Kris Hede, Bjørn Borsøe Christensen, Morten Lykke Olesen, Jesper Skovhus Thomsen, Casper Bindzus Foldager, Martin Lind
Orthopaedic Research Lab, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital; Orthopaedic Research Lab, Aarhus University Hospital; Department of Biomedicine, Aarhus University; Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, Aarhus University Hospital
Background: Recently several microfracture
enhancement treatments have been
developed to improve the cartilage repair
after microfracture treatment. One such
already clinically used enhancer is the
Cargel Bioscaffold (CB) which is based on
Purpose / Aim of Study: To gain knowledge of the repair tissue of
cartilage repair using bone marrow
stimulation combined with CARGEL
Bioscaffold compared with bone marrow
stimulation (BMS) alone in chondral defects
in a validated animal model.
Materials and Methods: Six adult Göttingen minipigs received two
chondral defects in each knee. The knees
were randomized to BMS combined with CB
or BMS alone. The animals were
euthanized after 6 months. Follow-up
consisted of histomorphometry,
scoring of the repair tissue (ICRS II), and
µCT of the trabecular bone beneath the
Findings / Results: There was significantly more fibrocartilage
(80% vs 64%, p = 0.04) and a trend towards
less fibrous tissue (15% vs 30%, p = 0.05)
in the defects treated with CB. Hyaline
tissue was only seen in one defect treated
with CB and none treated with BMS alone.
For histological semiquantitative score
(ICRS II), defects treated with CB scored
lower on subchondral bone (69 vs. 44, p =
0.04). No significant differences were seen
on the other parameters of the ICRS II.
Collagen type II staining revealed a trend
towards more positive staining in the CB
group (p = 0.08). µCT revealed thicker
trabeculae (p = 0.029) and a higher bone
material density (p = 0.028) in defects
treated with CB.
Conclusions: Treatment of cartilage injuries with CARGEL
Bioscaffold seems to lead to an improved
repair tissue and a more pronounced
subchondral bone response compared with
bone marrow stimulation alone, however the
treatment did not lead to formation of
Bo Bregenhof, Anders Holsgaard-Larsen, Jonas Bloch Thorlund, Carsten Jensen, Maria Thorning, Per Aagaard, Carsten Bogh Juhl
Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark , Department of Orthopaedics and Traumatology, Odense University Hospital, Denmark; Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark , Department of Orthopaedics and Traumatology, Odense University Hospital, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Denmark, Institute of Regional Health Research, University of Southern Denmark, Denmark; Department of Neurology, Department of Orthopeadics and Traumatology, Department of Molecular Medicine, University of Southern Denmark , Odense University Hospital, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, ; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
Background: Anterior cruciate ligament reconstruction (ACLR) may lead to persistent muscle strength deficiency for more than one year after ACLR, increasing the risk of developing knee osteoarthritis. Common harvest techniques include the Quadriceps tendon (QT), bone-patellar tendon-bone (BPTP) or Hamstring (HS) tendon. Previous systematic reviews have reported reduced knee extensor and knee flexor strength in the ACLR limb compared to the non-operated limb, depending on graft type. However, several randomized controlled trials (RCT) on the subject have since been published.
Purpose / Aim of Study: The aim was to determine short- and long-term deficits in knee flexor and extensor strength following ACLR using either QT/BPTB or HS graft, at 6, 12, 24 and +48 months, post-surgery.
Materials and Methods: A comprehensive literature search for RCTs comparing muscle strength deficits after QT/BPTP and HS graft after ACLR was performed in MEDLINE, EMBASE and CENTRAL. Risk of bias was assessed using the Cochrane risk-of-bias tool (RoB.2). GRADE guidelines for measuring the overall study quality were applied. Results were pooled using a random effect meta-analysis. PROSPERO Reg. nr: CRD42018068351
Findings / Results: Twenty-six studies, evaluating 1017 and 1050 ACLR patients with the PT/BPTB or HS graft, respectively were included. Studies revealed significant limb-to-limb strength deficits of both the knee flexors and extensors after ACLR. QT/BPTP showed extension deficits of 24% (SE: 5.1) at 6 months post-surgery, resolving over time to 16% (6.7), 9% (5.8) and 9% (5.8) at 12, 24 and +48 months. The corresponding values for flexion deficit were 8% (5.2), 5% (5.3), 5% (5.3) and 5% (5.3). HS showed extension deficits of 15% (5.4) at 6 months post-surgery, resolving to 10% (6.1), 8% (4.4) at 12, 24 and +48 months. The corresponding values for flexion deficits were 16% (5.6), 10% (5.3) and 6% (5.3) at 12, 24 and +48-months, respectively.
