Session 14: DOS Best Papers
19. November
16:30 - 18:00
Lokale: Auditorium
Liv Vesterby, Asger Haugaard, Jonas Adjal, Huda Ibrahim Muhudin, Kevser Sert, Morten Grove Thomsen, Peter Toft Tengberg, Ilija Ban, Søren Ohrt-Nissen
Department of Orthopaedics, Hvidovre Hospital; Department of Biomedical Engineering, Technical University of Denmark
Background: Tension band wire (TBW) fixation is a well-known method for treating simple displaced olecranon fractures, though associated with a high risk of complications such as wound breakdown or prominent hardware causing discomfort. An all- suture technique (AS) has been proposed as an alternative with potentially fewer complications but this technique has never been validated in a biomechanical setup.
Aim: To evaluate strength of fixation in simple olecranon fractures comparing TBW to AS.
Materials and Methods: Twenty matched pairs of fresh-frozen human cadaveric elbows were used. A transverse fracture was made, reduced and fixated using either TBW or AS. Standardized TBW fixation was done according to AO principles and AS was done as described by Phadnis et al. The triceps tendon was mounted in a Measure Test Simulate apparatus with the elbow fixed in 90 degree flexion and loaded to 200 N for 200 cycles. Fracture displacement was optically monitored using Digital Image Correlation (DIC). The Primary outcome was median fracture displacement after 200 cycles. Finally, a load-to- failure test (LF) was performed by a monotonic pull to 1000 N. Failure was defined as a drop in force measured by a force transducer.
Results: Two specimens in the AS group were excluded from cyclic loading analysis due to technical difficulties with DIC. For cyclic loading analyses, median (min- max) fracture displacement was 0.18 mm (0.00- 1.48) in the TBW group and 0.28 mm (0.10-0.44) in the AS group (p=0.315). No difference in displacement was found between the 2 groups in repeated measures analysis of variance (p=0.329). For LF, 8 out of 10 specimens failed in the TBW group (median LF 747 N) and 6 out of 10 specimens failed in the AS group (median LF 791 N). All TBW constructs failed due to breakage of the wire. Fracture in the dorsal cortex of the transverse suture tunnel, suture breakage and triceps failure were the failure mechanism in 3, 1 and 2 AS constructs, respectively.
Interpretation / Conclusion: There was no difference in fixation strength between TBW and AS. Our findings suggest AS to be a feasible alternative to TBW and we hypothesize that it may have fewer hardware-related complications as it is a non-metallic implant.
Department of Orthopaedics, Hvidovre Hospital; Department of Biomedical Engineering, Technical University of Denmark
Background: Tension band wire (TBW) fixation is a well-known method for treating simple displaced olecranon fractures, though associated with a high risk of complications such as wound breakdown or prominent hardware causing discomfort. An all- suture technique (AS) has been proposed as an alternative with potentially fewer complications but this technique has never been validated in a biomechanical setup.
Aim: To evaluate strength of fixation in simple olecranon fractures comparing TBW to AS.
Materials and Methods: Twenty matched pairs of fresh-frozen human cadaveric elbows were used. A transverse fracture was made, reduced and fixated using either TBW or AS. Standardized TBW fixation was done according to AO principles and AS was done as described by Phadnis et al. The triceps tendon was mounted in a Measure Test Simulate apparatus with the elbow fixed in 90 degree flexion and loaded to 200 N for 200 cycles. Fracture displacement was optically monitored using Digital Image Correlation (DIC). The Primary outcome was median fracture displacement after 200 cycles. Finally, a load-to- failure test (LF) was performed by a monotonic pull to 1000 N. Failure was defined as a drop in force measured by a force transducer.
Results: Two specimens in the AS group were excluded from cyclic loading analysis due to technical difficulties with DIC. For cyclic loading analyses, median (min- max) fracture displacement was 0.18 mm (0.00- 1.48) in the TBW group and 0.28 mm (0.10-0.44) in the AS group (p=0.315). No difference in displacement was found between the 2 groups in repeated measures analysis of variance (p=0.329). For LF, 8 out of 10 specimens failed in the TBW group (median LF 747 N) and 6 out of 10 specimens failed in the AS group (median LF 791 N). All TBW constructs failed due to breakage of the wire. Fracture in the dorsal cortex of the transverse suture tunnel, suture breakage and triceps failure were the failure mechanism in 3, 1 and 2 AS constructs, respectively.
