Session 10: Sport
16. November
13:30 - 15:00
Lokale: 102-105
Chair: Morten L Olesen and Henrik Aagaard
Stian Langgård Jørgensen1,2,3, Sine Brøchner-Kierkegaard1,2,3, Mathias Høgsholt1,2, Marie Bagger Bohn2, Per Aagaard4, Inger Mechlenburg3,5,6
1. Department of Occupational and Physical Therapy, Horsens Regional Hospital, Denmark 2. H-HIP, Department of Occupational and Physical Therapy and Department of Orthopedic Surgery, Horsens Regional Hospital, Denmark 3. Department of Clinical Medicine, Aarhus University, Denmark 4. Department of Sports Science and Clinical Biomechanics, University of Southern Denmark 5. Department of Orthopedic Surgery, Aarhus University Hospital, Denmark 6. Department of Public Health, Aarhus University, Denmark
Background: Limb unloading due to injury or surgery negatively affects muscle strength, muscle size and functional performance. Physical exercise is well documented to prevent disuse atrophy. Low-load blood-flow restricted resistance training (LL-BFR) and heavy-load resistance training (HL-RT) appear to induce comparable gains in skeletal muscle size and maximal muscle strength in healthy young-to- old populations. However, the high loading intensities with HL-RT may be contraindicated due to the high stress forces exerted on the joint and tendon structures. As LL-BFR utilizes reduced loading intensities, this training method has gained increasing usage in various rehabilitation settings.
Aim: To investigate the effectiveness of HL-RT and LL-BFR on gains in muscle strength, muscle mass, functional performance, and patient- reported outcome in patients with musculoskeletal dysfunction or injury.
Materials and Methods: The study was designed as a systematic review and meta-analysis. Web of Science, Cochrane Central, Medline, Embase, SportDiscus was searched on the 30th May 2022. Studies were included if: i) conducted as a Randomized Controlled Trial (RCT), ii) including patients, iii) comprising a LL-BFR intervention protocol and a group performing HL-RT (=70%1RM) for at least eight exercise sessions, vi) involving at least one lower limb exercise. The Cochrane Risk of Bias tool was used to evaluate the risk of bias. Meta- analyses were performed using a random effects model with an adjustment to the confidence interval.
Results: Seven RCTs (n=303) were identified. HL-RT and LL-BFR showed comparable gains in maximal lower limb strength, quadriceps cross-sectional area, sit-to-stand performance, pain and subjective function. There was a moderate effect favoring LL-BFR for evoking gains in maximal isometric knee extensor strength. Certainty of evidence was low-to-very low.
Interpretation / Conclusion: HL-RT and LL-BFR seems equally effective in producing significant gains in muscle strength, muscle mass, functional performance and patient-reported outcomes in patients affected by musculoskeletal disorders. Notably, training adherence and dropout rates were found to be similar between HL-RT and LL-BFR, which both involved no-to-few adverse events.
1. Department of Occupational and Physical Therapy, Horsens Regional Hospital, Denmark 2. H-HIP, Department of Occupational and Physical Therapy and Department of Orthopedic Surgery, Horsens Regional Hospital, Denmark 3. Department of Clinical Medicine, Aarhus University, Denmark 4. Department of Sports Science and Clinical Biomechanics, University of Southern Denmark 5. Department of Orthopedic Surgery, Aarhus University Hospital, Denmark 6. Department of Public Health, Aarhus University, Denmark
Background: Limb unloading due to injury or surgery negatively affects muscle strength, muscle size and functional performance. Physical exercise is well documented to prevent disuse atrophy. Low-load blood-flow restricted resistance training (LL-BFR) and heavy-load resistance training (HL-RT) appear to induce comparable gains in skeletal muscle size and maximal muscle strength in healthy young-to- old populations. However, the high loading intensities with HL-RT may be contraindicated due to the high stress forces exerted on the joint and tendon structures. As LL-BFR utilizes reduced loading intensities, this training method has gained increasing usage in various rehabilitation settings.
Aim: To investigate the effectiveness of HL-RT and LL-BFR on gains in muscle strength, muscle mass, functional performance, and patient- reported outcome in patients with musculoskeletal dysfunction or injury.
Materials and Methods: The study was designed as a systematic review and meta-analysis. Web of Science, Cochrane Central, Medline, Embase, SportDiscus was searched on the 30th May 2022. Studies were included if: i) conducted as a Randomized Controlled Trial (RCT), ii) including patients, iii) comprising a LL-BFR intervention protocol and a group performing HL-RT (=70%1RM) for at least eight exercise sessions, vi) involving at least one lower limb exercise. The Cochrane Risk of Bias tool was used to evaluate the risk of bias. Meta- analyses were performed using a random effects model with an adjustment to the confidence interval.
Results: Seven RCTs (n=303) were identified. HL-RT and LL-BFR showed comparable gains in maximal lower limb strength, quadriceps cross-sectional area, sit-to-stand performance, pain and subjective function. There was a moderate effect favoring LL-BFR for evoking gains in maximal isometric knee extensor strength. Certainty of evidence was low-to-very low.
Interpretation / Conclusion: HL-RT and LL-BFR seems equally effective in producing significant gains in muscle strength, muscle mass, functional performance and patient-reported outcomes in patients affected by musculoskeletal disorders. Notably, training adherence and dropout rates were found to be similar between HL-RT and LL-BFR, which both involved no-to-few adverse events.
Lasse Ishøi1, Otto Kraemer1, Krisitan Thorborg1, Per Hölmich 1
1. Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Arthroscopic Surgery, Hvidovre Hospital, Copenhagen
Background: Hip arthroscopy improves function, but ongoing symptoms are not uncommon. The extent of muscle- and tendon-related groin pain is associated with worse self-reported pain in both intra- and extra-articular hip and groin conditions. At this point it is unknown if associations exist in femoroacetabular impingement syndrome (FAIS), and if it may explain ongoing symptoms.