Conclusions: The available evidence suggest that lower limb muscular strength deficits persist one year or longer after ACLR. Use of QT/BPTB grafts showed substantially higher knee extensor strength deficits compared to HS grafts in the early post-surgical phase which resolved over time. Thus, the graft types were deemed comparable.
Jon Martin Clementsen, Søren T. Skou, Sascha Lohse Hansen, Henrik Eshøj, Carsten Møller Mølgaard, Lone Ramer Mikkelsen, Jonas B. Thorlund
Elective Surgery Centre, Silkeborg Regional Hospital; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital; Elective Surgery Centre, Silkeborg Regional Hospital; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark
Background: The Western Ontario Meniscal Evaluation Tool
(WOMET) is a widely used Patient Reported
Outcome Measure (PROM) designed to evaluate
Health Related Quality of Life (HRQOL) in patients
with meniscal injuries.
Purpose / Aim of Study: The purpose of this study was to translate and
cross-culturally adapt the WOMET for use in the
Danish speaking population and evaluate its test-
retest reliability and comparative responsiveness.
Materials and Methods: The WOMET consists of 3 subscales (physical
symptoms, sports/recreation/work/lifestyle and
emotions) and the total score range from 0-1600
(0=best and 1600=worst). It was forward and
backward translated into Danish according to
international guidelines. 60 patients (mean age
49 years (range 19-71 years), 57% females) with
meniscal injury scheduled for arthroscopy
meniscal surgery at Silkeborg Regional Hospital,
in the period from September 2017 to February
2018, were included in this study. The WOMET
was completed at 3 time points, at baseline, at 3-
and 6-months postoperatively. Additionally, test-
retest reliability was assessed at 3-months and
at 3-months plus one week, in 55 patients with
stable symptom state from test to retest
assessed with a Global Response Question.
Comparative responsiveness was assessed
between the WOMET and The Knee injury and
Osteoarthritis Outcome Score (KOOS4 – an
aggregate score of 4 of the 5 KOOS subscales,
excluding the activities of daily living subscale).
Findings / Results: The Danish version of the WOMET was
successfully translated and showed good face
validity. Test-retest reliability was excellent, with
Intra Class Correlation (ICC) of 0.88 (95%CI 0.84-
0.92) for the total score. The Standard Error of
Measurement (SEM) was 125 points and the
Minimal Detectable Change (MDC) was 347 points
(i.e., 7.8% and 21.7% of the total score,
respectively. No floor or ceiling effects was
observed. The WOMET had good responsiveness
with an effect size (ES) of 1.12 at 6 months after
surgery, which was comparable to the KOOS4 (ES
Conclusions: The Danish version of the WOMET is reliable and
responsive for assessing health-related quality of
life in patients with meniscal pathology.
Signe Kierkegaard, Inger Mechlenburg, Ulrik Dalgas, Bent Lund, Kjeld Søballe, Henrik Sørensen
Orthopaedics and Physio and Occupational Therapy, Horsens Hospital; Clinical Medicine and Orthopaedics, Aarhus University and Aarhus University Hospital; Section for Sports Science, Department of Public Health, Aarhus University; Orthopaedics, Horsens Hospital; Clinical Medicine and Orthopaedics, Aarhus University and Aarhus University Hospital; Section for Sports Science, Department of Public Health, Aarhus University
Background: Patients with femoroacetabular impingement
syndrome (FAIS) experience decreased
function. Consequently, earlier studies have
evaluated gait biomechanics in these patients,
but a larger study evaluating gait
biomechanics before and after an intervention
standardizing gait speed is lacking.
Purpose / Aim of Study: To investigate gait kinematics and kinetics in
patients with FAIS compared with pain-free
controls before and one year after surgery.
Secondary, we aimed at analyzing gait pattern
separately for sex and to investigate
associations between peak kinematics and
kinetics and the Copenhagen Hip and Groin
Outcome Score (HAGOS).
Materials and Methods: Sixty patients with FAIS and 30 pain-free
controls were tested at a standardized gait
speed (1.40 m/s ±10%). Patients were tested
twice: before and one year after surgery.
Kinematics and kinetics were recorded using
infrared high-speed cameras and a force plate.
