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  • 1. Alexandersson, Maria
    et al.
    Wang, Eugen Yuhui
    Eriksson, Staffan
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi. Centre for Clinical Research Sörmland, Uppsala University, Kungsgatan 41, 631 88 Eskilstuna, Sweden; Department of Neuroscience, Physiotherapy, Uppsala University, Box 593, 751 24 Uppsala, Sweden.
    A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study2019Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, nr 4, s. 1035-1042Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: When a tourniquet is used during surgery on the extremities, the pressure applied to the muscles, nerves and blood vessels can cause neuromuscular damage that contributes to postoperative weakness. The hypothesis was that the rehabilitation-related results would be improved if total knee arthroplasty (TKA) is performed without the use of a tourniquet.

    Methods: 81 patients with osteoarthritis of the knee who underwent TKA surgery were randomized to surgery with or without tourniquet. Active flexion and extension of the knee, pain by visual analog scale (VAS), swelling by knee circumference, quadriceps function by straight leg raise, and timed up and go (TUG) test results were measured before and up to 3 months after surgery.

    Results: ANCOVA revealed no between-groups effect for flexion of the knee at day 3 postsurgery. Compared with the tourniquet group, the nontourniquet group experienced elevated pain at 24 h, with a mean difference of 16.6 mm, p = 0.005. The effect on mobility (TUG test) at 3 months was better in the nontourniquet group, with a mean difference of -1.1 s, p = 0.029.

    Conclusions: The hypothesis that the rehabilitation-related results would be improved without a tourniquet is not supported by the results. When the results in this study for surgery performed with and without tourniquet are compared, no clear benefit for either procedure was observed, as the more pain exhibited by the nontourniquet group was only evident for a short period and the improved mobility in this group was not at a clinically relevant level.

    Level of evidence: Inconsistent results, Level II.

  • 2.
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Idrottsmedicin.
    Reply to the letter from Dr. Karsten Knobloch regarding our article "Sclerosing injections to treat midportion Achilles tendinosis: a randomized controlled study evaluating two different concentrations of polidocanol"2009Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 17, nr 1, s. 113-114Artikel i tidskrift (Övrigt vetenskapligt)
  • 3.
    Alfredson, Håkan
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Forsgren, Sture
    Umeå universitet, Medicinsk fakultet, Integrativ medicinsk biologi, Anatomi.
    Thorsen, Kim
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Fahlström, Martin
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Johansson, Håkan
    Lorentzon, Ronny
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Glutamate NMDAR1 receptors localised to nerves in human Achilles tendons. Implications for treatment?2001Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 9, nr 2, s. 123-126Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this investigation, we show the presence of both free glutamate (microdialysis) and glutamate NMDAR1 receptors (immunohistochemical analyses of tendon biopsies), in tendons from patients with chronic Achilles tendon pain (Achilles tendinosis) and in controls (pain-free tendons). The NMDAR1 immunoreaction was usually confined to acetylcholinesterase-positive structures, implying that the reaction is present in nerves. Glutamate is a potent pain mediator in the human central nervous system, and in animals it has been shown that peripherally administered glutamate NMDA receptor antagonists diminish the response to formalin-induced nociception. Our present finding of glutamate NMDA receptors in human Achilles tendons might have implications for pain treatment.

  • 4.
    Alfredson, Håkan
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Lorentzon, Ronny
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Intratendinous glutamate levels and eccentric training in chronic Achilles tendinosis: a prospective study using microdialysis technique.2003Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 11, nr 3, s. 196-199Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Microdialysis has shown intratendinous glutamate levels to be significantly higher in Achilles tendons with painful tendinosis than in normal pain-free tendons, and treatment with eccentric training has shown good clinical results with diminished tendon pain during activity. In six patients with chronic painful Achilles tendinosis we performed microdialysis for 2 h, before and after the 12-week eccentric training program. The treatment was successful in all six patients, and the mean VAS score (amount of pain during Achilles tendon loading) decreased from 69 before treatment to 17 after treatment. There was no significant difference between the intratendinous glutamate levels before and after treatment. Our results offer no obvious neurophysiological explanation but showed that successful treatment with eccentric training was not associated with lowered intratendinous glutamate levels.

  • 5.
    Alfredson, Håkan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Superior results with continuous passive motion compared to active motion after periosteal transplantation: A retrospective study of human patella cartilage defect treatment1999Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 7, nr 4, s. 232-238Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Fifty-seven consecutive patients (33 men and 24 women), with a mean age of 32 years (range 16-53 years), who suffered from an isolated full-thickness cartilage defect of the patella and disabling knee pain of long duration, were treated by autologous periosteal transplantation to the cartilage defect. The first 38 consecutive patients (group A) were postoperatively treated with continuous passive motion (CPM), and the next 19 consecutive patients (group B) were treated with active motion for the first 5 days postoperatively. In both groups, the initial regimens were followed by active motion, slowly progressive strength training, and slowly progressive weight bearing. In group A, after a mean follow-up of 51 months (range 33-92 months), 29 patients (76%) were graded as excellent or good, 7 patients (19%) were graded as fair, and 2 patients (5%) were graded as poor. In group B, after a mean follow-up of 21 months (range 14-28 months), 10 patients (53%) were graded as excellent or good, 6 patients (32%) were graded as fair, and 3 patients (15%) were graded as poor. Altogether, nine of the fair or poor cases (50%) were diagnosed with chondromalacia of the patella. Our results, after performing autologous periosteal transplantation in patients with full-thickness cartilage defects of the patella and disabling knee pain, are good if CPM is used postoperatively. The clinical results using active motion postoperatively are not acceptable, especially not in patients with chondromalacia of the patella.