Aim: We aimed to investigate the associations between muscle- and tendon-related hip and groin pain and self-reported symptoms before and after hip arthroscopy.
Materials and Methods: Ninety-seven patients (mean (SD) age: 32.3 (10.6)) with FAIS underwent hip arthroscopy by a single surgeon. Before and 12-months post-surgery, muscle- and tendon-related groin pain was identified with palpation: proximal and distal iliopsoas, proximal insertion of the adductor longus, and gluteal medius. Self-reported hip and groin function was collected with the Copenhagen Hip and Groin Outcome Score (HAGOS). Linear regression was used to analyze the associations between total number of painful muscle/tendon sites and HAGOS scores before and 12-months post-surgery.
Results: Before surgery 92.8 % had muscle- and tendon-related groin pain. Iliopsoas-related pain was the most common (80 %) followed by gluteal-related (75 %) and adductor- related (37 %) pain. Post-surgery, 66 % had muscle- and tendon-related groin pain, and proportions for the different palpation sites were: iliopsoas-related (56 %), gluteal- related (44 %), and adductor-related pain (12.5 %). Before surgery, the total number of painful muscle/tendon sites were negatively associated with 3 HAGOS subscales: pain, symptoms, and activities of daily living (beta- coefficient: -3.2 to -5.6, p < 0.017). Post- surgery, the total number of painful muscle/tendon sites were negatively associated with all HAGOS subscales (beta- coefficient: -4.1 to -5.3, p < 0.05).
Interpretation / Conclusion: The extent of muscle- and tendon-related groin pain identified with palpation resulted in worse self-reported pain and function in FAIS before and, 12-months post-surgery. This suggests that extra-articular pain sensitization may be an important contributor to ongoing symptoms after hip arthroscopy in two thirds of patients.
1. Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Arthroscopic Surgery, Hvidovre Hospital, Copenhagen
Background: Hip arthroscopy improves function, but ongoing symptoms are not uncommon. The extent of muscle- and tendon-related groin pain is associated with worse self-reported pain in both intra- and extra-articular hip and groin conditions. At this point it is unknown if associations exist in femoroacetabular impingement syndrome (FAIS), and if it may explain ongoing symptoms.
Aim: We aimed to investigate the associations between muscle- and tendon-related hip and groin pain and self-reported symptoms before and after hip arthroscopy.
Materials and Methods: Ninety-seven patients (mean (SD) age: 32.3 (10.6)) with FAIS underwent hip arthroscopy by a single surgeon. Before and 12-months post-surgery, muscle- and tendon-related groin pain was identified with palpation: proximal and distal iliopsoas, proximal insertion of the adductor longus, and gluteal medius. Self-reported hip and groin function was collected with the Copenhagen Hip and Groin Outcome Score (HAGOS). Linear regression was used to analyze the associations between total number of painful muscle/tendon sites and HAGOS scores before and 12-months post-surgery.
Results: Before surgery 92.8 % had muscle- and tendon-related groin pain. Iliopsoas-related pain was the most common (80 %) followed by gluteal-related (75 %) and adductor- related (37 %) pain. Post-surgery, 66 % had muscle- and tendon-related groin pain, and proportions for the different palpation sites were: iliopsoas-related (56 %), gluteal- related (44 %), and adductor-related pain (12.5 %). Before surgery, the total number of painful muscle/tendon sites were negatively associated with 3 HAGOS subscales: pain, symptoms, and activities of daily living (beta- coefficient: -3.2 to -5.6, p < 0.017). Post- surgery, the total number of painful muscle/tendon sites were negatively associated with all HAGOS subscales (beta- coefficient: -4.1 to -5.3, p < 0.05).
Interpretation / Conclusion: The extent of muscle- and tendon-related groin pain identified with palpation resulted in worse self-reported pain and function in FAIS before and, 12-months post-surgery. This suggests that extra-articular pain sensitization may be an important contributor to ongoing symptoms after hip arthroscopy in two thirds of patients.
Niclas Højgaard Eysturoy1, Elinborg Mortensen1, Hans-Christen Husum2, Lars Blønd3, Per Hölmich4, Kristoffer W. Barfod4
1. Department of Orthopedic Surgery, National Hospital of the Faroe Islands, Torshavn. 2. Interdisciplinary Orthopaedics, Aalborg University Hospital, Denmark. 3. Zealand University Hospital, Køge and Aleris Hospital, Copenhagen, Denmark 4. Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, Denmark
Background: .
Aim: To calculate the prevalence of patellar dislocation (PD) and Trochlear Dysplasia (TD) in a national cohort aged 15-19 years in the Faroe Island. We hypothesized the prevalence of PD to be 5-7%, around 80% of PD patients having TD, and 80% of patients with TD having bilateral TD.
Materials and Methods: All inhabitants in The Faroe Islands aged 15 to 19 years were invited by personal email to answer an online survey including basic demographics and questions concerning prior PD. Participants with prior PD were invited to take x-rays and MRI of both knees. Three cohorts were established: 1) The background cohort, consisting of the participants with no prior patellar dislocation, 2) The PD cohort, consisting of all participants with prior PD, 3) The clinical PD cohort, consisting of participants with prior PD who participated in the clinical and radiological follow-up. Trochlear dysplasia was defined as one of the following: Dejour type A-D on X-ray, Lateral Trochlear Inclination angle (LTI) < 11 ° or Trochlear Depth < 3 mm on MRI.
