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  • 1.
    Ahlden, M.
    et al.
    Orthocenter IFK-kliniken, Sahlgrenska akademin, Göteborgs universitetGöteborg, Sweden.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Samuelsson, K.
    Ortopedkliniken, Sahlgrenska universitetssjuk huset.
    Eriksson, K.O.
    Sahlgrenska akademin, Göteborgs universitet, Sweden; Sahlgrenska akademin, Göteborgs universitet, Sweden.
    Karlsson, J.
    Ortopedkliniken, Institutionen för klinisk forskning och utbildning, Södersjukhuset, Karolinska institutetStockholm, Sweden.
    Individualiserad terapi viktigt vid främre korsbandsskada2014Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, nr 36, s. 1440-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Anterior cruciate ligament (ACL) injury is a common injury and is often associated with concomitant injuries to the menisci and cartilage and, in the long term, osteoarthritis. Preventive training programs have shown to be highly effective in terms of reducing the risk for ACL injury in sports. ACL reconstruction is indicated when the patient experiences symtoms of instability (»giving way«) despite rehabilitation with a physiotherapist aiming to gain neuromuscular control of the knee. Early ACL reconstruction may be indicated, for example when the patient desires to return to pivoting contact-sports at high level. Modern surgical technique for ACL reconstruction has evolved rapidly and includes »anatomic reconstruction« and individualized treatment, where each patient’s unique anatomy, injury and requests on knee function are taken into consideration. In Sweden, more than 90% of all ACL reconstructions performed are included into the Swedish National ACL Register.

  • 2.
    Antonopoulos (Kvist), Joanna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
    Gillquist, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
    Anterior tibial translation related to isokinetic concentric quadriceps torques1996Inngår i: Isokinetics and exercise science, ISSN 0959-3020, E-ISSN 1878-5913, Vol. 6, nr 2, s. 145-151Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Sagittal translation of the tibia was examined in a static test with 90 N force at 20°of knee flexion and dynamically during knee extension in a Biodex machine using increasing quadriceps torque in six healthy volunteers. The translation increased in a non-linear fashion with increasing torque. Similar relative increases in quadriceps torque caused similar relative increases in translation in the different individuals. The dynamic translation at the individual maximum quadriceps torque was equal to the static 90-N translation. There was a negative correlation between the maximum quadriceps torque and the static 90-N translation. The results indicate that the quadriceps torque is related to the amount of translation in the knee joint possibly by some feed back mechanism from the ligaments preventing abnormal translation. The findings also imply that a limitation of quadriceps torque around 80% of maximum would limit the strain in an injured ligament to a level not higher than what is caused by normal laxity measurements.

  • 3.
    Ardern, Clare
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    What is the evidence to support a psychological component to rehabilitation programs after anterior cruciate ligament reconstruction?2016Inngår i: Current Orthopaedic Practice, ISSN 1940-7041, Vol. 27, nr 3, s. 263-268Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    One of the main indications for anterior cruciate ligament reconstruction is the athlete’s desire to return to his or her preinjury level of sports. Postoperative rehabilitation has a strong focus on recovery of the physical capabilities necessary to manage a return to sports. On average, athletes achieve good physical function after surgery, based on standard impairment-based and activity-based measures. Yet the return to sports rate is disappointingly low; only two in every three return to their preinjury level sport and only half of the athletes return to competitive sports after surgery. There are a range of factors, many of them nonmodifiable (e.g. age, sex, and preinjury level of competition), that affect returning to a specific sport. However, recent research has identified psychological factors as key influences on returning to sports after anterior cruciate ligament reconstruction. This is particularly important for clinicians given that these factors may be modifiable with appropriate intervention. However, they are not systematically discussed during standard postoperative rehabilitation. In this review, we examine the evidence for the effect of psychological factors on return to sport outcomes after anterior cruciate ligament reconstruction and provide a rationale for the inclusion of interventions that specifically and systematically affect these factors during postoperative rehabilitation.

  • 4.
    Ardern, Clare
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. School of Allied Health, La Trobe University, Melbourne, Australia.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Webster, Kate E.
    School of Allied Health, La Trobe University, Melbourne, Australia.
    Psychological Aspects of Anterior Cruciate Ligament Injuries2016Inngår i: Operative techniques in sports medicine, ISSN 1060-1872, E-ISSN 1557-9794, Vol. 24, nr 1, s. 77-83Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Impairment-based evaluation has, until recently, been the mainstay of orthopaedic research in anterior cruciate ligament (ACL) reconstruction. However, participation-based outcomes, in particular returning to sport, have lately garnered increased research attention. This is important because returning to sport is typically a main concern of injured athletes. Recent metaanalyses have demonstrated that the return to sport rate after ACL reconstruction is disappointingly low, and that a range of contextual factors including age, sex, sport participation level, and psychological factors may affect the return to sport rate. Moderate to large effect sizes have been demonstrated for greater psychological readiness to return to sport, and lower fear of reinjury favoring returning to the preinjury level sport after ACL reconstruction. Understanding the relationship between psychological factors and returning to sport is essential in light of the fact that most athletes recover good physical function after surgery, and many athletes with good knee function do not return to sport. Psychological factors are potentially modifiable with appropriate intervention, yet these factors are not systematically addressed in routine postoperative rehabilitation. This review summarizes the recent evidence for the relationship between psychological factors and ACL injury, including recovery from injury and returning to sport. Oper Tech Sports Med 24:77-83 Crown Copyright (C) 2015 Published by Elsevier Inc. All rights reserved.

  • 5.
    Ardern, Clare
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. School of Allied Health, La Trobe University, Melbourne, Australia, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
    Tagesson (Sonesson), Sofi
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Rörelse och Hälsa.
    Forssblad, M
    Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden. Capio Artro Clinic, Sophiahemmet, Stockholm, Sweden..
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Comparison of patient-reported outcomes among those who chose ACL reconstruction or non-surgical treatment.2017Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 27, nr 5, s. 535-544Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of our study was to cross-sectionally compare patient-reported knee function outcomes between people who chose non-surgical treatment for ACL injury and those who chose ACL reconstruction. We extracted Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQoL-5D data entered into the Swedish National ACL Registry by patients with a non-surgically treated ACL injury within 180 days of injury (n = 306), 1 (n = 350), 2 (n = 358), and 5 years (n = 114) after injury. These data were compared cross-sectionally to data collected pre-operatively (n = 306) and at 1 (n = 350), 2 (n = 358), and 5 years (n = 114) post-operatively from age- and gender-matched groups of patients with primary ACL reconstruction. At the 1 and 2 year comparisons, patients who chose surgical treatment reported superior quality of life and function in sports (1 year mean difference 12.4 and 13.2 points, respectively; 2 year mean difference 4.5 and 6.9 points, respectively) compared to those who chose non-surgical treatment. Patients who chose ACL reconstruction reported superior outcomes for knee symptoms and function, and in knee-specific and health-related quality of life, compared to patients who chose non-surgical treatment.

  • 6.
    Ardern, Clare
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. School of Allied Health, La Trobe University, Melbourne, Australia.
    Österberg, Annika
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Tagesson, Sofi
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Gauffin, Håkan
    Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Webster, Kate E.
    La Trobe University, Australia.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Hälsouniversitetet.
    Satisfaction With Knee Function After Primary Anterior Cruciate Ligament Reconstruction Is Associated With Self-Efficacy, Quality of Life, and Returning to the Preinjury Physical Activity2016Inngår i: Arthroscopy: The Journal of Arthroscopy And Related, ISSN 0749-8063, E-ISSN 1526-3231, Vol. 32, nr 8, s. 1631-1638Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To assess whether patient-reported outcomes (psychological factors, appraisals of knee function, and physical activity participation) were associated with satisfaction with knee function after anterior cruciate ligament (ACL) reconstruction. Methods: Participants who were aged 18 to 45 years and a minimum 12 months post primary ACL reconstruction completed a questionnaire battery evaluating knee self-efficacy, knee-related quality of life, self-reported function, and physical activity participation. Participants responses to the question "If you were to spend the rest of your life with your knee just the way it has been in the last week, would you feel.... (7-point ordinal scale; 1 = happy, 7 = unhappy)" were categorized as satisfied, mostly satisfied, or dissatisfied and used as the primary outcome. Ordinal regression was used to examine associations between independent variables and the primary outcome. Results: A total of 177 participants were included at an average of 3 years after primary ACL reconstruction. At follow-up, 44% reported they would be satisfied, 28% mostly satisfied, and 28% dissatisfied with the outcome of ACL reconstruction. There were significant differences in psychological responses and appraisal of knee function between the 3 groups (P = .001), and significantly more people in the satisfied group had returned to their preinjury activity (58%) than in the mostly satisfied (28%) and dissatisfied (26%) groups (P = .001). Multivariable analysis demonstrated that the odds of being satisfied increased by a factor of 3 with higher self-efficacy, greater knee-related quality of life, and returning to the preinjury activity. Conclusions: People who had returned to their preinjury physical activity and who reported higher knee-related self-efficacy and quality of life were more likely to be satisfied with the outcome of ACL reconstruction.

  • 7.
    Ardern, Clare
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Österberg, Annika
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet. Uppsala Univ, Ctr Clin Res Sormland, Eskilstuna, Sweden.
    Tagesson (Sonesson), Sofi
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Gauffin, Håkan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Webster, Kate E.
    La Trobe University, Australia.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction2014Inngår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, nr 22, s. 1613-U50Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background This cross-sectional study aimed to examine whether appraisal of knee function, psychological and demographic factors were related to returning to the preinjury sport and recreational activity following anterior cruciate ligament (ACL) reconstruction. Method 164 participants completed a questionnaire battery at 1-7 years after primary ACL reconstruction. The battery included questionnaires evaluating knee self-efficacy, health locus of control, psychological readiness to return to sport and recreational activity, and fear of reinjury; and self-reported knee function in sport-specific tasks, knee-related quality of life and satisfaction with knee function. The primary outcome was returning to the preinjury sport or recreational activity. Results At follow-up, 40% (66/164) had returned to their preinjury activity. Those who returned had more positive psychological responses, reported better knee function in sport and recreational activities, perceived a higher knee-related quality of life and were more satisfied with their current knee function. The main reasons for not returning were not trusting the knee (28%), fear of a new injury (24%) and poor knee function (22%). Psychological readiness to return to sport and recreational activity, measured with the ACL-Return to Sport after Injury scale (was most strongly associated with returning to the preinjury activity). Age, sex and preinjury activity level were not related. Conclusions Less than 50% returned to their preinjury sport or recreational activity after ACL reconstruction. Psychological readiness to return to sport and recreation was the factor most strongly associated with returning to the preinjury activity. Including interventions aimed at improving this in postoperative rehabilitation programmes could be warranted to improve the rate of return to sport and recreational activities.

