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  • 1.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. La Trobe Univ, Australia.
    Ekas, Guri
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway.
    Grindem, Hege
    Norwegian Sch Sport Sci, Norway.
    Moksnes, Havard
    Norwegian Sch Sport Sci, Norway.
    Anderson, Allen
    Not Found:[Ardern, Clare L.] Linkoping Univ, Div Physiotherapy, Linkoping, Sweden; [Ardern, Clare L.] La Trobe Univ, Sch Allied Hlth, Melbourne, Vic, Australia; [Ekas, Guri; Engebretsen, Lars] Oslo Univ Hosp, Div Orthopaed Surg, Oslo, Norway; [Ekas, Guri; Moksnes, Havard; Engebretsen, Lars] Norwegian Sch Sport Sci, Oslo Sports Trauma Res Ctr OSTRC, Oslo, Norway; [Ekas, Guri; Engebretsen, Lars] Univ Oslo, Inst Clin Med, Oslo, Norway; [Grindem, Hege] Norwegian Sch Sport Sci, Dept Sports Med, Oslo, Norway; [Chotel, Franck] Hop Femme Mere Enfant, Dept Pediat Orthopaed Surg, Lyon, France; [Cohen, Moises] Univ Fed Sao Paulo, Dept Orthoped, Sao Paulo, Brazil; [Forssblad, Magnus] Karolinska Inst, Stockholm Sports Trauma Res Ctr, Stockholm, Sweden; [Ganley, Theodore J.] Childrens Hosp Philadelphia, Dept Orthopaed, Philadelphia, PA 19104 USA; [Feller, Julian A.] Epworth Healthcare, OrthoSport Victoria Res Unit, Melbourne, Vic, Australia; [Feller, Julian A.] La Trobe Univ, Coll Sci Hlth and Engn, Melbourne, Vic, Australia; [Karlsson, Jon] Univ Gothenburg, Sahlgrenska Acad, Dept Orthopaed, Gothenburg, Sweden; [Kocher, Mininder S.; Micheli, Lyle] Boston Childrens Hosp, Div Sports Med, Boston, MA USA; [Kocher, Mininder S.; Micheli, Lyle] Harvard Med Sch, Boston, MA USA; [LaPrade, Robert F.] Steadman Philippon Res Inst, Vail, CO USA; [LaPrade, Robert F.] Steadman Clin, Vail, CO USA; [McNamee, Mike] Swansea Univ, Coll Engn, Swansea, W Glam, Wales; [Mandelbaum, Bert] Santa Monica Orthopaed and Sports Med Grp, Los Angeles, CA USA; [Micheli, Lyle] Micheli Ctr Sports Injury Prevent, Waltham, MA USA; [Mohtadi, Nicholas] Univ Calgary, Ctr Sports Med, Calgary, AB, Canada; [Reider, Bruce] Univ Chicago, Dept Orthopaed and Rehabil Med, Chicago, IL 60637 USA; [Roe, Justin] North Sydney Orthopaed and Sports Med Ctr, Sydney, NSW, Australia; [Seil, Romain] Ctr Hosp Luxembourg, Dept Orthopaed Surg, Luxembourg, Luxembourg; [Seil, Romain] Luxembourg Inst Hlth, Sports Med Res Lab, Luxembourg, Luxembourg; [Siebold, Rainer] Ruprecht Karls Univ Heidelberg, Inst Anat and Cell Biol, Heidelberg, Germany; [Siebold, Rainer] HKF Int Ctr Hip Knee Foot Surg and Sportstraumatol, ATOS Klin, Heidelberg, Germany; [Silvers-Granelli, Holly J.] FIFA Med Ctr Excellence, Veloc Phys Therapy, Los Angeles, CA USA; [Soligard, Torbjorn; Engebretsen, Lars] Int Olymp Comm, Med and Sci Dept, Lausanne, Switzerland; [Soligard, Torbjorn] Univ Calgary, Fac Kinesiol, Sports Injury Prevent Ctr, Calgary, AB, Canada; [Witvrouw, Erik] Univ Ghent, Fac Med and Healthsci, Dept Rehabil Sci and Physiotherapy, Ghent, Belgium;.
    Chotel, Franck
    Hop Femme Mere Enfant, France.
    Cohen, Moises
    Univ Fed Sao Paulo, Brazil.
    Forssblad, Magnus
    Karolinska Inst, Sweden.
    Ganley, Theodore J.
    Childrens Hosp Philadelphia, PA 19104 USA.
    Feller, Julian A.
    Epworth Healthcare, Australia; La Trobe Univ, Australia.
    Karlsson, Jon
    Univ Gothenburg, Sweden.
    Kocher, Mininder S.
    Boston Childrens Hosp, MA USA; Harvard Med Sch, MA USA.
    LaPrade, Robert F.
    Steadman Philippon Res Inst, CO USA; Steadman Clin, CO USA.
    McNamee, Mike
    Swansea Univ, Wales.
    Mandelbaum, Bert
    Santa Monica Orthopaed and Sports Med Grp, CA USA.
    Micheli, Lyle
    Boston Childrens Hosp, MA USA; Harvard Med Sch, MA USA; Micheli Ctr Sports Injury Prevent, MA USA.
    Mohtadi, Nicholas
    Univ Calgary, Canada.
    Reider, Bruce
    Univ Chicago, IL 60637 USA.
    Roe, Justin
    North Sydney Orthopaed and Sports Med Ctr, Australia.
    Seil, Romain
    Ctr Hosp Luxembourg, Luxembourg; Luxembourg Inst Hlth, Luxembourg.
    Siebold, Rainer
    Ruprecht Karls Univ Heidelberg, Germany; HKF Int Ctr Hip Knee Foot Surg and Sportstraumatol, Germany.
    Silvers-Granelli, Holly J.
    FIFA Med Ctr Excellence, CA USA.
    Soligard, Torbjorn
    Int Olymp Comm, Switzerland; Univ Calgary, Canada.
    Witvrouw, Erik
    Univ Ghent, Belgium.
    Engebretsen, Lars
    Oslo Univ Hosp, Norway; Norwegian Sch Sport Sci, Norway; Univ Oslo, Norway; Int Olymp Comm, Switzerland.
    2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 4, p. 989-1010Article in journal (Refereed)
    Abstract [en]

    In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric anterior cruciate ligament (ACL) injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery and Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America, and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis, and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions.

  • 2.
    Arundale, Amelia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Football Research Group, Linköping University, Linköping, Sweden.
    Fältström, Anne
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.
    Jumping performance based on duration of rehabilitation in female football players after anterior cruciate ligament reconstruction2019In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, no 2, p. 556-563Article in journal (Refereed)
    Abstract [en]

    Purpose

    To determine if female football players who had longer durations of rehabilitation, measured in months, after anterior cruciate ligament reconstruction would have lower tuck jump scores (fewer technique flaws) and smaller asymmetries during drop vertical jump landing.