Results: 3,749 persons were contacted, 41 were excluded, and 1,638 (44%) completed the survey. 146 reported a prior PD (the PD cohort) and 100 accepted to participate and take X-rays and MRI of both knees (The clinical PD cohort). 76 persons were diagnosed with TD. The national prevalence of PD was 8.9%. The PD group had a significantly higher bodyweight, did less sports and had more smokers compared to the background cohort (p<0.05). The national prevalence of symptomatic TD was 6.8%. The prevalence of TD in the clinical PD cohort was 78.0%. TD was bilateral in 77.6% of patients with TD and 27.0% of patients with bilateral TD had dislocations in both knees.
Interpretation / Conclusion: The prevalence of PD in the Faroe Islands is markedly higher than shown in other countries. The national prevalence of TD and the prevalence of TD in participants with prior PD is high, and correlates to earlier findings, although earlier studies are conducted on a population with recurrent PD. Most patients with TD in one knee exhibited the same pathology in the opposite knee with no clinical symptoms.
1. Department of Orthopedic Surgery, National Hospital of the Faroe Islands, Torshavn. 2. Interdisciplinary Orthopaedics, Aalborg University Hospital, Denmark. 3. Zealand University Hospital, Køge and Aleris Hospital, Copenhagen, Denmark 4. Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, Denmark
Background: .
Aim: To calculate the prevalence of patellar dislocation (PD) and Trochlear Dysplasia (TD) in a national cohort aged 15-19 years in the Faroe Island. We hypothesized the prevalence of PD to be 5-7%, around 80% of PD patients having TD, and 80% of patients with TD having bilateral TD.
Materials and Methods: All inhabitants in The Faroe Islands aged 15 to 19 years were invited by personal email to answer an online survey including basic demographics and questions concerning prior PD. Participants with prior PD were invited to take x-rays and MRI of both knees. Three cohorts were established: 1) The background cohort, consisting of the participants with no prior patellar dislocation, 2) The PD cohort, consisting of all participants with prior PD, 3) The clinical PD cohort, consisting of participants with prior PD who participated in the clinical and radiological follow-up. Trochlear dysplasia was defined as one of the following: Dejour type A-D on X-ray, Lateral Trochlear Inclination angle (LTI) < 11 ° or Trochlear Depth < 3 mm on MRI.
Results: 3,749 persons were contacted, 41 were excluded, and 1,638 (44%) completed the survey. 146 reported a prior PD (the PD cohort) and 100 accepted to participate and take X-rays and MRI of both knees (The clinical PD cohort). 76 persons were diagnosed with TD. The national prevalence of PD was 8.9%. The PD group had a significantly higher bodyweight, did less sports and had more smokers compared to the background cohort (p<0.05). The national prevalence of symptomatic TD was 6.8%. The prevalence of TD in the clinical PD cohort was 78.0%. TD was bilateral in 77.6% of patients with TD and 27.0% of patients with bilateral TD had dislocations in both knees.
Interpretation / Conclusion: The prevalence of PD in the Faroe Islands is markedly higher than shown in other countries. The national prevalence of TD and the prevalence of TD in participants with prior PD is high, and correlates to earlier findings, although earlier studies are conducted on a population with recurrent PD. Most patients with TD in one knee exhibited the same pathology in the opposite knee with no clinical symptoms.
Rudi Hansen1,2, Bryan Haddock3, Markus Lonsdale4, René Svensson2, Lisbeth Marner4, Lene Rørdam4, Inge Lise Rasmussen4, Christoffer Brushøj2, Stig Peter Magnusson1,2, Marius Henriksen5, Christian Couppé1,2
1. Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; 2. Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark; 3. Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Denmark; 4. Department of Clinical Physiology & Nuclear Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark; 5. The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
Background: Anterior knee pain (patellofemoral pain, PFP) is a common knee problem that mainly affects young sports-active people. The etiology of PFP is not fully understood, making diagnosis and treatment challenging. Recently, [18F]sodium fluoride ([18F]NaF) positron emission tomography (PET) imaging has been used to evaluate bone metabolism and potentially identify areas of subchondral bone stress.
Aim: First, we aimed to assess if patients with unilateral PFP have increased bone metabolism in the painful knee compared to the pain-free knee at rest measured by [18F]NaF PET. Secondly, we aimed to compare the response in bone metabolic activity to knee loading (three times ten repetitions of single- leg squatting) between the painful and pain-free knee.
Materials and Methods: Twenty-seven patients diagnosed with unilateral PFP were recruited from the Institute of Sports Medicine Copenhagen, Bispebjerg-Frederiksberg Hospital, Denmark. All participants received an [18F]NaF PET scan of their knees before and after a bout of single-leg squatting. We assessed the following quantitative measures of bone metabolism: Mean and maximum Standardized Uptake Values (SUVmean and SUVmax), kinetic parameters of bone perfusion (K1), tracer extraction fraction, and total tracer uptake into bone (Ki) for the patella and medial and lateral parts of the trochlea. Statistical analysis was performed using a linear mixed model.
Results: We found no difference in SUV values or kinetic parameters between painful and pain-free knees at rest (SUVmean; p=0.478). The SUVmean, SUVmax, Ki and K1 change values were significantly higher on the painful compared with the pain-free side after knee loading in several joint regions, including the medial and lateral part of trochlea.
Interpretation / Conclusion: In our cohort of patients with unilateral PFP, there was no evidence for altered bone metabolism of the painful knee at rest compared to the pain-free knee. Kinetic modeling revealed differences in several parameters after exercise, indicating a differential response to load that could be associated with knee pain.
1. Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; 2. Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark; 3. Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Denmark; 4. Department of Clinical Physiology & Nuclear Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark; 5. The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
Background: Anterior knee pain (patellofemoral pain, PFP) is a common knee problem that mainly affects young sports-active people. The etiology of PFP is not fully understood, making diagnosis and treatment challenging. Recently, [18F]sodium fluoride ([18F]NaF) positron emission tomography (PET) imaging has been used to evaluate bone metabolism and potentially identify areas of subchondral bone stress.