  • 8.
    Arundale, Amelia
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Hägglund, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Football Research Group, Linköping University, Linköping, Sweden.
    Fältström, Anne
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. 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 reconstruction2019Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, nr 2, s. 556-563Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 9.
    Eklund, Jörgen
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för konstruktions- och produktionsteknik, Industriell arbetsvetenskap.
    Kvist, Joanna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik.
    Carlsson, Anna
    IAV LiU.
    Näsström, Eva
    IAV LiU.
    Rahm, Malin
    Muscle load on the neck for welders2005Inngår i: NES 2005,2005, Oslo: NES , 2005, s. 226-Konferansepaper (Fagfellevurdert)
  • 10.
    Engstrand, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease2015Inngår i: Journal of Hand Therapy, ISSN 0894-1130, E-ISSN 1545-004X, Vol. 28, nr 3, s. 255-260Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study design: Prospective cohort study. Introduction: The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. Purpose of the study: To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytrens disease. Methods: Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Explanatory variables: range of motion of the finger joints, five questions regarding safety and social issues of hand function, and health-related quality of life (Euroqol). Results: The three variables "need to take special precautions", "avoid using the hand in social context", and health-related quality of life (EQ-5D index) explained 62.1% of the variance in DASH, where the first variable had the greatest relative effect. Discussion: Safety and social issues of hand function and quality of life had an evident association with functional recovery. Level of evidence: IV.

  • 11.
    Engstrand, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Interrater Reliability in Finger Joint Goniometer Measurement in Dupuytrens Disease2012Inngår i: American Journal of Occupational Therapy, ISSN 0272-9490, E-ISSN 1943-7676, Vol. 66, nr 1, s. 98-103Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We investigated interrater reliability of range of motion (ROM) measurement in the finger joints of people with Dupuytrens disease. Eight raters measured flexion and extension of the three finger joints in one affected finger of each of 13 people with different levels of severity of Dupuytrens disease, giving 104 measures of joints and motions. Reliability measures, represented by intraclass correlation coefficient (ICC), standard error of the mean (SEM), and differences between raters with the highest and lowest mean scores, were calculated. ICCs ranged from .832 to .973 depending on joint and motion. The SEM was andlt;= 3 degrees for all joints and motions. Differences in mean between highest and lowest raters were larger for flexion than for extension; the largest difference was in the distal interphalangeal joint. The results indicate that following these standardized guidelines, the interrater reliability of goniometer measurements is high for digital ROM in people with Dupuytrens disease.

  • 12.
    Engstrand, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Nylander, Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Hand function and quality of life before and after fasciectomy for Dupuytren contracture2014Inngår i: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 39, nr 7, s. 1333-1343Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE:

    To describe changes in joint motion, sensibility, and scar pliability and to investigate the patients' expectations, self-reported recovery, and satisfaction with hand function, disability, and quality of life after surgery and hand therapy for Dupuytren disease.

    METHODS:

    This prospective cohort study collected measurements before surgery and 3, 6, and 12 months after surgery and hand therapy. Ninety patients with total active extension deficits of 60° or more from Dupuytren contracture were included. Outcomes measures were range of motion; sensibility; scar pliability; self-reported outcomes on expectations, recovery, and satisfaction with hand function; Disabilities of the Arm, Shoulder, and Hand scores; safety and social issues of hand function; physical activity habits; and quality of life with the Euroqol.

    RESULTS:

    The extension deficit decreased, and there was a transient decrease in active finger flexion during the first year after surgery. Sensibility remained unaffected. Generally, patients with surgery on multiple fingers had worse scar pliability. The majority of the patients had their expectations met, and at 6 months, 32% considered hand function as fully recovered, and 73% were satisfied with their hand function. Fear of hurting the hand and worry about not trusting the hand function were of greatest concern among safety and social issues. The Disability of the Arm, Shoulder, and Hand score and the Euroqol improved over time.

    CONCLUSIONS:

    After surgery and hand therapy, disability decreased independent of single or multiple operated fingers. The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment.

  • 13.
    Engstrand, Christina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Patients'€™ perspective on surgical intervention for Dupuytren'€™s disease€: experiences, expectations and appraisal of results2016Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, nr 24-26, s. 2538-2549Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose To explore patients’ perspectives on surgical intervention for Dupuytren’s disease (DD), focusing on patients’ appraisal of results, involving previous experiences, expectations and patient characters.

    Method The participants were 21 men, mean age 66 years, scheduled for DD surgery. Qualitative interviews were conducted 2–4 weeks before surgery and 6–8 months after surgery. The model of the Patient Evaluation Process was used as theoretical framework. Data were analyzed using problem-driven content analysis.

    Results Five categories are described: previous experiences, expectations before surgery, appraisal of results, expectations of the future and patient character. Previous experiences influenced participants’ expectations, and these were used along with other aspects as references for appraisal of results. Participants’ appraisal of results concerned perceived changes in hand function, care process, competency and organization, and could vary in relation to patient character. The appraisal of results influenced participants’ expectations of future hand function, health and care.

    Conclusions Patients’ appraisal of results involved multidimensional reasoning reflecting on hand function, interaction with staff and organizational matters. Thus, it is not enough to evaluate results after DD surgery only by health outcomes as this provides only a limited perspective. Rather, evaluation of results should also cover process and structure aspects of care.

    Implications for Rehabilitation

    • To improve health care services, it is important to be aware of the role played by patient’s previous experiences, expectations as well as staff and organizational aspects of care.
    • Knowledge about patients’ experience and view of the results from surgery and rehabilitation should be established by assessment of care effects on health as well as structure and process aspects of care.
    • Evaluation of structure and process aspects of care can be done by using questions about if the patient felt listened to, received clear information and explanations, was included in decision-making, and their view of waiting time or continuity of care.
    • Improving health care services means not only providing the best treatment method available but also developing individualized care by ensuring good interaction with the patient, providing accurate information, and working to improve the structure of the care process.
    • Before treatment, health care providers should have a dialogue with the patient and consider previous experiences and expectations in order to ensure the patient has balanced expectations of the outcome.
  • 14.
    Fältström, Anne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Hälsouniversitetet.
    Hägglund, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Hälsouniversitetet.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Hälsouniversitetet.
    Factors associated with playing football after anterior cruciate ligament reconstruction in female football players.2016Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 26, nr 11, s. 1343-1352Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study investigated whether player-related factors (demographic, personality, or psychological factors) or the characteristics of the anterior cruciate ligament (ACL) injury were associated with the return to playing football in females after ACL reconstruction (ACLR). We also compared current knee function, knee related quality of life and readiness to return to sport between females who returned to football and those who had not returned. Females who sustained a primary ACL rupture while playing football and underwent ACLR 6-36 months ago were eligible. Of the 460 contacted, 274 (60%) completed a battery of questionnaires, and 182 were included a median of 18 months (IQR 13) after ACLR. Of these, 94 (52%) returned to football and were currently playing, and 88 (48%) had not returned. Multiple logistic regression analysis identified two factors associated with returning to football: short time between injury and ACLR (0-3 months, OR 5.6; 3-12 months OR 4.7 vs reference group > 12 months) and high motivation. Current players showed higher ratings for current knee function, knee-related quality of life, and psychological readiness to return to sport (P < 0.001). Undergoing ACLR sooner after injury and high motivation to return to sports may impact a player's return to football after ACLR.

  • 15.
    Fältström, Anne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.
    Hägglund, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls2017Inngår i: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 45, nr 2, s. 377-385Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Good functional performance with limb symmetry is believed to be important to minimize the risk of injury after a return to pivoting and contact sports after anterior cruciate ligament reconstruction (ACLR).

    Purpose: This study aimed to investigate any side-to-side limb differences in functional performance and movement asymmetries in female soccer players with a primary unilateral anterior cruciate ligament (ACL)–reconstructed knee and to compare these players with knee-healthy controls from the same soccer teams.

    Study Design: Cross-sectional study; Level of evidence, 3.

    Methods: This study included 77 active female soccer players at a median of 18 months after ACLR (interquartile range [IQR], 14.5 months; range, 7-39 months) and 77 knee-healthy female soccer players. The mean age was 20.1 ± 2.3 years for players with an ACL-reconstructed knee and 19.5 ± 2.2 years for controls. We used a battery of tests to assess postural control (Star Excursion Balance Test) and hop performance (1-legged hop for distance, 5-jump test, and side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using 2-dimensional analyses.

    Results: The reconstructed and uninvolved limbs did not differ in any of the tests. In the 5-jump test, players with an ACL-reconstructed knee performed worse than controls (mean 8.75 ± 1.05 m vs 9.09 ± 0.89 m; P = .034). On the drop vertical jump test, the ACL-reconstructed limb had significantly less knee valgus motion in the frontal plane (median 0.028 m [IQR, 0.049 m] vs 0.045 m [IQR, 0.043 m]; P = .004) and a lower probability of a high knee abduction moment (pKAM) (median 69.2% [IQR, 44.4%] vs 79.8% [IQR, 44.8%]; P = .043) compared with the control players’ matched limb (for leg dominance). Results showed that 9% to 49% of players in both groups performed outside recommended guidelines on the different tests. Only 14 players with an ACL-reconstructed knee (18%) and 15 controls (19%) had results that met the recommended guidelines for all 5 tests (P = .837).

    Conclusion: The reconstructed and uninvolved limbs did not differ, and players with an ACL-reconstructed knee and controls differed only minimally on the functional performance tests, indicating similar function. It is worth noting that many players with an ACL-reconstructed knee and controls had movement asymmetries and a high pKAM pattern, which have previously been associated with an increased risk for both primary and secondary ACL injury in female athletes.

