Session 15: Sports orthopaedics
15. November
12:45 - 13:45
Lokale: Sal A
Chair: Bjarne Mygind-Klavsen & Eva Wetke
121. Reoperation Rate and Predictive Factors for Healing Following Meniscus Repair - A Retrospective Analysis of 2492 cases
Bjørn Christensen1, Christopher Holst Hansen1, Martin Lundorff1, Thomas Egendal1, Anders El-Galaly2, Martin Lind3
1. Department of orthopedic surgery, Horsens Regional Hospital; 2. Department of
orthopedic surgery, Rigshospitalet; 3. Department of orthopedic surgery, Aarhus
University Hospital
Background: Meniscal injuries are common in orthopedic
practice, with conservative treatment, surgical
repair or resection being the standard treatments.
Resection of the meniscus can lead to the
development of early arthritis and there is an
increasing focus on saving the meniscus.
However, the reoperation rate following meniscus
repair remains a concern, impacting patient
outcomes and healthcare resources.
Aim: This retrospective study aimed to evaluate the
reoperation rate after meniscus repair and identify
potential risk factors associated with reoperation.
Materials and Methods: We conducted a retrospective analysis of 2492
cases undergoing meniscus repair between 2011
and 2023 in the Central Denmark Region (6
different hospitals) . Data on patient
demographics, including age at operation, sex,
BMI, type of injury, number of sutures,
concomitant ACL injury, age of injury, and smoking
status, were collected. Reoperation due to failure
of the meniscus suture were recorded. Kaplan-
Meyer analysis was performed and multivariate
Cox regression adjusted for confounders.
Results: A total of 2492 meniscus repairs were analyzed.
The reoperation rate following meniscus suture at
1 year was 13,2% CI [11.9 , 14.6], at 2 years
22,4% CI [20.7 , 24.0] and at 5 years 30% CI
[25.0 , 31.8]. The mean time until reoperation was
1.68 years (SD±1.62). We found no significant
correlation between reoperation rates and age of
patient (p=0.28), age of injury (p=0.47), BMI
(p=0.78), or sex (p=0.23). Smokers had a 5%
increased risk of reoperation (p<0.05).
Interpretation / Conclusion: A reoperation rate of 30% after meniscus suture is
relatively high and the lack of correlation to age of
injury, age of patient and BMI is noteworthy.
Previous assumptions of better clinical outcome in
young patients with a normal range BMI and an
acute injury, are not supported by the findings of
this study.
122. Anterior Cruciate Ligament Reconstruction Decreases the Risk of Meniscus Repair Failure
Bjørn Christensen1, Christopher Holst Hansen1, Martin Lundorff1, Thomas Egendal1, Anders El-Galaly2, Martin Lind3
1. Department of orthopedic surgery, Horsens Regional Hospital; 2. Department of
orthopedic surgery, Rigshospitalet; 3. Department of orthopedic surgery, Aarhus
University Hospital
Background: ACL injuries are often accompanied by meniscus
injuries. Meniscus repair is mostly performed with
ACL reconstruction, but not necessarily. Some
surgeons prefer to repair the meniscus and
perform ACL reconstruction in a subsequent
surgery, and some patients opt for meniscus
repair due to locking of the knee, but decline ACL
reconstruction.
Aim: To investigate the effect of ACL reconstruction on
the reoperation rate of meniscus repair
Materials and Methods: A retrospective analysis of 1227 cases of
combined ACL injury and meniscus repair was
conducted. The patients were treated between
2011 and 2023 in the Central Denmark Region (6
different hospitals). Data on age at operation, sex,
BMI, age of injury, and smoking status, were
collected. Reoperation due to failure of the
meniscus suture were recorded. Kaplan-Meyer
analysis was performed and multivariate Cox
regression adjusted for confounders.
Results: 1116 patients were treated with ACL
reconstruction and meniscus repair (group 1)
and 111 patients were treated with meniscus
repair and had their ACL injury treated
conservatively (group 2). In group 1, the
reoperation rate due to failed meniscus repair
at 1 year was 8.5% CI [6.9 , 10.1], at 2 years
18% CI [15.7 , 20.3] and at 5 years 26.7% CI
[21.5 , 26.7]. In Group 2, the reoperation rate
due to failed meniscus repair at 1 year was
17.0% CI [18.3 , 34.8], at 2 years 40.8% CI
[30.8 , 49.3] and at 5 years 53.3% CI [42.6 ,
62.0]. Patient age in group 1 (25.2 years) was
slightly lower than in group 2 (32.5 years), and
patient BMI in group 1 (24.5) was slightly lower
than in group 2 (26.6).
