Session 5: Sports orthopaedics
13. November
11:00 - 12:00
Lokale: Sal C
Chair: Kristoffer W. Barfod & Kristine B. Haugaard
Christian Dippmann1, Peter Siersma2, Anette Kourakis1, Simone Rechter1, Peter Lavard1
1 Section for Sports Traumatology M51, Department of orthopedic surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark. 2 The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
Background: Since 2011 patients with patellar instability and trochlear dysplasia (TD) have been treated at Bispebjerg Frederiksberg hospital according to a standardized treatment algorithm with Bereiter trochleoplasty (TP). We hypothesized that high body mass index (BMI), young age by the time of first- time dislocation, increased time from symptom debut to surgery and previous patella stabilizing surgery would affect the outcome after TP negatively.
Aim: To test if these factors influenced patient reported outcome 2 years after Bereiter TP.
Materials and Methods: Prospectively collected data from 2011 to 2021 for all patients undergoing patella stabilizing surgery with trochleoplasty and MPFL-reconstruction +/- concomitant procedures as well as preoperative, 1 yr. and 2 yrs. follow-up data including clinical examination and scores from patient reported outcome measures (PROMs) (Kujala, KOOS and Lysholm). were analysed in mixed repeated measurement models regarding differences between the longitudinal effects.
Results: 374 Bereiter TPs were performed on 335 patients (102 males, 233 females). TP was performed median 6 years (range: 0-35) after the first patellar dislocation. The median BMI of patients was 23.6 kg/m2 (range: 14.1-46.3). 92 patients (25%) had previous patella stabilizing surgery. Comparing the two-year outcome, no differences could be seen between patients 12 years of age when they had the first dislocation, between 2 years from first-time dislocation to surgery or whether patients had undergone previous patella stabilizing surgery or not. Patients with a BMI>30 kg/m2 showed larger increase in PROM-scores during the first two postoperative years than patients with a BMI<30 kg/m2 (p<0.01, except for KOOS QoL).
Interpretation / Conclusion: Age at the first patella dislocation, time between first dislocation and surgery, and previous patella stabilising surgery did not influence the two-year outcome after Bereiter TP for severe TD. Patients with a BMI>30 kg/m2 seemed to benefit more from patella stabilizing surgery than patients with a BMI<30 kg/m2.
1 Section for Sports Traumatology M51, Department of orthopedic surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark. 2 The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
Background: Since 2011 patients with patellar instability and trochlear dysplasia (TD) have been treated at Bispebjerg Frederiksberg hospital according to a standardized treatment algorithm with Bereiter trochleoplasty (TP). We hypothesized that high body mass index (BMI), young age by the time of first- time dislocation, increased time from symptom debut to surgery and previous patella stabilizing surgery would affect the outcome after TP negatively.
Aim: To test if these factors influenced patient reported outcome 2 years after Bereiter TP.
Materials and Methods: Prospectively collected data from 2011 to 2021 for all patients undergoing patella stabilizing surgery with trochleoplasty and MPFL-reconstruction +/- concomitant procedures as well as preoperative, 1 yr. and 2 yrs. follow-up data including clinical examination and scores from patient reported outcome measures (PROMs) (Kujala, KOOS and Lysholm). were analysed in mixed repeated measurement models regarding differences between the longitudinal effects.
Results: 374 Bereiter TPs were performed on 335 patients (102 males, 233 females). TP was performed median 6 years (range: 0-35) after the first patellar dislocation. The median BMI of patients was 23.6 kg/m2 (range: 14.1-46.3). 92 patients (25%) had previous patella stabilizing surgery. Comparing the two-year outcome, no differences could be seen between patients 12 years of age when they had the first dislocation, between 2 years from first-time dislocation to surgery or whether patients had undergone previous patella stabilizing surgery or not. Patients with a BMI>30 kg/m2 showed larger increase in PROM-scores during the first two postoperative years than patients with a BMI<30 kg/m2 (p<0.01, except for KOOS QoL).
Interpretation / Conclusion: Age at the first patella dislocation, time between first dislocation and surgery, and previous patella stabilising surgery did not influence the two-year outcome after Bereiter TP for severe TD. Patients with a BMI>30 kg/m2 seemed to benefit more from patella stabilizing surgery than patients with a BMI<30 kg/m2.