  • 16.
    Fältström, Anne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Hälsouniversitetet.
    Hägglund, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Patient-Reported Knee Function, Quality of Life, and Activity Level After Bilateral Anterior Cruciate Ligament Injuries2013Inngår i: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 41, nr 12, s. 2805-2813Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: About 12% of patients who have undergone primary anterior cruciate ligament (ACL) reconstruction sustain a contralateral ACL injury within 5 years. less thanbrgreater than less thanbrgreater thanPurpose: To investigate patient-reported knee function, quality of life, and activity level in patients with bilateral ACL injuries. less thanbrgreater than less thanbrgreater thanStudy Design: Cohort study; Level of evidence, 3. less thanbrgreater than less thanbrgreater thanMethods: A search of hospital records identified 147 patients, aged 18 to 45 years, with bilateral ACL injuries. Of these, 83 met the inclusion criteria, having had their first ACL injury up to 12 years ago with no other major injuries to the knee joint. Sixty-six of these patients (80% of total; 47% female; mean age, 29.1 7.2 years) answered a questionnaire packet. Patients who had undergone unilateral ACL reconstruction (n = 182) were used for comparison. less thanbrgreater than less thanbrgreater thanResults: Patients with bilateral ACL injuries had a median Lysholm knee score of 82 (range, 34-100). The mean EuroQol index (EQ-5D) score of the overall health status was 0.77 +/- 0.22, and the mean EQ-5D visual analog scale score was 75.5 +/- 17.6. The median Tegner activity level was 9 (range, 1-9) before any injuries, 7 (range, 1-9) before the second ACL injury, and 4 (range, 1-9) at the time of follow-up. The activity level before the second injury was higher compared with the follow-up for patients who had undergone unilateral ACL reconstruction. At follow-up, 23% of the patients with bilateral ACL injuries returned to their previous activity, and 12% of patients returned to the same level as before their injuries compared with 43% (P = .004) and 28% (P = .01) in patients who had undergone unilateral ACL reconstruction, respectively. Patients with bilateral ACL injuries had significantly lower values in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for pain, function in sports and recreation, and knee-related quality of life as well as the ACL Deficiency Quality of Life (ACL-QOL) score compared with patients who had undergone unilateral ACL reconstruction. less thanbrgreater than less thanbrgreater thanConclusion: Patients with bilateral ACL injuries reported poorer knee function and quality of life compared with those who had undergone unilateral ACL reconstruction. Their activities had changed, and they were dissatisfied with their current activity level. They had a high activity level before their first and second ACL injuries but an impaired activity level after their contralateral injury at follow-up.

  • 17.
    Fältström, Anne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Department of Physiotherapy, Ryhov County Hospital, Jönköping, Sweden.
    Hägglund, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Magnusson, Henrik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Forssblad, Magnus
    Carpio Artro Clinic AB, Sophiahemmet, Stockholm, Sweden.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Predictors for additional anterior cruciate ligament reconstruction: data from the Swedish national ACL register.2016Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, nr 3, s. 885-894Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 18.
    Fältström, Anne
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Gauffin, Håkan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Hägglund, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Football Research Group, Linköping University, Linköping, Sweden.
    Female Soccer Players With Anterior Cruciate Ligament Reconstruction Have a Higher Risk of New Knee Injuries and Quit Soccer to a Higher Degree Than Knee-Healthy Controls2019Inngår i: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 47, nr 1, s. 31-40Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    Many patients with anterior cruciate ligament (ACL) reconstruction who return to sport suffer new ACL injuries or quit sports soon after returning.

    Purpose:

    To prospectively follow a cohort of female soccer players with primary unilateral ACL reconstruction and matched knee-healthy controls from the same soccer teams to compare (1) the rate of new traumatic and nontraumatic knee injuries and other injuries, (2) the proportion of players who quit soccer, and (3) player-reported activity level and satisfaction with activity level and knee function.

    Study Design:

    Cohort study; Level of evidence, 2.

    Methods:

    A total of 117 active female soccer players (mean ± SD age, 19.9 ± 2.5 years) 18.9 ± 8.7 months after ACL reconstruction and 119 knee-healthy female soccer players (19.5 ± 2.5 years) matched from the same teams were prospectively followed for 2 years for new knee injuries, other injuries, soccer playing level, activity level according to the Tegner Activity Scale, and satisfaction with activity level and knee function.

    Results:

    Players with ACL reconstruction had a higher rate of new ACL injuries (n = 29 vs 8; 19 vs 4 per 100 player years; rate ratio [RR], 4.82; 95% CI, 2.20-10.54; P < .001), other traumatic knee injuries (29 vs 16 per 100 player years; RR, 1.84; 95% CI, 1.16-2.93; P < .01), and nontraumatic knee injuries (33 vs 9 per 100 player years; RR, 3.62; 95% CI, 2.11-6.21; P < .001) as compared with controls. There was no difference in the rate of other (not knee) injuries (43 vs 48 per 100 player years; RR, 0.90; 95% CI, 0.65-1.23; P = .494). During the 2-year follow-up, 72 (62%) players with ACL reconstruction quit soccer, as opposed to 43 (36%) controls (P = .001). The median Tegner Activity Scale score decreased in both groups (P < .001) but more for the ACL-reconstructed group (P < .015).

    Conclusion:

    Female soccer players with ACL reconstruction had nearly a 5-fold-higher rate of new ACL injuries and a 2- to 4-fold-higher rate of other new knee injuries, quit soccer to a higher degree, and reduced their activity level to a greater extent as compared with knee-healthy controls.

  • 19.
    Gauffin, Håkan
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Tagesson (Sonesson), Sofi
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Rörelse och Hälsa.
    Meunier, Andreas
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi.
    Magnusson, Henrik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms A 3-Year Follow-up of a Prospective, Randomized Study2017Inngår i: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 45, nr 9, s. 2077-2084Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The optimal treatment for middle-aged patients with knee pain and meniscal lesions has been extensively debated. Most previous studies have revealed only short-term beneficial results of knee arthroscopic surgery. The authors have previously shown a positive benefit of knee arthroscopic surgery and an exercise program after 1 year when compared with an exercise program alone. Purpose: To evaluate if knee arthroscopic surgery combined with an exercise program provided an additional long-term benefit after 3 years compared with an exercise program alone in middle-aged patients with meniscal symptoms. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients, aged 45 to 64 years, 150 were randomized to (1) a 3-month exercise program (nonsurgery group) or (2) the same as group 1 plus knee arthroscopic surgery within 4 weeks (surgery group). The primary outcome was the change in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscore of pain between baseline and the 3-year follow-up. Results from the 1-year follow-up have been published previously. Results: Both treatment groups improved significantly in the KOOS pain subscore at 3 years follow-up in the intention-to-treat and as-treated analyses (P amp;lt; .001). The between-group difference for the change in the KOOS pain subscore between baseline and the 3-year follow-up was no longer statistically significant, neither in the intention-to-treat analysis (7.6 points; 95% CI, -0.6 to 15.9; P = .068) nor in the as-treated analysis (5.3 points; 95% CI, -3.1 to 13.8; P = .216). The factorial analysis of the effect of the intervention and age, onset of pain, and mechanical symptoms indicated that older patients improved more, regardless of treatment, and surgery may be more beneficial for patients without mechanical symptoms (as-treated analysis). The effect of the predictive factors on the KOOS pain subscore was uncertain because of the small sample size in the subgroup analyses. Conclusion: The benefit of knee arthroscopic surgery, seen at 1 year in middle-aged patients with meniscal symptoms, was diminished at 3 years and was no longer statistically significant.

  • 20.
    Gauffin, Håkan
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Tagesson (Sonesson), Sofi
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Meunier, Andreas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Magnusson, Henrik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Knee arthroscopic surgery is beneficial to middle-aged patients with meniscal symptoms: a prospective, randomised, single-blinded study2014Inngår i: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653, Vol. 22, nr 11, s. 1808-1816Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: There is no evidence that a knee arthroscopy is more beneficial to middle-aged patients with meniscal symptoms compared to other treatments. This randomised controlled trial aimed to determine whether an arthroscopic intervention combined with a structured exercise programme would provide more benefit than a structured exercise programme alone for middle-aged patients with meniscal symptoms that have undergone physiotherapy. Method: 150 out of 179 eligible patients, aged 45 to 64 (mean: 54 +/- 5), symptom duration more than 3 months and standing X-ray with Ahlback grade 0, were randomised to: (1) a physiotherapy appointment within 2 weeks of inclusion that included instructions for a 3-month exercise programme (non-surgery group); or (2) the same as (1) plus, within 4 weeks of inclusion, knee arthroscopy for resection of any significant meniscal injuries (surgery group). The primary outcome was change in pain at 12 months, assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOSPAIN). Results: In the Intention-To-Treat analysis, pain at 12 months was significantly lower in the surgery than in the non-surgery group. The change in KOOSPAIN was significantly larger in the surgery than in the non-surgery group (between-group difference was 10.6 points of change; 95% CI: 3.4 to 17.7, P = 0.004). The As-Treated analysis results were consistent with the Intention-To-Treat analysis results. Conclusion: Middle-aged patients with meniscal symptoms may benefit from arthroscopic surgery in addition to a structured exercise programme. Patients age or symptom history (i.e., mechanical symptoms or acute onset of symptoms) didnt affect the outcome.

  • 21.
    Gustafsson, Kristin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Department of Physiotherapy, Rehabilitation Centre, Ryhov County Hospital Jönköping, Jönköping, Sweden.
    Rolfson, Ola
    Department of Orthopaedics, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
    Eriksson, Marit
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Futurum, Region Jönköping County, Jönköping, Sweden.
    Dahlberg, Leif
    Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University and Clinical Epidemiology Unit, Skåne University Hospital, Lund, Sweden.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Study protocol for an observational register-based study on health and risk factors in patients with hip and knee osteoarthritis2018Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 10, artikkel-id e022812Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction Hip and knee osteoarthritis is a leading cause of disability worldwide. Currently, the course of deterioration in pain and physical functioning in individuals with osteoarthritis is difficult to predict. Factors such as socioeconomic status and comorbidity contribute to progression of osteoarthritis, but clear associations have not been established. There is a need for early identification of individuals with slow disease development and a good prognosis, and those that should be recommended for future joint replacement surgery.