Interpretation / Conclusion: Treating an ACL injury conservatively while
repairing the meniscus results in a 62.3%
increased risk of failure and reoperation (RR 5
years 1.623). Patients should be informed of this
increased risk before opting out of ACL
reconstruction, and If possible surgeons should
perform ACL reconstruction and meniscus repair
in the same procedure.
123. No differences between 4-strand semitendinosus or semitendinosus/gracilis grafts in revision rates, knee stability and patient-reported outcomes after anterior cruciate ligament reconstruction.
Torsten Grønbech Nielsen1,2,3, Martin Lind1
1. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark;
2. Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital;
3. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Background: The semitendinosus/gracilis (ST/G) graft has
been the main choice for Anterior Cruciate
ligament reconstruction (ACLr) in the recent
years. The 4-strand semitendinosus (4-ST) graft
is not widely used, but shows promising results
in terms of revision rates, knee stability and
patient satisfaction. With the 4-ST, it is easier to
achieve an optimal graft diameter while
maintaining the hamstring strength, which
protects the knee from recurrent ACL injury. Only
studies with small sample sizes have been
published and only one study has compared
ST/G and 4-ST grafts in ACLr patients, without
looking at revision rates.
Aim: The aim of this study was to compare revision rates,
knee stability and patient-reported outcomes after
ACLr using either ST/G or 4-ST grafts identified in
the Danish Knee Ligament Reconstruction Registry.
Materials and Methods: ACLr patients from 2014 to 2021 who met the
following criteria: minimum two-year follow-up,
isolated ACL with either ST/G or 4-ST grafts. The
primary outcome was ACL revision surgery
assessed at two-year follow-up. Secondary
outcomes were knee laxity (side-to-side difference)
and pivot shift (rotational stability difference - grade
0 or grade 1-3), and patient-reported outcomes;
Knee Osteoarthritis and Outcome Score (KOOS)
subscales and Tegner activity scale assessed at
one-year follow-up.
Results: 6,750 ST/G and 1,321 4-ST patients were included
in the study. There was no statistical difference in
two-year revision rates between the groups (ST/G;
1.73 (95%CI 1.44;2.07), 4-ST; 1.40 (95%CI
0.88;2.21)). A small significant difference was seen
in knee laxity (1.3 mm vs. 1.1 mm), but no other
significant differences were seen in pivot shift or
patient-reported outcomes at one year. Both groups
showed significant improvement from baseline to
one year.
Interpretation / Conclusion: The use of ST/G or 4-ST in ACLr patients shows
similar results in terms of revision rates, knee laxity
and patient-reported outcomes.
124. Translation, cross-cultural adaptation and validation of the Danish version of the Knee Outcome Survey - Activities of Daily Living Scale
Kamilla Arp1,2, Claus Varnum1,2, Ulrik Dalgas3, Bettina Mølri4, Signe Timm1, Bjarke Viberg5,6, 7
1. Department of Orthopedic Surgery, Lillebaelt Hospital - University Hospital of
Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
2. Department of Regional Health Research, University of Southern Denmark,
Campusvej 55, 5230 Odense M, Denmark
3. Exercise Biology, Department of Public Health, Aarhus University, Dalgas
Avenue 4, 8000 Aarhus C, Denmark
4. Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of
Southern Denmark, Vejle, Denmark
5. Orthopaedic Surgery and Traumatology, Odense University Hospital, J. B.
Winsløws Vej 4, 5000 Odense C, Denmark
6. Orthopaedic Surgery and Traumatology, Hospital Lillebaelt - University
Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
7. Department of Physio- and Occupational therapy, Lillebaelt Hospital -
University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle,
Denmark
Background: The Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS) is a
patient-reported outcome measure (PROM) developed to assess functional
abilities in patients with various knee disorders. The original version of KOS-
ADLS has shown to be reliable, valid and responsive to change in patients
with various knee disorders.
Aim: We aimed to translate and culturally adapt the KOS-ADLS to Danish and to
evaluate the psychometric properties of the Danish version (KOS-ADLS-
DK) in patients with anterior cruciate ligament (ACL) injury.
