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  • 1.
    Hovelius, L.
    et al.
    Department of Orthopedics, Gävle Hospital, S-801 87 Gävle, Sweden.
    Olofsson, A.
    Department of Orthopedics, Gävle Hospital, S-801 87 Gävle, Sweden.
    Sandstrom, B.
    Sandström, B., Department of Orthopedics, Gävle Hospital, S-801 87 Gävle, Sweden.
    Augustini, B.-G.
    Läkargruppen AB, Box 344, S-70146 Örebro, Sweden.
    Krantz, L.
    Orthopedic Department, Högalidssjukhuset, S-5758 Eksjö, Sweden.
    Fredin, H.
    Läkargruppen St Petri, Hamng 4, S-21122 Malmö, Sweden.
    Tillander, Bo
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Skoglund, U.
    Department of Orthopedics, Karlstad Hospital, S-65185 Karlstad, Sweden.
    Salomonsson, B.
    Department of Orthopedics, Danderyd Hospital, S-18288 Danderyd, Sweden.
    Nowak, J.
    Department of Orthopedics, Samariterhemmet, S-85125 Uppsala, Sweden.
    Sennerby, U.
    Department of Orthopedics, Nordfjord Hospital, N-6771 Nordfjord, Norway.
    Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger: A prospective twenty-five-year follow up2008In: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 90, no 5, p. 945-952Article in journal (Refereed)
    Abstract [en]

    Background: During 1978 and 1979, we initiated a prospective multicenter study to evaluate the results of nonoperative treatment of primary anterior shoulder dislocation. In the current report, we present the outcome after twenty-five years. Methods: Two hundred and fifty-five patients (257 shoulders) with an age of twelve to forty years who had a primary anterior shoulder dislocation were managed with immobilization (achieved by tying the arm to the torso with use of a bandage) or without immobilization. All 227 living patients (229 shoulders) completed the follow-up questionnaire, and 214 patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results: Ninety-nine (43%) of 229 shoulders had not redislocated, and seventeen (7%) redislocated once. Thirty-three recurrent dislocations had become stable overtime (14.4%), and eighteen were considered to be still recurrent (7.9%). Sixty-two shoulders (27%) had undergone surgery for the treatment of recurrent instability. Immobilization after the primary dislocation did not change the prognosis. Only two of twenty-four shoulders with a fracture of the greater tuberosity at the time of the primary dislocation redislocated (p < 0.001). When shoulders with a fracture of the greater tuberosity were excluded, forty-four (38%) of 115 shoulders in patients who had been twelve to twenty-five years of age at the time of the original dislocation and sixteen (18%) of ninety shoulders in patients who had been twenty-six to forty years of age had undergone surgical stabilization. At twenty-five years, fourteen (23%) of sixty-two shoulders that had undergone surgical stabilization were in patients who subsequently had a contralateral dislocation, compared with seven (7%) of ninety-nine shoulders in patients in whom the index dislocation had been classified as solitary (p = 0.01). Gender and athletic activity did not appear to affect the redislocation rate, however, women had worse DASH scores than men did (p = 0.006). Conclusions: After twenty-five years, half of the primary anterior shoulder dislocations that had been treated nonoperatively in patients with an age of twelve to twenty-five years had not recurred or had become stable over time. Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence. Copyright © 2008 by the Journal of Bone and Joint Surgery, Incorporated.

  • 2.
    Pettersson, Johanna
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, The Institute of Technology.
    Palmerius, Karljohan
    Linköping University, Department of Science and Technology. Linköping University, The Institute of Technology.
    Knutsson, Hans
    Linköping University, Department of Biomedical Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, The Institute of Technology.
    Wahlström, Ola
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Tillander, Bo
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Borga, Magnus
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Simulation of Patient Specific Cervical Hip Fracture Surgery With a Volume Haptic Interface2008In: IEEE Transactions on Biomedical Engineering, ISSN 0018-9294, E-ISSN 1558-2531, Vol. 55, no 4, p. 1255-1265Article in journal (Refereed)
    Abstract [en]

    The interest for surgery simulator systems with anatomical models generated from authentic patient data is growing as these systems evolve.With access to volumetric patient data, e.g., from a computer tomography scan, haptic and visual feedback can be created directly from this dataset. This opens the door for patient specific simulations. Hip fracture surgery is one area where simulator systems is useful to train new surgeons and plan operations. To simulate the drilling procedure in this type of surgery, a repositioning of the fractured bone into correct position is first needed. This requires a segmentation process in which the bone segments are identified and the position of the dislocated part is determined. The segmentation must be automatic to cope with the large amount of data from the computer tomography scan. This work presents the first steps in the development of a hip fracture surgery simulation with patient specific models. Visual and haptic feedback is generated from the computer tomography data by simulating fluoroscopic images and the drilling process. We also present an automatic segmentation method to identify the fractured bone and determine the dislocation. This segmentation method is based on nonrigid registration with the Morphon method.

