKR and one UKR), a rate of 4.4% (age ≥ 40 years). 85.1% of patients were satisfied with the result at 5 years follow-up. Patients who were satisfied had a mean OKS of 88.3, unsatisfied patients had a mean of 55.7, p < 0.001. Gender and age did not correlate with OKS outcome.
Conclusions: Oxford Knee Score improved at 5-year follow-up after APM with a high satisfaction rate. Preoperative age and gender did not correlate with PROM outcome.
Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark; Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark; Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark; Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark
Background: The number of arthroscopic partial meniscectomies (APM) has declined since 2010, however, it is still one of the most common orthopaedic surgeries in Denmark. Results have been debated as well as predictors of the outcome.
Purpose / Aim of Study: The purpose of this study was to evaluate Patient Reported Outcome Measures (PROM) five years following APM.
Materials and Methods: Oxford Knee Score 0-100 (OKS) and questions on patient satisfaction and further postoperative treatment were prospectively collected from patients treated with APM in 2013 and 2014. Patients treated with chondrectomy, murectomy or micro fracture were excluded. 113 eligible patients completed the questions (73,9%). Improvements in OKS and differences in gender was analyzed by t-tests. Correlation analysis between age and the improvement in OKS was performed with Pearson’s correlation coefficient. Significance level was set at p < 0.05.
Findings / Results: At 5 year after surgery (mean 61.2 months) OKS had improved 27.9 ± 18.5 points on average, p<0.001. Preoperative scores were 55.1 (SD 17.3), at 3 months scores were 74.6 (SD 19.4), and at 5 years 83.0 (SD 19.1) Patients with no further treatment had a mean score of 87.1 (SD 16.9) and patients with any further treatment had a mean of 70.2 (SD 20.1), p < 0.001. There was no significant difference in the improvement in OKS between these groups (p = 0.085). Four patients had an arthroplasty at follow-up (three TKR and one UKR), a rate of 4.4% (age ≥ 40 years). 85.1% of patients were satisfied with the result at 5 years follow-up. Patients who were satisfied had a mean OKS of 88.3, unsatisfied patients had a mean of 55.7, p < 0.001. Gender and age did not correlate with OKS outcome.
Conclusions: Oxford Knee Score improved at 5-year follow-up after APM with a high satisfaction rate. Preoperative age and gender did not correlate with PROM outcome.
52. Bone ingrowth into open architecture PEEK interference screw after ACL reconstruction
Martin Lind, Torsten Nielsen, Ole Gade Sørensen, Bjarne Mygind-Klavsen, Peter Faunø, Stacy Leake-Gardner
Orthopedics, Aarhus University Hospital; Orthopedics, Aarhus University Hospital; Orthopedics, Aarhus University Hospital; Orthopedics, Aarhus University Hospital; Orthopedics, Aarhus University Hospital; , Smith & Nephew Clinical, Scientific & Medical Affairs
Background: Open or fenestrated interference screw design that allow bone ingrowth is a concept for improved bone healing to softtissue graft and bone filling in bone tunnels after anterior cruciate ligament reconstruction (ACLR) No clinical studies with this concept has been performed.
Purpose / Aim of Study: The aim of the current study was to assess CT scanning evaluated bone ingrowth into an open architecture interference screws in the tibial tunnel of patients undergoing ACL with soft tissue grafts.
Materials and Methods: Twelve patients requiring ACLR were included. They underwent arthroscopic ACLR with semitendinosus-/gracilis tendon graft and an open architecture polyetheretherketone (PEEK) interference screw. The patients were scanned with a multi-slice CT scanner two weeks, 6 and 12 months postoperatively. On CT reconstruction slices bone ingrowth into the screws was measured.
Findings / Results: At 6 months no implants demonstrated more than 10 % bone ingrowth. At 12 months 42 % (5/12) implants had more than 10 % bone ingrowth (p = 0.009). There was no tunnel widening or cyst formation seen in relation to any of the implants. Subjective IKDC score improved significantly from 50.6 baseline to 80.1 at 24 month follow-up. Preoperative side-to-side knee laxity improved from 3.7 (2.1) to 1.4 (1.2) mm (p = 0.004) at 12 months. There were no serious adverse events in relation to the new open architecture thread PEEK interference screw during or after hamstring ACL reconstruction. Knee stability, functional, subjective and objective outcomes were similar to large volume ACL outcome studies.
Conclusions: The present study demonstrated bone ingrowth into the open architecture thread PEEK interference screw after soft tissue ACL reconstruction with 42 % of implants having more than 10 % increase in bone ingrowth at 12 months and average bone filling into screws was 7.7 %. Clinical outcome were similar to large volume ACL outcome studies.
Orthopedics, Aarhus University Hospital; Orthopedics, Aarhus University Hospital; Orthopedics, Aarhus University Hospital; Orthopedics, Aarhus University Hospital; Orthopedics, Aarhus University Hospital; , Smith & Nephew Clinical, Scientific & Medical Affairs
Background: Open or fenestrated interference screw design that allow bone ingrowth is a concept for improved bone healing to softtissue graft and bone filling in bone tunnels after anterior cruciate ligament reconstruction (ACLR) No clinical studies with this concept has been performed.
