Torbjørn Strand - Academia.edu (original) (raw)

Papers by Torbjørn Strand

American Journal of Sports Medicine, Jul 12, 2021

Deciding when to return to sport following an ACL injury can be extremely challenging. Athletes m... more Deciding when to return to sport following an ACL injury can be extremely challenging. Athletes must contend not only with the physical consequences, but also with the psychological ones. While readiness tests take various factors into account, it's unclear how these factors might be linked. In a study published in _The American Journal of Sports Medicine_, researchers from Norway report on the association they found between psychological readiness to return to sport and tibial displacement. The study enrolled 132 patients aged 16 or older nine to twelve months after ACL reconstruction surgery. At baseline, patients completed a project-speci c activity questionnaire and the ACL-Return to Sport After Injury scale evaluation. Knee laxity was assessed using the Lachman test, a KT-1000 arthrometer, and the pivot-shift test. Patients were followed-up two years after surgery. Data revealed small but signi cant negative associations between measurements of anterior tibial displacement and psychological readiness to return to sport: patients showing greater displacement on the Lachman test and in KT-1000 arthrometer measurements reported lower psychological readiness. No signi cant associations were observed between laxity determined by the pivot-shift test and psychological readiness. And there were no differences in ACL-RSI scores between patients with stable knees and those with slightly increased or residual laxity. Thirty-six percent of patients returned to their preinjury level of sport two years after surgery. Factors that predicted this return included higher age, higher psychological readiness, and less anterior tibial displacement. Although the association between psychological readiness and knee laxity was low, the results offer support for incorporating psychological readiness and clinical ndings into return-to-sport assessments following ACL reconstruction.

Knee Surgery, Sports Traumatology, Arthroscopy, Oct 29, 2009

We compared the results of microfracture in single versus multiple symptomatic articular cartilag... more We compared the results of microfracture in single versus multiple symptomatic articular cartilage defects in the knee in 110 patients with a median age of 38 years (range 15-60). Cases of reoperation of the cartilage defect were classified as failures. Clinical outcome in non-failures was evaluated by the Lysholm score and grading of knee pain and function of the knee by the use of patient-administered visual analog scales (VAS; 0-100). Data were prospectively collected before the operation and at the 2- to 9-year follow-up. The single lesion or the largest of multiple lesions were located on the medial femoral condyle (n = 62), trochlea (n = 18), lateral tibia (n = 11), patella (n = 10) or lateral femoral condyle (n = 9). We treated one (n = 76), two (n = 27) or three (n = 7) lesions with a median total area of 4 cm(2) (range 1-15). A total of 24 failures (22%) were registered-18% in the single-defect subgroup and 29% in the multiple-defects subgroup. In the remaining group of patients (n = 86), the mean Lysholm score, mean pain-score (0 = no pain; 100 = worst possible pain) and mean function-score (0 = useless; 100 = full function) improved from 51, 52 and 41, respectively, to 71 (P < 0.001), 30 (P < 0.001) and 69 (P < 0.001) at the follow-up. The pain-score was significant lower (P = 0.042), and the function-score significantly higher (P = 0.001) in the group of patients with a single lesion compared to the group with 2 or 3 lesions. The Lysholm score did not differ significantly between the two subgroups (P = 0.06).

Springer eBooks, 1986

Injuries to the posterior cruciate ligament (PCL) of the knee are relatively infrequent. Most aut... more Injuries to the posterior cruciate ligament (PCL) of the knee are relatively infrequent. Most authors recommend primary operative repair, but few larger series with documented results exist. lately the value of primary operative treatment has been questioned.

Background: The optimal treatment for cartilage lesions has not yet been established. The objecti... more Background: The optimal treatment for cartilage lesions has not yet been established. The objective of this randomized trial was to compare autologous chondrocyte implantation with microfracture. This paper represents an update, with presentation of the clinical results at five years. Methods: Eighty patients who had a single chronic symptomatic cartilage defect on the femoral condyle in a stable knee without general osteoarthritis were included in the study. Forty patients were treated with autologous chondrocyte implantation, and forty were treated with microfracture. We used the International Cartilage Repair Society, Lysholm, Short Form-36, and Tegner forms to collect clinical data, and radiographs were evaluated with use of the Kellgren and Lawrence grading system. Results: At two and five years, both groups had significant clinical improvement compared with the preoperative status. At the five-year follow-up interval, there were nine failures (23%) in both groups compared with two failures of the autologous chondrocyte implantation and one failure of the microfracture treatment at two years. Younger patients did better in both groups. We did not find a correlation between histological quality and clinical outcome. However, none of the patients with the best-quality cartilage (predominantly hyaline) at the two-year mark had a later failure. One-third of the patients in both groups had radiographic evidence of early osteoarthritis at five years. Conclusions: Both methods provided satisfactory results in 77% of the patients at five years. There was no significant difference in the clinical and radiographic results between the two treatment groups and no correlation between the histological findings and the clinical outcome. One-third of the patients had early radiographic signs of osteoarthritis five years after the surgery. Further long-term follow-up is needed to determine if one method is better than the other and to study the progression of osteoarthritis.