  • 3.
    Tillander, Bo
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    The Supraspinatus Tendon: Clinical and histopathological aspects2001Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The supraspinatus tendon is an important structure of the rotator cuff. Subacromial impingement is a common reason for shoulder pain. Despite extensive scientific work in this field, the cause of impingement syndrome is still not fully understood. The general aim of the present thesis was to generate new knowledge with respect to pathogenesis and treatment of impingement syndrome. A combination of animal and clinical studies were performed. Different methods were used such as histology, immunohistochemistry, development and assessment of a novel measuring device and clinical and radiological assessment.

    Thirty rats were injected with triamcinolone or saline into the subacromial bursa. After five corticosteroid injections, we found focal inflammation, degradation and fragmentation of collagen bundles in the supraspinatus tendon, whereas the control specimens were normal (p=0.035).

    Subacromial bursitis was induced by injections of carrageenan into the subacromial space (n=28). Fibrocartilaginous metaplasia and bony metaplasia were found in the supraspinatus tendon. Even in specimens with no histologic changes of the collagen bundles the staining for fibronectin was significantly increased.

    The distance between the anterolateral acromion and the supraspinatus tendon was measured in patients with impingement syndrome intraoperatively (n=30) and in controls (instability, n=15). The mean value of the subacromial distance in controls was 16 mm, the 95% mean confidence limits between 14 and 18 mm. The mean value in the group of patients with impingement syndrome was 8 mm before and 16 mm after the decompression.

    Fifty patients were reviewed after arthroscopic subacromial decompression. Twenty-five showed calcific deposits in the rotator cuff on radiographs preoperatively. In 13 patients the calcific deposits totally disappeared postoperatively. In another six patients the calcifications had decreased in size. Four patients still showed calcifications, which were 5 mm or greater in size. The postoperative results measured by the Constant score were almost identical in the calcific and the non-calcific groups. Tillander 010916 8 Human surgical supraspinatus tendon specimens were studied from patients with impingement (n=16), ruptured supraspinatus tendons (n=7) and controls (n=10). Degradation of tendinous tissue and fibrin were found only in some specimens from ruptures. The difference in fibronectin staining was significant between controls and patients with a rupture (p=0.002). Fibrosis and thinning of fascicles seemed to be a more non-specific finding, appearing in control, impingement and rupture specimens.

    In conclusion, subacromial corticosteroid injections may cause rupture of the supraspinatus tendon. Metaplasia of the supraspinatus tendon may play a role in the pathogenesis of impingement and rupture of the supraspinatus tendon. The subacromial distance can be measured intraoperatively and was shown to be lower in patients with impingement than in patients with instability. Calcifications disappear or decrease in size after arthroscopic subacromial decompression and do not seem to influence the postoperative outcome in patients with impingement. Degradation of tendon tissue, fibrin and fibronectin appear to be signs of tendon degeneration, whereas fibrosis and thinning of fascicles were found also in controls.

    List of papers
    1. Effect of steroid injections on the rotator cuff: An experimental study in rats
    Open this publication in new window or tab >>Effect of steroid injections on the rotator cuff: An experimental study in rats
    1999 (English)In: Journal of shoulder and elbow surgery, ISSN 1058-2746, Vol. 8, no 3, p. 271-274Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to evaluate the effects of repeated steroid injections into the subacromial space. Thirty rats were injected either 3 or 5 times with triamcinolone in a dosage equivalent to that given to human beings or 3 or 5 times with saline into the subacromial space. One rat received no injection. The supraspinatus and infraspinatus tendons were evaluated macroscopically and microscopically. Two different staining methods were used on each sample including hematoxylin eosin and Miller's elastin/van Gieson's solution. After 5 steroid injections, we found focal inflammation, necrosis, and fragmentation of collagen bundles in the tendon in 4 of 7 rats. The tendons of the controls showed a normal structure (P < .05). There were no pathologic changes among the rats that were injected with triamcinolone 3 times. These results show that repeated subacromial injections of triamcinolone may cause damage to the rotator cuff of the rat. This finding may indicate cautious use of subacromial steroid injections in human beings.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13704 (URN)10.1016/S1058-2746(99)90141-6 (DOI)
    Available from: 2001-11-27 Created: 2001-11-27 Last updated: 2009-08-21
    2. Carrageenan-induced subacromial bursitis caused changes in the rat's rotator cuff
    Open this publication in new window or tab >>Carrageenan-induced subacromial bursitis caused changes in the rat's rotator cuff
    2001 (English)In: Journal of Orthopaedic Research, ISSN 0736-0266, Vol. 19, no 3, p. 441-447Article in journal (Refereed) Published
    Abstract [en]