Interpretation / Conclusion: There was no difference in fixation strength between TBW and AS. Our findings suggest AS to be a feasible alternative to TBW and we hypothesize that it may have fewer hardware-related complications as it is a non-metallic implant.
Josefine Slater, Maiken Stilling, Pelle Hanberg, Mathias A.F Bendtsen, Andrea Jørgensen, Kjeld Søballe, Nis Pedersen Jørgensen, Mats Bue
Aarhus Microdialysis Research Group, Orthopaedic research unit, Aarhus Univeristy hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Clinical medicine, Aarhus University; Department of infectious diseases, Aarhus University hospital
Background: Peri- and postoperative antibiotics are key adjuvant treatment tools in the management of prosthetic joint infection (PJI). The combination of moxifloxacin and rifampicin may be an attractive treatment option for cases caused by staphylococci or other common Gram-positive bacteria; however, previous studies have reported a reduction in spinal tissue and plasma concentrations of moxifloxacin when coadministered with rifampicin. The magnitude of this reduction in the tissues relevant for PJI treatment is not known.
Aim: To evaluate the effect of rifampicin on moxifloxacin area under the concentration-time curve from 0 to 24 h (AUC0-24h) in the synovial fluid of the knee joint, tibial bone, and adjacent subcutaneous tissue under steady-state conditions using microdialysis in a porcine model.
Materials and Methods: Twenty female pigs were randomized to receive oral treatment with moxifloxacin monotherapy (Group A, n=10) of 400 mg once daily for three days or a combination-therapy (Group B, n=10) of 400 mg of moxifloxacin once daily for three days combined with 450 mg of rifampicin twice daily for seven days. Microdialysis was applied for sampling in the synovial fluid of the knee joint, tibial cancellous and cortical bone, and adjacent subcutaneous tissues. Plasma samples were taken as a reference. Measurements were obtained for 24 h.
Results: Coadministration of moxifloxacin and rifampicin resulted in reductions of the moxifloxacin AUC0-24 in the target tissues in the ranges of 67–85% (p <0.05). The corresponding change in plasma was 20% (p=0.60). For both groups the tissue penetration (fAUCtissue /fAUCplasma) was incomplete in all tissues. The highest moxifloxacin tissue penetration was in the knee joint: 0.59 (Group A) and 0.24 (Group B). The lowest tissue penetration was in cortical bone: 0.17 (Group A) and 0.04 (Group B).
Interpretation / Conclusion: We demonstrated a significant reduction of moxifloxacin AUC0-24 in tissues relevant for acute PJI treatment when coadministered with rifampicin. The target tissue concentrations were significantly more reduced than the plasma concentrations. This may be particularly important as plasma concentrations are used in clinical practice to assess moxifloxacin treatment sufficiency.
Aarhus Microdialysis Research Group, Orthopaedic research unit, Aarhus Univeristy hospital; Department of Orthopaedics, Aarhus University Hospital; Department of Clinical medicine, Aarhus University; Department of infectious diseases, Aarhus University hospital
Background: Peri- and postoperative antibiotics are key adjuvant treatment tools in the management of prosthetic joint infection (PJI). The combination of moxifloxacin and rifampicin may be an attractive treatment option for cases caused by staphylococci or other common Gram-positive bacteria; however, previous studies have reported a reduction in spinal tissue and plasma concentrations of moxifloxacin when coadministered with rifampicin. The magnitude of this reduction in the tissues relevant for PJI treatment is not known.
Aim: To evaluate the effect of rifampicin on moxifloxacin area under the concentration-time curve from 0 to 24 h (AUC0-24h) in the synovial fluid of the knee joint, tibial bone, and adjacent subcutaneous tissue under steady-state conditions using microdialysis in a porcine model.
Materials and Methods: Twenty female pigs were randomized to receive oral treatment with moxifloxacin monotherapy (Group A, n=10) of 400 mg once daily for three days or a combination-therapy (Group B, n=10) of 400 mg of moxifloxacin once daily for three days combined with 450 mg of rifampicin twice daily for seven days. Microdialysis was applied for sampling in the synovial fluid of the knee joint, tibial cancellous and cortical bone, and adjacent subcutaneous tissues. Plasma samples were taken as a reference. Measurements were obtained for 24 h.