Journal of Bone and Joint Surgery, American Volume, Oct 1, 2007

Background.-The optimal treatment for cartilage lesions has not yet been established. The objecti... more Background.-The optimal treatment for cartilage lesions has not yet been established. The objective of this randomized trial was to compare autologous chondrocyte implantation with microfracture. This paper represents an update, with presentation of the clinical results at five years. Methods.-Eighty patients who had a single chronic symptomatic cartilage defect on the femoral condyle in a stable knee without general osteoarthritis were included in the study. Forty patients were treated with autologous chondrocyte implantation, and forty were treated with microfracture. We used the International Cartilage Repair Society, Lysholm, Short Form-36, and Tegner forms to collect clinical data, and radiographs were evaluated with use of the Kellgren and Lawrence grading system. Results.-At two and five years, both groups had significant clinical improvement compared with the preoperative status. At the five-year follow-up interval, there were nine failures (23%) in both groups compared with two failures of the autologous chondrocyte implantation and one failure of the microfracture treatment at two years. Younger patients did better in both groups. We did not find a correlation between histological quality and clinical outcome. However, none of the patients with the best-quality cartilage (predominantly hyaline) at the two-year mark had a later failure. One-third of the patients in both groups had radiographic evidence of early osteoarthritis at five years. Conclusions.-Both methods provided satisfactory results in 77% of the patients at five years. There was no significant difference in the clinical and radiographic results between the two treatment groups and no correlation between the histological findings and the clinical outcome. One-third of the patients had early radiographic signs of osteoarthritis five years after the surgery. Further long-term follow-up is needed to determine if one method is better than the other and to study the progression of osteoarthritis. Level of Evidence.-Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence. : For those involved with athletics or in sports medicine, optimum management of the patient with isolated knee lesions continue to be the source of debate and discussion. The effectiveness of microfracture has been demonstrated in the past, as has autologous chondrocyte implantation. Studies have

Clinical Journal of Sport Medicine, Jul 1, 1991

Treatment of ACL tears is controversial. Recent reports on nonoperative treatment have shown poor... more Treatment of ACL tears is controversial. Recent reports on nonoperative treatment have shown poor results. Results after primary repair have deteriorated with time, leading to augmentation procedures that seem to have improved the results. However, there have been few prospective, randomized studies in this field. Our goal was to compare primary repair with a bone-patellar tendon-bone augmentation method and with a new method using the Kennedy Ligament Augmentation Device. One hundred fifty patients aged 16 to 50, all of whom had acute ACL tears, were randomized with the closed envelope method to one of three groups treated with open surgical methods. Fifty patients were treated with primary repair, 50 patients with patellar tendon augmentation, and 50 patients were augmented with the Kennedy Ligament Augmentation Device. All patients were operated on within 10 days of injury. The rehabilitation protocol was identical, consisting of a long leg cast for 2 weeks, followed by a brace with no weight-bearing and limited motion for 6 weeks. The patients were followed prospectively by one surgeon (LE) using the Lysholm functional score, Tegner activity level score, clinical evaluation and KT-1000 arthrometer at 6 months, 1, and 2 years. Three patients were lost to followup. There was no age or activity level difference between the groups. Sport activities led to 85% of the injuries, with skiing, soccer, and European handball representing 80% of injuries. All three groups reduced their activity level the 1st year. The repair group remained at the same level after 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Medicine and Science in Sports and Exercise, May 1, 1993