    This study was designed to investigate the histologic expression of the rat's supra- and infraspinatus tendons in carrageenan-induced subacromial bursitis. Thirty-two rats received subacromial injections with carrageenan (n = 28) or saline (n = 4). The tendons were analysed microscopically after staining with hematoxyline eosin, Van Giesons hematoxyline and immunofluorescent staining of fibronectin and fibrinogen. In the controls (saline × 10) and group A (carrageenan × 5) there were no changes in the tendons. In group B (carrageenan × 10) 3/8 rats showed macrophages between the collagen fibres and an increased staining of fibronectin. In group C (double dosis carrageenan) all rats had signs of fibrocartilaginous metaplasia in the supraspinatus tendon. In eight of these specimens even bony metaplasia was seen. The infraspinatus tendon showed fibrosis but no fibro-cartilaginous metaplasia. The results showed that iatrogenic bursitis after carrageenan subacromial injections was associated with marked changes of the supraspinatus tendon.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13705 (URN)10.1016/S0736-0266(00)90022-6 (DOI)
    Available from: 2001-11-27 Created: 2001-11-27 Last updated: 2009-08-21
    3. Intraoperative measurements of the subacromial distance
    Open this publication in new window or tab >>Intraoperative measurements of the subacromial distance
    2002 (English)In: Arthroscopy : the journal of arthroscopic & related surgery, ISSN 0749-8063, Vol. 18, no 4, p. 347-352Article in journal (Refereed) Published
    Abstract [en]

    Purpose: The purpose of this study was 2-fold: to document the accuracy of a new measuring device and to intraoperatively compare the subacromial distance between controls and patients with impingement syndrome before and after arthroscopic subacromial decompression (ASD).

    Type of Study: Clinical study.

    Methods: When performing an ASD, it is important that bone resection is adequate. Today the correct subacromial distance after bone resection is only assessed by eye, directly or indirectly. The subacromial distance was measured between the anterolateral corner of the acromion and the supraspinatus tendon in the lateral decubitus position. The device was inserted 2 to 3 cm below the anterolateral acromion. There was no subacromial pathology among the controls (n = 15, mean age, 28 years). In 30 patients with impingement syndrome (average age, 53 years) an ASD was performed. The subacromial distance was measured after bursectomy and then after bone resection. Intraindividual and interindividual assessment was performed.

    Results: The mean value of the subacromial distance in controls was 16 mm, the 95% confidence limits between 14 and 18 mm. The mean value in the group of patients with impingement syndrome was 8 mm before and 16 mm after the decompression. Due to the pressure within the subacromial space, the subacromial distance increased 1 mm. Intraindividual measurements never varied more than 1 mm (n = 5). The correlation coefficient between the measurements by both authors was 0.99.

    Conclusions: In this study, we assessed and described the use of a measuring device that enables the surgeon to quantify the subacromial distance before and after bone resection. After bone resection, the mean value of the subacromial distance was well within the control values. The amount of bone resected varied from 5 to 13 mm. This new device enables documentation in clinical work as well as in research.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13706 (URN)10.1053/jars.2002.30040 (DOI)
    Available from: 2001-11-27 Created: 2001-11-27 Last updated: 2009-08-21
    4. Change of calcifications after arthroscopic subacromial decompression
    Open this publication in new window or tab >>Change of calcifications after arthroscopic subacromial decompression
    1998 (English)In: Journal of shoulder and elbow surgery, ISSN 1058-2746, Vol. 7, no 3, p. 213-217Article in journal (Refereed) Published
    Abstract [en]