Aim: First, we aimed to assess if patients with unilateral PFP have increased bone metabolism in the painful knee compared to the pain-free knee at rest measured by [18F]NaF PET. Secondly, we aimed to compare the response in bone metabolic activity to knee loading (three times ten repetitions of single- leg squatting) between the painful and pain-free knee.
Materials and Methods: Twenty-seven patients diagnosed with unilateral PFP were recruited from the Institute of Sports Medicine Copenhagen, Bispebjerg-Frederiksberg Hospital, Denmark. All participants received an [18F]NaF PET scan of their knees before and after a bout of single-leg squatting. We assessed the following quantitative measures of bone metabolism: Mean and maximum Standardized Uptake Values (SUVmean and SUVmax), kinetic parameters of bone perfusion (K1), tracer extraction fraction, and total tracer uptake into bone (Ki) for the patella and medial and lateral parts of the trochlea. Statistical analysis was performed using a linear mixed model.
Results: We found no difference in SUV values or kinetic parameters between painful and pain-free knees at rest (SUVmean; p=0.478). The SUVmean, SUVmax, Ki and K1 change values were significantly higher on the painful compared with the pain-free side after knee loading in several joint regions, including the medial and lateral part of trochlea.
Interpretation / Conclusion: In our cohort of patients with unilateral PFP, there was no evidence for altered bone metabolism of the painful knee at rest compared to the pain-free knee. Kinetic modeling revealed differences in several parameters after exercise, indicating a differential response to load that could be associated with knee pain.
Jasmin Bagge1, Per Hölmich1, Freja Aabæk Hammer1, Jan Nehlin2, Lars Blønd3, Lisbet Rosenkrantz Hölmich4, Kristoffer Weisskirchner Barfod1
1. Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital – Hvidovre, Denmark; 2. Department of Clinical Research, Copenhagen University Hospital – Hvidovre, Denmark; 3. Department of Orthopedic Surgery, Zealand University Hospital – Køge, Denmark; 4. Department of Plastic Surgery, Copenhagen University Hospital – Herlev and Gentofte, Denmark.
Background: Treatment of knee osteoarthritis (OA) with stem cells from microfragmented adipose tissue (AT) has shown promising results. Cryopreservation and biobanking of stem cells are becoming increasingly important for research purposes, treatment of aged patients, and for repetitive treatments to improve long- term outcomes without the need for additional lipoaspirations.
Aim: To investigate if viable stem cells could be isolated and expanded from cryopreserved microfragmented AT harvested from knee OA patients by two different isolation methods; (1) tissue explant culture (TEC), and (2) enzymatic digestion (ED).
Materials and Methods: Microfragmented abdominal AT from knee OA patients was cryopreserved in cryomedium containing 10% dimethyl sulfoxide at -80oC. The samples were thawed for stem cell isolation by TEC and ED, respectively. Viability, population doublings, and doubling time was assessed by trypan blue staining. Cell type and senescence-associated ß-galactosidase (SA-BGAL) activity were measured by flow cytometry. Osteogenic and adipogenic differentiation was assessed quantitatively by Alizarin Red S and Oil-Red-O staining. Statistical analysis was performed using paired t-tests. p-values <0.05 were considered statistically significant.
Results: Microfragmented AT from 7 patients was cryopreserved for a period of 46-150 days (mean 115.9 days, SD 44.3 days). Viable stem cells were successfully recovered and expanded from all patients using both isolation methods with no significant difference in viable population doublings or doubling time from passage 1 to 3 (p>0.05). Low levels of SA-BGAL activity were detected for both methods. Stemness was verified by stem cell surface markers and osteogenic and adipogenic differentiation performance. Adventitial stem cells (CD31-/CD34+/CD45-/CD146-), pericytes (CD31-/CD34-/CD45-/CD146+), transitional pericytes (CD31-/CD34+/CD45-/CD146+), and CD271+ stem cells (CD31-/CD45-/CD90+/CD271+) were identified using both methods. More pericytes were present when using TEC compared to ED (p=0.04).
Interpretation / Conclusion: Viable stem cells can be isolated and expanded from cryopreserved microfragmented AT using both TEC and ED. TEC provides more clinically relevant pericytes than ED.
1. Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital – Hvidovre, Denmark; 2. Department of Clinical Research, Copenhagen University Hospital – Hvidovre, Denmark; 3. Department of Orthopedic Surgery, Zealand University Hospital – Køge, Denmark; 4. Department of Plastic Surgery, Copenhagen University Hospital – Herlev and Gentofte, Denmark.
Background: Treatment of knee osteoarthritis (OA) with stem cells from microfragmented adipose tissue (AT) has shown promising results. Cryopreservation and biobanking of stem cells are becoming increasingly important for research purposes, treatment of aged patients, and for repetitive treatments to improve long- term outcomes without the need for additional lipoaspirations.
Aim: To investigate if viable stem cells could be isolated and expanded from cryopreserved microfragmented AT harvested from knee OA patients by two different isolation methods; (1) tissue explant culture (TEC), and (2) enzymatic digestion (ED).
Materials and Methods: Microfragmented abdominal AT from knee OA patients was cryopreserved in cryomedium containing 10% dimethyl sulfoxide at -80oC. The samples were thawed for stem cell isolation by TEC and ED, respectively. Viability, population doublings, and doubling time was assessed by trypan blue staining. Cell type and senescence-associated ß-galactosidase (SA-BGAL) activity were measured by flow cytometry. Osteogenic and adipogenic differentiation was assessed quantitatively by Alizarin Red S and Oil-Red-O staining. Statistical analysis was performed using paired t-tests. p-values <0.05 were considered statistically significant.
