Session 5: Sports orthopaedics
13. November
11:00 - 12:00
Lokale: Sal C
Chair: Kristoffer W. Barfod & Kristine B. Haugaard
37. Factors influencing the two-year outcome after Bereiter trochleoplasty. Subgroup analysis of a cohort of 374 consecutive cases over a 10-years period (2011-2022).
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.
38. No difference in clinical outcome between quadriceps tendon anterior cruciate ligament reconstruction with and without bone block - Results from the Danish Knee Ligament Registry
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.
39. Postoperative joint stiffness after Bereiter trochleoplasty does not seem to influence two-year outcome
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.
40. From hip arthroscopy to hip replacement, what do the patient-reported outcomes tell us? A registry-based, national, cohort study.
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.
41. No correlation between radiological measurements for patellar instability and patient-reported outcome measurements: A study from the Faroese Knee Cohort.
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.
42. Does hip abductor tendon repair improve functional capacity after one year?
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.
43. Translation, cross-cultural validity, and reliability of a Danish version of the Anterior Knee Pain Scale (Kujala-DK)
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.