    Fifty patients were reviewed after arthroscopic subacromial decompression. Twenty-five had calcific deposits in the rotator cuff visible on x-ray evaluation. Each patient with calcification was matched with a patient without calcification who had a similar state of the rotator cuff, date of surgery, age, and sex. The calcific deposits were left untouched in all cases. No significant difference was found in the postoperative outcome between the patients in the two groups measured by the Constant score. Before surgery 7 (28%) patients had calcifications of < 5 mm, and 18 (72%) patients had calcifications that were > or = 5 mm. At a 2-year follow-up (n = 24) these figures were 20 (83%) and 4 (17%), respectively (p < 0.001). Postoperative x-ray evaluations revealed a disappearance or decrease in size of the calcific deposits in 19 (79%) of the patients. These results provide new information on the course of calcifying tendinitis, which may indicate that we can leave calcific deposits untouched within the rotator cuff when performing arthroscopic subacromial decompression.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13707 (URN)
    Available from: 2001-11-27 Created: 2001-11-27 Last updated: 2009-08-21
    5. Human biopsies in the rotator cuff disease
    Open this publication in new window or tab >>Human biopsies in the rotator cuff disease
    (English)Manuscript (preprint) (Other (popular science, discussion, etc.))
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13708 (URN)
    Available from: 2001-11-27 Created: 2001-11-27 Last updated: 2010-01-14
  • 4.
    Tillander, Bo
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Franzen, L.
    Franzén, L., Department of Pathology, University Hospital of Örebro, S-701 85 Örebro, Sweden.
    Norlin, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Fibronectin, MMP-1 and histologic changes in rotator cuff disease2002In: Journal of Orthopaedic Research, ISSN 0736-0266, E-ISSN 1554-527X, Vol. 20, no 6, p. 1358-1364Article in journal (Refereed)
    Abstract [en]

    This study was designed to investigate human surgical specimens from patients with impingement (n = 16), ruptured supraspinatus tendons (n = 7), frozen shoulder (n = 2) and controls (n = 9) with respect to histological changes and the presence of fibronectin and Matrix metalloprotease-1 (MMP-1). The biopsy of the middle part of the supraspinatus tendons was analyzed microscopically after staining with hematoxyline eosin, Van Giesons hematoxyline and Phospho Tungstic Acid Hematoxyline for visualization of fibrin. Immunofluorescent stainings for fibronectin and MMP-1 were performed. Histology and immunofluorescence were assessed blindly. Necrotic tendinous tissue and fibrin were found only in some specimens from ruptures. The staining for fibronectin was significantly increased among patients with a rupture. MMP-1 was, however, only infrequently found in specimens from patients with impingement and ruptures. Fibrosis and thinning of fascicles seemed to be a more non-specific finding, appearing in control, impingement and rupture specimens. In conclusion, necrotic tendinous tissue, fibrin and fibronectin appear to be signs of tendon degeneration, whereas fibrosis and thinning of fascicles were found also in controls. © 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.

  • 5.
    Tillander, Bo
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Franzén, Lennart
    Linköping University, Department of Clinical and Experimental Medicine, Molecular and Immunological Pathology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Clinical Genetics.
    Karlsson, Maria H.
    Norlin, Rolf
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Effect of steroid injections on the rotator cuff: An experimental study in rats1999In: Journal of shoulder and elbow surgery, ISSN 1058-2746, Vol. 8, no 3, p. 271-274Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate the effects of repeated steroid injections into the subacromial space. Thirty rats were injected either 3 or 5 times with triamcinolone in a dosage equivalent to that given to human beings or 3 or 5 times with saline into the subacromial space. One rat received no injection. The supraspinatus and infraspinatus tendons were evaluated macroscopically and microscopically. Two different staining methods were used on each sample including hematoxylin eosin and Miller's elastin/van Gieson's solution. After 5 steroid injections, we found focal inflammation, necrosis, and fragmentation of collagen bundles in the tendon in 4 of 7 rats. The tendons of the controls showed a normal structure (P < .05). There were no pathologic changes among the rats that were injected with triamcinolone 3 times. These results show that repeated subacromial injections of triamcinolone may cause damage to the rotator cuff of the rat. This finding may indicate cautious use of subacromial steroid injections in human beings.