Results: Coadministration of moxifloxacin and rifampicin resulted in reductions of the moxifloxacin AUC0-24 in the target tissues in the ranges of 67–85% (p <0.05). The corresponding change in plasma was 20% (p=0.60). For both groups the tissue penetration (fAUCtissue /fAUCplasma) was incomplete in all tissues. The highest moxifloxacin tissue penetration was in the knee joint: 0.59 (Group A) and 0.24 (Group B). The lowest tissue penetration was in cortical bone: 0.17 (Group A) and 0.04 (Group B).
Interpretation / Conclusion: We demonstrated a significant reduction of moxifloxacin AUC0-24 in tissues relevant for acute PJI treatment when coadministered with rifampicin. The target tissue concentrations were significantly more reduced than the plasma concentrations. This may be particularly important as plasma concentrations are used in clinical practice to assess moxifloxacin treatment sufficiency.
Janni Kjærgaard Thillemann: , Sepp de Raedt, Emil Toft Petersen, Katriina Bøcker Puhakka, Torben Bæk Hansen, Maiken Stilling
Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West; Department of Clinical Medicine, Aarhus University; NRT X-RAY A/S, Hasselager; AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital; Department of Radiology, Regional Hospital Horsens; Department of Radiology, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital.
Background: Little is known about the normal values for in-vivo distal radioulnar joint (DRUJ) kinematics. Such data could be useful to diagnose DRUJ instability by defining normal DRUJ translation during active exercises.
Aim: This study aimed to report normal values of DRUJ kinematics in uninjured forearms during a subject applied press test using dynamic radiostereometry (RSA) and investigate method reliability.
Materials and Methods: Thirty-three subjects (19 women) with a mean age of 31 years were prospectively recruited for participation in a study on triangular fibrocartilagnous complex injury and DRUJ instability. The current study included the contralateral uninjured asymptomatic and clinical stable forearm. DRUJ kinematics was recorded by non- invasive dynamic RSA during a standardized press test examination performed by the subjects. AutoRSA software was used for image analyses. Computer tomography-based forearm bone models were generated to define standardized anatomical axes and coordinate systems to estimate kinematic outcomes including: DRUJ translation, the ulnar head position in the sigmoid notch (DRUJ position ratio), and changes in ulnar variance. Repeatability of dynamic RSA press test- retest examinations was evaluated in order to approximate the method precision and Inter Class Coefficient (ICC) rater agreement.
Results: The mean maximum press test pressure application was 6.0 kg (95%CI 5.1; 6.9). This pressure resulted in a mean DRUJ translation of 4.7 mm (95%CI 4.2; 5.5), a mean DRUJ position ratio of 0.40 (95%CI 0.33; 0.44) and a mean ulnar variance increase of 1.1 mm (95%CI 1.0; 1.2). Maximum DRUJ translation was reached at a 5 kg press test threshold. The ICC rater agreement of DRUJ translation was excellent (r .93) and within a prediction interval of 0.53 mm.
Interpretation / Conclusion: In conclusion, this clinical study reports the normal values of DRUJ kinematics during the press test examination using a non- invasive dynamic RSA imaging method and demonstrate excellent ICC rater agreement and high precision. The next step will be to establish kinematic values in patients with DRUJ instability and determine limits for normal versus pathological DRUJ kinematics.
Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West; Department of Clinical Medicine, Aarhus University; NRT X-RAY A/S, Hasselager; AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital; Department of Radiology, Regional Hospital Horsens; Department of Radiology, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital.
Background: Little is known about the normal values for in-vivo distal radioulnar joint (DRUJ) kinematics. Such data could be useful to diagnose DRUJ instability by defining normal DRUJ translation during active exercises.
Aim: This study aimed to report normal values of DRUJ kinematics in uninjured forearms during a subject applied press test using dynamic radiostereometry (RSA) and investigate method reliability.
Materials and Methods: Thirty-three subjects (19 women) with a mean age of 31 years were prospectively recruited for participation in a study on triangular fibrocartilagnous complex injury and DRUJ instability. The current study included the contralateral uninjured asymptomatic and clinical stable forearm. DRUJ kinematics was recorded by non- invasive dynamic RSA during a standardized press test examination performed by the subjects. AutoRSA software was used for image analyses. Computer tomography-based forearm bone models were generated to define standardized anatomical axes and coordinate systems to estimate kinematic outcomes including: DRUJ translation, the ulnar head position in the sigmoid notch (DRUJ position ratio), and changes in ulnar variance. Repeatability of dynamic RSA press test- retest examinations was evaluated in order to approximate the method precision and Inter Class Coefficient (ICC) rater agreement.