Medicine & Science in Sports & Exercise, 1993

Knee Surgery, Sports Traumatology, Arthroscopy, 2009

We compared the results of microfracture in single versus multiple symptomatic articular cartilag... more We compared the results of microfracture in single versus multiple symptomatic articular cartilage defects in the knee in 110 patients with a median age of 38 years (range 15-60). Cases of reoperation of the cartilage defect were classified as failures. Clinical outcome in non-failures was evaluated by the Lysholm score and grading of knee pain and function of the knee by the use of patient-administered visual analog scales (VAS; 0-100). Data were prospectively collected before the operation and at the 2- to 9-year follow-up. The single lesion or the largest of multiple lesions were located on the medial femoral condyle (n = 62), trochlea (n = 18), lateral tibia (n = 11), patella (n = 10) or lateral femoral condyle (n = 9). We treated one (n = 76), two (n = 27) or three (n = 7) lesions with a median total area of 4 cm(2) (range 1-15). A total of 24 failures (22%) were registered-18% in the single-defect subgroup and 29% in the multiple-defects subgroup. In the remaining group of patients (n = 86), the mean Lysholm score, mean pain-score (0 = no pain; 100 = worst possible pain) and mean function-score (0 = useless; 100 = full function) improved from 51, 52 and 41, respectively, to 71 (P < 0.001), 30 (P < 0.001) and 69 (P < 0.001) at the follow-up. The pain-score was significant lower (P = 0.042), and the function-score significantly higher (P = 0.001) in the group of patients with a single lesion compared to the group with 2 or 3 lesions. The Lysholm score did not differ significantly between the two subgroups (P = 0.06).

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2003

Results: Traumatic etiology of the lesion was found to be associated with postero-medial talar le... more Results: Traumatic etiology of the lesion was found to be associated with postero-medial talar lesions (p Ͻ 0.012). Significant clinical and radiographic improvements were found comparing pre and post operative CT scoring (p Ͻ 0.005), plain radiographs (p Ͻ 0.01) and clinical score (p Ͻ 0.003). No correlation was found between the XR, CT findings and arthroscopic grading. Clinical improvement was found to correlate directly with CT grade (P Ͻ 0.05). Fixation technique with Biofix was found to be associated with post operative subchondral cyst formation detected on plain radiographs and on CT (P Ͻ 0.0001). Tibial and talar "kissing lesions" correlated with poor preoperative clinical score (P Ͻ 0.05) Lesions with sclerosis and or cyst on XR or CT before operation appears to carry less clinical improvement with surgery (P Ͻ 0.05). Conclusions: Ankle X-ray and CT play a limited role in planning the intraoperative procedure. Findings like sclerosis and subchondral cysts carries a less favorable prognosis, a finding which is not reflected in the current classifications. Arthroscopy is a valuable tool for evaluation and treatment of talar osteochondral lesions. The operative technique should be selected according to arthroscopic findings-the surgeon should be prepared to tailor the different types of treatment to each lesion.

Reasonably good results have been reported in short- and medium-term followups after primary sutu... more Reasonably good results have been reported in short- and medium-term followups after primary suture of ACL tears. Deteriorating knee function with recurrence of instability, however, has been reported after 5 years in a few lofiger-term studies.

Knee Surgery, Sports Traumatology, Arthroscopy, Nov 23, 2014

symptoms. The Lysholm score, function VAS and pain VAS all significantly improved from the baseli... more symptoms. The Lysholm score, function VAS and pain VAS all significantly improved from the baseline values to the mean scores of 65 (SD 24), 65 (SD 24) and 31 (SD 24), respectively, at the long-term evaluation. The long-term scores did not differ significantly from the midterm scores. Conclusions The outcome scores improved significantly from baseline to the long-term evaluation and were not different from the midterm outcome. Still, a normal knee function was generally not achieved, and many patients had further surgery. The results call for more research and, at present, caution in recommending microfracture in articular cartilage defects, especially in subgroups with worse prognosis. Level of evidence Case series, Level IV.

Knee Surgery, Sports Traumatology, Arthroscopy, Dec 8, 2012

American Journal of Sports Medicine, Dec 1, 2019

Background: Rupture of the anterior cruciate ligament (ACL) is a common and feared injury among a... more Background: Rupture of the anterior cruciate ligament (ACL) is a common and feared injury among athletes because of its potential effect on further sports participation. Reported rates of return to pivoting sports after ACL reconstruction (ACLR) vary in the literature, and the long-term consequences of returning have rarely been studied. Purpose: To examine the rate and level of return to pivoting sports after ACLR, the duration of sports participation, and long-term consequences of returning to pivoting sports.

Orthopaedic Journal of Sports Medicine, Oct 1, 2020

Background: Failed anterior cruciate ligament (ACL) reconstruction (ACLR) can lead to reduced qua... more Background: Failed anterior cruciate ligament (ACL) reconstruction (ACLR) can lead to reduced quality of life because of recurrent episodes of instability, restrictions in level of activity, and development of osteoarthritis. A profound knowledge of the causes of a failed surgery can ultimately help improve graft survival rates. Purpose: To investigate the patient-related risks of inferior outcomes leading to revision surgery after ACLR.