  • 6.
    Tillander, Bo
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Franzén, Lennart
    Linköping University, Department of Clinical and Experimental Medicine, Molecular and Immunological Pathology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Clinical Genetics.
    Nilsson, Elise
    Department of Pathology, University Hospital of Malmö, Malmö, Sweden.
    Norlin, Rolf
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Carrageenan-induced subacromial bursitis caused changes in the rat's rotator cuff2001In: Journal of Orthopaedic Research, ISSN 0736-0266, Vol. 19, no 3, p. 441-447Article in journal (Refereed)
    Abstract [en]

    This study was designed to investigate the histologic expression of the rat's supra- and infraspinatus tendons in carrageenan-induced subacromial bursitis. Thirty-two rats received subacromial injections with carrageenan (n = 28) or saline (n = 4). The tendons were analysed microscopically after staining with hematoxyline eosin, Van Giesons hematoxyline and immunofluorescent staining of fibronectin and fibrinogen. In the controls (saline × 10) and group A (carrageenan × 5) there were no changes in the tendons. In group B (carrageenan × 10) 3/8 rats showed macrophages between the collagen fibres and an increased staining of fibronectin. In group C (double dosis carrageenan) all rats had signs of fibrocartilaginous metaplasia in the supraspinatus tendon. In eight of these specimens even bony metaplasia was seen. The infraspinatus tendon showed fibrosis but no fibro-cartilaginous metaplasia. The results showed that iatrogenic bursitis after carrageenan subacromial injections was associated with marked changes of the supraspinatus tendon.

  • 7.
    Tillander, Bo
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Franzén, Lennart
    Linköping University, Department of Clinical and Experimental Medicine, Molecular and Immunological Pathology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Clinical Genetics.
    Nilsson, Elise
    Department of Pathology, University Hospital of Malmö, Malmö, Sweden.
    Norlin, Rolf
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Human biopsies in the rotator cuff diseaseManuscript (preprint) (Other (popular science, discussion, etc.))
  • 8.
    Tillander, Bo
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Ledin, Torbjörn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Nordqvist, P.
    Melerit Medical AB, Linköping, Sweden.
    Skarman, E.
    Melerit Medical AB, Linköping, Sweden.
    Wahlström, Ola
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    A virtual reality trauma simulator2004In: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 26, no 2, p. 189-191Article in journal (Refereed)
    Abstract [en]

    The authors have evaluated a trauma simulator based on virtual reality techniques. Ten surgeons and 15 medical students performed distal locking of a femoral nail (A). Furthermore, 10 medical students performed simulated osteosynthesis of a femoral neck fracture (B). Total surgery time (A) (mean value) was shorter for surgeons (108 s) compared with students (157 s) at the first (p = 0.033), second (102 respectively 138 s, p = 0.13) and third (96 respectively 160 s, p = 0.15) operation. Total fluoroscopy time (A) (mean value) was shorter for surgeons compared with students at the first (45 respectively 89s p = 0.001), second (48 respectively 83 s, p = 0.02) and third (50 respectively 107 s, p = 0.10) operation. The positioning of the hip nails (B) improved between the first and last trial. Total surgery and fluoroscopy time were reduced. All participants thought that this and similar simulators should be part of the programme and that this simulator would be helpful if they were about to learn the procedures).

  • 9.
    Tillander, Bo
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Norlin, Rolf
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Change of calcifications after arthroscopic subacromial decompression1998In: Journal of shoulder and elbow surgery, ISSN 1058-2746, Vol. 7, no 3, p. 213-217Article in journal (Refereed)
    Abstract [en]

    Fifty patients were reviewed after arthroscopic subacromial decompression. Twenty-five had calcific deposits in the rotator cuff visible on x-ray evaluation. Each patient with calcification was matched with a patient without calcification who had a similar state of the rotator cuff, date of surgery, age, and sex. The calcific deposits were left untouched in all cases. No significant difference was found in the postoperative outcome between the patients in the two groups measured by the Constant score. Before surgery 7 (28%) patients had calcifications of < 5 mm, and 18 (72%) patients had calcifications that were > or = 5 mm. At a 2-year follow-up (n = 24) these figures were 20 (83%) and 4 (17%), respectively (p < 0.001). Postoperative x-ray evaluations revealed a disappearance or decrease in size of the calcific deposits in 19 (79%) of the patients. These results provide new information on the course of calcifying tendinitis, which may indicate that we can leave calcific deposits untouched within the rotator cuff when performing arthroscopic subacromial decompression.