Materials and Methods: The KOS-ADLS was translated and culturally adapted to Danish in
accordance with recommended guidelines. To evaluate psychometric
properties 117 patients with ACL injury completed KOS-ADLS-DK, Knee Injury
and Osteoarthritis Outcome Score (KOOS), Lysholm and UCLA at baseline
and 14 days later. A sub-population (79 patients) completed the KOS-ADLS-
DK before and after 3 months rehabilitation. Internal consistency
(Chronbach’s alpha), factor analysis, test-retest reliability (Intraclass
Correlation Coefficient [ICC]), test-retest agreement (Bland-Altman [BA] plots
with 95% limits of agreement [LOA]), Standard Error of Measurement (SEM),
Smallest Detectable Chance (SDC), construct validity (hypothesis testing),
responsiveness (construct approach with hypothesis testing) and floor/ceiling
effects were assessed.
Results: No major problems were revealed in the cross-cultural adaptation process.
The factor analysis supported the unidimensionality of KOS-ADLS-DK and
showed a high internal consistency (Chronbach’s alpha = 0.90). Test-retest
agreement showed equal distribution on the BA plot with SEM of 7.1%, SDC
of 19.7% and good reliability (ICC = 0.88). However, construct validity was not
satisfactory as only 5 of 7 hypotheses were confirmed. Hypotheses testing on
change scores revealed the KOS-ADLS-DK to be responsive and there were
no floor/ceiling effects.
Interpretation / Conclusion: The Danish version of KOS-ADLS is a valid, reliable and responsive PROM
for assessing symptoms and functional limitations in patients with ACL injury.
However, it may have some limitations in its construct validity.
125. Medial collateral ligament as a pulley in the reconstruction of the medial patellofemoral ligament for children with lateral patellar instability
Maria Frøkjær Harders1, Magnus Winther Knudsen1, Uggi Balle1, Jens Christian Poerneki2, Knud Gade Freund3, Niels Maagaard1, Bjarke Viberg1
1. Department of Orthopaedic Surgery and Traumatology, Odense
University Hospital
2. Department of Orthopaedic Surgery and Traumatology, Hospital
Lillebælt
3. Department of Orthopaedic Surgery and Traumatology, Hospital of
South West Jutland
Background: Lateral patellar instability in children is
challenging and the initial treatment is often
non-operatively. If that fails, surgery can be
indicated and the gold standard is medial
patellofemoral ligament (MPFL)
reconstruction. This usually is performed
with a screw close to the epiphyses but we
present an alternative option.
Aim: To assess our non-anatomical MPFL
reconstruction using the medial collateral
ligament (MCL) as a pulley in children with
lateral patellar instability.
Materials and Methods: This was a multicenter retrospective cohort
study on children up to 16 years with
primary MPFL reconstruction performed
between January 1st 2014 and December
31st 2020 in three hospitals (Odense
University Hospital, Hospital Lillebælt,
Hospital of South West Jutland). The
patients were identified through
administrative databases and all health
records were reviewed for demographics,
symptoms, comobordities and surgical
informations. The primary outcome was
complications (dislocations of the patella,
re-operations to the MPFL graft,
arthroscopy, and infection) with follow-up of
1 and 2 years post-operatively.
Results: There were 145 knees (119 patients)
included with a median (range) age of 15 (7-
15) years old, 76% female, and 63% had a
normal BMI. The gracilis tendon was
primarily used (93%) as graft, and 35% had
additional surgery such as lateral release
(10.3%), cartilage debridement (15.2%),
and synovectomy (15.9%). At the 6-weeks
follow-up, 22% had recorded medial
tenderness.
Within one year postoperatively there were
a total of 5.5% (n=8) with complications; 2
had a new MPFL reconstruction, 3 had
tightening of the MPFL graft, and 3 had an
arthroscopy without MPFL involvement.
After 2 years there were 10.3% (n=15) with
complications; 3 had a new MPFL
reconstruction, 5 had tightening of the
MPFL graft, 1 had a dislocation, and 6 had
an arthroscopy without MPFL involvement.
Interpretation / Conclusion: Lateral patellar instability can be treated
effectively with a low medial tenderness and
complication rate using a non-anatomical
functional MPFL reconstruction with the
MCL as a pulley in children.