Purpose / Aim of Study: The aim of the current study was to assess CT scanning evaluated bone ingrowth into an open architecture interference screws in the tibial tunnel of patients undergoing ACL with soft tissue grafts.
Materials and Methods: Twelve patients requiring ACLR were included. They underwent arthroscopic ACLR with semitendinosus-/gracilis tendon graft and an open architecture polyetheretherketone (PEEK) interference screw. The patients were scanned with a multi-slice CT scanner two weeks, 6 and 12 months postoperatively. On CT reconstruction slices bone ingrowth into the screws was measured.
Findings / Results: At 6 months no implants demonstrated more than 10 % bone ingrowth. At 12 months 42 % (5/12) implants had more than 10 % bone ingrowth (p = 0.009). There was no tunnel widening or cyst formation seen in relation to any of the implants. Subjective IKDC score improved significantly from 50.6 baseline to 80.1 at 24 month follow-up. Preoperative side-to-side knee laxity improved from 3.7 (2.1) to 1.4 (1.2) mm (p = 0.004) at 12 months. There were no serious adverse events in relation to the new open architecture thread PEEK interference screw during or after hamstring ACL reconstruction. Knee stability, functional, subjective and objective outcomes were similar to large volume ACL outcome studies.
Conclusions: The present study demonstrated bone ingrowth into the open architecture thread PEEK interference screw after soft tissue ACL reconstruction with 42 % of implants having more than 10 % increase in bone ingrowth at 12 months and average bone filling into screws was 7.7 %. Clinical outcome were similar to large volume ACL outcome studies.
53. Combined Bone Marrow Aspirate and Platelet-rich Plasma for Cartilage Repair – Two-Year Clinical Results
Kris Tvilum Chadwick Hede, Bjørn Borsøe Christensen, Jonas Jensen, Casper Bindzus Foldager, Martin Lind
Orthopaedic Research Lab, Aarhus University Hospital; Orthopaedic Research Lab, Aarhus University Hospital; Department of Radiology, Aarhus University Hospital; Orthopaedic Research Lab, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital
Background: Cartilage injuries remain a challenge. Development of two-step cell-based treatments have led to large increases in costs but no significant improvements in patient outcome. Autologous bone marrow aspirate concentrate (BMAC) has been proposed as cell source in a one-step cell- based treatment. Platelet-rich plasma (PRP) is a popular source of endogenous growth factors.
Purpose / Aim of Study: To evaluate the clinical and biological outcome of combined BMAC and PRP on a collagen 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 in the patella (n=7), trochlea (n=2) or the femoral condyle (n=1) were treated with BMAC and PRP from January 2015 to December 2016. In a one-step procedure autologous BMAC and PRP was seeded onto a collagen scaffold and sutured into the debrided defect. Patients were evaluated by clinical outcome scores (IKDC, KOOS and pain score using the numeric rating scale (NRS)) pre- operatively, after three months, one and two years. Second-look arthroscopies were performed (n = 7), with biopsies of the repair tissue for histology. All patients had MRI pre-operatively, after one year and 2- 3.5 years evaluated using “magnetic resonance observation of cartilage repair tissue” (MOCART) score (0(worst) - 100(best)).
Findings / Results: After one year significant improvements were found in IKDC (p = 0.003), KOOS symptoms (p = 0.01), KOOS ADL (p = 0.04), KOOS QOL (p = 0.04) and pain at activity (p = 0.006). At the latest follow-up significant improvements were seen in IKDC (p = 0.009), KOOS symptoms (p = 0.04), KOOS QOL (p = 0.04), pain at rest (p = 0.02) and pain at activity (p = 0.007). MRI MOCART score for cartilage repair improved significantly from baseline to one- year follow-up (p = 0.01). Histomorphometry of repair tissue demonstrated a mixture of fibrous tissue (58%) and fibrocartilage (40%).
Conclusions: Treatment of cartilage injuries using combined BMAC and PRP improved subjective clinical outcome scores and pain scores at one and two years postoperatively. MRI and histology indicated repair tissue inferior to the native hyaline cartilage.
Orthopaedic Research Lab, Aarhus University Hospital; Orthopaedic Research Lab, Aarhus University Hospital; Department of Radiology, Aarhus University Hospital; Orthopaedic Research Lab, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital
Background: Cartilage injuries remain a challenge. Development of two-step cell-based treatments have led to large increases in costs but no significant improvements in patient outcome. Autologous bone marrow aspirate concentrate (BMAC) has been proposed as cell source in a one-step cell- based treatment. Platelet-rich plasma (PRP) is a popular source of endogenous growth factors.