Participants answered HAGOS.
Findings / Results: The largest difference among groups was that
gait differed between males and females.
Neither before nor after surgery could we
demonstrate large alterations in gait pattern
between patients and pain-free controls. Male
patients demonstrated associations between
peak kinematics and kinetics and HAGOS
Conclusions: Gait pattern was only vaguely altered in
patients with FAIS compared with pain-free
controls before and after surgery when using
at standardized gait speed. Hence, analyzing
gait in patients with FAIS does not seem of
major importance. Nevertheless, there was an
association between HAGOS Sports function
and peak kinematics and kinetics in male
patients implying that there could be a clinical
Kasper Krommes, Jesper Dyhr, Vibberstoft Thomas, Asger Møller, Nielsen Nedergaard, Jesper Bencke, Kristian Thorborg, Per Hölmich, Ishøi Ishøi
Orthopedic Department, Sports Orthopedic Research Center - Copenhagen, Hvidovre Hospital; Bachelor's Degree Programme in Physiotherapy, Faculty of Health and Technology, University College Copenhagen; Bachelor's Degree Programme in Physiotherapy, Faculty of Health and Technology, University College Copenhagen; Orthopedic Department, Sports Orthopedic Research Center - Copenhagen, Hvidovre Hospital; Orthopedic Department, Human Movement Analysis Laboratory, Hvidovre Hospital; Orthopedic Department, Human Movement Analysis Laboratory, Hvidovre Hospital; Orthopedic Department, Sports Orthopedic Research Center - Copenhagen, Hvidovre Hospital; Orthopedic Department, Sports Orthopedic Research Center - Copenhagen, Hvidovre Hospital; Orthopedic Department, Sports Orthopedic Research Center - Copenhagen, Hvidovre Hospital
Background: The unilateral drop jump has been proposed as a test for
measuring single-limb reactive strength index (RSI), a
metric for the ability to rapidly absorb and produce force.
RSI is considered important for performance and for
guiding rehabilitation in athletes and physically active
patients. RSI can be obtained clinically using a simple
smartphone app based in video analysis. However, no
data exists on the reliability or validity of deriving single-
limb RSI from the MyJump2 application.
Purpose / Aim of Study: This study aims to investigate the reliability and
validity of MyJump2 compared to a force platform,
Materials and Methods: Thirty-seven participants (Tegner >5) aged 18-35
years attended two sessions and performed UDJs
from three different box heights (15, 20, 25 cm)
down onto a force plate in a random order whilst
being recorded on a smartphone camera. Minimal
detectable change (MDC) was established, and
Bland-Alman plots and ICC (intraclass correlation
coefficient) scores between instruments were
examined for systematic bias.
Findings / Results: Excellent validity was found across all three
heights; 15, 20 and 25 cm, respectively (ICC =
0.986, 95%CI:0.976-0.989, p<0.001). However,
MyJump2 underestimated the RSI by
approximately 0.05 RSI. Inter-rater reliability
within MyJump2 showed excellen to near to
perfect correlation (ICC = 0.989, 95%CI:0.952-
0.996, p<0.001). Intra-day reliability showed
moderate-excellent correlation across all three
heights (ICC = 0.810-0.887, p<0.001). Inter-day
reliability showed moderate-excellent correlation
across all three heights (ICC = 0.805-0.865,
p<0.001). Low SB was found between the two
instruments. The MDC of the RSI extracted from
MyJump2 ranged 0.08-0.18 (10.4-24.25%), with
the 25 cm box height having the lowest MDC.
Conclusions: MyJump2 app is valid and reliable compared to a
force platform when measuring the RSI of UDJs
from different jump heights. The 25 cm box height
had the best results indicating that this height would
be the best option when testing UDJs. Systematic
bias is present between the app and force platform;
therefore, practitioners should not compare results
across these two instruments.
Anton Alexander Peterlin Peterlin, Stig Brorson, Jonas Vestergaard Iversen
Department of Orthopaedic Surgery, Zealand University Hospital, Koege, Denmark; Department of Orthopaedic Surgery, Zealand University Hospital, Koege, Denmark; Department of Orthopaedic Surgery, Gildhoej Privathospital
Background: The FASH questionnaire is a valid and reliable
patient reported outcome measure (PROM) for
evaluating pain and functional status of athletes
suffering from an acute hamstring muscle injury
Purpose / Aim of Study: The aim was to translate and adapt FASH cross-
culturally with validity and reliability testing for
Danish-speaking footballers suffering from AHI.