    Methods and analysis This nationwide register-based study will use data for approximately 75 000 patients who sought and received core treatment for osteoarthritis in primary healthcare, and were registered in the Swedish population-based National Quality Register for Better Management of Patients with Osteoarthritis. These data will be merged with data for replacement surgery, socioeconomic factors, healthcare consumption and comorbidity from the Swedish Hip Arthroplasty Register, the Swedish Knee Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare, Sweden. The linkage will be performed using personal identity numbers that are unique to all citizens in Sweden.

    Ethics and dissemination The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (dnr 1059–16). The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings.

    Trial registration number NCT03438630.

  • 22.
    Johannesson, Eva
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Silén, Charlotte
    Centre for Medical Education, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Hult, Håkan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Students’ experiences of learning manual clinical skills through simulation2013Inngår i: Advances in Health Sciences Education, ISSN 1382-4996, E-ISSN 1573-1677, Vol. 18, nr 1, s. 99-114Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Learning manual skills is a fundamental part of health care education, and motor, sensory and cognitive learning processes are essential aspects of professional development. Simulator training has been shown to enhance factors that facilitate motor and cognitive learning. The present study aimed to investigate the students’ experiences and thoughts about their learning through simulation skills training. The study was designed for an educational setting at a clinical skills centre. Ten thirdyear undergraduate nursing students performed urethral catheterisation, using the virtual reality simulator UrecathVision™, which has haptic properties. The students practised in pairs. Each session was videotaped and the video was used to stimulate recall in subsequent interviews. The interviews were analysed using qualitative content analysis. The analysis from interviews resulted in threethemes: what the students learn, how the students learn, and the simulator’s contribution to the students’ learning. Students learned manual skills, how to perform the procedure, and professional behaviour. They learned by preparing, watching, practising and reflecting. The simulator contributed by providing opportunities for students to prepare for the skills training, to see anatomical structures, to feel resistance, and to become aware of their own performance ability. The findings show that the students related the task to previous experiences, used sensory information, tested themselves and practised techniques in a hands-on fashion, and reflected in and on action. The simulator was seen as a facilitator to learning the manual skills. The study design, with students working in pairs combined with video recording, was found to enhance opportunities for reflection.

  • 23.
    Kvist, Joanna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Dynamisk translation av tibia vid olika rehabiliteringsövningar efter en främre korsbandsskada2002Inngår i: Svensk Idrottsmedicinsk Förenings Vårmöte. Göteborg 10-12 Maj 2002,2002, 2002Konferansepaper (Fagfellevurdert)
  • 24.
    Kvist, Joanna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik.
    Rehabilitation following ACL Injury: Current Recommendations for Sports Participation2004Inngår i: Sports Medicine, ISSN 0112-1642, E-ISSN 1179-2035, Vol. 34, nr 4, s. 269-280Artikkel i tidsskrift (Fagfellevurdert)
  • 25.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Rehabilitation following anterior - Cruciate ligament injury current recommendations for sports participation2004Inngår i: Sports Medicine, ISSN 0112-1642, E-ISSN 1179-2035, Vol. 34, nr 4, s. 269-280Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Knee ligament injuries often result in a premature end to a career in sports. The treatment after rupture of the anterior cruciate ligament (ACL) may be operative or conservative. In both cases, the goal is to reach the best functional level for the patient without risking new injuries or degenerative changes in the knee. Return to high level of athletic activity has been an indicator of treatment success. Rehabilitation is an important part of the treatment. Knowledge of heating processes and biomechanics in the knee joint after injury and reconstruction, together with physiological aspects on training effects is important for the construction of rehabilitation programmes. Current rehabilitation programmes use immediate training of range of motion. Weight bearing is encouraged within the first week after an ACL reconstruction. Commonly, the patients are allowed to return to light sporting activities such as running at 2-3 months after surgery and to contact sports, including cutting and jumping, after 6 months. In many cases, the decisions are empirically based and the rehabilitation programmes are adjusted to the time selected for returning to sports. In this article, some criteria that should be fulfilled in order to allow the patient to return to sports are presented. Surgery together with completed rehabilitation and sport-specific exercises should result in functional stability of the knee joint. In addition, adequate muscle strength and performance should be used as a critical criterion. Other factors, such as associated injuries and social and psychological hindrances may also influence the return to sports and must be taken into consideration, both during the rehabilitation and at the evaluation of the treatment.

  • 26.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
    Sagittal plane knee motion during activity in the anterior cruciate ligament deficient knee2000Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    A complete rupture of the anterior cruciate ligament (ACL) results in static and often in functional instability. After an ACL-injury, most patients have to decrease their activity level, while some can cope with their injury and manage to keep a high activity level. A better tmderstanding of the influence of muscle activation and external load on the non-injured and injured knee, but also of the adaptive motion strategies employed by the patients with an unstable knee, is of importance for the construction of rehabilitation programs.

    The general purpose of this thesis was to study certain knee motions during activities focused on rehabilitation, in individuals with anterior cmciate ligament injury and uninjured controls. The sagittal tibial translation and knee flexion angle were registered during motion with the CA-4000 computerized electrogoniometer and EMG was used for analysis of muscle activity. The injured knee had increased static laxity compared to the contralateral non-injured knee and the non-impaired group.

    The amount of tibial translation increased with increased quadriceps torque during nonweight bearing activities (isokinetic and isotonic contractions). In the non-injured knees, the restraining mechanism was engaged above 50% of isokinetic concentric quadriceps torque and during the eccentric contractions already at low quadriceps torques (<10% of maximum). The motion pattern was similar in the injured knees and the amount of individual translation was larger during the eccentric contractions, compared to the non-injured knees.

    During weight bearing, tibia translated anteriorly and remained in that position. In the non-injured knee, different loads and performance of weight bearing activities produced different amount of translation. Level walking and squat with the center of gravity behind the feet produced somewhat smaller amount of translations, while other weight bearing activities produced similar amount of translation compared to the non-weight bearing isotonic knee extension. In the injured knee, all weight bearing activities produced similar amount of translation, smaller compared to the non-weight bearing isotonic knee extension.

    Quadriceps - hamstrings co-activation was not present during non-weight bearing quadriceps dominant activities and therefore, it was not shown to be a factor limiting anterior tibial translation. Also, during the weight bearing activities, hamstrings eo-contraction could not limit the anterior tibial translation. Quadriceps and gastrocnemius seems to work synergistically to stabilize the knee by maintaining an anterior position of tibia.

    In the injured knee, isokinetic concentric quadriceps contraction below 50% of maximum torque produced the smallest amount of tibial translation. Weight bearing exercises produced similar ammmt of translation despite of load and performance, indicating that when level walking is allowed after an injury, other weight bearing activities can be performed without increasing the amount of translation. Eccentric isokinetic quadriceps contractions above 50% of maximum torque and isotonic quadriceps exercise with and without weights at flexion angles less that 40°, should be avoided in order protect the knee joint.

    Delarbeid
    1. Anterior tibial translation related to isokinetic concentric quadriceps torques
    Åpne denne publikasjonen i ny fane eller vindu >>Anterior tibial translation related to isokinetic concentric quadriceps torques
    1996 (engelsk)Inngår i: Isokinetics and exercise science, ISSN 0959-3020, E-ISSN 1878-5913, Vol. 6, nr 2, s. 145-151Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Sagittal translation of the tibia was examined in a static test with 90 N force at 20°of knee flexion and dynamically during knee extension in a Biodex machine using increasing quadriceps torque in six healthy volunteers. The translation increased in a non-linear fashion with increasing torque. Similar relative increases in quadriceps torque caused similar relative increases in translation in the different individuals. The dynamic translation at the individual maximum quadriceps torque was equal to the static 90-N translation. There was a negative correlation between the maximum quadriceps torque and the static 90-N translation. The results indicate that the quadriceps torque is related to the amount of translation in the knee joint possibly by some feed back mechanism from the ligaments preventing abnormal translation. The findings also imply that a limitation of quadriceps torque around 80% of maximum would limit the strain in an injured ligament to a level not higher than what is caused by normal laxity measurements.

    Emneord
    Concentric quadriceps contraction, Isokinetic testing, Knee kinematics, Sagittal plane translation
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-79911 (URN)
    Tilgjengelig fra: 2012-08-15 Laget: 2012-08-15 Sist oppdatert: 2017-12-07bibliografisk kontrollert
    2. Anterior tibial translation during eccentric, isokinetic quadriceps work in healthy subjects
    Åpne denne publikasjonen i ny fane eller vindu >>Anterior tibial translation during eccentric, isokinetic quadriceps work in healthy subjects
    1999 (engelsk)Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 9, nr 4, s. 189-194Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    The effect of increasing isokinetic, eccentric quadriceps torques on sagittal translation of the tibia was examined in six healthy volunteers and compared to the translation at 20° of knee flexion during a drawer test with 90 N force. The tibial translation increased in a linear fashion with a mean of 0.5 mm per 20% torque increase. In 20° of knee flexion, 10% of eccentric quadriceps peak torque consumed 80% of the anterior tibial translation induced by the 90 N Lachman test while eccentric quadriceps peak torque utilized 100% of the translation at the same test. The in vivo relation between muscle force and tibial translation is of importance in the treatment of patients with injury to the cruciate ligaments. The results indicate that an already low eccentric quadriceps torque causes a tibial translation that reaches the limit of the passive knee joint displacement where strain is assumed to develop in the anterior cruciate ligament. Already low eccentric quadriceps torque levels may therefore be harmful during rehabilitation after anterior cruciate ligament surgery.

    Emneord
    knee joint, anterior cruciate ligament, biomechanics, muscle contraction
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-27781 (URN)10.1111/j.1600-0838.1999.tb00232.x (DOI)10407925 (PubMedID)12528 (Lokal ID)12528 (Arkivnummer)12528 (OAI)
    Tilgjengelig fra: 2009-10-08 Laget: 2009-10-08 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    3. Anterior tibial translation during different isokinetic quadriceps torque in anterior cruciate ligament deficient and nonimpaired individuals
    Åpne denne publikasjonen i ny fane eller vindu >>Anterior tibial translation during different isokinetic quadriceps torque in anterior cruciate ligament deficient and nonimpaired individuals
    2001 (engelsk)Inngår i: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 31, nr 1, s. 4-15Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Study Design: Factorial quasi-experimental design.