Purpose / Aim of Study: To evaluate the clinical and biological outcome of combined BMAC and PRP on a collagen 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 in the patella (n=7), trochlea (n=2) or the femoral condyle (n=1) were treated with BMAC and PRP from January 2015 to December 2016. In a one-step procedure autologous BMAC and PRP was seeded onto a collagen scaffold and sutured into the debrided defect. Patients were evaluated by clinical outcome scores (IKDC, KOOS and pain score using the numeric rating scale (NRS)) pre- operatively, after three months, one and two years. Second-look arthroscopies were performed (n = 7), with biopsies of the repair tissue for histology. All patients had MRI pre-operatively, after one year and 2- 3.5 years evaluated using “magnetic resonance observation of cartilage repair tissue” (MOCART) score (0(worst) - 100(best)).
Findings / Results: After one year significant improvements were found in IKDC (p = 0.003), KOOS symptoms (p = 0.01), KOOS ADL (p = 0.04), KOOS QOL (p = 0.04) and pain at activity (p = 0.006). At the latest follow-up significant improvements were seen in IKDC (p = 0.009), KOOS symptoms (p = 0.04), KOOS QOL (p = 0.04), pain at rest (p = 0.02) and pain at activity (p = 0.007). MRI MOCART score for cartilage repair improved significantly from baseline to one- year follow-up (p = 0.01). Histomorphometry of repair tissue demonstrated a mixture of fibrous tissue (58%) and fibrocartilage (40%).
Conclusions: Treatment of cartilage injuries using combined BMAC and PRP improved subjective clinical outcome scores and pain scores at one and two years postoperatively. MRI and histology indicated repair tissue inferior to the native hyaline cartilage.
54. Risk Factors to First Time and Recurrent Patella Dislocation with Focus on Familial Association. - A Systematic Review and Best Knowledge Synthesis of Present Literature
Oddrún Danielsen, Turið Akraberg Poulsen, Niclas Højgaard Eysturoy, Elinborg Mortensen, Per Hölmich, Kristoffer Weisskirchner Barfod
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.; , Landssygehuset, Thorshavn, Færøerne; , Landssygehuset, Thorshavn, Færøerne; 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.
Background: The etiology of patellar dislocation (PD) is complex and to a large extent unknown. A range of biomechanical as well as epidemiological risk factors have been identified, familial association being one of them.
Purpose / Aim of Study: The aim of the study was to do a systematic review and best knowledge synthesis of present literature concerning risk factors for developing first time and recurrent PD with a special focus on familial association.
Materials and Methods: The study was performed as a systematic review following the PRISMA guidelines. PubMed and EMBASE were systematically searched. Studies investigating participants with risk factors for first time as well as recurrent PD were included. The records were screened and data extracted independently by two researchers supervised by a third independent assessor. The study is registered in PROSPERO: ID number 127931.
Findings / Results: 5,209 records were screened to find 62 eligible studies. Familial association was described as a risk factor to PD in six studies. Four studies found accumulation of PD across generations in specific families. One study found a family history of PD in 9% of 74 participants and another that participants with a family history of PD had 3.7 higher odds of PD in the contralateral asymptomatic knee. Also, a range of genetic syndromes were found to be associated with PD. Anatomical factors such as trochlear dysplasia, increased TT- TG distance, patella alta and patellar tilt were described as risk factors to PD. Epidemiologically, young age and skeletal immaturity was found to be risk factors to PD.
Conclusions: There may be familial association to PD, but further investigation is necessary to determine the strength and the etiology of the association. There is evidence that trochlear dysplasia, increased TT-TG distance, patella alta, patellar tilt, young age and skeletal immaturity are risk factors to PD
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.; , Landssygehuset, Thorshavn, Færøerne; , Landssygehuset, Thorshavn, Færøerne; 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.
Background: The etiology of patellar dislocation (PD) is complex and to a large extent unknown. A range of biomechanical as well as epidemiological risk factors have been identified, familial association being one of them.
Purpose / Aim of Study: The aim of the study was to do a systematic review and best knowledge synthesis of present literature concerning risk factors for developing first time and recurrent PD with a special focus on familial association.
Materials and Methods: The study was performed as a systematic review following the PRISMA guidelines. PubMed and EMBASE were systematically searched. Studies investigating participants with risk factors for first time as well as recurrent PD were included. The records were screened and data extracted independently by two researchers supervised by a third independent assessor. The study is registered in PROSPERO: ID number 127931.
Findings / Results: 5,209 records were screened to find 62 eligible studies. Familial association was described as a risk factor to PD in six studies. Four studies found accumulation of PD across generations in specific families. One study found a family history of PD in 9% of 74 participants and another that participants with a family history of PD had 3.7 higher odds of PD in the contralateral asymptomatic knee. Also, a range of genetic syndromes were found to be associated with PD. Anatomical factors such as trochlear dysplasia, increased TT- TG distance, patella alta and patellar tilt were described as risk factors to PD. Epidemiologically, young age and skeletal immaturity was found to be risk factors to PD.
Conclusions: There may be familial association to PD, but further investigation is necessary to determine the strength and the etiology of the association. There is evidence that trochlear dysplasia, increased TT-TG distance, patella alta, patellar tilt, young age and skeletal immaturity are risk factors to PD