Martin Lind, Torsten Grønbeck Nielsen
Department of Orthopaedics, Aarhus University Hospital
Background: Quadriceps tendon (QT) has recently gained increased interest as ACL reconstruction (ACLR) graft due to the introduction of minimal invasive harvesting techniques and low donor site morbidity. QT grafts can be used either with patella bone block or as complete soft tissue graft. It is unknown whether QT graft type affects clinical outcomes.
Aim: The purpose of the present study was to use the Danish Knee Ligament Reconstruction Registry (DKRR) to compare revision rates, knee stability and subjective clinical outcomes in patients who underwent ACLR with QT graft with (QT-B) and without block (QT-S).
Materials and Methods: Inclusion criteria were primary ACL reconstruction with QT autograft in DKRR. Two study populations were identified based on QT graft type for ACL reconstruction: patients with QT-B (n = 925); and patients with QT-S (n = 659). Clinical outcome was evaluated by revision rates for the two cohorts. Objective instrumented knee stability and pivot shift tests were performed at one-year follow-up as well as KOOS and Tegner Activity scale scores.
Results: The revision rate at 2 years was similar in both groups at 2.8 %. Postoperative knee laxity was equal between QT-B and QT-S ACLR with 1.5 and1.6 mm side-to-side laxity respectively. QT-B had a 22 % incidence of postoperative positive pivot shift compared to 29 % for QT-S. Subjective outcome was similar for KOOS and Tegner Activity scale scores at one year, but with reduced improvements for KOOS symptoms and KOOS sport for QT-B compared to QT- S.
Interpretation / Conclusion: ACL reconstructions with QT autograft with a bone block or as a complete soft tissue graft resulted in similar low revision rates and achieved similar good sagittal knee stability. A secondary finding was that ACL reconstructions with QT graft with a bone block obtained better rotational stability than ACL reconstructions with complete soft tissue QT grafts.
Department of Orthopaedics, Aarhus University Hospital
Background: Quadriceps tendon (QT) has recently gained increased interest as ACL reconstruction (ACLR) graft due to the introduction of minimal invasive harvesting techniques and low donor site morbidity. QT grafts can be used either with patella bone block or as complete soft tissue graft. It is unknown whether QT graft type affects clinical outcomes.
Aim: The purpose of the present study was to use the Danish Knee Ligament Reconstruction Registry (DKRR) to compare revision rates, knee stability and subjective clinical outcomes in patients who underwent ACLR with QT graft with (QT-B) and without block (QT-S).
Materials and Methods: Inclusion criteria were primary ACL reconstruction with QT autograft in DKRR. Two study populations were identified based on QT graft type for ACL reconstruction: patients with QT-B (n = 925); and patients with QT-S (n = 659). Clinical outcome was evaluated by revision rates for the two cohorts. Objective instrumented knee stability and pivot shift tests were performed at one-year follow-up as well as KOOS and Tegner Activity scale scores.
Results: The revision rate at 2 years was similar in both groups at 2.8 %. Postoperative knee laxity was equal between QT-B and QT-S ACLR with 1.5 and1.6 mm side-to-side laxity respectively. QT-B had a 22 % incidence of postoperative positive pivot shift compared to 29 % for QT-S. Subjective outcome was similar for KOOS and Tegner Activity scale scores at one year, but with reduced improvements for KOOS symptoms and KOOS sport for QT-B compared to QT- S.
Interpretation / Conclusion: ACL reconstructions with QT autograft with a bone block or as a complete soft tissue graft resulted in similar low revision rates and achieved similar good sagittal knee stability. A secondary finding was that ACL reconstructions with QT graft with a bone block obtained better rotational stability than ACL reconstructions with complete soft tissue QT grafts.
Christos Soleas1, Peter Lavard2, Anette Holm Kourakis2, Simone Rechter2, Volkert Siersma3, Christian Dippmann2
¹Department of orthopedic surgery and traumatology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark 2 Section for Sports Traumatology M51, Department of orthopedic surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark. 3 The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
Background: Bereiter trochleoplasty (TP) is a well-described treatment for patellar instability due to trochlear dysplasia. Joint stiffness with reduced range of motion (ROM) is a known complication following TP, often requiring arthroscopically assisted manipulation (AAM) with removal of adhesions and scar tissue under general anesthesia. It is unknown if patients who have joint stiffness following TP have an inferior postoperative outcome.