Materials and Methods: Translation and following cross-cultural adaptation
was done according to guidelines by Beaton et al.
The final Danish version (FASH-DK) accepted by
the original authors was tested for reliability and
validity on 11 footballers with hamstring injuries and
70 asymptomatic controls.
Findings / Results: Healthy controls and AHI patients had mean FASH-
DK scores of 95 (SD 6.1) and 40.5 (SD 17.3)
respectively. Validity was demonstrated by a
significant difference between AHI patients and
healthy controls (p < 0.001). Concurrent validity
displayed no statistical difference between the
original (p = 0.14 AHI; p = 0.88 healthy) or the
German questionnaire (p = 0.35 AHI; p = 0.94
healthy) and that of the Danish FASH. FASH-DK
demonstrated good to excellent test-retest reliability
(ICC = 0.93 with a 95% confidence interval 0.84 -
0.97 and a Spearman’s rho r = 0.91. Internal
consistency was excellent (α = 0.97).
Conclusions: FASH-DK is a valid and reliable instrument shown
compatible to the original version. It is useful to
assess and determine the severity of AHI in Danish
footballers, both for researchers and clinicians.
Asger m. Nielsen, Lasse Ishøi, Laura Krohn, Mette k. Zebis, Lars Louis Andersen, Kristian Thorborg, Mikkel Bek Clausen
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 Physiotherapy, ; Faculty of Health and Technology, University College Copenhagen, Copenhagen, Denmark, National Research Centre for the Working Environment DK-2100 Copenhagen, Denmark; Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark; Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen
Background: Assessment of hip adduction and abduction
isometric peak torque and rate of torque
development are important when assessing and
monitoring athletes with groin pain. Such
measures can be easily obtained using the long-
lever hip adduction squeeze test and the
bilateral hip abduction press test, both with a
handheld dynamometer. However, data is
lacking on the intra- and inter-tester reliability.
Purpose / Aim of Study: The purpose was to investigate the intra- and
inter-tester reliability of maximal torque exertion
and the ability to exert torque rapidly obtained
during the hip adduction long lever squeeze test
and a bilateral hip abduction press test using a
Materials and Methods: Forty-nine healthy subjects (39 males, 24 years
(SD 4) were included for intra- (n=20) and inter-
tester reliability (n=29). Subjects performed the
hip adduction long lever squeeze test and the
bilateral hip abduction press test in a
randomized order. Isometric peak torque and
early (0-100 ms) and late (0-200 ms) phase rate
of torque development were obtained using a
hand-held dynamometer. Relative reliability was
assessed for all tests using ICC2,1 two-way
mixed model - absolute agreement, thereby
taking any bias between testers into account.
Findings / Results: Assessment of peak torque showed good intra-
and inter-tester reliability for adduction (ICC:
0.93-0.97) and abduction (ICC: 0.88-0.92). For
0-200 ms rate of torque development, both tests
showed good intra-tester reliability (ICC: 0.85-
0.87), whereas intertester reliability was good for
hip adduction squeeze (ICC: 0.75) and
moderate for hip abduction press (ICC: 0.71).
For 0-100 ms rate of torque development, the
hip abduction press test showed good intra-
tester reliability (ICC: 0.78). Remaining tests for
intra- and inter-tester reliability showed
moderate reliability (ICC: 0.50-0.71).
Conclusions: Assessment of isometric peak torque in hip
adduction squeeze and abduction press test
showed good intra- and inter-tester reliability,
whereas 0-200 ms rate of torque development
demonstrated good intra-tester reliability.
Therefore, measures of hip torque development
should preferably be conducted by the same
tester, while this is less important for measures
of isometric peak torque.
Bjørn Borsøe Christensen, Morten Lykke Olesen, Kris Chadwick Hede, Jonas Jensen, Martin Lind
Ortopædkirurgisk afdeling, Aarhus Universitetshospital; Ortopædkirurgisk afdeling, Regionshospitalet Horsens; Ortopædkirurgisk forskningslaboratorium, Aarhus Universitetshospital; Radiologisk Afdeling, Aarhus Universitetshospital; Ortopædkirurgisk afdeling, Aarhus Universitetshospital
Background: Osteochondral injuries have proved difficult to treat.
There are several treatments available, but no gold
standard treatment exists.