    Methods

    One-hundred-and-seventeen female football players, aged 16ᅵ25 years, after primary unilateral ACL reconstruction (median 16 months, range 6ᅵ39) were included. Athletes reported the duration of rehabilitation they performed after anterior cruciate ligament reconstruction. Athletes also performed the tuck jump and drop vertical jump tests. Outcome variables were: tuck jump score, frontal plane knee motion and probability of peak knee abduction moment during drop vertical jump landing.

    Results

    There was no difference in tuck jump score based on duration of rehabilitation (n.s.). No interaction (n.s.), difference between limbs (n.s.), or duration of rehabilitation (n.s.) was found for peak knee abduction moment during drop vertical jump landing. No interaction (n.s.) or difference between limbs (n.s.) was found for frontal plane knee motion, but there was a difference based on duration of rehabilitation (P?=?0.01). Athletes with >?9 months of rehabilitation had more frontal plane knee motion (medial knee displacement) than athletes with <?6 months (P?=?0.01) or 6ᅵ9 months (P?=?0.03).

    Conclusion

    As there was no difference in tuck jump score or peak knee abduction moment based on duration of rehabilitation, the results of this study press upon clinicians the importance of using objective measures to progress rehabilitation and clear athletes for return to sport, rather than time alone.

  • 3.
    Asker, Martin
    et al.
    Karolinska Inst, Sweden; Naprapathogskolan Scandinavian Coll Naprapath Man, Sweden.
    Holm, Lena W.
    Karolinska Inst, Sweden.
    Kallberg, Henrik
    Publ Hlth Agcy Sweden, Sweden.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Hassleholm Kristianstad Ystad Hosp, Sweden.
    Skillgate, Eva
    Karolinska Inst, Sweden; Naprapathogskolan Scandinavian Coll Naprapath Man, Sweden.
    Female adolescent elite handball players are more susceptible to shoulder problems than their male counterparts2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 7, p. 1892-1900Article in journal (Refereed)
    Abstract [en]

    Shoulder problems are frequent among senior elite handball players. The objective of this study was to assess the prevalence of shoulder problems among adolescent elite handball players and to investigate potential differences in gender, school grade, playing position and playing level. During the 2014 and 2015 pre-season periods, 471 players (age 15-18 years, 54% female) completed a comprehensive baseline questionnaire regarding history of any shoulder pain and shoulder problems experienced during the past season. The players were monitored weekly for one competition season (September-April) regarding shoulder problems and the amount of match and training. Generalised linear models with a binomial link function were used to calculate a prevalence ratio (PR) with 95% confidence interval (CI) to compare the subgroups of players. In total, 110 players (23%) reported having substantial shoulder problems (defined as moderate/severe reduction in training volume, or moderate/severe reduction in performance, or complete inability to participate) at some point during the follow-up season, of which almost half reported complete inability to participate. Of those players reporting substantial problems, 43% (95% CI 39-48) did so for at least 3 consecutive weeks during the season. The prevalence was significantly higher in female players (PR 1.46, 95% 1.04-2.06) and in backcourt players (PR 1.58, 95% CI 1.08-2.32), but no differences were found for school grade (PR 1.21 95% CI 0.88-1.67) or playing level (PR 1.09 95% CI 0.76-1.56). The prevalence of substantial shoulder problems in adolescent elite handball players is high, especially among females, and this warrants further studies on risk factors for shoulder injury and the development of prevention strategies in handball players already before the age of 15. These findings also highlight the importance of introducing a clinical monitoring programme on a routine basis and improving the medical support, taking gender-related aspects into consideration, at handball-profiled secondary schools. II.

  • 4.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A 94% return to elite level football after ACL surgery: a proof of possibilities with optimal caretaking or a sign of knee abuse? in KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY2011In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 19, no 1, p. 1-2Article in journal (Other academic)
  • 5.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Tornqvist, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Kristenson, Karolina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Bengtsson, Håkan
    Linköping University, Department of Electrical Engineering, Electronic Devices. Linköping University, The Institute of Technology.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Upper extremity injuries in male elite football players2013In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 21, no 7, p. 1626-1632Article in journal (Refereed)
    Abstract [en]

    To investigate the epidemiology of upper extremity injuries in male elite football players and to describe their characteristics, incidence and lay-off times. less thanbrgreater than less thanbrgreater thanBetween 2001 and 2011, 57 male European elite football teams (2,914 players and 6,215 player seasons) were followed prospectively. Time-loss injuries and exposure to training and matches were recorded on individual basis. less thanbrgreater than less thanbrgreater thanIn total, 11,750 injuries were recorded, 355 (3 %) of those affected the upper extremities giving an incidence of 0.23 injuries/1,000 h of football. The incidence in match play was almost 7 times higher than in training (0.83 vs. 0.12 injuries/1,000 h, rate ratio 6.7, 95 % confidence interval 5.5-8.3). As much as 32 % of traumatic match injuries occurred as a result of foul play situations. Goalkeepers had a significantly higher incidence of upper extremity injuries compared to outfield players (0.80 vs. 0.16 injuries/1,000 h, rate ratio 5.0, 95 % confidence interval 4.0-6.2). The average absence due to an upper extremity injury was 23 +/- A 34 days. less thanbrgreater than less thanbrgreater thanUpper extremity injuries are uncommon among male elite football players. Goalkeepers, however, are prone to upper extremity injury, with a five times higher incidence compared to outfield players. less thanbrgreater than less thanbrgreater thanII.

  • 6.
    Fältström, Anne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Department of Physiotherapy, Ryhov County Hospital, Jönköping, Sweden.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Forssblad, Magnus
    Carpio Artro Clinic AB, Sophiahemmet, Stockholm, Sweden.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Predictors for additional anterior cruciate ligament reconstruction: data from the Swedish national ACL register.2016In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, no 3, p. 885-894Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To identify predictors for additional anterior cruciate ligament (ACL) reconstruction.

    METHODS: Patients from the Swedish national ACL register who underwent ACL reconstruction between January 2005 and February 2013 (follow-up duration 6-104 months) were included. Cox regression analyses included the following independent variables regarding primary injury: age, sex, time between injury and primary ACL reconstruction, activity at primary injury, concomitant injuries, injury side, graft type, and pre-surgery KOOS and EQ-5D scores.

    RESULTS: Among ACL reconstruction procedures, 93 % involved hamstring tendon (HT) autografts. Graft type did not predict additional ACL reconstruction. Final regression models only included patients with HT autograft (n = 20,824). Of these, 702 had revision and 591 contralateral ACL reconstructions. The 5-year post-operative rates of revision and contralateral ACL reconstruction were 4.3 and 3.8 %, respectively. Significant predictors for additional ACL reconstruction were age (fourfold increased rate for <16-year-old patients vs. >35-year-old patients), time between injury and primary surgery (two to threefold increased rate for ACL reconstruction within 0-90 days vs. >365 days), and playing football at primary injury.