    Objectives: To quantify the effect of different levels of isokinetic concentric and eccentric knee extensor torques on the anterior tibial translation in subjects with anterior cruciate ligament (ACL) deficiency. Electromyogram (EMG) activity of 4 leg muscles was recorded in order to detect any co-activation of extensors and flexors.

    Background: The rehabilitation after an ACL injury is of importance for the functional outcome of the patient. In order to construct a rehabilitation program after that injury, it is important to understand the in vivo relationships between muscle force and tibial translation.

    Methods and Measures: Twelve patients with unilateral ACL injury and 11 uninjured volunteers performed 36 repetitions of a quadriceps contraction at different isokinetic concentric and eccentric torque levels, on a KinCom machine (60°•s-1), with simultaneous recordings of tibial translation (CA-4000) and EMG activity from quadriceps and hamstrings muscles. Tibial translations and EMG levels were normalized to the maximum of each subject.

    Results: The individual anterior tibial translation increased with increased quadriceps torque in a similar manner in both quadriceps contraction modes in all legs tested. During concentric mode, translation was similar in all groups, but during eccentric mode, the mean translation was 38% larger in the ACL injured knees. No quadriceps-hamstrings co-activation occurred in any test or group.

    Conclusions: An ACL deficient knee can limit the translation within a normal space during concentric muscle activity but not during eccentric activity. That limitation depends on other mechanisms than hamstrings co-activation.

    Emneord
    concentric contraction, eccentric contraction, knee kinematics, rehabilitation
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-27776 (URN)11204794 (Scopus ID)12523 (Lokal ID)12523 (Arkivnummer)12523 (OAI)
    Tilgjengelig fra: 2009-10-08 Laget: 2009-10-08 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    4. Sagittal Plane Knee Translation and Electromyographic Activity During Closed and Open Kinetic Chain Exercises in Anterior Cruciate Ligament-Deficient Patients and Control Subjects
    Åpne denne publikasjonen i ny fane eller vindu >>Sagittal Plane Knee Translation and Electromyographic Activity During Closed and Open Kinetic Chain Exercises in Anterior Cruciate Ligament-Deficient Patients and Control Subjects
    2001 (engelsk)Inngår i: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 29, nr 1, s. 72-82Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Using electrogoniometry and electromyography, we measured tibial translation and muscle activation in 12 patients with unilateral anterior cruciate ligament injury and in 12 control subjects. Measurements were made during an active extension exercise with 0-, 4-, and 8-kg weights and during squats on two legs and on one leg where the projection of the center of gravity was placed over, behind, and in front the feet. In the uninjured subjects, tibial translation increased with increasing load except during the squat with the center of gravity behind the feet, which produced the smallest translation. For the active extension exercises, translation was greater during eccentric activity. In the anterior cruciate ligament-injured knees, all squats resulted in similar translation, which was smaller than that during the active extension exercise. The highest muscle activation was seen during squats. Hamstring muscle activity was low. Increased static laxity in the anterior cruciate ligament-deficient knee can be controlled during closed but not during open kinetic chain exercises. Coactivation of the quadriceps and gastrocnemius muscles seems to be important for knee stability, whereas hamstring muscle coactivation was insignificant. To minimize sagittal translation during nonoperative management of anterior cruciate ligament-deficient knees, closed kinetic chain exercises are preferable to open kinetic chain exercises, and importance should be attached to the spontaneous coactivation of the quadriceps and gastrocnemius muscles.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-27779 (URN)12526 (Lokal ID)12526 (Arkivnummer)12526 (OAI)
    Tilgjengelig fra: 2009-10-08 Laget: 2009-10-08 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    5. Anterior positioning of tibia during motion after anterior cruciate ligament injury
    Åpne denne publikasjonen i ny fane eller vindu >>Anterior positioning of tibia during motion after anterior cruciate ligament injury
    2001 (engelsk)Inngår i: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 33, nr 7, s. 1063-1072Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    PURPOSE: The purpose of this study was to describe the sagittal tibial translation and EMG activity of muscles v. medialis and lateralis, gastrocnemius, and hamstrings, during common locomotion, in patients with an anterior cruciate ligament deficiency (ACL-def) and uninjured controls.

    METHODS: In 12 ACL-def patients and 17 controls, sagittal tibial translation was registered with the CA-4000 electrogoniometer during level walking, cutting, and stair walking. Tibial position at each flexion angle was expressed relative to the femuro-tibial position at passive knee extension. EMG activity, measured with ME-4000, was normalized to the individual maximum isometric voluntary contraction for each muscle.

    RESULTS: During the weight-bearing phase of motion, the tibia was anteriorly positioned in all legs. In the injured leg, the tibia translated more rapidly to an anterior position that was maintained for a longer time during the gait cycle. In the noninjured knees, motions with increased load lead to an increased anterior tibial translation in contrast to the injured knees, where the maximum displacement was already reached during level walking. The quadriceps and gastrocnemius muscles were simultaneously active during stance phase. Hamstrings were mainly active when the knee was close to extension and translation increased in spite of this activity.

    CONCLUSIONS: The mechanism of the anterior positioning of tibia is qualitatively similar in the normal and the injured knee, but that position is obtained much further forward in the ACL deficient knee. Quadriceps and gastrocnemius muscles seem to work synergistically to stabilize the knee by maintaining the anterior position of tibia during weight-bearing motion. The role of hamstrings to restrict anterior translation is questioned.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-27780 (URN)11445751 (PubMedID)12527 (Lokal ID)12527 (Arkivnummer)12527 (OAI)
    Tilgjengelig fra: 2009-10-08 Laget: 2009-10-08 Sist oppdatert: 2017-12-13bibliografisk kontrollert
  • 27.
    Kvist, Joanna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik.
    Sagittal plane knee motion in the ACL-deficient knee during body weight shift exercises on different support surfaces2006Inngår i: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 36, nr 12, s. 954-962Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study design: Experimental design with group comparisons. Objectives: To compare anterior tibial translation and muscle activity among different exercises for early weight-bearing and neuromuscular training in individuals with a unilateral anterior cruciate ligament (ACL) injury and in uninjured controls. Background: The effects of exercise and activity on tibial translation must be taken into consideration during rehabilitation after ACL injury. Methods and Measures: Twelve patients with an ACL-deficient knee and 12 age- and gender-matched controls participated in the study. Sagittal tibial translation and muscle activity were registered during the Lachman test (static translation) and 4 body weight shift exercises (dynamic translation). A Student t test with Bonferroni correction and analysis of variance were used for the statistical analysis. Results: Forward-backward body weight shift exercise resulted in smaller anterior tibial translation compared to body weight shift from side to side. Analysis of EMG activity could not explain this difference in anterior tibial translation. The amount of anterior tibial translation or EMG activity did not change when the exercises were performed on a trampoline compared to a firm surface. Conclusions: Forward-backward weight shifting may be preferable in initial rehabilitation after ACL injury compared to body weight shift from side to side.

  • 28.
    Kvist, Joanna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik.
    Sagittal plane translation during level walking in poor-functioning and well-functioning patients with anterior cruciate ligament deficiency2004Inngår i: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 32, nr 5, s. 1250-1255Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Some patients with anterior cruciate ligament deficiency can function well and participate in high-level sports, whereas others have functional limitations even during activities of daily living. Hypothesis: Patients who function well after an anterior cruciate ligament injury can stabilize the knee joint during gait by an anterior positioning of the tibia. Study Design: Controlled laboratory study. Methods: Sagittal tibial translation was registered with the CA-4000 electrogoniometer, during the Lachman test and walking, in 20 patients with a unilateral anterior cruciate ligament injury. Eleven patients functioned well (Lysholm score =84), and 9 patients had poor knee function (Lysholm score <84). Results: During gait, the well-functioning group had 24% greater anterior translation in the injured leg compared to the noninjured leg. In the poor-functioning group, the anterior translation in the injured leg was 16% smaller compared to the noninjured leg (P = .0003). Tibial translation during the Lachman test was similar in the injured leg in the 2 groups. Conclusion: Patients who function well position their tibiae near the anterior border of the joint play. This position may encourage functional stability. Clinical Relevance: Rehabilitation that emphasizes training to stabilize the tibia in an anterior position may improve functional stability of the anterior cruciate ligament-deficient knee.

  • 29.
    Kvist, Joanna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik.
    Sagittal tibial translation during exercises in the anterior cruciate ligament-deficient knee2005Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 15, nr 3, s. 148-158Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to describe and compare the sagittal tibial translation and electromyographic activity of muscles v. medialis and lateralis, gastrocnemius and hamstrings, during common rehabilitation exercises, in patients with anterior cruciate ligament (ACL) deficiency and non-injured controls. Sagittal tibial translation was registered with the CA-4000 electrogoniometer, in 12 patients and 17 controls, during Lachman test (static translation) and five exercises (dynamic translation). The exercises were grouped according to muscle work and joint compression (active extension, heel raises, cycling, one-legged squat and chair squat). The non-weight-bearing exercise with isolated muscle work (active extension) produced a large amount of tibial translation. During weight bearing, the total anterior-posterior tibial motion was halved compared to the non-weight-bearing exercises, but tibia was anterior positioned. Heel raising resulted in equal translation as the one-legged squat and chair squat, whereas cycling produced the smal-lest amount of tibial translation. The subjects utilized different amounts of their individual joint play (static translation) during the exercises, which may explain why there are no correlation between static translation and the patients functional outcome. These results enhance understanding on tibial translation during activity and gives indications on which exercises can be used early after ACL injury and reconstruction. Copyright © Blackwell Munksgaard 2004.