Aim: The purpose of this study was to analyze the two- year outcome following TP with AAM compared to TP patients without postoperative joint stiffness.
Materials and Methods: 374 consecutive knees were followed after TP with clinical examination 3 months, 1 and 2 years after surgery. All had specialized physiotherapy postoperatively. The clinical examination included measurement of range of motion (ROM), and the subjective outcome at 1- and 2- year follow-up was assessed by three patient reported outcome measures (PROMs): Kujala score, KOOS and Lysholm score. There was particular focus on ROM the first 3 months after surgery. The indication for AAM at 3-month follow-up was > 10 degrees extension deficit and/or flexion <120 degrees with no improvement.
Results: 49 (38 females, 11 males) of the 374 knees (13 %) underwent AAM for postoperative joint stiffness. 7 patients had two AAM, while two patients underwent three AMM. The average time from TP to AAM was 12.1 weeks (range 4-24 weeks). Neutral extension and flexion >135 degrees was achieved in 37 cases (76%). In 11 cases, flexion remained reduced, while data on range of motion could not be retrieved in one case. No statistical difference in mean improvement could be seen in patienten undergoing AAM after TP compared to patients without AAM (p>0.05).
Interpretation / Conclusion: Joint stiffness is a relatively common complication to Bereiter TP. However, full ROM was achieved in 75% of all cases following AAM and similar improvements in subjective outcome 2 years after TP could be seen.
¹Department of orthopedic surgery and traumatology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark 2 Section for Sports Traumatology M51, Department of orthopedic surgery, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark. 3 The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
Background: Bereiter trochleoplasty (TP) is a well-described treatment for patellar instability due to trochlear dysplasia. Joint stiffness with reduced range of motion (ROM) is a known complication following TP, often requiring arthroscopically assisted manipulation (AAM) with removal of adhesions and scar tissue under general anesthesia. It is unknown if patients who have joint stiffness following TP have an inferior postoperative outcome.
Aim: The purpose of this study was to analyze the two- year outcome following TP with AAM compared to TP patients without postoperative joint stiffness.
Materials and Methods: 374 consecutive knees were followed after TP with clinical examination 3 months, 1 and 2 years after surgery. All had specialized physiotherapy postoperatively. The clinical examination included measurement of range of motion (ROM), and the subjective outcome at 1- and 2- year follow-up was assessed by three patient reported outcome measures (PROMs): Kujala score, KOOS and Lysholm score. There was particular focus on ROM the first 3 months after surgery. The indication for AAM at 3-month follow-up was > 10 degrees extension deficit and/or flexion <120 degrees with no improvement.
Results: 49 (38 females, 11 males) of the 374 knees (13 %) underwent AAM for postoperative joint stiffness. 7 patients had two AAM, while two patients underwent three AMM. The average time from TP to AAM was 12.1 weeks (range 4-24 weeks). Neutral extension and flexion >135 degrees was achieved in 37 cases (76%). In 11 cases, flexion remained reduced, while data on range of motion could not be retrieved in one case. No statistical difference in mean improvement could be seen in patienten undergoing AAM after TP compared to patients without AAM (p>0.05).
Interpretation / Conclusion: Joint stiffness is a relatively common complication to Bereiter TP. However, full ROM was achieved in 75% of all cases following AAM and similar improvements in subjective outcome 2 years after TP could be seen.
Bjarne Mygind-Klavsen1, Bent Lund2, Jeppe Lange2, Otto Kraemer4, David Kocemba2, Inger Mechlenburg1,3, Martin Lind1, Per Hölmich4, Signe Kierkegaard-Brøchner2,3
1 Dept. of Orthopedics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark. 2 H-HiP, Horsens Regional Hospital, Dept. of Orthopedics, 8700 Horsens, Denmark. 3 Department of Clinical Medicine, Aarhus University. 4 Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Allé 30, 2650 Hvidovre Denmark.