    CONCLUSION: This study identified younger age, having ACL reconstruction early after the primary injury, and incurring the primary injury while playing football as the main predictors for revision and contralateral ACL reconstruction. This suggests that the rate of additional ACL reconstruction is increased in a selected group of young patients aiming to return to strenuous sports after primary surgery and should be taken into consideration when discussing primary ACL reconstruction, return to sports, and during post-surgery rehabilitation. LEVEL OF EVIDENCE: II.

  • 7.
    Gao, J.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Immunolocalization of types I, II, and X collagen in the tibial insertion sites of the medial meniscus2000In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 8, no 1, p. 61-65Article in journal (Refereed)
    Abstract [en]

    The medial meniscus of the rabbit knee joint attaches to the tibial plateau via anterior and posterior insertions. Intact meniscal tibial insertions are essential for meniscal function. In the present study the distributions of types I, II, and X collagen in meniscal tibial insertions were investigated by indirect immunohistochemistry in a rabbit model. Four tissue zones were histologically identified in the anterior insertion site, including the ligamentous zone, uncalcified and calcified fibrocartilaginous zones and bone, the ligamentous zone was not observed in the posterior insertion site. Labeling for type I collagen was found to be strong in the ligament tissue and bone, and weak in the fibrocartilages which were also labeled for type II collagen. Tissues positive for different types of collagen overlapped and formed an irregular interface with various angles and depths, especially at the interface between the calcified fibrocartilage and bone. Positive labeling for type X collagen was identified only in the calcified fibrocartilage zone. The coexistence of types I and II collagen in the meniscal tibial insertions may indicate that this structural unit is subjected to both compressive and tensile loads. Type X collagen may play a role in maintaining the calcifying status of this tissue zone, so that its mechanical stiffness is kept between that of uncalcified fibrocartilage and hard bone. Restoration of the insertional structure including the distinct collagen distribution should be considered for a functional meniscal substitution.

  • 8.
    Gouttebarge, Vincent
    et al.
    ACES, Academic Medical Center, Amsterdam / Amsterdam Collaboration for Health and Safety in Sports / Dept. of Orthopaedic Surgery, Academic Medical Center, Amsterdam / World Players Union, Hoofddorp .
    Aoki, Haruhito
    St. Marianna University School of Medicine, Kawasaki, Japan.
    Ekstrand, Jan
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Verhagen, Evert A L M
    Amsterdam Collaboration for Health and Safety in Sports / Dept. of Public and Occupational Health, VU, University Medical Center, Amsterdam.
    Kerkhoffs, Gino M M J
    ACES, Academic Medical Center, Amsterdam / Amsterdam Collaboration for Health and Safety in Sports / Dept. of Orthopaedic Surgery, Academic Medical Center, Amsterdam .
    Are severe musculoskeletal injuries associated with symptoms of common mental disorders among male European professional footballers?2016In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, no 12, p. 3934-3942Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To explore the associations of severe musculoskeletal injuries (joint and muscles) and surgeries with symptoms of common mental disorders (distress, anxiety/depression, sleeping disturbance, adverse alcohol behaviour , smoking, adverse nutrition behaviour) among male European professional footballers.

    METHODS: Cross-sectional analyses were conducted on electronic questionnaires completed by professional footballers recruited from the national players' unions of Finland, France, Norway, Spain or Sweden. The number of severe (time loss of more than 28 days) musculoskeletal injuries (total, joint, muscle) and surgeries during a professional football career was examined through four questions, while symptoms of common mental disorders were evaluated through validated scales.

    RESULTS: A total of 540 professional footballers (mean age of 27 years; 54 % playing in the highest leagues) participated in the study. Sixty-eight per cent of the participants had already incurred one or more severe joint injuries and 60 % one or more severe muscle injuries. Prevalence of symptoms of common mental disorders ranged from 3 % for smoking to 37 % for anxiety/depression and 58 % for adverse nutrition behaviour. The number of severe musculoskeletal injuries during a football career was positively correlated with distress, anxiety and sleeping disturbance, while the number of surgeries was correlated with adverse alcohol behaviour and smoking. Professional footballers who had sustained one or more severe musculoskeletal injuries during their career were two to nearly four times more likely to report symptoms of common mental disorders than professional footballers who had not suffered from severe musculoskeletal injuries.

    CONCLUSION: It can be concluded that the number of severe musculoskeletal injuries and surgeries during a career is positively correlated and associated with symptoms of common mental disorders among male European professional footballers. This study emphasises the importance of applying a multidisciplinary approach to the clinical care and support of professional footballers, especially when a player faces lengthy periods without training and competition as a consequence of recurrent severe joint or muscle injuries.

    LEVEL OF EVIDENCE: III.

  • 9.
    Hägglund, Martin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Hassleholm Kristianstad Ystad Hosp, Dept Orthopaed, Hassleholm, Sweden.
    Risk factors for acute knee injury in female youth football.2016In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, no 3, p. 737-746Article in journal (Refereed)
    Abstract [en]

    Purpose: To prospectively evaluate risk factors for acute time-loss knee injury, in particular ACL injury, in female youth football players.andlt;br /andgt;Methods: Risk factors were studied in 4556 players aged 12-17 years from a randomised controlled trial during the 2009 season. Covariates were both intrinsic (body mass index, age, relative age effect, onset of menarche, previous acute knee injury or ACL injury, current knee complaints, and familial disposition of ACL injury) and extrinsic (no. of training sessions/week, no. of matches/week, match exposure ratio, match play with other teams, and artificial turf exposure). Hazard ratios (HRs) and 95 % confidence intervals (CIs) were calculated from individual variable and multiple Cox regression analyses.andlt;br /andgt;Results: Ninety-six acute knee injuries were recorded, 21 of them ACL injuries. Multiple Cox regression showed a fourfold higher ACL injury rate for players with familial disposition of ACL injury (HR 3.57; 95 % CI 1.48-8.62). Significant predictor variables for acute knee injury were age andgt;14 years (HR 1.97; 95 % CI 1.30-2.97), knee complaints at the start of the season (HR 1.98; 95 % CI 1.30-3.02), and familial disposition of ACL injury (HR 1.96; 95 % CI 1.22-3.16). No differences in injury rates were seen when playing on artificial turf compared with natural grass.andlt;br /andgt;Conclusion: Female youth football players with a familial disposition of ACL injury had an increased risk of ACL injury and acute knee injury. Older players and those with knee complaints at pre-season were more at risk of acute knee injury. Although the predictive values were low, these factors could be used in athlete screening to target preventive interventions.andlt;br /andgt;Level Of Evidence: II.