  • 30.
    Kvist, Joanna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Sagittal tibial translation during rehabilitation exercises after anterior cruciate ligament injury2002Inngår i: 7th Annual Congress of the European College of Sport Science. Athens 24-28 July 2002,2002, 2002, s. 635-635Konferansepaper (Fagfellevurdert)
  • 31.
    Kvist, Joanna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik.
    Tibial translation in exercises used early in rehabilitation after anterior cruciate ligament reconstruction. Exercises to achieve weight-bearing2006Inngår i: Knee (Oxford), ISSN 0968-0160, E-ISSN 1873-5800, Vol. 13, nr 6, s. 460-463Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Accelerated rehabilitation after ACL reconstruction involves early weight-bearing. Exercises designed to achieve weight-bearing should be effective for the neuromuscular system and protect the knee from excessive anterior tibial translation. The aim of this study was to assess the anterior tibial translation under two different body-weight shift exercises at 2 weeks post-ACL reconstruction and compare this with healthy controls. Methods: Seven patients at 2 weeks after ACL reconstruction and seven controls participated in the study. Dynamic sagittal tibial translation was registered during two body weight shift exercises (from side to side and forward-backward). Results: There was no significant difference in maximal translation between the two exercises in the ACL-reconstructed group. In the control group, the body weight shift from side-to-side exercise resulted in larger anterior translation compared to the forward-backward body weight shift. Conclusions: Two weeks after ACL reconstruction, both body weight shift exercises can be used to train body weight acceptance. © 2006 Elsevier B.V. All rights reserved.

  • 32.
    Kvist, Joanna
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik.
    Cunningham, Desireé
    Sjukgymnaststudent IHS.
    Tigerstrand-Weijlemark, Hanna
    Sjukgymnaststudent IHS.
    Gender differences in post-exercise sagittal knee translation: A comparison between elite volleyball players and swimmers2006Inngår i: Knee (Oxford), ISSN 0968-0160, E-ISSN 1873-5800, Vol. 13, nr 2, s. 132-136Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There is an increased risk for anterior cruciate ligament injury during the last part of a match or training session and one reason for that could be a post-exercise increase in tibial translation. Purpose: To investigate if sagittal tibial translation is affected after a workout session in volleyball or swimming in elite athletes. In addition, gender differences in sagittal tibial translation after the workout session were investigated. Method: Thirty-one elite volleyball players (16 male) and 33 elite swimmers (15 male) participated in this study. Measurements of total tibial translation were taken before and after a workout session in either volleyball or swimming with the use of a KT-1000 arthrometer. Results: Total tibial translation increased by 1.1 mm (SD 1.9) in the group consisting of both male and female volleyball players (p = 0.003) and remained unchanged in the swimmers. Male athletes increased their tibial translation with 1.8 mm (SD 1.8) and 0.6 mm (SD 1.1) in the two sports, respectively, while the tibial translation did not increase in the female athletes. Conclusion: Impact sports such as volleyball training leads to a post-exercise increase in tibial translation in male athletes. The increase in tibial translation in swimmers, that is a non-impact sport, was small and may not be clinically significant for the functional stability of the joint. It has been shown that female athletes have an increased risk for injury. Our results show no support for an increase in tibial translation being an important factor for this increased risk, and suggest that the difference between males and females in this regard should be sought elsewhere. © 2006 Elsevier B.V. All rights reserved.

  • 33.
    Kvist, Joanna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Karolinska Inst, Sweden.
    Gauffin, Håkan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Tigerstrand Grevnerts, Hanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Rörelse och Hälsa.
    Ardern, Clare
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. La Trobe Univ, Australia.
    Hägglund, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Stalman, Anders
    Capio ArtroClin, Sweden.
    Frobell, Richard
    Lund Univ, Sweden.
    Natural corollaries and recovery after acute ACL injury: the NACOX cohort study protocol2018Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 6, artikkel-id e020543Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction Anterior cruciate ligament (ACL) injury can result in joint instability, decreased functional performance, reduced physical activity and quality of life and an increased risk for post-traumatic osteoarthritis. Despite the development of new treatment techniques and extensive research, the complex and multifaceted nature of ACL injury and its consequences are yet to be fully understood. The overall aim of the NACOX study is to evaluate the natural corollaries and recovery after an ACL injury. Methods and analysis The NACOX study is a multicentre prospective prognostic cohort study of patients with acute ACL injury. At seven sites in Sweden, we will include patients aged 15-40 years, within 6 weeks after primary ACL injury. Patients will complete questionnaires at multiple occasions over the 3 years following injury or the 3 years following ACL reconstruction (for participants who have surgical treatment). In addition, a subgroup of 130 patients will be followed with clinical examinations, several imaging modalities and biological samples. Data analyses will he specific to each aim. Ethics and dissemination This study has been approved by the regional Ethical committee in Linkoping, Sweden (Dnr 2016/44-31 and 2017/221-32). We plan to present the results at national and international conferences and in peer-reviewed scientific journals. Participants will receive a short summary of the results following completion of the study.

  • 34.
    Kvist, Joanna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
    Gillquist, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
    Anterior positioning of tibia during motion after anterior cruciate ligament injury2001Inngår i: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 33, nr 7, s. 1063-1072Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The purpose of this study was to describe the sagittal tibial translation and EMG activity of muscles v. medialis and lateralis, gastrocnemius, and hamstrings, during common locomotion, in patients with an anterior cruciate ligament deficiency (ACL-def) and uninjured controls.

    METHODS: In 12 ACL-def patients and 17 controls, sagittal tibial translation was registered with the CA-4000 electrogoniometer during level walking, cutting, and stair walking. Tibial position at each flexion angle was expressed relative to the femuro-tibial position at passive knee extension. EMG activity, measured with ME-4000, was normalized to the individual maximum isometric voluntary contraction for each muscle.

    RESULTS: During the weight-bearing phase of motion, the tibia was anteriorly positioned in all legs. In the injured leg, the tibia translated more rapidly to an anterior position that was maintained for a longer time during the gait cycle. In the noninjured knees, motions with increased load lead to an increased anterior tibial translation in contrast to the injured knees, where the maximum displacement was already reached during level walking. The quadriceps and gastrocnemius muscles were simultaneously active during stance phase. Hamstrings were mainly active when the knee was close to extension and translation increased in spite of this activity.

    CONCLUSIONS: The mechanism of the anterior positioning of tibia is qualitatively similar in the normal and the injured knee, but that position is obtained much further forward in the ACL deficient knee. Quadriceps and gastrocnemius muscles seem to work synergistically to stabilize the knee by maintaining the anterior position of tibia during weight-bearing motion. The role of hamstrings to restrict anterior translation is questioned.

  • 35.
    Kvist, Joanna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
    Gillquist, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
    Anterior tibial translation during eccentric, isokinetic quadriceps work in healthy subjects1999Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 9, nr 4, s. 189-194Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The effect of increasing isokinetic, eccentric quadriceps torques on sagittal translation of the tibia was examined in six healthy volunteers and compared to the translation at 20° of knee flexion during a drawer test with 90 N force. The tibial translation increased in a linear fashion with a mean of 0.5 mm per 20% torque increase. In 20° of knee flexion, 10% of eccentric quadriceps peak torque consumed 80% of the anterior tibial translation induced by the 90 N Lachman test while eccentric quadriceps peak torque utilized 100% of the translation at the same test. The in vivo relation between muscle force and tibial translation is of importance in the treatment of patients with injury to the cruciate ligaments. The results indicate that an already low eccentric quadriceps torque causes a tibial translation that reaches the limit of the passive knee joint displacement where strain is assumed to develop in the anterior cruciate ligament. Already low eccentric quadriceps torque levels may therefore be harmful during rehabilitation after anterior cruciate ligament surgery.

  • 36.
    Kvist, Joanna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
    Gillquist, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
    Sagittal Plane Knee Translation and Electromyographic Activity During Closed and Open Kinetic Chain Exercises in Anterior Cruciate Ligament-Deficient Patients and Control Subjects2001Inngår i: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 29, nr 1, s. 72-82Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Using electrogoniometry and electromyography, we measured tibial translation and muscle activation in 12 patients with unilateral anterior cruciate ligament injury and in 12 control subjects. Measurements were made during an active extension exercise with 0-, 4-, and 8-kg weights and during squats on two legs and on one leg where the projection of the center of gravity was placed over, behind, and in front the feet. In the uninjured subjects, tibial translation increased with increasing load except during the squat with the center of gravity behind the feet, which produced the smallest translation. For the active extension exercises, translation was greater during eccentric activity. In the anterior cruciate ligament-injured knees, all squats resulted in similar translation, which was smaller than that during the active extension exercise. The highest muscle activation was seen during squats. Hamstring muscle activity was low. Increased static laxity in the anterior cruciate ligament-deficient knee can be controlled during closed but not during open kinetic chain exercises. Coactivation of the quadriceps and gastrocnemius muscles seems to be important for knee stability, whereas hamstring muscle coactivation was insignificant. To minimize sagittal translation during nonoperative management of anterior cruciate ligament-deficient knees, closed kinetic chain exercises are preferable to open kinetic chain exercises, and importance should be attached to the spontaneous coactivation of the quadriceps and gastrocnemius muscles.

  • 37.
    Kvist, Joanna
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik.
    Good, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Ortopedi och Idrottsmedicin. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Tagesson (Sonesson), Sofi
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Changes in knee motion pattern after anterior cruciate ligament injury - A case report2007Inngår i: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 22, nr 5, s. 551-556Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: After an anterior cruciate ligament injury, the contra-lateral non-injured leg has been found to adapt towards the injured leg. Accordingly, in order to study changes in knee motion pattern after an anterior cruciate ligament injury, the ideal is to compare the same leg prior to and after the injury. However, this is very seldom possible. The purpose of the present study was to describe changes in static and dynamic sagittal tibial translation, electromyographic activity and muscle torque relevant to an anterior cruciate ligament tear in one patient evaluated both before and after the injury.

    Methods: A male soccer player was examined 11 weeks before and eight weeks after an anterior cruciate ligament injury. Sagittal tibial translation was measured with the CA-4000 electrogoniometer, statically during Lachman's test, and dynamically during isokinetic muscle testing, one-legged squat and level walking. The electromyographic activity of mm. quadriceps and hamstrings, was registered simultaneously during the one-legged squat test.

    Findings: Static tibial translation was increased by ∼2 mm, while dynamic tibial translation was decreased by 0.4 mm at isokinetic testing, 0.9 mm at one-legged squat and 2.4 mm during level walking compared to before the injury. Muscle torque decreased 30% and 35% for the quadriceps and the hamstrings muscle, respectively. The electromyographic activity revealed similar activation levels in quadriceps and a doubled level of activation in hamstring compared to before the injury.

    Interpretation: In spite of an increase in static tibial translation eight weeks after an anterior cruciate ligament injury, the tibial translation decreased during activity, thus indicating that the patient could stiffen the knee in order to protect it against increased shear forces.