Background: Patients with Femoroacetabular Impingement Syndrome (FAIS) may experience persistent hip problems following arthroscopic FAIS surgery, with total hip replacement surgery (THR) being the last option.
Aim: 1) To investigate the number of patients in the Danish Hip Arthroscopy Registry (DHAR) who underwent conversion to THR after FAIS surgery 2) Patient-reported outcomes of THR converted cases, compared with control groups: non converted FAIS cases, and primary osteoarthritic THR cases, identified in international literature.
Materials and Methods: Patients above 18 years registered with arthroscopic surgery due to FAIS between January 2012 and November 2023 were identified in (DHAR). Cases registered with a positive impingement test, radiological cam and/or pincer morphology on a standing anterior-posterior radiograph, no signs of hip osteoarthritis were eligible. All patients were invited to participate in a REDCap controlled survey. If they responded “yes” to the entry question: Have you had total hip replacement?, they were immediately hereafter asked to complete the Copenhagen Hip and Groin Outcome Score (HAGOS) and Hip Osteoarthritis Outcome Score (HOOS) questionnaires (0- 100 scores, 100 being no problems).
Results: 5118 patients were eligible and received the survey, of whom 2364 (46%) responded. 223 patients (9%) reported, they had a THR at 1 to 10 years after their primary hip arthroscopy. Converted cases reported median HAGOS scores of: Pain: 75, Symptoms: 75, Activities of daily living: 75, Sport: 53, Participation in Sport: 38, Quality of life: 50. HOOS scores were: Pain: 80, Symptoms: 81, Sport: 63 and Quality of life: 50. Compared to patients undergoing primary hip arthroscopy and primary THR, hip-related quality of life was inferior in converted cases.
Interpretation / Conclusion: A low number of conversion to THR (9%) was demonstrated. Converted cases reported good outcomes after THR surgery, similar to those who underwent primary FAIS surgery and primary THR, although an inferior Hip-related quality of life was found in the studied patient group.
1 Dept. of Orthopedics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark. 2 H-HiP, Horsens Regional Hospital, Dept. of Orthopedics, 8700 Horsens, Denmark. 3 Department of Clinical Medicine, Aarhus University. 4 Sports Orthopedic Research Center – Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Allé 30, 2650 Hvidovre Denmark.
Background: Patients with Femoroacetabular Impingement Syndrome (FAIS) may experience persistent hip problems following arthroscopic FAIS surgery, with total hip replacement surgery (THR) being the last option.
Aim: 1) To investigate the number of patients in the Danish Hip Arthroscopy Registry (DHAR) who underwent conversion to THR after FAIS surgery 2) Patient-reported outcomes of THR converted cases, compared with control groups: non converted FAIS cases, and primary osteoarthritic THR cases, identified in international literature.
Materials and Methods: Patients above 18 years registered with arthroscopic surgery due to FAIS between January 2012 and November 2023 were identified in (DHAR). Cases registered with a positive impingement test, radiological cam and/or pincer morphology on a standing anterior-posterior radiograph, no signs of hip osteoarthritis were eligible. All patients were invited to participate in a REDCap controlled survey. If they responded “yes” to the entry question: Have you had total hip replacement?, they were immediately hereafter asked to complete the Copenhagen Hip and Groin Outcome Score (HAGOS) and Hip Osteoarthritis Outcome Score (HOOS) questionnaires (0- 100 scores, 100 being no problems).
Results: 5118 patients were eligible and received the survey, of whom 2364 (46%) responded. 223 patients (9%) reported, they had a THR at 1 to 10 years after their primary hip arthroscopy. Converted cases reported median HAGOS scores of: Pain: 75, Symptoms: 75, Activities of daily living: 75, Sport: 53, Participation in Sport: 38, Quality of life: 50. HOOS scores were: Pain: 80, Symptoms: 81, Sport: 63 and Quality of life: 50. Compared to patients undergoing primary hip arthroscopy and primary THR, hip-related quality of life was inferior in converted cases.
Interpretation / Conclusion: A low number of conversion to THR (9%) was demonstrated. Converted cases reported good outcomes after THR surgery, similar to those who underwent primary FAIS surgery and primary THR, although an inferior Hip-related quality of life was found in the studied patient group.