Purpose / Aim of Study: We present long term data on a one-step, combined
autologous bone and articular cartilage chips
transplantation, Autologous Dual-Tissue
The aim of this study was to investigate the long-
term results using MRI, CT and patient reported
outcome of ADTT.
Materials and Methods: Eight patients (age 32 ± 7.5 years) suffering from osteochondritis
dissecans in the knee were included. There were no control group.
The lesion was debrided and the osteochondral defect was filled with
autologous bone, to a level at the base of the adjacent cartilage.
Cartilage from the intercondylar notch was chipped using a scalpel
and embedded in fibrin glue in the defect. Radiologic evaluation was
performed using MRI and CT preoperatively, at 1 and at 6 years, and
patient reported outcome scores were used to assess subjective and
functional clinical outcome preoperatively and at 1, 2 and 5 years
(IKDC, KOOS and Tegner activity score).
Findings / Results: The preoperative IKDC score increased from 35.9 to
68.1, 75.4 and 78.2 after 1, 2 and 5 years (p<0.01).
The Tegner score improved from 2.5 to 4.7, 5.1 and
5.1 at 1, 2 and 5 years (p<0.05). KOOS subscores
Sport/rec, and quality of life improved at 1 year and
the improvements persisted at 2 and 5 years
(p<0.05). KOOS pain improved after 5 years
Cartilage tissue repair evaluated using MOCART
score improved from 22.5 to 52.5 at 1 year (p<0.01).
There was a slight deterioration at 6 years (not
statistically significant). CT imaging demonstrated
good subchondral bone healing at 1 year, with an
avg defect bone filling of 75%. At 6 years CT
showed an improvement in all patients with an
average bone filling of 90% and a more even
surface than at 1 year.
Conclusions: Treatment of osteochondral defects with ADTT
resulted in very good subchondral bone restoration
and good cartilage repair. Significant improvements
in patient reported outcome was found at 1 year
postoperative and the improvements persisted at 2
and 5 years.
This study suggests ADTT as a promising, low-cost,
treatment for osteochondral injuries.
Martin Lind, Torsten Nielsen
Orthopedics, Aarhus University Hospital; Orthopedics, Aarhus University Hospital
Background: Quadriceps tendon (QT) has recently
gained increase interest as ACL
reconstruction (ACLR) graft due to
introduction of minimal invasive harvesting
techniques and low donor site morbidity.
Recent Danish registry data have
demonstrated surprizing higher revision rate
of 4.7 % for QT graft compared to hamstring
(HT) and patella tendon (PT) graft. The
influence of individual department/clinic
routine for the procedure could be an
important factor for revision outcome.
Purpose / Aim of Study: The purpose of the present study is to use
the Danish Knee Ligament Reconstruction
Registry (DKRR) to compare revision rates
in patients who have undergone ACLR with
QT, HT, and PT as graft for ACLR related to
individual clinic surgical activity. It was
hypothesized that low clinic volume of the
new QT grafts would result in higher
revision rates compared to high volume
Materials and Methods: Data on primary ACLRs in the DKRR from
2012 through 2019 were analyzed since QT
graft usage started in 2012. Revision rates
for QT, HT, and PT grafts were compared
according to clinic activity (0-100
procedures) and (> 100 procedures).
Revisions rates for the three autograft
cohorts are presented as well as adjusted
revision hazard rates.
Findings / Results: QT revision rate for low activity clinics (0-
100 procedures) was 5.1 % which was
significantly higher than a rate of 2.0 % for
high activity clinics. (p = 0.003) Adjusted
revision hazard rate for low 0-100 group
was 2.0 (P=0.01). HT revision rate for
clinics (0-100 procedures) was 1.9 % and
2.3 % for > 100 procedure clinics. (ns). PT
revision rate for low activity clinics (0-100
procedures) was 3.2 % and 2.2 % for high
activity clinics. (ns).
Conclusions: Quadriceps tendon autografts for ACLR was
associated with higher revision rates in
clinics with lower than 100 procedures
performed from 2012-2019. Learning curve
and surgical routine appears to account for
the previously demonstrated high revision
rate for QT graft ACLR in Denmark
compared to HT and PT grafts.