Results: The mean maximum press test pressure application was 6.0 kg (95%CI 5.1; 6.9). This pressure resulted in a mean DRUJ translation of 4.7 mm (95%CI 4.2; 5.5), a mean DRUJ position ratio of 0.40 (95%CI 0.33; 0.44) and a mean ulnar variance increase of 1.1 mm (95%CI 1.0; 1.2). Maximum DRUJ translation was reached at a 5 kg press test threshold. The ICC rater agreement of DRUJ translation was excellent (r .93) and within a prediction interval of 0.53 mm.
Interpretation / Conclusion: In conclusion, this clinical study reports the normal values of DRUJ kinematics during the press test examination using a non- invasive dynamic RSA imaging method and demonstrate excellent ICC rater agreement and high precision. The next step will be to establish kinematic values in patients with DRUJ instability and determine limits for normal versus pathological DRUJ kinematics.
Pelle Hanberg, Mats Bue, Jesper Kabel, Andrea René Jørgensen, Christian Jessen, Kjeld Søballe, Maiken Stilling
Department of Orthopaedic Surgery, Horsens Regional Hospital Aarhus Microdialysis Research Group, Orthopaedic Research Unit Department of Clinical Medicine, Aarhus University Department of Orthopaedic Surgery, Aarhus University Hospital Department of Anesthesiology, Horsens Regional Hospital
Background: Tourniquet is widely used in orthopedic surgery to reduce intraoperative bleeding and improve visualization. In order to prevent surgical site infection, correct timing of antimicrobial prophylaxis and tourniquet inflation is important.
Aim: The objective of this study was to evaluate the effect of tourniquet application on peri- and postoperative cefuroxime concentrations in subcutaneous tissue, skeletal muscle, calcaneal cancellous bone, and plasma.
Materials and Methods: Ten patients scheduled for hallux valgus or hallux rigidus surgery were included. Microdialysis catheters were placed for sampling of cefuroxime concentrations bilaterally in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone. A tourniquet was applied on the thigh of the leg scheduled for surgery (tourniquet duration time (range): 65 (58; 77) minutes). Cefuroxime (1.5 g) was administered intravenously 15 minutes prior to tourniquet inflation, followed by a second dose 6 hours later. Dialysates and venous blood samples were collected for 12 hours. The primary endpoint was the time for which the free cefuroxime concentration was maintained above the clinical breakpoint minimal inhibitory concentration (T>MIC) for Staphylococcus aureus (4 µg/mL).
Results: A cefuroxime concentration of 4 µg/mL was reached within 22.5 minutes in all compartments and patients. For cefuroxime the T>MIC (4 µg/mL) ranged between 4.8– 5.4 hours across compartments, with similar results for the tourniquet and non-tourniquet exposed leg. Comparable T>MIC and penetration ratios were found for the first and second dosing intervals.
Interpretation / Conclusion: Administration of cefuroxime (1.5 g) 15 minutes prior to tourniquet inflation is safe in order to achieve tissue concentrations above 4 µg/mL throughout surgery. A tourniquet application time of approximately 1 hour did not affect the cefuroxime tissue penetration in the following dosing interval.
Department of Orthopaedic Surgery, Horsens Regional Hospital Aarhus Microdialysis Research Group, Orthopaedic Research Unit Department of Clinical Medicine, Aarhus University Department of Orthopaedic Surgery, Aarhus University Hospital Department of Anesthesiology, Horsens Regional Hospital
Background: Tourniquet is widely used in orthopedic surgery to reduce intraoperative bleeding and improve visualization. In order to prevent surgical site infection, correct timing of antimicrobial prophylaxis and tourniquet inflation is important.
Aim: The objective of this study was to evaluate the effect of tourniquet application on peri- and postoperative cefuroxime concentrations in subcutaneous tissue, skeletal muscle, calcaneal cancellous bone, and plasma.