Niclas Højgaard Eysturoy1,5, Hans-Christen Husum2, Lina H. Ingelsrud3, Lars Blønd4, Kristoffer W. Barfod5
1. Department of Orthopaedic Surgery, National Hospital of the Faroe Islands, Torshavn, Faroe Island 2. Interdisciplinary Orthopaedics, Aalborg University Hospital, Denmark. 3. Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital Amager- Hvidovre, Copenhagen, Denmark 4. Zealand University Hospital, Køge and Aleris Hospital, Copenhagen, Denmark. 5. Sports Orthopaedic Research Center – Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, Denmark
Background: No studies have investigated the relationship between radiological measurements used in patellofemoral instability diagnostics and subjective patient well-being.
Aim: This study aims to investigate this correlation in individuals with previous patellar dislocation.
Materials and Methods: All inhabitants of the Faroe Islands aged 15-19 were invited to answer an online survey. All patients with prior patellar dislocation and no prior surgery to the knee were invited to have X- rays and MRIs of both knees. The radiological measurements were the Dejour classification, the Lateral Trochlear Inclination Angle (LTI), the Trochlear Depth, the Caton-Deschamps index (CD-index), and the Tuberositas Tibia – Trochlear Groove distance (TT-TG). The participants answered the patient-reported outcome measurements (PROMs): Banff patellar instability score 2.0 (BPII), The Kujala score, the Marx score and the EQ-5D-5L score. Continuous data from each radiological measurement was plotted against each PROM to create scatter plots for visual inspection and analysis.
Results: A total of 3,708 individuals were contacted. After excluding participants with prior knee surgery, 102 reported a history of patellar dislocation. 75 underwent X-rays and MRIs of their knees and were included in the study for further analysis. Scatter plots showed no correlation between the radiological measurements and the PROM scores.
Interpretation / Conclusion: This study found no correlation between the most used radiological measurements in patellar instability and PROM scores. The results imply that radiological measurements used in patellofemoral instability diagnostics are not indicative of patient subjective health and well-being.
1. Department of Orthopaedic Surgery, National Hospital of the Faroe Islands, Torshavn, Faroe Island 2. Interdisciplinary Orthopaedics, Aalborg University Hospital, Denmark. 3. Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital Amager- Hvidovre, Copenhagen, Denmark 4. Zealand University Hospital, Køge and Aleris Hospital, Copenhagen, Denmark. 5. Sports Orthopaedic Research Center – Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Copenhagen, Denmark
Background: No studies have investigated the relationship between radiological measurements used in patellofemoral instability diagnostics and subjective patient well-being.
Aim: This study aims to investigate this correlation in individuals with previous patellar dislocation.
Materials and Methods: All inhabitants of the Faroe Islands aged 15-19 were invited to answer an online survey. All patients with prior patellar dislocation and no prior surgery to the knee were invited to have X- rays and MRIs of both knees. The radiological measurements were the Dejour classification, the Lateral Trochlear Inclination Angle (LTI), the Trochlear Depth, the Caton-Deschamps index (CD-index), and the Tuberositas Tibia – Trochlear Groove distance (TT-TG). The participants answered the patient-reported outcome measurements (PROMs): Banff patellar instability score 2.0 (BPII), The Kujala score, the Marx score and the EQ-5D-5L score. Continuous data from each radiological measurement was plotted against each PROM to create scatter plots for visual inspection and analysis.
Results: A total of 3,708 individuals were contacted. After excluding participants with prior knee surgery, 102 reported a history of patellar dislocation. 75 underwent X-rays and MRIs of their knees and were included in the study for further analysis. Scatter plots showed no correlation between the radiological measurements and the PROM scores.
Interpretation / Conclusion: This study found no correlation between the most used radiological measurements in patellar instability and PROM scores. The results imply that radiological measurements used in patellofemoral instability diagnostics are not indicative of patient subjective health and well-being.