Knee Surgery, Sports Traumatology, Arthroscopy, Jul 4, 2013

To examine the relationship between the radiographically assessed placement of the tibial tunnel ... more To examine the relationship between the radiographically assessed placement of the tibial tunnel and the long-term clinical and subjective outcome in anterior cruciate ligament-reconstructed patients. Patients were examined clinically, with subjective score systems and with standardised radiographs 10-12 years postoperatively. Only patients reconstructed with the aid of the 70-degree tibial drill guide were included. A posterior placement of the tibial tunnel was defined as >50% along the Amis and Jakob line (AJL). A high tunnel inclination was defined as >75° in the coronal plane. The possible linear relationships between clinical findings, subjective scores and tibial tunnel placement were investigated. Eighty-six percentage of the 96 patients were available for examination. Mean tibial tunnel inclination was 71.1° (SD 4.2). No difference was found in subjective scores and knee stability between high (14%) and low (86%) inclination groups. Mean placement of the tibial tunnel along the AJL was 46% (SD 5). Patients with a posterior tibial tunnel placement (24%) had a higher incidence of rotational instability (P = 0.02). Patients with rotational instability (grade 2 pivot shift) had significant lower Lysholm score than those with grade 0 and 1 rotational instability (P = 0.001). The use of a tibial drill guide that relates to the femoral roof leads to a posterior tibial tunnel placement (>50% of the tibial AP-diameter) in 24% of the patients. These patients have a significant higher proportion of rotational instability and worse subjective outcome. Case series, Level IV.

Knee Surgery, Sports Traumatology, Arthroscopy, Nov 18, 2015

Long-term results after reconstruction of the ACL with hamstrings autograft and transtibial femor... more Long-term results after reconstruction of the ACL with hamstrings autograft and transtibial femoral drilling Paper II: Effect of a too posterior placement of the tibial tunnel on clinical outcome 10-12 years after anterior cruciate ligament reconstruction using the 70-degree tibial guide Paper III: The effect of feedback from postoperative 3D-CT on placement of femoral tunnels in single-bundle anatomic ACL reconstruction Paper IV: The effect of intraoperative fluoroscopy on the accuracy of femoral tunnel placement in single-bundle anatomic ACL reconstruction Discussion Methodological considerations Study design Outcome evaluation Results Long-term results after ACL reconstruction Tibial tunnel placement related to clinical outcome Learning curve of the AM portal technique

International Journal of Sports Medicine, 1995

Knee Surgery, Sports Traumatology, Arthroscopy, Oct 2, 2014

variation of femoral tunnel localizations when initially only using intra-articular landmarks as ... more variation of femoral tunnel localizations when initially only using intra-articular landmarks as guidance for tunnel placement-this variation, however, converged towards the anatomical centre throughout the feedback period and the AM2 group had a femoral tunnel closer (P = 0.001) to the anatomical centre than the AM1 group. Conclusions Post-operative 3D CT is effective in the learning process of placing femoral tunnels anatomically by giving post-operative feedback on tunnel placement. Bony landmarks and ACL remnants were found unreliable as the only guidance for femoral tunnel placement in the AM-portal technique-therefore, the use of an aid is recommended to reduce unwanted tunnel variations in a learning phase. Level of evidence Cohort Study, Level III. Keywords ACL • Anterior cruciate ligament reconstruction • Anteromedial portal • 3D CT technique aims to restore as closely as possible the native biomechanical properties of the ACL and has been shown to give superior stability and a good clinical outcome [16, 24, 32, 38]. The femoral footprint of the human native ACL has been the subject of thorough investigation, and recent anatomical Abstract Purpose To evaluate the effect of feedback from postoperative 3D CT in the learning process of placing the femoral graft tunnel anatomically using the anteromedial (AM)-portal technique in single-bundle anterior cruciate ligament (ACL) reconstruction. Methods An experienced knee surgeon converting from transtibial to AM-portal technique was offered post-operative feedback on tunnel placement. Three groups of patients were included: transtibial drilling, (AM1) anteromedial drilling without feedback and (AM2) anteromedial drilling with post-operative CT feedback. Intra-articular landmarks were used as the only guidance for tunnel placement. Tunnel position was compared to an ideal anatomical ACL position using the Bernard and Hertel grid and visual feedback was given on tunnel placements. The effect of feedback was measured as the distance from the anatomical centre, and spread of tunnel placements on post-operative CT performed feedback was initiated. Results When comparing the femoral tunnel placement to an ideal anatomical centre, there was an improvement in the mean tunnel position after (A) changing from a transtibial to an anatomical technique and a further improvement after (B) initializing the radiological feedback. There was a great