Results: Microfragmented AT from 7 patients was cryopreserved for a period of 46-150 days (mean 115.9 days, SD 44.3 days). Viable stem cells were successfully recovered and expanded from all patients using both isolation methods with no significant difference in viable population doublings or doubling time from passage 1 to 3 (p>0.05). Low levels of SA-BGAL activity were detected for both methods. Stemness was verified by stem cell surface markers and osteogenic and adipogenic differentiation performance. Adventitial stem cells (CD31-/CD34+/CD45-/CD146-), pericytes (CD31-/CD34-/CD45-/CD146+), transitional pericytes (CD31-/CD34+/CD45-/CD146+), and CD271+ stem cells (CD31-/CD45-/CD90+/CD271+) were identified using both methods. More pericytes were present when using TEC compared to ED (p=0.04).
Interpretation / Conclusion: Viable stem cells can be isolated and expanded from cryopreserved microfragmented AT using both TEC and ED. TEC provides more clinically relevant pericytes than ED.
Niclas Højgaard Eysturoy1,4, Noomi O. Gregersen2, Guðrið Andorsdóttir2, Elinborg S. Mortensen1, Lars Blønd3, Hölmich Per4, Kristoff Weisskirchner Barfod4
1.Department of Orthopaedics, National Hospital of the Faroe Islands; 2.Faroe Genome Project, FarGen. Department of Health, Faroe Islands; 3.Zealand University Hospital, Køge and Aleris Hospital, Copenhagen, Denmark; 4.Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, Denmark
Background: .
Aim: The purpose of this study is to investigate the familiar association of trochelar dysplasi (TD) in a national cohort in the Faroe Island. The prevalence of patellar dislocation (PD) and TD in the Faroese population are 8.9% and 6.8%, respectively. Genetic risk factors may contribute to these high prevalence’s. Due to the demographic history of the Faroese population, with few founders and isolation for centuries, we have the hypothesis that family relations (kinship) contribute to the relative risk of developing TD compared to the background population
Materials and Methods: All inhabitants in the Faroe Islands in the age from 15 to 19 years were invited to answer an online survey. Participants with prior PD were invited to participate further in the study, undergoing x-rays and MRI of both knees. TD was defined as one of the following: Dejour type A-D on X-ray, Lateral Trochlear Inclination angle < 11 ° or Trochlear Depth < 3 mm on MRI. The Multi-Generation Register at the National Biobank of the Faroe Islands was used to obtain information regarding family relations of the individuals with TD. Pedigrees were generated using the genetic pedigree software Progeny. Kinship, inbreeding coefficients and relative risk were calculated using the GENLIB software package in R. A control cohort from FarGen will be used as the background population.
Results: A total of 3,749 persons were contacted and 1,638 (44%) completed the survey. From these, 146 reported a prior PD and 100 accepted to participate in the clinical PD cohort. 76 were found to have TD. We reconstruct a single connected genealogical tree for the TD cohort with a genealogical depth of 9. The inbreeding coefficient for patients with TD was 0.003318. For 1. degree relatives of the patients with TD, the relative risk of TD was 2.7.
Interpretation / Conclusion: The relative risk of TD for siblings of a patients with TD was 2.7. This shows that there is a familiar association in the development of TD and that familiar association can be considered a risk-factor for PD. To show whether kinship and inbreeding reflect the relative risk of TD in the Faroese population, future perspective will be to compare the genealogical data of the TD cohort with the background population.
1.Department of Orthopaedics, National Hospital of the Faroe Islands; 2.Faroe Genome Project, FarGen. Department of Health, Faroe Islands; 3.Zealand University Hospital, Køge and Aleris Hospital, Copenhagen, Denmark; 4.Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, Denmark
Background: .
Aim: The purpose of this study is to investigate the familiar association of trochelar dysplasi (TD) in a national cohort in the Faroe Island. The prevalence of patellar dislocation (PD) and TD in the Faroese population are 8.9% and 6.8%, respectively. Genetic risk factors may contribute to these high prevalence’s. Due to the demographic history of the Faroese population, with few founders and isolation for centuries, we have the hypothesis that family relations (kinship) contribute to the relative risk of developing TD compared to the background population
Materials and Methods: All inhabitants in the Faroe Islands in the age from 15 to 19 years were invited to answer an online survey. Participants with prior PD were invited to participate further in the study, undergoing x-rays and MRI of both knees. TD was defined as one of the following: Dejour type A-D on X-ray, Lateral Trochlear Inclination angle < 11 ° or Trochlear Depth < 3 mm on MRI. The Multi-Generation Register at the National Biobank of the Faroe Islands was used to obtain information regarding family relations of the individuals with TD. Pedigrees were generated using the genetic pedigree software Progeny. Kinship, inbreeding coefficients and relative risk were calculated using the GENLIB software package in R. A control cohort from FarGen will be used as the background population.
Results: A total of 3,749 persons were contacted and 1,638 (44%) completed the survey. From these, 146 reported a prior PD and 100 accepted to participate in the clinical PD cohort. 76 were found to have TD. We reconstruct a single connected genealogical tree for the TD cohort with a genealogical depth of 9. The inbreeding coefficient for patients with TD was 0.003318. For 1. degree relatives of the patients with TD, the relative risk of TD was 2.7.
Interpretation / Conclusion: The relative risk of TD for siblings of a patients with TD was 2.7. This shows that there is a familiar association in the development of TD and that familiar association can be considered a risk-factor for PD. To show whether kinship and inbreeding reflect the relative risk of TD in the Faroese population, future perspective will be to compare the genealogical data of the TD cohort with the background population.