  • 6.
    Alfredson, Håkan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Thorsen, Kim
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    In situ microdialysis in tendon tissue: high levels of glutamate, but not prostaglandin E2 in chronic Achilles tendon pain1999Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 7, nr 6, s. 378-381Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This investigation was to our knowledge the first to use the microdialysis technique to study concentrations of substances in a human tendon. In four patients (mean age 40.7 years) with a painful nodule in the Achilles tendon (chronic Achilles tendinosis) and in five controls (mean age 37.2 years) with normal Achilles tendons (confirmed by ultrasonography) the local concentrations of glutamate and prostaglandin E2 were measured under resting conditions. A standard microdialysis catheter was inserted into the Achilles tendon under local anesthesia. Sampling was performed every 15 min over a 4-h period. The results showed significantly higher concentrations of glutamate in tendons with tendinosis than in normal tendons (196 +/- 59 vs. 48 +/- 27 mumol/l, P < 0.05), and there were no significant changes in glutamate concentration over the period of investigation. There were no significant differences in the mean concentrations of prostaglandin E2 (83 +/- 22 vs. 54 +/- 24 pg/ml) between tendons with tendinosis and normal tendons. In conclusion, in situ microdialysis appears a useful method to study certain metabolic events in tendon tissue. The higher concentrations of the excitatory neurotransmitter glutamate in Achilles tendons with a painful nodule may possibly be involved in the pain mechanism in this chronic condition. Furthermore, there were no signs of inflammation in the tendons with painful nodules, as indicated by the normal prostaglandin E2 levels.

  • 7.
    Alfredson, Håkan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Thorsen, Kim
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Treatment of tear of the anterior cruciate ligament combined with localised deep cartilage defects in the knee with ligament reconstruction and autologous periosteum transplantation.1999Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 7, nr 2, s. 69-74Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An acute tear of the anterior cruciate ligament (ACL) is frequently associated with injuries to the joint cartilage and subchondral bone. These injuries may progress to deep cartilage defects, causing disabling pain, and represent a therapeutic challenge in patients with the combination instability and pain. At our clinic we treat patients with the combined injury with simultaneous ACL reconstruction and autologous periosteum transplantation of the cartilage defect. This report describes the technique for periosteum transplantation of full-thickness cartilage defects in the medial femoral condyle. Our clinical report includes the first 7 patients (6 men and 1 woman, mean age 29.1 years at operation) who have been followed for 2 years or longer of 14 consecutive patients (12 men and 2 women). All patients had suffered a total tear of the ACL and a full-thickness defect of the cartilage at the medial femoral condyle. The cartilage defects had a mean area of 7.3 cm2 (range 1.0-13.5 cm2). All patients had disabling instability and medial knee pain when walking. The anterior cruciate ligament was reconstructed with a bone-tendon-bone graft of the central third of the patellar ligament. After preparation of the cartilage lesion, the periosteum transplant was anchored to the underlying bone with suture anchors and fibrin glue. Postoperatively, these patients (n = 7) were initially treated with continuous passive motion, followed by active flexibility training and slowly progressing strength training and weight-bearing activities. At follow-up a mean of 31.3 months (range 24-38 months) later, 6 patients evidenced subjectively stable knees, no pain during rest or when walking, and had returned to not too heavy knee-loading work. One patient had a subjectively stable knee, but felt medial knee pain. Meticulous surgical technique and rigorous postoperative rehabilitation are probably of the greatest importance in this procedure. With the use of suture anchors and fibrin glue, the periosteum transplant can be well adapted to the condylar subchondral bone bed.