American Journal of Sports Medicine, Jul 12, 2021

Deciding when to return to sport following an ACL injury can be extremely challenging. Athletes m... more Deciding when to return to sport following an ACL injury can be extremely challenging. Athletes must contend not only with the physical consequences, but also with the psychological ones. While readiness tests take various factors into account, it's unclear how these factors might be linked. In a study published in _The American Journal of Sports Medicine_, researchers from Norway report on the association they found between psychological readiness to return to sport and tibial displacement. The study enrolled 132 patients aged 16 or older nine to twelve months after ACL reconstruction surgery. At baseline, patients completed a project-speci c activity questionnaire and the ACL-Return to Sport After Injury scale evaluation. Knee laxity was assessed using the Lachman test, a KT-1000 arthrometer, and the pivot-shift test. Patients were followed-up two years after surgery. Data revealed small but signi cant negative associations between measurements of anterior tibial displacement and psychological readiness to return to sport: patients showing greater displacement on the Lachman test and in KT-1000 arthrometer measurements reported lower psychological readiness. No signi cant associations were observed between laxity determined by the pivot-shift test and psychological readiness. And there were no differences in ACL-RSI scores between patients with stable knees and those with slightly increased or residual laxity. Thirty-six percent of patients returned to their preinjury level of sport two years after surgery. Factors that predicted this return included higher age, higher psychological readiness, and less anterior tibial displacement. Although the association between psychological readiness and knee laxity was low, the results offer support for incorporating psychological readiness and clinical ndings into return-to-sport assessments following ACL reconstruction.

Knee Surgery, Sports Traumatology, Arthroscopy, Oct 29, 2009

We compared the results of microfracture in single versus multiple symptomatic articular cartilag... more We compared the results of microfracture in single versus multiple symptomatic articular cartilage defects in the knee in 110 patients with a median age of 38 years (range 15-60). Cases of reoperation of the cartilage defect were classified as failures. Clinical outcome in non-failures was evaluated by the Lysholm score and grading of knee pain and function of the knee by the use of patient-administered visual analog scales (VAS; 0-100). Data were prospectively collected before the operation and at the 2- to 9-year follow-up. The single lesion or the largest of multiple lesions were located on the medial femoral condyle (n = 62), trochlea (n = 18), lateral tibia (n = 11), patella (n = 10) or lateral femoral condyle (n = 9). We treated one (n = 76), two (n = 27) or three (n = 7) lesions with a median total area of 4 cm(2) (range 1-15). A total of 24 failures (22%) were registered-18% in the single-defect subgroup and 29% in the multiple-defects subgroup. In the remaining group of patients (n = 86), the mean Lysholm score, mean pain-score (0 = no pain; 100 = worst possible pain) and mean function-score (0 = useless; 100 = full function) improved from 51, 52 and 41, respectively, to 71 (P < 0.001), 30 (P < 0.001) and 69 (P < 0.001) at the follow-up. The pain-score was significant lower (P = 0.042), and the function-score significantly higher (P = 0.001) in the group of patients with a single lesion compared to the group with 2 or 3 lesions. The Lysholm score did not differ significantly between the two subgroups (P = 0.06).

Springer eBooks, 1986

Injuries to the posterior cruciate ligament (PCL) of the knee are relatively infrequent. Most aut... more Injuries to the posterior cruciate ligament (PCL) of the knee are relatively infrequent. Most authors recommend primary operative repair, but few larger series with documented results exist. lately the value of primary operative treatment has been questioned.

Background: The optimal treatment for cartilage lesions has not yet been established. The objecti... more Background: The optimal treatment for cartilage lesions has not yet been established. The objective of this randomized trial was to compare autologous chondrocyte implantation with microfracture. This paper represents an update, with presentation of the clinical results at five years. Methods: Eighty patients who had a single chronic symptomatic cartilage defect on the femoral condyle in a stable knee without general osteoarthritis were included in the study. Forty patients were treated with autologous chondrocyte implantation, and forty were treated with microfracture. We used the International Cartilage Repair Society, Lysholm, Short Form-36, and Tegner forms to collect clinical data, and radiographs were evaluated with use of the Kellgren and Lawrence grading system. Results: At two and five years, both groups had significant clinical improvement compared with the preoperative status. At the five-year follow-up interval, there were nine failures (23%) in both groups compared with two failures of the autologous chondrocyte implantation and one failure of the microfracture treatment at two years. Younger patients did better in both groups. We did not find a correlation between histological quality and clinical outcome. However, none of the patients with the best-quality cartilage (predominantly hyaline) at the two-year mark had a later failure. One-third of the patients in both groups had radiographic evidence of early osteoarthritis at five years. Conclusions: Both methods provided satisfactory results in 77% of the patients at five years. There was no significant difference in the clinical and radiographic results between the two treatment groups and no correlation between the histological findings and the clinical outcome. One-third of the patients had early radiographic signs of osteoarthritis five years after the surgery. Further long-term follow-up is needed to determine if one method is better than the other and to study the progression of osteoarthritis.