  • 10.
    Jorgensen, U.
    et al.
    Jørgensen, U., Department of Orthopedic Surgery, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark.
    Bak, K.
    Department of Orthopedic Surgery, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark.
    Ekstrand, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Scavenius, M.
    Department of Orthopedic Surgery, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark.
    Reconstruction of the anterior cruciate ligament with the iliotibial band autograft in patients with chronic knee instability2001In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 9, no 3, p. 137-145Article in journal (Refereed)
    Abstract [en]

    We performed combined internal and external anterior cruciate ligament (ACL) reconstruction with the iliotibial band autograft in 169 consecutive patients with chronic ACL insufficiency who were followed up for 24-61 months. Of these, 155 (91%) agreed to an additional independent observer follow-up after 24-92 months. Eight patients (5%) had sustained a rerupture/elongation of the graft and were operated on again, nine (6%) had sustained a tear of the contralateral ACL. Knee function and activity increased after the reconstruction. Lysholm scores improved from median 81 preoperatively to 99 at follow-up and Tegner scores from median 4 to 7. At follow-up 97 (71%) were active at the same level as prior to injury. In 17 of the 40 patients (12%) dropping to a lower activity level this was due to knee problems. The side-to-side difference in anterior-posterior knee laxity was more than 3 mm in 18 knees (13%) and more than 5 mm in 3 knees (2%). Including eight reruptures, this results in a "stability" failure rate of 8.8%. The overall IKCD rating showed normal knee function in 88 (73%) and nearly normal knee function in 30 (25%). Anterior knee pain was present in 14 (10%) of the patients at follow-up. Patients with isolated ACL injury had higher Lysholm scores and Tegner scores than patients with associated injuries. No clinical signs of varus knee development were seen. Of the 155 patients 94% would have the procedure repeated if necessary with the knowledge that they have today. The combined internal and external iliotibial band procedure can restore knee stability and function in the majority of chronic ACL-insufficient knees.

  • 11.
    Kerkhoffs, Gino M M J
    et al.
    University of Amsterdam, Netherlands .
    van Es, Nick
    University of Amsterdam, Netherlands .
    Wieldraaijer, Thijs
    University of Amsterdam, Netherlands .
    Sierevelt, Inger N.
    University of Amsterdam, Netherlands .
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Niek van Dijk, C
    University of Amsterdam, Netherlands .
    Diagnosis and prognosis of acute hamstring injuries in athletes2013In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 21, no 2, p. 500-509Article in journal (Refereed)
    Abstract [en]

    Identification of the most relevant diagnostic and prognostic factors of physical examination and imaging of hamstring injuries in (elite) athletes. less thanbrgreater than less thanbrgreater thanA literature search was conducted in MEDLINE and EMBASE for articles between 1950 and April 2011. A survey was distributed among the members of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy, which focused on physical examination, prognosis, imaging and laboratory tests of hamstring injuries in (elite) athletes. less thanbrgreater than less thanbrgreater thanMedical history, inspection and palpation of the muscle bellies and imaging are most valuable at the initial assessment according to the literature. Experts considered medical history, posture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing, referred pain tests and imaging to be most important in the initial assessment of hamstring injuries. Magnetic resonance imaging (MRI) is preferred over ultrasonography and should take place within 3 days post-trauma. Important prognostic factors are injury grade, length of the muscle tear on MR images, MRI-negative injuries and trauma mechanism. less thanbrgreater than less thanbrgreater thanPosture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing and referred pain tests within 2 days post-trauma were identified as the most relevant diagnostic factors. less thanbrgreater than less thanbrgreater thanLiterature review and expert opinion, Level V.

  • 12.
    Kilic, O.
    et al.
    Acad Med Ctr, Netherlands.
    Aoki, H.
    St Marianna Univ, Japan.
    Goedhart, E.
    Royal Netherlands Football Assoc KNVB, Netherlands.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Kerkhoffs, G. M. M. J.
    Acad Med Ctr, Netherlands; Vrije Univ Amsterdam Med Ctr, Netherlands.
    Kuijer, P. P. F. M.
    Acad Med Ctr, Netherlands.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Gouttebarge, V.
    Acad Med Ctr, Netherlands; Vrije Univ Amsterdam Med Ctr, Netherlands; World Players Union FIFPro, Netherlands; Univ Cape Town, South Africa.
    Severe musculoskeletal time-loss injuries and symptoms of common mental disorders in professional soccer: a longitudinal analysis of 12-month follow-up data2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 3, p. 946-954Article in journal (Refereed)
    Abstract [en]

    Psychological factors have shown to be predictors of injury in professional football. However, it seems that this is a two-way relationship, as severe musculoskeletal time-loss injuries have shown to be associated with the onset of symptoms of common mental disorders (CMD). There is no longitudinal study performed exploring this interaction between symptoms of CMD and injuries. The purpose of this study was to explore the interaction between severe musculoskeletal time-loss injuries and symptoms of CMD in professional football players over a 12-month period. Players were recruited by their national players unions in five European countries. Symptoms of CMD included in the study were related to distress, anxiety/depression, sleep disturbance and adverse alcohol use. A total of 384 professional football players were enrolled in the study, of whom 262 (68%) completed the 12-month follow-up period. The mean age of the participants at baseline was 27 +/- 5 years, and they had played professional football for 8 +/- 5 years on average. Symptoms of CMD at baseline were not associated with the onset of severe musculoskeletal time-loss injuries during the follow-up period with relative risks (and 95% CI) ranging from 0.6 (0.3-1.0) to 1.0 (0.5-2.2). In contrast, severe musculoskeletal time-loss injuries reported at baseline were associated with the onset of symptoms of CMD during the follow-up period with relative risks ranging from 1.8 (0.8-3.7) to 6.9 (4.0-11.9). No relationship was found between symptoms of CMD and the onset of severe musculoskeletal time-loss injuries. However, professional football players who suffered from severe musculoskeletal time-loss injuries are likely to develop subsequent symptoms of CMD. This study emphasizes the need for an interdisciplinary medical approach, which not only focuses on the physical but also on the mental health of professional football players. An early identification of players at risk of symptoms of CMD, such as those suffering from severe musculoskeletal injuries, creates the opportunity for an interdisciplinary clinical medical team to treat the players timely and adequately. Prospective cohort study, Level II.

  • 13.
    Kvist, Joanna
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy.
    Sporrstedt, Katja
    Sjukgymnastik Linköpings universitet.
    Ek, Anna
    Sjukgymnastik Linköpings universitet.
    Good, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Fear of re-injury: A hindrance for returning to sports after anterior cruciate ligament reconstruction2005In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 13, no 5, p. 393-397Article in journal (Refereed)
    Abstract [en]

    Unrestricted participation in sports activities and return to the pre-injury level is often reported as an indicator of the success of ACL reconstruction. The athletes' choice not to return to their pre-injury level may depend on the knee function, but some times, social reasons or psychological hindrances such as fear of re-injury may influence their return to sports. The aim of this study was to investigate whether fear of re-injury due to movement is of significance for returning to previous level of activity in patients who have undergone anterior cruciate ligament reconstruction. The Tampa Scale of Kinesiophobia (TSK), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and some general questions were mailed to 87 patients who underwent ACL reconstruction 3-4 years before the study was conducted. Sixty-two patients (74%) answered the questionnaires (34 men and 28 women). Fifty-three percent of the patients returned to their pre-injury activity level. The patients who did not return to their pre-injury activity level had more fear of re-injury, which was reflected in the TSK. In addition, high fear of re-injury was correlated with low knee-related quality of life. Fear of re-injury must be considered in the rehabilitation and evaluation of the effects of an ACL reconstruction. © Springer-Verlag 2005.