Materials and Methods: Ten patients scheduled for hallux valgus or hallux rigidus surgery were included. Microdialysis catheters were placed for sampling of cefuroxime concentrations bilaterally in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone. A tourniquet was applied on the thigh of the leg scheduled for surgery (tourniquet duration time (range): 65 (58; 77) minutes). Cefuroxime (1.5 g) was administered intravenously 15 minutes prior to tourniquet inflation, followed by a second dose 6 hours later. Dialysates and venous blood samples were collected for 12 hours. The primary endpoint was the time for which the free cefuroxime concentration was maintained above the clinical breakpoint minimal inhibitory concentration (T>MIC) for Staphylococcus aureus (4 µg/mL).
Results: A cefuroxime concentration of 4 µg/mL was reached within 22.5 minutes in all compartments and patients. For cefuroxime the T>MIC (4 µg/mL) ranged between 4.8– 5.4 hours across compartments, with similar results for the tourniquet and non-tourniquet exposed leg. Comparable T>MIC and penetration ratios were found for the first and second dosing intervals.
Interpretation / Conclusion: Administration of cefuroxime (1.5 g) 15 minutes prior to tourniquet inflation is safe in order to achieve tissue concentrations above 4 µg/mL throughout surgery. A tourniquet application time of approximately 1 hour did not affect the cefuroxime tissue penetration in the following dosing interval.
Anders El-Galaly, Anette Tarp Hansen, Andreas Kappel
Interdisciplinary Orthopaedics, Aalborg University Hospital
Background: In TKA, “Tourniquet use was associated with significantly higher risk of venous thromboembolisms (VTE) compared to surgery without a tourniquet” concluded a recent Cochrane Review based on underpowered RCTs with VTE as secondary outcome. Nationwide arthroplasty registries have the power to analyze rare outcomes like VTEs but are also vulnerable for confounding. Currently, Denmark has a unique set-up as tourniquet-use is (1) 50/50, (2) based on the surgeons’ preference and (3) rarely contraindicated and thus unrelated to the patients. Together, this enables tourniquet-use to pseudorandomize the patients registered in the Danish Knee Arthroplasty Registry.
Aim: Does the use of tourniquet increase the risk of VTE within 90-days of primary TKA?
Materials and Methods: We retrieved 19,804 patients with CR-TKA from 2014 to 2018. Of these, tourniquet was used in 10,111(51%) and not in 9,693 (49%). The cohort was linked with the National Prescription Database and the National Patient Registry to collect a total of 42 potential confounders such as length of stay, prior VTE, heart diseases, anticoagulants, BMI etc. The 90-days incidence of VTEs and the relative risk of VTE were endpoints and reported with 95% confidence intervals (CI). Standardized mean difference (SMD) was used to estimate the intergroup balance. As a sensitivity analysis, we repeated the calculation in a propensity-score matched setup to ensure balance in all potential confounders.
Results: As expected, the groups were comparable across all included confounders (SMD<0.1) except 3 (Charnley class, American Knee Society’s functional score and implant fixation). The 90-days incidence of VTEs was 0.8% (95% CI: 0.6-1.0) when tourniquet was used and 1.1% (95% CI: 0.9-1.3) when not (p=0.02) corresponding to a relative risk of 0.70 (95% CI: 0.53-0.93) associated with tourniquet- use. 1,292 (6%) patients were excluded to balance the remaining 3 potential confounders in the matched cohort and comparable results were found in this analysis.
Interpretation / Conclusion: Based on this, first-of-its-kind, pseudorandomized nationwide arthroplasty registry study it seems safe to conclude that use of tourniquet does not increase risk of VTE within 90 days of primary TKA.
Interdisciplinary Orthopaedics, Aalborg University Hospital
Background: In TKA, “Tourniquet use was associated with significantly higher risk of venous thromboembolisms (VTE) compared to surgery without a tourniquet” concluded a recent Cochrane Review based on underpowered RCTs with VTE as secondary outcome. Nationwide arthroplasty registries have the power to analyze rare outcomes like VTEs but are also vulnerable for confounding. Currently, Denmark has a unique set-up as tourniquet-use is (1) 50/50, (2) based on the surgeons’ preference and (3) rarely contraindicated and thus unrelated to the patients. Together, this enables tourniquet-use to pseudorandomize the patients registered in the Danish Knee Arthroplasty Registry.
Aim: Does the use of tourniquet increase the risk of VTE within 90-days of primary TKA?