Michael Rindom Krogsgaard, John Brodersen, Karl Bang Christensen, Volkert Siersma, Jonas Jensen, Christian Fugl Hansen, Jonathan David Comins
Section for Sports Traumatology M51, Bispebjerg and Fredeiksberg Hospital; (2) The Research Unit for General Practice and Section for General Practice, Department of Public Health, University of Copenhagen & Primary Health Care Research Unit, Region Zealand, Denmark; (3) Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; (2) The Research Unit for General Practice and Section for General Practice, University of Copenhagen ; Section for Sports Traumatology M51, Bispebjerg an Frederiksberg Hospital; Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital; Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital
Background: If a good PROM exists in one
language, it is convenient to translate
this PROM instead of developing a
new one in another language.
However, translation may alter the
meaning of items and thereby the
psychometric properties of the PROM.
Hence, translation has to be structured
in order to achieve proper adaptation
to a new culture.
Purpose / Aim of Study: The aims were to assess how the most
commonly used PROMs in sports
research had been translated,
culturally adapted and validated,
including assessment of differential
item functioning (DIF) locally and
Materials and Methods: For 392 translated versions of 61
different PROMs identified by search in
PubMed and SCOPUS, the methods
for translation, cultural adaption and
construct validation were assessed.
Information about translated versions
were obtained from the homepages of
commonly used PROMs and
compared to the translations that could
be identified in literature.
Findings / Results: 94% of all translations had been
performed with forward-backwards
technique, but only 49% used cognitive
interviews to ensure appropriate
wording, understandability, and
adaption to the local culture with
patients and laypersons. Only 2% of
the translated versions were validated
according to modern test theory
models, and no study assessed
differential item functioning (DIF) for
the local PROM or cross-cultural DIF.
For PROMs that were not developed in
English language, it was common that
translations to other languages were
based on undocumented English
versions. Many translated versions of
commonly used PROMs were
Conclusions: A majority of translated PROMs are of
questionable quality, despite the
common conclusion that the actual
PROM is a valid and reliable
Michael Rindom Krogsgaard, Martin Rathcke
Section for Sports Traumatology, Bispebjerg and Frederiksberg Hospital; Section for Sports Traumatology, Bispebjerg and Frederiksberg Hospital
Background: Advantages of arthroscopy of the
sternoclavicular joint (SCJ) is a better
visualization and lower surgical
morbidity. However, there are only few,
small treatment series reported in
Purpose / Aim of Study: To report a prospective, consecutive
series of SCJ-arthroscopies.
Materials and Methods: In 67 patients with pain from the SCJ
we found indication for the procedure.
All cases were unilateral, and we used
the same arthroscopic technique in all
(published earlier). Patients completed
DASH and Oxford Shoulder Score
(OSS) before the operation and at 1, 2
and 5 years. Complications and
reoperations were recorded.
Findings / Results: In twelve of the 67 cases it was not
possible to insert the scope to the joint:
two joints turned out to be anchylotic,
in one case the subcutaneous fat was
extensive making portal positioning
unsafe, and in nine osteophytes
blocked for the scope. These cases
were converted to open surgery. In two
cases open resection of osteophytes at
the costoclavicular ligament was
added to arthroscopy of the joint. In the
majority the degenerated or torn disc
was resected, and cartilage was
debrieded/medial clavicle end
resected. In two cases the disc was
sutured and in three loose bodies were
There were no infections, no per- or
post-operative bleedings and no case
of penetration of the posterior capsule.
Two cases needed re-arthroscopy with
further resection of the clavicle. In one
case instability occurred after resection
of osteophytes and was treated with a
stabilizing procedure. In one case an
interposition plasty with a gracilis
tendon was performed for persisting
pain despite resection of the medial
DASH score decreased from median
54 (range 30-94) preoperatively, to
37.5 (24-108)(p<0.05) at 1 year and 36
(24-102) at 2 years follow-up. Worst
pain item from OSS decreased from
mean 2,6 preoperatively to 1,9 at 1
year (p<0.05) and 1,7 at 2 years. Usual
pain-item decreased from 2,2
preoperatively to 1,4 at 1 year (p <
0.05) and 1,1 at 2 years. Pain at night
decreased from 2,4 preoperatively to
1,3 at 1 year (p<0,05) and 1,4 at 2
Conclusions: SCJ arthroscopy was safe and the
clinical results were comparable to or
better than reported results of similar
Markus Gadeberg, Allan Cramer, Per Hølmich, Kristoffer Barfod
Sports Orthopedic Research Center (SORC-C), Hvidovre Hospital; Sports Orthopedic Research Center (SORC-C), Hvidovre Hospital; Sports Orthopedic Research Center (SORC-C), Hvidovre Hospital; Sports Orthopedic Research Center (SORC-C), Hvidovre Hospital
Background: The diagnosis codes for sports injuries in the
Danish National Patient Register (DNPR) are
frequently used for research, however the
validity is unknown.
