Session 15: Sports orthopaedics
15. November
12:45 - 13:45
Lokale: Sal A
Chair: Bjarne Mygind-Klavsen & Eva Wetke
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.