Journal of Bone and Joint Surgery, American Volume, Oct 1, 2007

Background.-The optimal treatment for cartilage lesions has not yet been established. The objecti... more Background.-The optimal treatment for cartilage lesions has not yet been established. The objective of this randomized trial was to compare autologous chondrocyte implantation with microfracture. This paper represents an update, with presentation of the clinical results at five years. Methods.-Eighty patients who had a single chronic symptomatic cartilage defect on the femoral condyle in a stable knee without general osteoarthritis were included in the study. Forty patients were treated with autologous chondrocyte implantation, and forty were treated with microfracture. We used the International Cartilage Repair Society, Lysholm, Short Form-36, and Tegner forms to collect clinical data, and radiographs were evaluated with use of the Kellgren and Lawrence grading system. Results.-At two and five years, both groups had significant clinical improvement compared with the preoperative status. At the five-year follow-up interval, there were nine failures (23%) in both groups compared with two failures of the autologous chondrocyte implantation and one failure of the microfracture treatment at two years. Younger patients did better in both groups. We did not find a correlation between histological quality and clinical outcome. However, none of the patients with the best-quality cartilage (predominantly hyaline) at the two-year mark had a later failure. One-third of the patients in both groups had radiographic evidence of early osteoarthritis at five years. Conclusions.-Both methods provided satisfactory results in 77% of the patients at five years. There was no significant difference in the clinical and radiographic results between the two treatment groups and no correlation between the histological findings and the clinical outcome. One-third of the patients had early radiographic signs of osteoarthritis five years after the surgery. Further long-term follow-up is needed to determine if one method is better than the other and to study the progression of osteoarthritis. Level of Evidence.-Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence. : For those involved with athletics or in sports medicine, optimum management of the patient with isolated knee lesions continue to be the source of debate and discussion. The effectiveness of microfracture has been demonstrated in the past, as has autologous chondrocyte implantation. Studies have

Clinical Journal of Sport Medicine, Jul 1, 1991

Treatment of ACL tears is controversial. Recent reports on nonoperative treatment have shown poor... more Treatment of ACL tears is controversial. Recent reports on nonoperative treatment have shown poor results. Results after primary repair have deteriorated with time, leading to augmentation procedures that seem to have improved the results. However, there have been few prospective, randomized studies in this field. Our goal was to compare primary repair with a bone-patellar tendon-bone augmentation method and with a new method using the Kennedy Ligament Augmentation Device. One hundred fifty patients aged 16 to 50, all of whom had acute ACL tears, were randomized with the closed envelope method to one of three groups treated with open surgical methods. Fifty patients were treated with primary repair, 50 patients with patellar tendon augmentation, and 50 patients were augmented with the Kennedy Ligament Augmentation Device. All patients were operated on within 10 days of injury. The rehabilitation protocol was identical, consisting of a long leg cast for 2 weeks, followed by a brace with no weight-bearing and limited motion for 6 weeks. The patients were followed prospectively by one surgeon (LE) using the Lysholm functional score, Tegner activity level score, clinical evaluation and KT-1000 arthrometer at 6 months, 1, and 2 years. Three patients were lost to followup. There was no age or activity level difference between the groups. Sport activities led to 85% of the injuries, with skiing, soccer, and European handball representing 80% of injuries. All three groups reduced their activity level the 1st year. The repair group remained at the same level after 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Medicine and Science in Sports and Exercise, May 1, 1993