Purpose / Aim of Study: The aim was to investigate the validity of
diagnosis codes for some of the most
common sports related injuries: acute Achilles
tendon rupture (DS86.0A), Achilles tendinitis
(DM76.6), rupture of anterior cruciate
ligament of the knee (ACL) (DS83.5E),
dislocation of the patella (DS83.0), traumatic
tear of the meniscus (DS83.2) and
degenerative meniscal lesion (DM23.2).
Materials and Methods: The study was performed as a registry study
in the DNPR. For each diagnosis code,
patient records from Copenhagen University
Hospital Hvidovre were retrieved from
January 1st to December 31st 2017. We
considered a positive predictive value (PPV)
of 80% or higher to be satisfying.
Findings / Results: The population consisted of 85 patients
registered with the diagnosis code for
acute Achilles tendon rupture, 65 patients
with Achilles tendinitis, 73 patients with
ACL rupture , 100 patients with dislocation
of the patella , 100 patients with traumatic
tear of the meniscus, and 100 patients
with degenerative meniscal lesion. For
acute Achilles tendon rupture the PPV
was 98% (95% CI: 92%-100%), for
Achilles tendinitis 85% (95% CI:
74%-92%), for ACL rupture 96% (95% CI:
88%-99%) and for dislocation of the
patella 96% (95% CI: 90%-99%).
Depending on the definition of the
diagnoses, the PPVs were 56%-72% for
traumatic tear of the meniscus and
53%-77% for degenerative meniscal
Conclusions: This study documented a satisfying validity
allowing for epidemiological research
concerning the diagnosis codes for acute
Achilles tendon rupture, Achilles tendinitis,
ACL rupture and dislocation of the patella.
The diagnosis codes for traumatic tear of the
meniscus and degenerative meniscal lesion
showed a lower validity and should therefore
be used with caution.
Thomas Linding Jakobsen, Kristian Thorborg, Jakob Fister, Thomas Kallemose, Thomas Bandholm
Section for Orthopaedic and Sports Rehabilitation (SOS-R), Health Centre Nørrebro, City of Copenhagen; Department of Orthopedic Surgery , Amager and Hvidovre Hospital ; Section for Orthopaedic and Sports Rehabilitation (SOS-R), Health Centre Nørrebro, City of Copenhagen; Clinical Research Centre, Amager and Hvidovre Hospital; Department of Orthopedic Surgery, Amager and Hvidovre Hospital
Background: In musculoskeletal rehabilitation, blood flow
restriction (BFR) resistance exercise is potentially
indicated in patients who may not load tissues as
required for “classic” heavy resistance exercise.
Purpose / Aim of Study: The purpose of this study was to explore the
feasibility of rehabilitation with BFR resistance
exercise in patients with early weight bearing
restrictions after knee meniscus or cartilage repair.
Materials and Methods: In total, 42 patients with meniscus (n=21) or
cartilage repair (n=21) attended 9 weeks of
supervised rehabilitation with BFR resistance
exercise at an outpatient rehabilitation center (5
sessions/week). Clinical outcomes were assessed at
different time points from 2 to 26 weeks
postoperatively and included: Thigh circumference
(muscle size proxy), isometric knee-extension
strength, knee joint and thigh pain, knee joint range
of motion and effusion, perceived exertion, self-
reported disability and quality of life, and adverse
Findings / Results: On average, patients performed 48 BFR sessions
(35 home, 13 supervised). 38 patients reported 64
harms (dizziness, n=52) - none considered serious.
Thigh circumference increased 0.6 cm (SD=1.5)
from baseline to end of the rehabilitation program for
the operated leg from 52.8 to 53.3 cm (p=0.01), and
0.1 cm (SD=1.1) for the healthy leg from 54.9 to
55.0 cm (p=0.41). At 26 weeks postoperatively,
isometric knee-extension strength (limb symmetry
index) was 83% (SD=25).
Conclusions: Rehabilitation with BFR resistance exercise initiated
early after meniscus or cartilage repair seems
feasible and may increase thigh muscle mass during
a period of weight bearing restrictions. Harms were
reported, but no serious adverse events were found.
Trial registration: NCT03371901