  • 14.
    Lindblom, Hanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Department of Orthopaedics, Hässleholm-Kristianstad Hospitals.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Limited positive effects on jump-landing technique in girls but not in boys after 8 weeks of injury prevention exercise training in youth football2019In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate changes in jump-landing technique in football-playing boys and girls after 8 weeks of injury prevention training.

    METHODS: Four boys' and four girls' teams (mean age 14.1 ± 0.8 years) were instructed to use either the original Knee Control injury prevention exercise programme (IPEP) or a further developed IPEP, Knee Control + , at every training session for 8 weeks. Baseline and follow-up testing of jump-landing technique included drop vertical jumps (DVJ), assessed subjectively and with two-dimensional movement analysis, and tuck jump assessment (TJA).

    RESULTS: Only minor differences in intervention effects were seen between the two IPEPs, and results are therefore presented for both intervention groups combined. At baseline 30% of the boys showed good knee control during the DVJ, normalised knee separation distances of 77-96% (versus hip) and a median of 3 flaws during the TJA. Among girls, 22% showed good knee control, normalised knee separation distances of 67-86% and a median of 4 flaws during the TJA. At follow-up, boys and girls performed significantly more jumps during TJA. No changes in jump-landing technique were seen in boys, whereas girls improved their knee flexion angle at initial contact in the DVJ (mean change + 4.7°, p < 0.001, 95% CI 2.36-6.99, d = 0.7) and their TJA total score (- 1 point, p = 0.045, r = - 0.4).

    CONCLUSION: The study showed small positive effects on jump-landing technique in girls, but not in boys, after 8 weeks of injury prevention training.

    LEVEL OF EVIDENCE: Level II.

    TRIAL REGISTRATION: Clinical Trials gov identifier: NCT03251404.

  • 15.
    Lindblom, Hanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy.
    No effect on performance tests from a neuromuscular warm-up programme in youth female football: a randomised controlled trial2012In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 20, no 10, p. 2116-2123Article in journal (Refereed)
    Abstract [en]

    The objective of the present randomised controlled trial was to study the effect of a neuromuscular warm-up programme on performance tests in youth female football. less thanbrgreater than less thanbrgreater thanFour youth female football teams with players aged 12-16 years were randomised into an intervention group and control group. The intervention was a 15-min neuromuscular warm-up programme carried out twice a week during the 11-week study period. Baseline and follow-up measurements of performance were made indoors and included the star excursion balance test, a countermovement jump test, a triple-hop for distance test, a modified Illinois agility test, and 10- and 20-m sprint tests. less thanbrgreater than less thanbrgreater thanFifty-two players (intervention 28; control 24) took part in baseline measurements, and after dropout, 41 players (intervention 23; control 18) were included for analysis. Minor positive changes were seen in the control group compared to the intervention group for a sub-score of the star excursion balance test (P andlt; 0.05) and in the modified Illinois agility test (P andlt; 0.05). No improvement was seen in the intervention group from baseline to follow-up. less thanbrgreater than less thanbrgreater thanThe study showed that a neuromuscular warm-up programme carried out during 11 weeks did not improve performance in youth female football. This could indicate that the programme does not contain sufficient stimulus to improve performance. A low player attendance at training sessions, and low specificity between exercises in the warm-up programme and the evaluated performance tests may also contribute to the lack of effect. less thanbrgreater than less thanbrgreater thanI.

  • 16.
    Lundblad, Matilda
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Gothenburg Univ, Sweden.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Thomee, Christoffer
    Linköping University, Faculty of Medicine and Health Sciences.
    Hamrin Senorski, Eric
    Univ Gothenburg, Sweden.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Karlsson, Jon
    Linköping University, Faculty of Medicine and Health Sciences. Gothenburg Univ, Sweden.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Medial collateral ligament injuries of the knee in male professional football players: a prospective three-season study of 130 cases from the UEFA Elite Club Injury Study2019In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, no 11, p. 3692-3698Article in journal (Refereed)
    Abstract [en]

    Purpose Medial collateral ligament (MCL) injury is the single most common traumatic knee injury in football. The purpose of this study was to study the epidemiology and mechanisms of MCL injury in mens professional football and to evaluate the diagnostic and treatment methods used. Methods Fifty-one teams were followed prospectively between one and three full seasons (2013/2014-2015/2016). Individual player exposure and time-loss injuries were recorded by the teams medical staffs. Moreover, details on clinical grading, imaging findings and specific treatments were recorded for all injuries with MCL injury of the knee as the main diagnosis. Agreement between magnetic resonance imaging (MRI) and clinical grading (grades I-III) was described by weighted kappa. Results One hundred and thirty of 4364 registered injuries (3%) were MCL injuries. Most MCL injuries (98 injuries, 75%) occurred with a contact mechanism, where the two most common playing situations were being tackled (38 injuries, 29%) and tackling (15 injuries, 12%). MRI was used in 88 (68%) of the injuries, while 33 (25%) were diagnosed by clinical examination alone. In the 88 cases in which both MRI and clinical examination were used to evaluate the grading of MCL injury, 80 (92% agreement) were equally evaluated with a weighted kappa of 0.87 (95% CI 0.77-0.96). Using a stabilising knee brace in players who sustained a grade II MCL injury was associated with a longer lay-off period compared with players who did not use a brace (41.5 (SD 13.2) vs. 31.5 (SD 20.3) days, p = 0.010). Conclusion Three-quarter of the MCL injuries occurred with a contact mechanism. The clinical grading of MCL injuries showed almost perfect agreement with MRI grading, in cases where the MCL injury is the primary diagnosis. Not all grade II MCL injuries were treated with a brace and may thus indicate that routine bracing should not be necessary in milder cases.