126. Three-year results of surgical or conservative treatment of proximal hamstring avulsion using a shared decision strategy
Kasper Spoorendonk1, Marie Bagger Bohn2, Bent Lund2, Signe Kierkegaard-Brøchner1
1. Department of Physio and Occupational Therapy, Horsens Regional
Hospital
2. Department of Orthopedic Surgery, Horsens Regional Hospital
Background: Proximal hamstring avulsion is a rare injury
and happens with hyperextended knee and
hyperflexed hip. Studies evaluating mid-
term follow up of treatment of proximal
hamstring avulsion are lacking.
Aim: The aim was to evaluate patients
undergoing surgical or conservative
treatment for proximal hamstring avulsion
three years after initiation of treatment.
Materials and Methods: Patients were included in the study when
they reached three-year follow up after
either surgical or conservative treatment for
proximal hamstring avulsion.
Magnetic Resonance Imaging was used to
visualize proximal hamstring avulsions.
Treatment allocation to either 1) open
surgical proximal hamstring avulsion repair
and rehabilitation or 2) rehabilitation alone
(conservative group) was based on a
shared decision between the patient, a
physiotherapist, and a surgeon. The
decision was based on factors related to the
injury. All patients followed a standardized
rehabilitation program in different levels
supervised by a physiotherapist.
At baseline, one- and three-year follow-up,
patients answered the Perth Hamstring
Assessment Tool (PHAT) (0-100 scale with
100 corresponding to no problems) and Hip
Sports Activity Scale (HSAS) (0-8 with 8
corresponding to an elite athlete).
Results: The cohort included 24 patients: 11 patients
(5 women) had surgery (mean±SD age of
50±16 years) and 13 patients (4 women)
had conservative treatment (mean±SD age
of 50±17years).
At baseline, the surgical group had median
3 ruptured tendons and a tendon retraction
of median 3 cm. Surgery was performed
median 15 days after injury. The
conservative group had median 2 ruptured
tendons and a retraction of median 2 cm
and treatment was initiated median 64 days
after injury.
Patient reported outcomes improved in both
groups from baseline to three-year follow-up
(p<0.05): In the surgical group, the median
PHAT: score increased from 43 to 87,
overall health from 53 to 88 and their HSAS:
0 to 4.
In the conservative group, the PHAT
increased from 53 to 80, overall health
improved from 70 to 90, and HSAS went
from 0 to 3.
Interpretation / Conclusion: At three-year follow-up of either surgery or
conservative treatment after proximal
hamstring avulsion, both groups had good
clinical outcomes.
127. All-inside Anterior Cruciate Ligament Reconstruction (ACLR) demonstrates improved sagittal and rotational knee stability compared to conventional ACLR
Simone Elmholt1, Torsten Nielsen1, Martin Lind1
Department of Othopaedic Surgery, Aarhus University Hospital
Background: All-inside anterior cruciate ligament
reconstruction (ACLR) is performed with
inside-out drilling and adjustable
suspensory graft fixation in both the femur
and tibia. This technique has several
surgical advantages. Precise anatomical
placement of the ACL footprint, less tunnel
widening and improved graft-bone healing.
However, these advantages have not been
shown to improve clinical outcomes
compared to conventional ACLR.
Aim: This study aimed to compare clinical
outcomes between all-inside ACLR and
conventional ACLR with screw fixation.
Materials and Methods: This study was performed as a retrospect
cohort study. Data were obtained from the
Danish Knee Reconstruction Registry
(DKKR). After inclusion, 877 patients were
included in the all-inside group and 9033
patients in the conventional ACLR group.
The primary outcome was sagittal knee
laxity. Secondary outcomes included
rotational laxity (pivot shift), patient reported
outcomes (PROMs) and revision rates.
Results: ACLR performed using the all-inside
technique demonstrated improved sagittal
knee stability compared to conventional
ACLR (0.8mm vs. 1.3mm, p < 0.01) at one
year follow-up. Furthermore, fewer patients
in the all-inside group had a positive pivot
shift compared to conventional ACLR (8.2%
vs. 15.9%, p < 0.01). Both groups
demonstrated similar PROMs and similar
risk of surgical revision at two years follow-
up.
Interpretation / Conclusion: Compared to conventional ACLR the all-
inside technique for ACLR demonstrated
improved clinical outcomes regarding both
sagittal and rotational knee stability. In
addition, PROMs and revisions rates were
similar compared to conventional ACLR.