  • 38.
    Kvist, Joanna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Idrottsmedicin. Linköpings universitet, Institutionen för nervsystem och rörelseorgan. Linköpings universitet, Hälsouniversitetet.
    Karlberg, Christian
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Rehabiliteringsmedicin. Linköpings universitet, Institutionen för nervsystem och rörelseorgan. Linköpings universitet, Hälsouniversitetet.
    Gerdle, Björn
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Rehabiliteringsmedicin. Linköpings universitet, Hälsouniversitetet.
    Gillquist, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Idrottsmedicin. Linköpings universitet, Institutionen för nervsystem och rörelseorgan. Linköpings universitet, Hälsouniversitetet.
    Anterior tibial translation during different isokinetic quadriceps torque in anterior cruciate ligament deficient and nonimpaired individuals2001Inngår i: Journal of Orthopaedic and Sports Physical Therapy, ISSN 0190-6011, E-ISSN 1938-1344, Vol. 31, nr 1, s. 4-15Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study Design: Factorial quasi-experimental design.

    Objectives: To quantify the effect of different levels of isokinetic concentric and eccentric knee extensor torques on the anterior tibial translation in subjects with anterior cruciate ligament (ACL) deficiency. Electromyogram (EMG) activity of 4 leg muscles was recorded in order to detect any co-activation of extensors and flexors.

    Background: The rehabilitation after an ACL injury is of importance for the functional outcome of the patient. In order to construct a rehabilitation program after that injury, it is important to understand the in vivo relationships between muscle force and tibial translation.

    Methods and Measures: Twelve patients with unilateral ACL injury and 11 uninjured volunteers performed 36 repetitions of a quadriceps contraction at different isokinetic concentric and eccentric torque levels, on a KinCom machine (60°•s-1), with simultaneous recordings of tibial translation (CA-4000) and EMG activity from quadriceps and hamstrings muscles. Tibial translations and EMG levels were normalized to the maximum of each subject.

    Results: The individual anterior tibial translation increased with increased quadriceps torque in a similar manner in both quadriceps contraction modes in all legs tested. During concentric mode, translation was similar in all groups, but during eccentric mode, the mean translation was 38% larger in the ACL injured knees. No quadriceps-hamstrings co-activation occurred in any test or group.

    Conclusions: An ACL deficient knee can limit the translation within a normal space during concentric muscle activity but not during eccentric activity. That limitation depends on other mechanisms than hamstrings co-activation.

  • 39.
    Kvist, Joanna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Kartus, Juri
    NU Hospital Group, Trollhättan/Uddevalla, Sweden.
    Karlsson, Jon
    University of Gothenburg, Sweden .
    Forssblad, Magnus
    Karolinska Institutet, and Capio Artro Clinic AB, Sophiahemmet, Stockholm, Sweden .
    Results From the Swedish National Anterior Cruciate Ligament Register2014Inngår i: Arthroscopy: The Journal of Arthroscopy And Related, ISSN 0749-8063, E-ISSN 1526-3231, Vol. 30, nr 7, s. 803-810Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE:

    The purpose of the study was to analyze the baseline variables and clinical outcomes for almost 24,000 patients entered into the Swedish National ACL Register between January 2005 and December 2012.

    METHODS:

    The register consists of 2 parts: 1 section in which surgeons report baseline and surgical data and 1 section in which patients report the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the EQ-5D score before and 1, 2, and 5 years after surgery.

    RESULTS:

    By December 2012, 23,744 patients had been entered into the surgeons' part of the register. The female-male ratio in the register is 42:58. The mean age at primary anterior cruciate ligament (ACL) reconstruction was 26 years (SD, 11 years) and 28 years (SD, 9 years) for the female and male patients, respectively. The ACL injury occurred during soccer in 36% of the female patients and 49% of the male patients. In 2012, 95% of the primary ACL reconstructions were performed using hamstring tendon autografts. For patients who had a minimum of 5 years' follow-up, the revision rate was 3.3% and the contralateral reconstruction rate was 3.8%. On all follow-up occasions up to 5 years, patients who had undergone revision had a significantly (P < .001) poorer outcome than those who had undergone primary unilateral ACL reconstructions in all KOOS and EQ-5D dimensions. On all follow-up occasions, smokers obtained significantly poorer scores than nonsmokers in terms of both the KOOS (P < .008) and the EQ-5D (P < .024).

    CONCLUSIONS:

    Soccer is the most common cause of injury in both female and male patients, and patients undergoing revisions fare less well than those undergoing primary unilateral ACL reconstructions, as well as bilateral reconstructions. Furthermore, smokers fare less well than nonsmokers. The cumulative risk of an ACL revision or contralateral ACL reconstruction during a 5-year period is approximately 7%. For patients aged younger than 19 years, the cumulative risk is significantly higher.

    LEVEL OF EVIDENCE:

    Level II, retrospective prognostic study.

  • 40.
    Kvist, Joanna
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik.
    Sporrstedt, Katja
    Sjukgymnastik Linköpings universitet.
    Ek, Anna
    Sjukgymnastik Linköpings universitet.
    Good, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Ortopedi och Idrottsmedicin. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Fear of re-injury: A hindrance for returning to sports after anterior cruciate ligament reconstruction2005Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 13, nr 5, s. 393-397Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 41.
    Kvist, Joanna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Österberg, Annika
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Gauffin, Håkan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Tagesson (Sonesson), Sofi
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Webster, K
    La Trobe University, Australia .
    Ardern, C
    La Trobe University, Australia .
    Translation and measurement properties of the Swedish version of ACL-Return to Sports after Injury questionnaire2013Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 23, nr 5, s. 568-575Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Psychological factors may be a hindrance for returning to sport after an anterior cruciate ligament (ACL) reconstruction. The ACL-Return to Sport after Injury scale (ACL-RSI) measures athletes emotions, confidence in performance, and risk appraisal in relation to return to sport. The aim of this study was to translate the ACL-RSI scale from English to Swedish and to examine some of the measurement properties of the Swedish version. The ACL-RSI was translated and culturally adapted. A professional expert group and five patients evaluated face validity. One hundred and eighty-two patients completed the translated ACL-RSI, a project-specific questionnaire, the Tampa Scale of Kinesiophobia (TSK), the Knee-Self-Efficacy Scale (K-SES), the Multidimensional Health Locus of Control (MHLC-C), the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Anterior Cruciate Ligament-Quality of Life (ACL-QoL) questionnaires. Fifty-three patients answered the ACL-RSI twice to examine reproducibility. The ACL-RSI showed good face validity, internal consistency (Cronbachs alpha=0.948), low floor and ceiling effects and high construct validity when evaluated against the TSK, K-SES, MHLC-C, KOOS, and ACL-QoL scales. The reproducibility was also high (intra-class correlation=0.893). Therefore, the ACL-RSI can be used to evaluate psychological factors relevant to returning to sport after ACL reconstruction surgery.

  • 42.
    Palm, Lars
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Jacobsson, Sven-Arne
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Lindholm, Anna
    Öjersjö, Andreas
    Ivarsson, Ingemar
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Acetabular revision with extensive allograft impaction and uncemented hydroxyapatite-coated implants. Results after 9 (7-11) years follow-up2007Inngår i: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 22, nr 8, s. 1083-1091Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This is a clinical and radiographic review of 87 hips in 79 patients 9 (7-11) years after acetabular revision with extensive use of morselized allograft firmly impacted into localized defects as well as the entire acetabular cavity, followed by insertion of an uncemented hydroxyapatite-coated cup with supplementary screw fixation. The 9-year survival rate for the acetabular implant was 90.5% (95% CI, 83.4%-97.6%) with revision for any reason as end point and 94% (95% CI, 89%-99.1%) with revision for aseptic loosening as end point. Acetabular revision with massive allograft impaction and hydroxyapatite-coated implants show very promising results. The limited contact between implant and host bone does not seem to compromise implant survival in the 7- to 11-year perspective.

  • 43.
    Peolsson, Anneli
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Hamp, Catarina
    Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Albinsson, Anna-Karin
    Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Engdahl, Sara
    Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Kvist, Joanna
    Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Test position and reliability in measurements of dorsal neck muscle endurance2007Inngår i: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 9, nr 4, s. 181-189Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aims of the study were to compare the relative electromyographic (EMG) activity of the extensor muscles at three different locations of the spine (cervical, thoracic and lumbar) during three different dorsal neck muscle endurance test procedures, in order to determine the procedure in which the dorsal neck muscles are maximally activated in asymptomatic individuals. The reliability for one of these test procedures was evaluated using an endurance test expressed in seconds in both healthy volunteers and patients with neck discomfort. Surface EMG activity of the spinal extensor muscles was acquired in three different locations during three different test procedures: the “extended neck lift”, and “straight neck lift” with light and heavy loads in 12 healthy volunteers. The “extended neck lift” was assessed for intra-rater reliability in 30 healthy volunteers and 10 patients with neck disorders and for inter-rater reliability in another 30 healthy volunteers and nine patients with neck disorders. EMG activation of the spinal extensor muscles was generally low. Only during the “extended neck lift” was there a slight tendency that cervical extensors were more activated compared with thoracic extensors. The reliability was good (ICC 0.80–0.94); however, the maximal intra-individual differences and the measurement error were large. The different test procedures used are comparable but there was a slight tendency for “the extended neck lift” to be a more selective measurement for the cervical extensors. The “extended neck lift” is reliable and could be appropriate for evaluating groups of patients.