Freja A. Hammer1, Per Hölmich1, Jan O. Nehlin2, Kristoffer W. Barfod1, Jasmin Bagge1
1. Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital - Hvidovre, Denmark 2. Department of Clinical Research, Copenhagen University Hospital - Hvidovre, Denmark
Background: Intra-articular injection of autologous stem cells from microfragmented adipose tissue is a promising treatment for patients with knee osteoarthritis (OA). However, studies on enzymatically processed adipose tissue have identified an increase in senescent stem cells with increasing donor age. This may diminish treatment outcome, due to lost proliferative and differentiation capacity, and secretion of inhibitory factors to surrounding cells.
Aim: To investigate the level of cellular senescence in stem cells derived from microfragmented adipose tissue.
Materials and Methods: Stem cells harvested from microfragmented abdominal adipose tissue from 20 patients with knee OA, aged 29 to 65 years (mean = 49.8, SD = 9.58), were analyzed as a function of patient age, and compared to control cells positive for cellular senescence. Steady state mRNA levels of a panel of genes associated with senescence were measured by qPCR. Intracellular senescence-associated proteins p16 and p21, and senescence-associated ß- galactosidase activity were measured by flow cytometry. Cellular proliferation was assessed using a 5-ethynyl-2’-deoxyuridine (EdU) proliferation assay. Stemness was assessed by stem cell surface markers using flow cytometry, and the capacity to undergo adipogenic and osteogenic differentiation in vitro.
Results: No correlation was found between cellular senescence levels of the microfragmented adipose tissue-derived stem cells and patient age for any of the typical assays used to quantify senescence. The level of cellular senescence was generally low across all senescence- associated assays compared to the positive senescence control cells. Stemness was verified for all samples. An increased capacity to undergo adipogenic differentiation was found with increasing patient age (p=0.0207). No effect of patient age was found for osteogenic differentiation.
Interpretation / Conclusion: Autologous microfragmented adipose tissue- derived stem cells may be used in clinical trials of knee OA of patients aged 29 to 65 years, at least until passage 4, as they show stemness potential and negligible senescence in vitro.
1. Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital - Hvidovre, Denmark 2. Department of Clinical Research, Copenhagen University Hospital - Hvidovre, Denmark
Background: Intra-articular injection of autologous stem cells from microfragmented adipose tissue is a promising treatment for patients with knee osteoarthritis (OA). However, studies on enzymatically processed adipose tissue have identified an increase in senescent stem cells with increasing donor age. This may diminish treatment outcome, due to lost proliferative and differentiation capacity, and secretion of inhibitory factors to surrounding cells.
Aim: To investigate the level of cellular senescence in stem cells derived from microfragmented adipose tissue.
Materials and Methods: Stem cells harvested from microfragmented abdominal adipose tissue from 20 patients with knee OA, aged 29 to 65 years (mean = 49.8, SD = 9.58), were analyzed as a function of patient age, and compared to control cells positive for cellular senescence. Steady state mRNA levels of a panel of genes associated with senescence were measured by qPCR. Intracellular senescence-associated proteins p16 and p21, and senescence-associated ß- galactosidase activity were measured by flow cytometry. Cellular proliferation was assessed using a 5-ethynyl-2’-deoxyuridine (EdU) proliferation assay. Stemness was assessed by stem cell surface markers using flow cytometry, and the capacity to undergo adipogenic and osteogenic differentiation in vitro.
Results: No correlation was found between cellular senescence levels of the microfragmented adipose tissue-derived stem cells and patient age for any of the typical assays used to quantify senescence. The level of cellular senescence was generally low across all senescence- associated assays compared to the positive senescence control cells. Stemness was verified for all samples. An increased capacity to undergo adipogenic differentiation was found with increasing patient age (p=0.0207). No effect of patient age was found for osteogenic differentiation.
Interpretation / Conclusion: Autologous microfragmented adipose tissue- derived stem cells may be used in clinical trials of knee OA of patients aged 29 to 65 years, at least until passage 4, as they show stemness potential and negligible senescence in vitro.
Lars Blønd1,2, Kristoffer Weisskirchner Barfod3
1. Aleris Private Hospital, Denmark; 2. The Zealand University Hospital, Køge, Denmark; 3. BarfodSports Orthopedic Research Center–Copenhagen (SORC-C), Copenhagen University Hospital, Amager-Hvidovre, Denmark.
Background: Sparse objective data documenting changes of the trochlea shape after trochleoplasty exists
Aim: The aim of the present study was to investigate whether standardized magnetic resonance imaging (MRI) measurements that characterize TD change significantly after combined arthroscopic deepening trochleoplasty (ADT) with medial patellofemoral (MPFL) reconstruction. We hypothesized that MRI measurements would approximate normal values
Materials and Methods: Patients who underwent ADT from October 2014 to 2017 were considered for this study. The preoperative inclusion criteria for ADT surgery were patellar instability, a dynamic patellar apprehension sign at 45° of flexion, a lateral trochlear inclination (LTI) angle of <11°, and failed physiotherapy. MRI was performed pre- and postoperatively and standardized MRI measurements were calculated: LTI angle, trochlear depth, trochlear facet asymmetry, cartilage thickness, and trochlear height. In the course of the MRI analysis at follow-up, a new 2- level method to measure LTI angle was implemented. The Banff Patella Instability Instrument 2.0 (BPII), Knee injury and Osteoarthritis Outcome Score (KOOS) and the Kujala score were obtained pre- and postoperatively
Results: A total of 16 knees in 15 patients (12 females and 3 males; median age, 20.9 years; range, 14.1-51.3 years) were evaluated. The average follow-up time was 63.6 months (range, 23-97 months). The median (range) LTI angle improved from 1.25° (–25.1° to 10.6°) preoperatively to 10.7°(–17.7° to 25.8°) postoperatively (P<0.001), trochlear depth increased from 0.0 mm (–4.2 to 1.8 mm) to 3.23 mm (0.25-5.3 mm) (P<0.001), and trochlear facet asymmetry improved from 4.55% (0.0%-28.6%) to 17.8% (0.0%-55.6%) (P<0.001). Cartilage thickness was unchanged (from 4.5 mm [range, 1.9- 7.4 mm] to 4.9 mm [range, 0.6-8.3 mm]; P=0.796). BPII, KOOS, Kujala scores improved significantly (P < .01 for all).