Materials and Methods: We retrieved 19,804 patients with CR-TKA from 2014 to 2018. Of these, tourniquet was used in 10,111(51%) and not in 9,693 (49%). The cohort was linked with the National Prescription Database and the National Patient Registry to collect a total of 42 potential confounders such as length of stay, prior VTE, heart diseases, anticoagulants, BMI etc. The 90-days incidence of VTEs and the relative risk of VTE were endpoints and reported with 95% confidence intervals (CI). Standardized mean difference (SMD) was used to estimate the intergroup balance. As a sensitivity analysis, we repeated the calculation in a propensity-score matched setup to ensure balance in all potential confounders.
Results: As expected, the groups were comparable across all included confounders (SMD<0.1) except 3 (Charnley class, American Knee Society’s functional score and implant fixation). The 90-days incidence of VTEs was 0.8% (95% CI: 0.6-1.0) when tourniquet was used and 1.1% (95% CI: 0.9-1.3) when not (p=0.02) corresponding to a relative risk of 0.70 (95% CI: 0.53-0.93) associated with tourniquet- use. 1,292 (6%) patients were excluded to balance the remaining 3 potential confounders in the matched cohort and comparable results were found in this analysis.
Interpretation / Conclusion: Based on this, first-of-its-kind, pseudorandomized nationwide arthroplasty registry study it seems safe to conclude that use of tourniquet does not increase risk of VTE within 90 days of primary TKA.
Ole Gade Sørensen, Torsten Nielsen, Lars Konradsen, Bjarne Mygind-Klavsen, Susanne Schaarup, Peter Faunø, Michael Krogsgaard, Martin Lind
Department of Orthopaedics, Aarhus Universityhospital; Department of Orthopaedics, Bispebjerg Hospital
Background: It is essential to obtain rotational stability of the knee after anterior cruciate ligament reconstruction (ACL-R) and a supplemental reconstruction of the antero-lateral ligament (ALL-R) has been suggested to support this. It is unknown, if ALL-R in combination with ACL revision after failed ACL reconstruction result in better outcome than ACL revision alone.
Aim: To investigate the effect of ALL-R in ACL revision surgery.
Materials and Methods: Patients eligible for first time ACL revision were randomized to either isolated ACL revision (- ALL group) or ACL revision combined with a single-stranded allograft ALL-reconstruction (+ALL group). Patient reported outcomes and function were evaluated at two-year follow-up using KNEES-ACL, KOOS, and Tegner activity scale. Objective knee laxity was evaluated using an instrumented Rolimeter test, the pivot shift test, and a manual Lachman test.
Results: A total of 103 patients were enrolled with 49 patients in the +ALL group and 54 patients in the -ALL group. No baseline differences between groups were seen regarding age, gender, and body mass index. Meniscal injury and cartilage lesions were seen in 27% and 45% in the +ALL and in 20% and 41% in the -ALL group, respectively. The ACL revision was performed with allograft in 20% of the patients in the +ALL group and 15% in the -ALL group. There were no significant differences in the KNEES-ACL subgroups, KOOS subgroups and Tegner score between groups at two-year follow- up. No significant differences between groups were seen at one-year follow-up regarding objective laxity measured with Rolimeter test, Lachman test, and pivot shift test.
Interpretation / Conclusion: Supplemental ALL reconstruction in ACL revision does not improve subjective outcome at two-year follow-up and objective outcome at one-year follow-up compared to isolated ACL revision.
Department of Orthopaedics, Aarhus Universityhospital; Department of Orthopaedics, Bispebjerg Hospital
Background: It is essential to obtain rotational stability of the knee after anterior cruciate ligament reconstruction (ACL-R) and a supplemental reconstruction of the antero-lateral ligament (ALL-R) has been suggested to support this. It is unknown, if ALL-R in combination with ACL revision after failed ACL reconstruction result in better outcome than ACL revision alone.
Aim: To investigate the effect of ALL-R in ACL revision surgery.
Materials and Methods: Patients eligible for first time ACL revision were randomized to either isolated ACL revision (- ALL group) or ACL revision combined with a single-stranded allograft ALL-reconstruction (+ALL group). Patient reported outcomes and function were evaluated at two-year follow-up using KNEES-ACL, KOOS, and Tegner activity scale. Objective knee laxity was evaluated using an instrumented Rolimeter test, the pivot shift test, and a manual Lachman test.