  • 44.
    Schepull, Thorsten
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Norrman, Hanna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi.
    Trinks, Marie
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi.
    Berlin, Gösta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk immunologi och transfusionsmedicin.
    Aspenberg, Per
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Autologous Platelets Have No Effect on the Healing of Human Achilles Tendon Ruptures A Randomized Single-Blind Study2011Inngår i: AMERICAN JOURNAL OF SPORTS MEDICINE, ISSN 0363-5465, Vol. 39, nr 1, s. 38-47Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Animal studies have shown that local application of platelet-rich plasma (PRP) stimulates tendon repair. Preliminary results from a retrospective case series have shown faster return to sports. Hypothesis: Autologous PRP stimulates healing of acute Achilles tendon ruptures. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Thirty patients were recruited consecutively. During surgery, tantalum beads were implanted in the Achilles tendon proximal and distal to the rupture. Before skin suture, randomization was performed, and 16 patients were injected with 10 mL PRP (10 times higher platelet concentration than peripheral blood) whereas 14 were not. With 3-dimensional radiographs (roentgen stereophotogrammetric analysis; RSA), the distance between the beads was measured at 7, 19, and 52 weeks while the patient resisted different dorsal flexion moments over the ankle joint, thereby estimating tendon strain per load. An estimate of elasticity modulus was calculated using callus dimensions from computed tomography. At 1 year, functional outcome was evaluated, including the heel raise index and Achilles Tendon Total Rupture Score. The primary effect variables were elasticity modulus at 7 weeks and heel raise index at 1 year. Results: The mechanical variables showed a large degree of variation between patients that could not be explained by measuring error. No significant group differences in elasticity modulus could be shown. There was no significant difference in heel raise index. The Achilles Tendon Total Rupture Score was lower in the PRP group, suggesting a detrimental effect. There was a correlation between the elasticity modulus at 7 and 19 weeks and the heel raise index at 52 weeks. Conclusion: The results suggest that PRP is not useful for treatment of Achilles tendon ruptures. The variation in elasticity modulus provides biologically relevant information, although it is unclear how early biomechanics is connected to late clinical results.

  • 45.
    Schepull, Torsten
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan.
    Kvist, Joanna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik.
    Andersson, Christer A
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Aspenberg, Per
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Östergötlands Läns Landsting, Ortopedicentrum, Ortopedkliniken Linköping.
    Mechanical properties during healing of Achilles tendon ruptures to predict final outcome: A pilot Roentgen stereophotogrammetric analysis in 10 patients2007Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. There are presently few methods described for in vivo monitoring of the mechanics of healing human tendon ruptures, and no methods for prediction of clinical outcome. We tested if Roentgen stereophotogrammetric analysis (RSA) can be used to follow the restoration of mechanical properties during healing of ruptured Achilles tendons, and if early measurements can predict clinical results. Methods. Achilles tendon repair was studied with RSA in 10 patients with a total rupture. Tantalum beads were implanted in conjunction with surgical repair. The patients were evaluated at 6, 12 and 18 weeks, and after 1 year. RSA was performed with two different mechanical loadings, and the strain induced by increasing load was measured. The transverse area was determined by ultrasound. CT scan at 12 weeks confirmed that the tantalum beads were located within the tendons. Functional testing was done after 1 year. A heel raise index was chosen as primary clinical outcome variable. Results. The strain was median 0.90, 0.32 and 0.14 percent per 100 N tendon force at 6 weeks, 18 weeks and one year respectively. The error of measurement was 0.04 percent units at 18 weeks. There was a large variation between patients, which appears to reflect biological variation. From 6 to 18 weeks, there was a negative correlation between increase in transverse area and increase in material properties, suggesting that healing is regulated at the organ level, to maximize stiffness. Modulus of elasticity during this time correlated with a heel raise index at one year (Rho = 0.76, p = 0.02). Conclusion. We conclude that the RSA method might have potential for comparing different treatments of Achilles tendon ruptures. © 2007 Schepull et al, licensee BioMed Central Ltd.

  • 46.
    Schepull, Torsten
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Aspenberg, Per
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Ortopedi och idrottsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Early E-modulus of healing Achilles tendons correlates with late function: Similar results with or without surgery2012Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 22, nr 1, s. 18-23Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Non-operative treatment of Achilles tendon ruptures is associated with an increased risk of rerupture. We hypothesized that this is due to inferior mechanical properties during an early phase of healing, and performed a randomized trial, using a new method to measure the mechanical properties. Tantalum markers were inserted in the tendon stumps, and tendon strain at different loadings was measured by stereo-radiography (Roentgen stereophotogrammetric analysis) at 3, 7 and 19 weeks and 18 months after injury. Thirty patients were randomized to operative or non-operative treatment. The primary out-come variable was an estimate for the modulus of elasticity at 7 weeks. Strain per force, cross-sectional area and tendon elongation were also measured. The functional outcome variable was the heel-raise index after 18 months. There was no difference in the mean modulus of elasticity or other mechanical or functional variables between operative and non-operative treatments at any time-point, but strain per force at 7 and 19 weeks had a significantly larger variation in the non-operative group. This group, therefore, might contain more outliers with poor healing. The modulus of elasticity at 7 weeks correlated with the heel-raise index after 18 months in both treatment groups (r2=0.75; P=0.0001). This correlation is an intriguing finding.

  • 47.
    Silén, Charlotte
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Wirell, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk radiologi. Östergötlands Läns Landsting, Bildmedicinskt centrum, Röntgenkliniken i Linköping. Linköpings universitet, Hälsouniversitetet.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Nylander, Eva
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Fyrénius, Anna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi.
    Smedby, Örjan
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk radiologi. Östergötlands Läns Landsting, Bildmedicinskt centrum, Röntgenkliniken i Linköping. Linköpings universitet, Hälsouniversitetet.
    Advanced 3D visualization in student-centred medical education2008Inngår i: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 30, nr 5, s. e115-e124Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Healthcare students have difficulties achieving a conceptual understanding of 3D anatomy and misconceptions about physiological phenomena are persistent and hard to address. 3D visualization has improved the possibilities of facilitating understanding of complex phenomena. A project was carried out in which high quality 3D visualizations using high-resolution CT and MR images from clinical research were developed for educational use. Instead of standard stacks of slices (original or multiplanar reformatted) volume-rendering images in the quicktime VR format that enables students to interact intuitively were included. Based on learning theories underpinning problem based learning, 3D visualizations were implemented in the existing curricula of the medical and physiotherapy programs. The images/films were used in lectures, demonstrations and tutorial sessions. Self-study material was also developed. AIMS: To support learning efficacy by developing and using 3D datasets in regular health care curricula and enhancing the knowledge about possible educational value of 3D visualizations in learning anatomy and physiology. METHOD: Questionnaires were used to investigate the medical and physiotherapy students' opinions about the different formats of visualizations and their learning experiences. RESULTS: The 3D images/films stimulated the students will to understand more and helped them to get insights about biological variations and different organs size, space extent and relation to each other. The virtual dissections gave a clearer picture than ordinary dissections and the possibility to turn structures around was instructive. CONCLUSIONS: 3D visualizations based on authentic, viable material point out a new dimension of learning material in anatomy, physiology and probably also pathophysiology. It was successful to implement 3D images in already existing themes in the educational programs. The results show that deeper knowledge is required about students' interpretation of images/films in relation to learning outcomes. There is also a need for preparations and facilitation principles connected to the use of 3D visualizations.

  • 48.
    Sjödahl, Jenny
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Gutke, Annelie
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    The postural response of the pelvic floor muscles during limb movements: A methodological electromyography study in parous women without lumbopelvic pain2009Inngår i: CLINICAL BIOMECHANICS, ISSN 0268-0033, Vol. 24, nr 2, s. 183-189Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Pregnancy-related lumbopelvic pain is common. More than 30% of women have persistent pain 3 months after giving birth. There is no consensus regarding the pathology. However, coordination of muscle activity by appropriate timing and amplitude is necessary for maintaining adequate stability in the lumbopelvic area. The aim was to develop a method using surface electromyography to detect a feed-forward response in the pelvic floor muscles during limb movements performed at a comfortable speed applicable in future studies for women with lumbopelvic pain.

    Methods: Ten parous women with no lumbopelvic pain in the past 12 months were included. Surface electromyographic activity was recorded from the pelvic floor muscles and unilaterally from transversus abdominis/internal oblique, rectus abdominis, erector spinae, hip adductors, rectus femoris and deltoid. The subjects performed leg lift in supine and arm lift from standing. The electromyographic onset was related to the initiation of the movement.

    Findings: In the majority of the women the electromyographic onsets of the pelvic floor muscles occurred before the movement was initiated, regardless of whether it was a leg or an arm lift. In addition. electromyographic onsets for the other muscles, except the rectus abdominis during the arm lift, also occurred prior to the movements.

    Interpretation: The findings suggest a feed-forward response in the pelvic floor muscles during leg and arm lifts in women who had previously given birth and were without lumbopelvic pain. Movements performed at a comfortable speed seem to be useful in order to detect such a response.

  • 49.
    Sjödahl, Jenny
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Gutke, Annelie
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Folkhälsovetenskapligt centrum.
    The Postural response of the pelvic floor muscles during the active straight leg raise test in women with and without persistent postpartum pelvic girdle pain: an experimental studyManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    The hypothesis was that women with pelvic girdle pain (PGP) would lack a feedforward mechanism in the pelvic floor muscles (PFM) in relation to a functional instability problem. Eight women with PGP and 10 pain-free women were included. A clinical examination was performed to verify that participants with PGP fulfilled the diagnostic criteria used in this study. Surface electromyographic activity was recorded from the PFM and unilaterally from abdominal muscles and the rectus femoris muscle. Participants performed leg lifts (performed as Active Straight Leg Raise (ASLR) tests), first with one leg and then with the other. The lift was also performed with an extra weight strapped on one leg. Median onset of PFM activity occurred before the initiation of the lifts in both groups. One woman experienced more severe PGP/dysfunction demonstrated by a higher score on the ASLR test during the clinical examination. This woman presented onset of PFM activity after the initiation of the lifts. The findings suggest that a feed-forward response of the PFM is present during leg lifts in women with and without postpartum PGP. However, one can speculate that a lack of feed-forward in the PFM may be associated with a load transfer problem.

  • 50.
    Smedby, Örjan
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Medicinsk radiologi. Östergötlands Läns Landsting, Bildmedicinskt centrum, Avdelningen för radiologi US. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Wirell, Staffan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Medicinsk radiologi.
    Kvist, Joanna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Sjukgymnastik.
    Silén, Charlotte
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi.
    Göran, Pettersson
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för datavetenskap, CSELAB - Cognitive Systems Engineering Laboratory.
    Fyrenius, Anna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi.
    Nylander, Eva
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Interactive volume rendering 3D images for anatomy learning on low-end computers2007Inngår i: ECR - European Congress of Radiology,2007, 2007Konferansepaper (Annet vitenskapelig)
    Abstract [en]

      

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