Interpretation / Conclusion: Combined ADT and MPFL reconstruction led to statistically significant and clinically relevant improvements in standardized MRI measurements that characterize TD and in patient reported outcomes. The improvements corresponded to those obtained by open trochleoplasty. No significant reduction in cartilage thickness was seen.
1. Aleris Private Hospital, Denmark; 2. The Zealand University Hospital, Køge, Denmark; 3. BarfodSports Orthopedic Research Center–Copenhagen (SORC-C), Copenhagen University Hospital, Amager-Hvidovre, Denmark.
Background: Sparse objective data documenting changes of the trochlea shape after trochleoplasty exists
Aim: The aim of the present study was to investigate whether standardized magnetic resonance imaging (MRI) measurements that characterize TD change significantly after combined arthroscopic deepening trochleoplasty (ADT) with medial patellofemoral (MPFL) reconstruction. We hypothesized that MRI measurements would approximate normal values
Materials and Methods: Patients who underwent ADT from October 2014 to 2017 were considered for this study. The preoperative inclusion criteria for ADT surgery were patellar instability, a dynamic patellar apprehension sign at 45° of flexion, a lateral trochlear inclination (LTI) angle of <11°, and failed physiotherapy. MRI was performed pre- and postoperatively and standardized MRI measurements were calculated: LTI angle, trochlear depth, trochlear facet asymmetry, cartilage thickness, and trochlear height. In the course of the MRI analysis at follow-up, a new 2- level method to measure LTI angle was implemented. The Banff Patella Instability Instrument 2.0 (BPII), Knee injury and Osteoarthritis Outcome Score (KOOS) and the Kujala score were obtained pre- and postoperatively
Results: A total of 16 knees in 15 patients (12 females and 3 males; median age, 20.9 years; range, 14.1-51.3 years) were evaluated. The average follow-up time was 63.6 months (range, 23-97 months). The median (range) LTI angle improved from 1.25° (–25.1° to 10.6°) preoperatively to 10.7°(–17.7° to 25.8°) postoperatively (P<0.001), trochlear depth increased from 0.0 mm (–4.2 to 1.8 mm) to 3.23 mm (0.25-5.3 mm) (P<0.001), and trochlear facet asymmetry improved from 4.55% (0.0%-28.6%) to 17.8% (0.0%-55.6%) (P<0.001). Cartilage thickness was unchanged (from 4.5 mm [range, 1.9- 7.4 mm] to 4.9 mm [range, 0.6-8.3 mm]; P=0.796). BPII, KOOS, Kujala scores improved significantly (P < .01 for all).
Interpretation / Conclusion: Combined ADT and MPFL reconstruction led to statistically significant and clinically relevant improvements in standardized MRI measurements that characterize TD and in patient reported outcomes. The improvements corresponded to those obtained by open trochleoplasty. No significant reduction in cartilage thickness was seen.
Signe Kierkegaard-Brøchner1,2, Joanne Kemp3, Bent Lund1, Bjarne Mygind-Klavsen4, Kasper Spoorendonk1, Marie Bagger Bohn1, Ulrik Dalgas5, Inger Mechlenburg2,4
1. Horsens Regional Hospital, Horsens, Denmark; 2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 3. LaTrobe University, Melbourne, Australia; 4. Aarhus University Hospital, Aarhus, Denmark; 5. Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark.
Background: Patients with femoroacetabular impingement syndrome (FAIS) are offered hip arthroscopic surgery when conservative treatment has failed. However, we have no evidence-based training program to offer the patients.
Aim: The aim of the present study was therefore to develop and test the feasibility of a 12-week training program for patients with FAIS.
Materials and Methods: Fifteen patients (age 38±7, 11 women) with FAIS were recruited. The training intervention lasted 12-weeks and consisted of progressive strength training targeting the hip muscles 3 times/week. 7 supervised sessions were offered with home-based training in between. Feasibility was measured by completion rate, adverse events and adherence to training (attendance rate). We a priori defined an attendance rate of >75% of planned training sessions as satisfactory. Secondary outcomes were measured at baseline and at 12 week follow up: Patients completed the international Hip Outcome Tool 33 (0-100 score) (iHOT33) and the Copenhagen Hip and Groin Outcome Score (0-100 score) (HAGOS). Maximal hip muscle strength (MHMS) was assessed during hip flexion, extension, abduction and adduction using a fixated, hand-held dynamometer and patients performed a one legged hop for distance (HFD). A change >0.15 Nm/kg in MHMS and a change >15 cm in HFD was considered clinically important.
Results: 15/15 patients completed the training program. 97% training sessions were completed and no adverse events observed. No change was seen in patient reported outcomes (mean change [95% confidence interval]): iHOT33: 1.8 [-8;11], HAGOS Pain: 3.3 [-6;12], HAGOS Symptoms: 5.4 [-4;15], HAGOS Activities of Daily Living: 1.4 [-12;14], HAGOS Sport: -0.7 [-12;11], HAGOS Participation in sport: -5.0 [-21;10], HAGOS Quality of life: -3.6 [-10;2]. Clinically important changes were seen in MHMS during flexion: 0.20 [0.08;0.32], extension: 0.34 [0.14;0.55], abduction: 0.29 [0.13;0.46] and adduction: 0.23 [0.09;0.37] Nm/kg and HFD: 17 [9;24] cm.