  • 17.
    Perera, Nirmala
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Åkerlund, Ida
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Motivation for sports participation, injury prevention expectations, injury risk perceptions and health problems in youth floorball players2019In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, no 11, p. 3722-3732Article in journal (Refereed)
    Abstract [en]

    Purpose Describe the motivation for floorball participation, injury prevention expectations, injury risk perceptions and prevalence of health problems in youth floorball players at the start of the season. Methods This cross-sectional survey is part of a larger Sport Without Injury ProgrammE (SWIPE) project and provides baseline data before a cluster randomised controlled trial of an injury prevention program (Knee Control). A baseline survey (online and paper based) was collected from 47 teams with 471 youth floorball players from two provinces of Sweden before the start of the 2017 season. Results The mean age for 140 females and 331 males was 13.7 (+/- 1.5) and 13.3 (+/- 1.0) years, respectively. The two most significant motivators for floorball participation were being part of the team (82% females, 75% males) and friends (65% females, 70% males). Fractures (84% females, 90% males), eye injuries (90% females, 83% males) and concussion (82% females, 83% males) were perceived as the most severe injuries. 93% of players believed that sports injuries can be prevented, while 74% believed it is unlikely that they will sustain an injury. Existing health problems at the beginning of the season were prevalent in 33% of players, with 65% being injuries and 35% illnesses. 17% of existing injuries at the start of the season caused time-loss from play and 17% required medical attention. Conclusion Social aspects were the greatest motivators for floorball participation in youths, suggesting that these factors are important to retain sports participants. The high number of health problems in youth is a concern; as such more effort, resources and priority should be given to sports safety programs. Many players believed that sports injuries can be prevented, possibly providing a fertile ground for implementation of such programs.

  • 18.
    Rockborn, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Sports Medicine . Linköping University, Faculty of Health Sciences.
    Messner, Karola
    Linköping University, Department of Medical and Health Sciences, Sports Medicine . Linköping University, Faculty of Health Sciences.
    Long-term results of meniscus repair and meniscectomy: A 13-year functional and radiographic follow-up study2000In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 8, no 1, p. 2-9Article in journal (Refereed)
    Abstract [en]

    This study investigated the long-term outcome of common meniscus treatment (meniscectomy, repair). A consecutive series of 30 patients with open meniscus repair were compared retrospectively to 30 patients who had an arthroscopic partial or subtotal meniscectomy. The groups were matched according to sex, age, meniscus lesion, and follow-up time. The patients were aged 13-43 years at the time of operation, all had intact cruciate ligaments, and none had had previous surgery on the knee. Patients were reexamined at a mean of 13 years after the operation. In addition, for a subgroup of 22 matched pairs, data were available from a 7-year follow-up. Four of the repaired menisci did not heal, and another three reruptured during the 13-year follow-up, these menisci were all excised (23%). Meniscal remnant surgery was needed in 6 cases (20%) after initial meniscectomy. At the 13-year follow-up there was no difference between the groups in knee function, subjective complaints, or manual findings. Almost 90% of the patients in both groups had no knee problems during daily activities. At the late follow-up radiographic signs for bone spurs, sclerosis, or flattening of the femoral condyle were found in around half of the cases in each group. Three patients (10%) with initial repair and 8 (27%) with meniscectomy had minor joint space reduction, but no patient had more severe radiographic changes. After 7 years (subgroup) joint space reduction was more common after initial meniscectomy than after repair (P < 0.05). After 13 years the incidence and severity of arthrosis did not differ significantly between the two groups, even when only the successful repairs were compared to meniscectomy (P = 0.06).

  • 19.
    Sandon, Alexander
    et al.
    Karolinska Inst, Sweden; Vastmanland Reg Hosp, Sweden.
    Forssblad, Magnus
    Karolinska Inst, Sweden.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Hassleholm Hosp, Sweden.
    Should "garbage in-garbage out" be replaced by "little in-little out"? Questionnaire response rates need to be improved in surgical quality registries!2019In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, no 8, p. 2387-2388Article in journal (Other academic)
    Abstract [en]

    n/a

  • 20.
    Schepull, Thorsten
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Healing of human Achilles tendon ruptures: Radiodensity reflects mechanical properties2015In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 23, no 3, p. 884-889Article in journal (Refereed)
    Abstract [en]

    Purpose

    This study tests the idea of using radiodensity from computed tomography to quantitatively evaluate the healing of ruptured Achilles tendons.

    Methods

    The radiodensity of the healing tendons in sixty-five patients who were treated for Achilles tendon rupture was measured. The hypothesis was that density would correlate with an estimate for e-modulus, derived from strain, measured by radiostereometry with different mechanical loadings.

    Results

    Radiodensity 7 weeks after injury was decreased to 67 % (SD 11) of the contralateral, uninjured tendon. There was no improvement in radiodensity from 7 to 19 weeks, whereas at 1 year, it had increased to 106 % (SD 7). Only 2 of 52 measured values at 1 year were lower than the highest value at 19 weeks, i.e. there was minimal overlap. The variation in radiodensity could explain 80 % of the variation in e-modulus, but radiodensity correlated only weakly with e-modulus at each time point separately. At 1 year, both radiodensity and e-modulus correlated with functional results, although weakly.

    Conclusions

    From 19 weeks onwards, radiodensity appears to reflect mechanical properties of the tendon and might to some extent predict the final outcome. Radiodensity at 7 weeks is difficult to interpret, probably because it reflects both callus and damaged tissues.

    Level of evidence

    Prospective, diagnostic study, Level II.

  • 21.
    Seil, Romain
    et al.
    Ctr Hosp Luxembourg Clin Eich, Luxembourg; Luxembourg Inst Hlth, Luxembourg.
    Laver, Lior
    Univ Hosp Coventry and Warwickshire, England.
    Landreau, Philippe
    Aspetar, Qatar.
    Myklebust, Grethe
    Norwegian Sch Sports Sci, Norway.
    Waldén, Markus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Hassleholm Kristianstad Ystad Hosp, Sweden.
    ESSKA helps making a change: the example of handball medicine2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 7, p. 1881-1883Article in journal (Other academic)
    Abstract [en]

    n/a

  • 22.
    Tagesson (Sonesson), Sofi
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Dynamic and static tibial translation in patients with anterior cruciate ligament deficiency initially treated with a structured rehabilitation protocol2017In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 25, no 8, p. 2337-2346Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    To compare dynamic and static tibial translation, in patients with anterior cruciate ligament deficiency, at 2- to 5-year follow-up, with the tibial translation after 4 months of rehabilitation initiated early after the injury. Secondarily, to compare tibial translation in the injured knee and non-injured knee and explore correlations between dynamic and static tibial translation.

    METHODS:

    Twelve patients with ACL rupture were assessed at 3-8 weeks after ACL injury, after 4 months of structured rehabilitation, and 2-5 years after ACL injury. Sagittal tibial translation was measured during the Lachman test (static translation) and during gait (dynamic translation) using a CA-4000 electrogoniometer.

    RESULTS:

    Static tibial translation was increased bilateral 2-5 years after ACL injury, whereas the dynamic tibial translation was unchanged. Tibial translation was greater in the injured knee compared with the non-injured knee (Lachman test 134 N 9.1 ± 1.0 vs. 7.0 ± 1.7 mm, P = 0.001, gait 5.6 ± 2.1 vs. 4.7 ± 1.8 mm, P = 0.011). There were no correlations between dynamic and static tibial translation.