Marie Bagger Bohn1,2, Jeppe Lange1,2, Bent Lund1, Kasper Spoorendong3, Signe Kierkegaard-Brøchner2,3
1 H-HiP, Department of Orthopedic Surgery, Horsens Regional Hospital, Denmark 2 Department of Clinical Medicine, Aarhus University, Denmark 3 H-HiP, Department of Physio and Occupational Therapy, Horsens Regional Hospital, Denmark
Background: Data regarding improvements in functional capacity after hip abductor tendon surgery is lacking.
Aim: The aim of the study was to investigate multiple aspects of hip abduction strength including comparison to matched healthy controls and association to degree of damage evaluated during surgery, and association with performance in the 30 second sit-to-stand (STS) test and Trendelenburg test one year after hip abductor tendon repair.
Materials and Methods: 50 women (mean age 56±11) were included. Inclusion criteria were: MRI verified hip abductor tendon tears, open surgical repair of hip abductor tendons, and maximal hip abduction strength tested with a handheld dynamometer at baseline and at one year follow-up. Patients also completed the STS test and the Trendelenburg test before and one year after surgery and rehabilitation. 25 age and sex matched persons (controls) with no lateral hip pain underwent the same tests.
Results: Patients improved their maximal hip abduction strength from median [25th;75th quartile]: 0.51 [0.34;0.70] Nm/kg to 0.69 [0.54;1.01] Nm/kg, p<0.001. At 1-year follow up, patients were weaker than the healthy controls (p=0.008), but 62% of the patients reached the 95%reference interval for healthy controls. Neither before nor after surgery was the patients’ maximal hip abduction strength associated with their degree of tendon rupture. Patients’s maximal hip abduction strength one year after surgery was associated with number of completed STS repetitions (coefficient (95%confidence interval)): 7.4 (5;10), p<0.001). Patients with a positive Trendelenburg test at one year follow up had lower maximal hip abduction strength (0.65 Nm/kg vs. 0.87 Nm/kg, p=0.02).
Interpretation / Conclusion: Patients undergoing surgical hip abductor tendon repair improved their maximal hip abduction strength at one year follow up approaching healthy reference levels. Interestingly, no association was found between the degree of tendon rupture and maximal hip abduction strength while associations between reduced hip abductor strength and performance in STS and Trendelenburg tests were found.
1 H-HiP, Department of Orthopedic Surgery, Horsens Regional Hospital, Denmark 2 Department of Clinical Medicine, Aarhus University, Denmark 3 H-HiP, Department of Physio and Occupational Therapy, Horsens Regional Hospital, Denmark
Background: Data regarding improvements in functional capacity after hip abductor tendon surgery is lacking.
Aim: The aim of the study was to investigate multiple aspects of hip abduction strength including comparison to matched healthy controls and association to degree of damage evaluated during surgery, and association with performance in the 30 second sit-to-stand (STS) test and Trendelenburg test one year after hip abductor tendon repair.
Materials and Methods: 50 women (mean age 56±11) were included. Inclusion criteria were: MRI verified hip abductor tendon tears, open surgical repair of hip abductor tendons, and maximal hip abduction strength tested with a handheld dynamometer at baseline and at one year follow-up. Patients also completed the STS test and the Trendelenburg test before and one year after surgery and rehabilitation. 25 age and sex matched persons (controls) with no lateral hip pain underwent the same tests.
Results: Patients improved their maximal hip abduction strength from median [25th;75th quartile]: 0.51 [0.34;0.70] Nm/kg to 0.69 [0.54;1.01] Nm/kg, p<0.001. At 1-year follow up, patients were weaker than the healthy controls (p=0.008), but 62% of the patients reached the 95%reference interval for healthy controls. Neither before nor after surgery was the patients’ maximal hip abduction strength associated with their degree of tendon rupture. Patients’s maximal hip abduction strength one year after surgery was associated with number of completed STS repetitions (coefficient (95%confidence interval)): 7.4 (5;10), p<0.001). Patients with a positive Trendelenburg test at one year follow up had lower maximal hip abduction strength (0.65 Nm/kg vs. 0.87 Nm/kg, p=0.02).
Interpretation / Conclusion: Patients undergoing surgical hip abductor tendon repair improved their maximal hip abduction strength at one year follow up approaching healthy reference levels. Interestingly, no association was found between the degree of tendon rupture and maximal hip abduction strength while associations between reduced hip abductor strength and performance in STS and Trendelenburg tests were found.