Medicine & Science in Sports & Exercise, 1993

Knee Surgery, Sports Traumatology, Arthroscopy, 2009

We compared the results of microfracture in single versus multiple symptomatic articular cartilag... more We compared the results of microfracture in single versus multiple symptomatic articular cartilage defects in the knee in 110 patients with a median age of 38 years (range 15-60). Cases of reoperation of the cartilage defect were classified as failures. Clinical outcome in non-failures was evaluated by the Lysholm score and grading of knee pain and function of the knee by the use of patient-administered visual analog scales (VAS; 0-100). Data were prospectively collected before the operation and at the 2- to 9-year follow-up. The single lesion or the largest of multiple lesions were located on the medial femoral condyle (n = 62), trochlea (n = 18), lateral tibia (n = 11), patella (n = 10) or lateral femoral condyle (n = 9). We treated one (n = 76), two (n = 27) or three (n = 7) lesions with a median total area of 4 cm(2) (range 1-15). A total of 24 failures (22%) were registered-18% in the single-defect subgroup and 29% in the multiple-defects subgroup. In the remaining group of patients (n = 86), the mean Lysholm score, mean pain-score (0 = no pain; 100 = worst possible pain) and mean function-score (0 = useless; 100 = full function) improved from 51, 52 and 41, respectively, to 71 (P < 0.001), 30 (P < 0.001) and 69 (P < 0.001) at the follow-up. The pain-score was significant lower (P = 0.042), and the function-score significantly higher (P = 0.001) in the group of patients with a single lesion compared to the group with 2 or 3 lesions. The Lysholm score did not differ significantly between the two subgroups (P = 0.06).

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2003

Results: Traumatic etiology of the lesion was found to be associated with postero-medial talar le... more Results: Traumatic etiology of the lesion was found to be associated with postero-medial talar lesions (p Ͻ 0.012). Significant clinical and radiographic improvements were found comparing pre and post operative CT scoring (p Ͻ 0.005), plain radiographs (p Ͻ 0.01) and clinical score (p Ͻ 0.003). No correlation was found between the XR, CT findings and arthroscopic grading. Clinical improvement was found to correlate directly with CT grade (P Ͻ 0.05). Fixation technique with Biofix was found to be associated with post operative subchondral cyst formation detected on plain radiographs and on CT (P Ͻ 0.0001). Tibial and talar "kissing lesions" correlated with poor preoperative clinical score (P Ͻ 0.05) Lesions with sclerosis and or cyst on XR or CT before operation appears to carry less clinical improvement with surgery (P Ͻ 0.05). Conclusions: Ankle X-ray and CT play a limited role in planning the intraoperative procedure. Findings like sclerosis and subchondral cysts carries a less favorable prognosis, a finding which is not reflected in the current classifications. Arthroscopy is a valuable tool for evaluation and treatment of talar osteochondral lesions. The operative technique should be selected according to arthroscopic findings-the surgeon should be prepared to tailor the different types of treatment to each lesion.

Reasonably good results have been reported in short- and medium-term followups after primary sutu... more Reasonably good results have been reported in short- and medium-term followups after primary suture of ACL tears. Deteriorating knee function with recurrence of instability, however, has been reported after 5 years in a few lofiger-term studies.

Knee Surgery, Sports Traumatology, Arthroscopy, Nov 23, 2014

symptoms. The Lysholm score, function VAS and pain VAS all significantly improved from the baseli... more symptoms. The Lysholm score, function VAS and pain VAS all significantly improved from the baseline values to the mean scores of 65 (SD 24), 65 (SD 24) and 31 (SD 24), respectively, at the long-term evaluation. The long-term scores did not differ significantly from the midterm scores. Conclusions The outcome scores improved significantly from baseline to the long-term evaluation and were not different from the midterm outcome. Still, a normal knee function was generally not achieved, and many patients had further surgery. The results call for more research and, at present, caution in recommending microfracture in articular cartilage defects, especially in subgroups with worse prognosis. Level of evidence Case series, Level IV.

Knee Surgery, Sports Traumatology, Arthroscopy, Dec 8, 2012

American Journal of Sports Medicine, Dec 1, 2019

Background: Rupture of the anterior cruciate ligament (ACL) is a common and feared injury among a... more Background: Rupture of the anterior cruciate ligament (ACL) is a common and feared injury among athletes because of its potential effect on further sports participation. Reported rates of return to pivoting sports after ACL reconstruction (ACLR) vary in the literature, and the long-term consequences of returning have rarely been studied. Purpose: To examine the rate and level of return to pivoting sports after ACLR, the duration of sports participation, and long-term consequences of returning to pivoting sports.

Orthopaedic Journal of Sports Medicine, Oct 1, 2020

Background: Failed anterior cruciate ligament (ACL) reconstruction (ACLR) can lead to reduced qua... more Background: Failed anterior cruciate ligament (ACL) reconstruction (ACLR) can lead to reduced quality of life because of recurrent episodes of instability, restrictions in level of activity, and development of osteoarthritis. A profound knowledge of the causes of a failed surgery can ultimately help improve graft survival rates. Purpose: To investigate the patient-related risks of inferior outcomes leading to revision surgery after ACLR.