    CONCLUSION:

    Dynamic tibial translation was unchanged in spite of increased static tibial translation in the ACL-deficient knee at 2- to 5-year follow-up compared to directly after rehabilitation. Dynamic tibial translation did not correlate with the static tibial translation. A more normal gait kinematics may be maintained from completion of a rehabilitation programme to mid-term follow-up in patients with ACL deficiency treated with rehabilitation only.

  • 23.
    Tagesson (Sonesson), Sofi
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ardern, Clare
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. School of Allied Health, La Trobe University, Melbourne, Australia, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
    Österberg, Annika
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Grävare Silbernagel, Karin
    Department of Physical Therapy, University of Delaware, Newark, DE, USA..
    Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy.2017In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 25, no 5, p. 1375-1384Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To describe individuals' expectations, motivation, and satisfaction before, during, and after rehabilitation for ACL reconstruction and to explore how these factors were associated with return to pre-injury sport activity at 1-year follow-up.

    METHODS: Sixty-five individuals (34 males), median age 22 (15-45) years, scheduled for ACL reconstruction participated. Participants completed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and questions about expectations, satisfaction, and motivation pre-operatively and at 16 and 52 weeks after surgery.

    RESULTS: Prior to surgery, 86 % of participants stated that their goal was to return to their pre-injury sport activity. Those who had returned to their pre-injury sport activity at 52 weeks were more motivated during rehabilitation to return to their pre-injury activity level, more satisfied with their activity level and knee function at 52 weeks, and scored significantly higher on the IKDC-SKF [median 92.0 (range 66.7-100.0)] at 52 weeks, compared to those who had not returned [median 77.6 (range 50.6-97.7)].

    CONCLUSION: Prior to ACL reconstruction, most participants expected to return to their pre-injury activity level. Higher motivation during rehabilitation was associated with returning to the pre-injury sport activity. The participants who had returned to their pre-injury sport activity were more satisfied with their activity level and knee function 1 year after the ACL reconstruction. Facilitating motivation might be important to support individuals in achieving their participation goals after ACL reconstruction.

    LEVEL OF EVIDENCE: Prospective cohort study, Level II.

  • 24.
    Tagesson (Sonesson), Sofi
    et al.
    Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Static and dynamic tibial translation before, 5 weeks after, and 5 years after anterior cruciate ligament reconstruction2015In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 23, no 12, p. 3691-3697Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate static and dynamic tibial translation before, 5 weeks after, and 5 years after anterior cruciate ligament (ACL) reconstruction. To explore whether static and dynamic tibial translation are correlated.

    METHODS: Ten patients undergoing quadruple hamstring tendon graft ACL reconstruction were evaluated before, 5 weeks after, and 5 years after ACL reconstruction. Sagittal tibial translation was measured during the Lachman test (static translation) and during gait (dynamic translation) using a CA-4000 electrogoniometer.

    RESULTS: Five years after ACL reconstruction, static tibial translation did not differ between knees (Lachman test 90 N and 134 N n.s.). In contrast, there was greater maximal anterior tibial translation during gait in ACL-reconstructed knees than in uninjured knees (5.5 ± 1.4 vs. 4.5 ± 1.6 mm, P = 0.028). There were no differences in static or dynamic tibial translation between the 5-year follow-up and before ACL reconstruction or between the 5-year follow-up and the 5-week follow-up. There were no correlations between static and dynamic tibial translation.

    CONCLUSION: Although static tibial translation did not differ between knees 5 years after ACL reconstruction, dynamic tibial translation during gait was greater in ACL-reconstructed knees than in uninjured knees. Neither static nor dynamic tibial translation changed 5 years after ACL reconstruction as compared to before surgery and 5 weeks after surgery. Static tibial translation did not correlate with dynamic tibial translation.

    CLINICAL RELEVANCE: This study indicates that although the knee is stable during static measurements, kinematics during gait is impaired 5 years after ACL reconstruction. This may affect the return to sport and risk of osteoarthritis.

    LEVEL OF EVIDENCE: Case series, Level IV.

  • 25.
    Thomee, Roland
    et al.
    Sahlgrens University Hospital.
    Kaplan, Yonatan
    Hebrew University of Jerusalem.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Myklebust, Grethe
    Oslo Sport Trauma Research Centre.
    Arna Risberg, May
    Oslo University Hospital.
    Theisen, Daniel
    Public Research Centre Heatlh.
    Tsepis, Elias
    Institute Educ Technology.
    Werner, Suzanne
    Stockholm Sports Trauma Research Centre.
    Wondrasch, Barbara
    Vienna Sports Medical Centre.
    Witvrouw, Erik
    University of Ghent.
    Muscle strength and hop performance criteria prior to return to sports after ACL reconstruction2011In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 19, no 11, p. 1798-1805Article in journal (Refereed)
    Abstract [en]

    Purpose The purpose of this article is to present recommendations for new muscle strength and hop performance criteria prior to a return to sports after anterior cruciate ligament (ACL) reconstruction. less thanbrgreater than less thanbrgreater thanMethods A search was made of relevant literature relating to muscle function, self-reported questionnaires on symptoms, function and knee-related quality of life, as well as the rate of re-injury, the rate of return to sports and the development of osteoarthritis after ACL reconstruction. The literature was reviewed and discussed by the European Board of Sports Rehabilitation in order to reach consensus on criteria for muscle strength and hop performance prior to a return to sports. less thanbrgreater than less thanbrgreater thanResults The majority of athletes that sustain an (ACL) injury do not successfully return to their pre-injury sport, even though most athletes achieve what is considered to be acceptable muscle function. On self-reported questionnaires, the athletes report high ratings for fear of re-injury, low ratings for their knee function during sports and low ratings for their knee-related quality of life. less thanbrgreater than less thanbrgreater thanConclusion The conclusion is that the muscle function tests that are commonly used are not demanding enough or not sensitive enough to identify differences between injured and non-injured sides. Recommendations for new criteria are given for the sports medicine community to consider, before allowing an athlete to return to sports after an ACL reconstruction. less thanbrgreater than less thanbrgreater thanLevel of evidence IV.