Torsten Grønbech Nielsen1,2,3, Martin Lind1, Annette De Thurah3,4, Pia Kjær Kritensen3
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; 4. Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
Background: The Anterior Knee Pain Scale (Kujala) is a widely used patient-reported outcome measure designed to assess adults with patellofemoral disorders. It is used for both anterior knee pain and patellar instability patients, and has been translated and validated in most major languages, but not previously in Danish.
Aim: To cross-culturally translate and adapt the Kujala into a Danish Kujala-DK. Secondarily, to determine the face validity and reliability of the Kujala-DK in a consecutive Danish population of patients with patellar dislocation.
Materials and Methods: The study was carried out in 2 stages. First, the Kujala was adapted cross-culturally according to the guidelines of Beaton et al. 2000. Face validity was ensured by think-aloud interviews with 2 health care professionals and 20 patients with anterior knee pain or patellar instability. Secondly, the Kujala-DK was tested for concurrent validity (Spearman Rho), internal consistency (Cronbach alpha) and reliability (intraclass correlation - ICC) in a prospective cohort of patients with patellar dislocation. Tegner activity score, the Victorian Institute of Sport Assessment-Patella (VISA-P), the Banff Patella Instability Instrument (BPII 2.0), and the International Knee Documentation Committee (IKDC) were used to assess convergent validity. The test-retest reliability of the Kujala-DK was evaluated in 50 patients with patellar dislocation. Patients completed the Kujala Score twice, with a 7-day interval between assessments.
Results: Face-validation resulted in only minor revisions to the Kujala-DK. High convergent validity was found with VISA-P (0.73), BPII 2.0 (0.79) and IKDC (0.76). Low convergent validity was found with the Tegner activity score (0.48). The calculated Cronbach alpha sum score was 0.95 and for the individual item, scores ranged from 0.74 to 0.99. A high level of reliability was found (ICC: 0.92 (95%CI: 0.83-0.96)). The individual sum scores ranged from 0.42 to 0.96.
Interpretation / Conclusion: The measurement properties revealed that the Kujala-DK is a reliable and valid tool for patients with patellar disorders.
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; 4. Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
Background: The Anterior Knee Pain Scale (Kujala) is a widely used patient-reported outcome measure designed to assess adults with patellofemoral disorders. It is used for both anterior knee pain and patellar instability patients, and has been translated and validated in most major languages, but not previously in Danish.
Aim: To cross-culturally translate and adapt the Kujala into a Danish Kujala-DK. Secondarily, to determine the face validity and reliability of the Kujala-DK in a consecutive Danish population of patients with patellar dislocation.
Materials and Methods: The study was carried out in 2 stages. First, the Kujala was adapted cross-culturally according to the guidelines of Beaton et al. 2000. Face validity was ensured by think-aloud interviews with 2 health care professionals and 20 patients with anterior knee pain or patellar instability. Secondly, the Kujala-DK was tested for concurrent validity (Spearman Rho), internal consistency (Cronbach alpha) and reliability (intraclass correlation - ICC) in a prospective cohort of patients with patellar dislocation. Tegner activity score, the Victorian Institute of Sport Assessment-Patella (VISA-P), the Banff Patella Instability Instrument (BPII 2.0), and the International Knee Documentation Committee (IKDC) were used to assess convergent validity. The test-retest reliability of the Kujala-DK was evaluated in 50 patients with patellar dislocation. Patients completed the Kujala Score twice, with a 7-day interval between assessments.
Results: Face-validation resulted in only minor revisions to the Kujala-DK. High convergent validity was found with VISA-P (0.73), BPII 2.0 (0.79) and IKDC (0.76). Low convergent validity was found with the Tegner activity score (0.48). The calculated Cronbach alpha sum score was 0.95 and for the individual item, scores ranged from 0.74 to 0.99. A high level of reliability was found (ICC: 0.92 (95%CI: 0.83-0.96)). The individual sum scores ranged from 0.42 to 0.96.
Interpretation / Conclusion: The measurement properties revealed that the Kujala-DK is a reliable and valid tool for patients with patellar disorders.