Knee Surgery, Sports Traumatology, Arthroscopy, Jul 4, 2013

To examine the relationship between the radiographically assessed placement of the tibial tunnel ... more To examine the relationship between the radiographically assessed placement of the tibial tunnel and the long-term clinical and subjective outcome in anterior cruciate ligament-reconstructed patients. Patients were examined clinically, with subjective score systems and with standardised radiographs 10-12 years postoperatively. Only patients reconstructed with the aid of the 70-degree tibial drill guide were included. A posterior placement of the tibial tunnel was defined as >50% along the Amis and Jakob line (AJL). A high tunnel inclination was defined as >75° in the coronal plane. The possible linear relationships between clinical findings, subjective scores and tibial tunnel placement were investigated. Eighty-six percentage of the 96 patients were available for examination. Mean tibial tunnel inclination was 71.1° (SD 4.2). No difference was found in subjective scores and knee stability between high (14%) and low (86%) inclination groups. Mean placement of the tibial tunnel along the AJL was 46% (SD 5). Patients with a posterior tibial tunnel placement (24%) had a higher incidence of rotational instability (P = 0.02). Patients with rotational instability (grade 2 pivot shift) had significant lower Lysholm score than those with grade 0 and 1 rotational instability (P = 0.001). The use of a tibial drill guide that relates to the femoral roof leads to a posterior tibial tunnel placement (>50% of the tibial AP-diameter) in 24% of the patients. These patients have a significant higher proportion of rotational instability and worse subjective outcome. Case series, Level IV.

Knee Surgery, Sports Traumatology, Arthroscopy, Nov 18, 2015

Long-term results after reconstruction of the ACL with hamstrings autograft and transtibial femor... more Long-term results after reconstruction of the ACL with hamstrings autograft and transtibial femoral drilling Paper II: Effect of a too posterior placement of the tibial tunnel on clinical outcome 10-12 years after anterior cruciate ligament reconstruction using the 70-degree tibial guide Paper III: The effect of feedback from postoperative 3D-CT on placement of femoral tunnels in single-bundle anatomic ACL reconstruction Paper IV: The effect of intraoperative fluoroscopy on the accuracy of femoral tunnel placement in single-bundle anatomic ACL reconstruction Discussion Methodological considerations Study design Outcome evaluation Results Long-term results after ACL reconstruction Tibial tunnel placement related to clinical outcome Learning curve of the AM portal technique

International Journal of Sports Medicine, 1995

Knee Surgery, Sports Traumatology, Arthroscopy, Oct 2, 2014

variation of femoral tunnel localizations when initially only using intra-articular landmarks as ... more variation of femoral tunnel localizations when initially only using intra-articular landmarks as guidance for tunnel placement-this variation, however, converged towards the anatomical centre throughout the feedback period and the AM2 group had a femoral tunnel closer (P = 0.001) to the anatomical centre than the AM1 group. Conclusions Post-operative 3D CT is effective in the learning process of placing femoral tunnels anatomically by giving post-operative feedback on tunnel placement. Bony landmarks and ACL remnants were found unreliable as the only guidance for femoral tunnel placement in the AM-portal technique-therefore, the use of an aid is recommended to reduce unwanted tunnel variations in a learning phase. Level of evidence Cohort Study, Level III. Keywords ACL • Anterior cruciate ligament reconstruction • Anteromedial portal • 3D CT technique aims to restore as closely as possible the native biomechanical properties of the ACL and has been shown to give superior stability and a good clinical outcome [16, 24, 32, 38]. The femoral footprint of the human native ACL has been the subject of thorough investigation, and recent anatomical Abstract Purpose To evaluate the effect of feedback from postoperative 3D CT in the learning process of placing the femoral graft tunnel anatomically using the anteromedial (AM)-portal technique in single-bundle anterior cruciate ligament (ACL) reconstruction. Methods An experienced knee surgeon converting from transtibial to AM-portal technique was offered post-operative feedback on tunnel placement. Three groups of patients were included: transtibial drilling, (AM1) anteromedial drilling without feedback and (AM2) anteromedial drilling with post-operative CT feedback. Intra-articular landmarks were used as the only guidance for tunnel placement. Tunnel position was compared to an ideal anatomical ACL position using the Bernard and Hertel grid and visual feedback was given on tunnel placements. The effect of feedback was measured as the distance from the anatomical centre, and spread of tunnel placements on post-operative CT performed feedback was initiated. Results When comparing the femoral tunnel placement to an ideal anatomical centre, there was an improvement in the mean tunnel position after (A) changing from a transtibial to an anatomical technique and a further improvement after (B) initializing the radiological feedback. There was a great