  • 26.
    Tigerstrand Grevnerts, Hanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Fältström, Anne
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Ryhov Cty Hosp, Sweden.
    Sonesson, Sofi
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Gauffin, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Activity demands and instability are the most important factors for recommending to treat ACL injuries with reconstruction2018In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 8, p. 2401-2409Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to (1) study and compare the factors that Swedish orthopaedic surgeons and physical therapists consider important for recommending ACL reconstruction and, (2) to assess how orthopaedic surgeons and physical therapists consider their own and each others, as well as patients, roles are in the treatment decision. A web-based survey assessing the relevance of 21 predetermined factors, in the choice to recommend ACL reconstruction, was sent to orthopaedic surgeons and physical therapists. Respondents were also asked to rate the importance of the assessment made by themselves, the other clinician (physical therapists rated the importance of surgeons, surgeons rated the importance of physical therapists), and the patients preferences. Orthopaedic surgeons agreed of eight, and physical therapists of seven factors as important in the choice to recommend ACL reconstruction. The factors both groups reported as important were; "patients wishes to return to contact/pivoting sports", "instability in physical activity", "instability in activities of daily living despite adequate rehabilitation", "physically demanding occupation", and "young age". Both professions rated their own and each others assessments as well as patients wishes as important for the decision to recommend ACL reconstruction. Orthopaedic surgeons and physical therapists agree about factors that are important for their decision to recommend ACL reconstruction, showing that both professions share a common ground in perceptions of factors that are important in recommending ACL reconstruction. Diagnostic study: Level III.

  • 27.
    Tigerstrand Grevnerts, Hanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Department of Activity and Health, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Terwee, Caroline B
    Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    The measurement properties of the IKDC-subjective knee form.2015In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 23, no 12, p. 3698-3706Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate the methodological quality of studies reporting on the measurement properties of the International Knee Documentation Committee subjective knee form (IKDC-SKF) and to evaluate their results following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines.

    METHODS: Systematic search of articles published about the measurement properties of the IKDC-SKF, review of the studies' methodological quality, and synthesis of the results using the COSMIN guidelines.

    RESULTS: Twenty-six studies were identified and reviewed. There was strong evidence for good internal consistency, test-retest reliability, and responsiveness. There was moderate evidence for good content and structural validity. With the SF36 as a gold standard, the level of evidence for criterion validity was indeterminate. There was conflicting evidence for hypothesis testing and not enough evidence to evaluate measurement error and cross-cultural validity. There were no floor or ceiling effects.

    CONCLUSIONS: This review shows that the IKDC-SKF is a measurement instrument with good internal consistency, test-retest reliability, content and structural validity, and responsiveness and interpretability (no floor and ceiling effects). Further evaluation of measurement error, minimal important change, and hypotheses testing is recommended. The IKDC-SKF seems to be useful as a general instrument for all kinds of knee injuries, which might facilitate its clinical use in situations in which time is a factor.

    LEVEL OF EVIDENCE: Systematic review, Level III.

  • 28.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Football injuries during European Championships 2004-20052007In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 15, no 9, p. 1155-1162Article in journal (Refereed)
    Abstract [en]

    The risk of injury in football is high, but few studies have compared men's and women's football injuries. The purpose of this prospective study was to analyse the exposure and injury characteristics of European Championships in football and to compare data for men, women and male youth players. The national teams of all 32 countries (672 players) that qualified to the men's European Championship 2004, the women's European Championship 2005 and the men's Under-19 European Championship 2005 were studied. Individual training and match exposure was documented during the tournaments as well as time loss injuries. The overall injury incidence was 14 times higher during match play than during training (34.6 vs. 2.4 injuries per 1000 h, P < 0.0001). There were no differences in match and training injury incidences between the championships. Teams eliminated in the women's championship had a significantly higher match injury incidence compared to teams going to the semi-finals (65.4 vs. 5.0 injuries per 1000 h, P = 0.02). Non-contact mechanisms were ascribed for 41% of the match injuries. One-fifth of all injuries were severe with absence from play longer than 4 weeks. In conclusion, injury incidences during the European Championships studied were very similar and it seems thus that the risk of injury in international football is at least not higher in women than in men. The teams eliminated in the women's championship had a significantly higher match injury incidence than the teams going to the final stage. Finally, the high frequency of non-contact injury is worrying from a prevention perspective and should be addressed in future studies.

  • 29.
    Waldén, Markus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy.
    Magnusson, Henrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy.
    Ekstrand, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Sports Medicine .
    Anterior cruciate ligament injury in elite football: a prospective three-cohort study.2011In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 19, no 1, p. 11-19Article in journal (Refereed)
    Abstract [en]

    Anterior cruciate ligament (ACL) injury causes long lay-off time and is often complicated with subsequent new knee injury and osteoarthritis. Female gender is associated with an increased ACL injury risk, but few studies have adjusted for gender-related differences in age although female players are often younger when sustaining their ACL injury. The objective of this three-cohort study was to describe ACL injury characteristics in teams from the Swedish men's and women's first leagues and from several European men's professional first leagues. Over a varying number of seasons from 2001 to 2009, 57 clubs (2,329 players) were followed prospectively and during this period 78 ACL injuries occurred (five partial). Mean age at ACL injury was lower in women compared to men (20.6 ± 2.2 vs. 25.2 ± 4.5 years, P = 0.0002). Using a Cox regression, the female-to-male hazard ratio (HR) was 2.6 (95% CI 1.4-4.6) in all three cohorts studied and 2.6 (95% CI 1.3-5.3) in the Swedish cohorts; adjusted for age, the HR was reduced to 2.4 (95% CI 1.3-4.2) and 2.1 (95% CI 1.0-4.2), respectively. Match play was associated with a higher ACL injury risk with a match-to-training ratio of 20.8 (95% CI 12.4-34.8) and 45 ACL injuries (58%) occurred due to non-contact mechanisms. Hamstrings grafts were used more often in Sweden than in Europe (67 vs. 34%, P = 0.028), and there were no differences in time to return to play after ACL reconstruction between the cohorts or different grafts. In conclusion, this study showed that the ACL injury incidence in female elite footballers was more than doubled compared to their male counterparts, but also that they were significantly younger at ACL injury than males. These findings suggest that future preventive research primarily should address the young female football player.

  • 30.
    Waldén, Markus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science.
    Hägglund, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy.
    Werner, Jonas
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Ekstrand, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Sports Medicine.
    The epidemiology of anterior cruciate ligament injury in football (soccer): a review of the literature from a gender-related perspective.2011In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 19, no 1, p. 3-10Article, review/survey (Refereed)
    Abstract [en]

    Football (soccer), the most popular sport worldwide, is associated with a high injury risk, and the knee joint is often affected. Several studies have found female players to be more susceptible to knee injury, anterior cruciate ligament (ACL) injury in particular, compared to their male counterparts. There is, however, some controversy regarding the magnitude of this risk increase and a few studies have found no differences. The influence of age and activity type on gender-related differences in injury risk is only scarcely investigated. In this paper, the literature reporting gender-specific ACL injury risk in football is reviewed. A literature search yielded 33 relevant articles that were included for review. These show that female players have a 2-3 times higher ACL injury risk compared to their male counterparts. Females also tend to sustain their ACL injury at a younger age than males, and a limiting factor in the existing literature is that age is not adjusted for in comparisons of ACL injury risk between genders. Furthermore, the risk increase in females is primarily evident during match play, but type of exposure is also rarely adjusted for. Finally, the studies included in this review share important methodological limitations that are discussed as a starting point for future research in the field.

1 - 30 of 30
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