Interpretation / Conclusion: Completion and adherence to the training program was high. Hence, the program is considered feasible and safe. Patients presented clinical important changes in MHMS and HFD. These changes were not reflected in their patient-reported outcomes.
1. Horsens Regional Hospital, Horsens, Denmark; 2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 3. LaTrobe University, Melbourne, Australia; 4. Aarhus University Hospital, Aarhus, Denmark; 5. Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark.
Background: Patients with femoroacetabular impingement syndrome (FAIS) are offered hip arthroscopic surgery when conservative treatment has failed. However, we have no evidence-based training program to offer the patients.
Aim: The aim of the present study was therefore to develop and test the feasibility of a 12-week training program for patients with FAIS.
Materials and Methods: Fifteen patients (age 38±7, 11 women) with FAIS were recruited. The training intervention lasted 12-weeks and consisted of progressive strength training targeting the hip muscles 3 times/week. 7 supervised sessions were offered with home-based training in between. Feasibility was measured by completion rate, adverse events and adherence to training (attendance rate). We a priori defined an attendance rate of >75% of planned training sessions as satisfactory. Secondary outcomes were measured at baseline and at 12 week follow up: Patients completed the international Hip Outcome Tool 33 (0-100 score) (iHOT33) and the Copenhagen Hip and Groin Outcome Score (0-100 score) (HAGOS). Maximal hip muscle strength (MHMS) was assessed during hip flexion, extension, abduction and adduction using a fixated, hand-held dynamometer and patients performed a one legged hop for distance (HFD). A change >0.15 Nm/kg in MHMS and a change >15 cm in HFD was considered clinically important.
Results: 15/15 patients completed the training program. 97% training sessions were completed and no adverse events observed. No change was seen in patient reported outcomes (mean change [95% confidence interval]): iHOT33: 1.8 [-8;11], HAGOS Pain: 3.3 [-6;12], HAGOS Symptoms: 5.4 [-4;15], HAGOS Activities of Daily Living: 1.4 [-12;14], HAGOS Sport: -0.7 [-12;11], HAGOS Participation in sport: -5.0 [-21;10], HAGOS Quality of life: -3.6 [-10;2]. Clinically important changes were seen in MHMS during flexion: 0.20 [0.08;0.32], extension: 0.34 [0.14;0.55], abduction: 0.29 [0.13;0.46] and adduction: 0.23 [0.09;0.37] Nm/kg and HFD: 17 [9;24] cm.
Interpretation / Conclusion: Completion and adherence to the training program was high. Hence, the program is considered feasible and safe. Patients presented clinical important changes in MHMS and HFD. These changes were not reflected in their patient-reported outcomes.
Christian Dippmann1, Peter Lavard1, Anette Holm Kourakis1, Volkert Siersma2, Michael Rindom Krogsgaard1
1. Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital. A part of IOC Research Center Copenhagen, Denmark 2 The Research Unit for General Practice, Department of Public Health, University of Copenhagen
Background: At the section for Sports Traumatology Bispebjerg Frederiksberg Hospital, patellar instability patients with trochlear dysplasia (TD) have been treated for more than 10 years using an á la carte approach, by which all predisposing factors are treated in a single procedure. However, according to current literature secondary surgery (metal removal, arthroscopic brisement force, arthroscopic debridment, etc.) has to be performed in up to 30% following Bereiter TP.
Aim: To analyze whether previous or postoperative additional surgery after primary TP affected the 5- year outcome.
Materials and Methods: Consecutive patients with patellar instability and TD were treated according to the á la carte approach and were followed 1, 2 and 5 years postoperatively, including four patient reported outcome measures (PROMs). In this study 5 year outcomes were compared between patients with previous or postoperative additional surgery and patients with no other surgery.
Results: There were 131 consecutive patients (87 females) with a median age of 22 yrs. [range 14-38yrs.] 30% of the patients underwent additional surgery within the follow-up period. All PROM scores had improved one, 2 and 5 years after the surgery with no difference between the two groups (p > 0.05). Two patients had a patellar dislocation 9 and 24 months postoperatively (1.5%).
Interpretation / Conclusion: Previous surgery or additional surgery after TP does not seem to affect the outcome following the á la carte treatment strategy for patellar instability.
1. Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital. A part of IOC Research Center Copenhagen, Denmark 2 The Research Unit for General Practice, Department of Public Health, University of Copenhagen
Background: At the section for Sports Traumatology Bispebjerg Frederiksberg Hospital, patellar instability patients with trochlear dysplasia (TD) have been treated for more than 10 years using an á la carte approach, by which all predisposing factors are treated in a single procedure. However, according to current literature secondary surgery (metal removal, arthroscopic brisement force, arthroscopic debridment, etc.) has to be performed in up to 30% following Bereiter TP.
Aim: To analyze whether previous or postoperative additional surgery after primary TP affected the 5- year outcome.
Materials and Methods: Consecutive patients with patellar instability and TD were treated according to the á la carte approach and were followed 1, 2 and 5 years postoperatively, including four patient reported outcome measures (PROMs). In this study 5 year outcomes were compared between patients with previous or postoperative additional surgery and patients with no other surgery.
Results: There were 131 consecutive patients (87 females) with a median age of 22 yrs. [range 14-38yrs.] 30% of the patients underwent additional surgery within the follow-up period. All PROM scores had improved one, 2 and 5 years after the surgery with no difference between the two groups (p > 0.05). Two patients had a patellar dislocation 9 and 24 months postoperatively (1.5%).
Interpretation / Conclusion: Previous surgery or additional surgery after TP does not seem to affect the outcome following the á la carte treatment strategy for patellar instability.