Results: A total of 103 patients were enrolled with 49 patients in the +ALL group and 54 patients in the -ALL group. No baseline differences between groups were seen regarding age, gender, and body mass index. Meniscal injury and cartilage lesions were seen in 27% and 45% in the +ALL and in 20% and 41% in the -ALL group, respectively. The ACL revision was performed with allograft in 20% of the patients in the +ALL group and 15% in the -ALL group. There were no significant differences in the KNEES-ACL subgroups, KOOS subgroups and Tegner score between groups at two-year follow- up. No significant differences between groups were seen at one-year follow-up regarding objective laxity measured with Rolimeter test, Lachman test, and pivot shift test.
Interpretation / Conclusion: Supplemental ALL reconstruction in ACL revision does not improve subjective outcome at two-year follow-up and objective outcome at one-year follow-up compared to isolated ACL revision.
Bjarke Viberg, Erlandsen Claville Lars, Røhl Andersen Lis, Lisbeth Fredholm, Dorte Dall-Hansen, Heidi Grejsen
Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt Kolding; Department of Geriatrics, Hospital Lillebaelt Kolding
Background: HIp fracture patients in nursing home facilities (NHF) are very fragile and have a higher readmission and mortality rate compared to other hip fracture patients . These fragile and complex patients needs special attention and cooperation between numerous parties in order to reduce the complications.
Aim: To assess the effect of an enhanced interdisciplinary cooperation between the orthogeriatric ward, municipality and nursing home facilities (NHF) for hip fracture patients
Materials and Methods: From January 2018 to July 2020, hip fracture patients who were discharged to NHF were included prospectively. Intervention was performed in the two of five municipalities having an acute team, the remainder municipalities were control group. The intervention group received multifaceted care with a tailored treatment plan. NHF followed a safety program 14 days post-discharge assessing vital signs, weight, pain, signs of constipation, hours of mobilization, daily intake of fluids and high-protein beverages. Acute team nurses undertook visits (planned as well as unplanned) and could take blood samples and administer intravenous fluids and antibiotics at the NHF. Control participants received usual care. Primary outcome were 30-days readmission, secondary were mortality, mobility, and quality of life.
Results: There were 100 patients in the intervention group and 152 in the control group. The median age was 86 years, 68% were female, over 60% had a low mental score but there were no statistical difference in any of the baseline variables. The 30-day readmission rate was 14% in the intervention group compared to 30% in the control group (p=0.004). The 30-day mortality was 6% in the intervention group compared to 13% in the control group (p=0.068) There was no statistical significant difference in mobility between the two groups but there was a higher health related quality of life score in the intervention group (p=0.045).
Interpretation / Conclusion: An enhanced interdisciplinary cooperation between hospital and NHF has the ability to lower readmissions and potentially mortality. This study calls for every department to reassess their strategy towards patients discharged to NHF.
Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt Kolding; Department of Geriatrics, Hospital Lillebaelt Kolding
Background: HIp fracture patients in nursing home facilities (NHF) are very fragile and have a higher readmission and mortality rate compared to other hip fracture patients . These fragile and complex patients needs special attention and cooperation between numerous parties in order to reduce the complications.
Aim: To assess the effect of an enhanced interdisciplinary cooperation between the orthogeriatric ward, municipality and nursing home facilities (NHF) for hip fracture patients
Materials and Methods: From January 2018 to July 2020, hip fracture patients who were discharged to NHF were included prospectively. Intervention was performed in the two of five municipalities having an acute team, the remainder municipalities were control group. The intervention group received multifaceted care with a tailored treatment plan. NHF followed a safety program 14 days post-discharge assessing vital signs, weight, pain, signs of constipation, hours of mobilization, daily intake of fluids and high-protein beverages. Acute team nurses undertook visits (planned as well as unplanned) and could take blood samples and administer intravenous fluids and antibiotics at the NHF. Control participants received usual care. Primary outcome were 30-days readmission, secondary were mortality, mobility, and quality of life.
Results: There were 100 patients in the intervention group and 152 in the control group. The median age was 86 years, 68% were female, over 60% had a low mental score but there were no statistical difference in any of the baseline variables. The 30-day readmission rate was 14% in the intervention group compared to 30% in the control group (p=0.004). The 30-day mortality was 6% in the intervention group compared to 13% in the control group (p=0.068) There was no statistical significant difference in mobility between the two groups but there was a higher health related quality of life score in the intervention group (p=0.045).
Interpretation / Conclusion: An enhanced interdisciplinary cooperation between hospital and NHF has the ability to lower readmissions and potentially mortality. This study calls for every department to reassess their strategy towards patients discharged to NHF.