  • 10.
    Tillander, Bo
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Norlin, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Intraoperative measurement of shoulder translation2001In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 10, no 4, p. 358-364Article in journal (Refereed)
    Abstract [en]

    Assessing laxity of the shoulder joint in patients who are under anesthesia is a standard procedure before arthroscopy. The aim of this study was to evaluate a novel instrument for quick and reliable intraoperative measurement of glenohumeral translation. Previous testing of various designs has resulted in a device secured by 1 pin in the acromion and 1 pin in the proximal humerus. These pins are interconnected by a sliding ruler that gives translation values in millimeter increments as the laxity tests are performed. Comparison between manual arbitrary approximation of laxity and instrumented translation measurements showed that manual testing is reasonably good for assessment of anterior and posterior translation, without, however, providing values of translation in millimeter increments. The low correlation between manual assessment and instrumented inferior translation measurements indicates that inferior translation is more difficult to approximate manually. The shoulder translation tester was used in 102 patients. The mean values for clinically stable shoulders (n = 58) were 5 mm for anterior translation, 5 mm for posterior translation, and 4 mm for inferior translation. The corresponding values in unstable shoulders were significantly higher than in the stable shoulders, especially in patients with multidirectional instability. We conclude that the shoulder translation tester is easy and quick to use. It provides quantitative values of translation and will thus contribute information for correct diagnosis, therapy, and documentation.

  • 11.
    Tillander, Bo
    et al.
    Linköping University, Department of Neuroscience and Locomotion.
    Norlin, Rolf
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Intraoperative measurements of the subacromial distance2002In: Arthroscopy : the journal of arthroscopic & related surgery, ISSN 0749-8063, Vol. 18, no 4, p. 347-352Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was 2-fold: to document the accuracy of a new measuring device and to intraoperatively compare the subacromial distance between controls and patients with impingement syndrome before and after arthroscopic subacromial decompression (ASD).

    Type of Study: Clinical study.

    Methods: When performing an ASD, it is important that bone resection is adequate. Today the correct subacromial distance after bone resection is only assessed by eye, directly or indirectly. The subacromial distance was measured between the anterolateral corner of the acromion and the supraspinatus tendon in the lateral decubitus position. The device was inserted 2 to 3 cm below the anterolateral acromion. There was no subacromial pathology among the controls (n = 15, mean age, 28 years). In 30 patients with impingement syndrome (average age, 53 years) an ASD was performed. The subacromial distance was measured after bursectomy and then after bone resection. Intraindividual and interindividual assessment was performed.

    Results: The mean value of the subacromial distance in controls was 16 mm, the 95% confidence limits between 14 and 18 mm. The mean value in the group of patients with impingement syndrome was 8 mm before and 16 mm after the decompression. Due to the pressure within the subacromial space, the subacromial distance increased 1 mm. Intraindividual measurements never varied more than 1 mm (n = 5). The correlation coefficient between the measurements by both authors was 0.99.

    Conclusions: In this study, we assessed and described the use of a measuring device that enables the surgeon to quantify the subacromial distance before and after bone resection. After bone resection, the mean value of the subacromial distance was well within the control values. The amount of bone resected varied from 5 to 13 mm. This new device enables documentation in clinical work as well as in research.

  • 12.
    Ålund, Martin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Hoe-Hansen, Carsten
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Tillander, Bo
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Héden, Bengt-Åke
    Linköping University, Department of Medicine and Care, Radiology. Linköping University, Faculty of Health Sciences.
    Norlin, Rolf
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Outcome after cup hemiarthroplasty in the rheumatoid shoulder: A retrospective evaluation of 39 patients followed for 2-6 years2000In: Acta Orthopaedica Scandinavica, ISSN 0001-6470, Vol. 71, no 2, p. 180-184Article in journal (Refereed)
    Abstract [en]

    33 rheumatoid patients, treated with hemispherical cup resurfacing hemiarthroplasty of the shoulder without medullary fixation (6 bilaterally), were reviewed after mean 4.4 (2-6) years. The median Constant score was 30 (15-79), mean proximal migration of the humerus 5.5 (SD 5.2) mm and mean glenoid erosion 2.6 (SD 1.7) mm. Proximal migration and glenoid erosion did not correlate with shoulder function or pain. Radiographic signs of loosening (changes in cup inclination combined with changes in cup distance above the greater tuberosity) occurred in one quarter of the shoulders. At follow-up, 26 patients were satisfied with the procedure, despite poor shoulder function and radiographic deterioration.

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