  • 8.
    Alfredson, Håkan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Öhberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Sclerosing injections to areas of neo-vascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomised controlled trial2005Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 13, nr 4, s. 338-344Artikel i tidskrift (Refereegranskat)
  • 9.
    Andersson, Gustav
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi.
    Danielson, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Forsgren, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Nerve-related characteristics of ventral paratendinous tissue in chronic Achilles tendinosis2007Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 15, nr 10, s. 1272-1279Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Ultrasound and Doppler examination has shown high blood flow-neovascularisation inside and outside the ventral Achilles tendon in chronic painful tendinosis, but not in pain-free normal Achilles tendons. In patients with Achilles tendinosis, injections with the sclerosing substance polidocanol, targeting the areas with increased blood flow, have been demonstrated to give pain relief. A drawback when interpreting these findings is the fact that the pattern of nerve supply in the target area, i.e. the ventral area of the tendon, is so far unknown. In this study, therefore, tissue specimens from this area, obtained during surgical treatment of patients with chronic painful midportion Achilles tendinosis, were examined. In the examined area, containing loose connective tissue, the general finding was a presence of large and small arteries and nerve fascicles. The nerve fascicles were distinguished in sections processed for the pan-neural marker protein gene-product 9.5. The nerve fascicles contain sensory nerve fibers, as shown via staining for the sensory markers substance P (SP) and calcitonin gene-related peptide, and sympathetic nerve fibers as seen via processing for tyrosine hydroxylase. In addition, there were immunoreactions for the SP-preferred receptor, the neurokinin-1 receptor, in blood vessel walls and nerve fascicles. Some of the blood vessels were supplied by an extensive peri-vascular innervation, sympathetic nerve fibers being a distinct component of this innervation. There was also a marked occurrence of immunoreactions for the alpha1-adrenoreceptor in arterial walls as well as in the nerve fascicles. Altogether, these findings suggest that the area investigated is under marked influence by the nervous system, including sympathetic and sensory components. Thus, sympathetic/sensory influences may be involved in the pain mechanisms from this area. In conclusion, the nerve-related characteristics of the area targeted by the polidicanol injection treatment for Achilles tendinosis, are shown here for the first time.

  • 10.
    Bjerke, Joakim
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Department of Physiotherapy, Faculty of Health and Social Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
    Öhberg, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Nilsson, Kjell G
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Stensdotter, Ann-Katrin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. epartment of Physiotherapy, Faculty of Health and Social Sciences, Norwegian University of Science and Technology, Trondheim, Norway .
    Walking on a compliant surface does not enhance kinematic gait asymmetries after unilateral total knee arthroplasty2016Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, nr 8, s. 2606-2613Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To investigate gait asymmetries and the effect of walking on compliant surfaces in individuals with unilateral total knee arthroplasty (TKA), hypothesizing that asymmetries would increase as an effect of the compliant surface.

    METHODS: Individuals with unilateral TKA ~19 months post-operative (n = 23, median age 59 years) recruited from one orthopaedic clinic and age- and gender-matched healthy individuals without knee complaints (n = 23, median age 56 years) walked at comfortable speed on a hard surface and on a compliant surface. 3D kinematic analyses were made for knee and hip angles in sagittal and frontal planes, stance time, step length, and gait velocity.

    RESULTS: Shorter stance time (p < 0.01) and less peak knee flexion (p < 0.001) at weight bearing acceptance was found in the prosthetic side compared with the contralateral side. Larger knee (p < 0.01) and hip (p < 0.001) adduction was found compared with healthy controls. Neither asymmetries between the prosthetic and the contralateral side nor differences compared with healthy controls were enhanced when walking on compliant surfaces compared with hard surfaces.

    CONCLUSION: The TKA group adapted their gait to compliant surfaces similarly to healthy controls. Gait asymmetries in the TKA group observed on hard surface were not enhanced, and adduction in hip and knee joints did not increase further as an effect of walking on compliant surfaces. Thus, unfavourable knee joint loading did not increase when walking on a compliant surface. This implies that recommendations for walking on soft surfaces to reduce knee joint loading are not counteracted by increased gait asymmetries and unfavourable joint loading configurations.

    LEVEL OF EVIDENCE: III.

  • 11.
    Brax-Olofsson, Lisbeth
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Svensson, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Lindström, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Periosteal transplantation to the rabbit patella.2007Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 15, nr 5, s. 560-563Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Autologous periosteal transplantation (without chondrocyte cell transplantation) for treating traumatic articular cartilage defects of the patella gives pain relief in uncontrolled clinical studies. To study the whole transplanted area macroscopically and microscopically, animal studies are motivated. In this pilot study, we reproduce the surgical technique for periosteum transplantation on human patella to a rabbit model. A full-thickness cartilage defect of the whole patella was created in eight adult female rabbits. The defect was treated with autologous periosteal transplantation. After surgery, the rabbits were allowed free activity. This is the difference compared to the treatment in humans, where our group uses CPM for 5 days and non-weight-bearing for 12 weeks. After 21 weeks, there was a diffuse synovitis in all transplanted knees, and in five of eight knees there were signs of osteoarthritis in the patello-femoral joint. Histologically, in three animals, small islands of hyaline cartilage surrounded by fibrocartilage were seen in the transplanted area. In the other five animals, fibrocartilage was the predominant tissue. In contrast to previous experimental studies using a rabbit model, we did not achieve hyaline cartilage resurfacing.

  • 12.
    Danielson, Patrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Forsgren, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi. Anatomi.
    Distribution of general (PGP 9.5) and sensory (substance P/CGRP) innervations in the human patellar tendon.2006Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 14, nr 2, s. 125-132Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is no information on the pattern of blood vessel innervation, and in principle no information on innervation in general, in the human patellar tendon. In the present study, biopsies from the proximal part of normal and pain-free patellar tendons (11 men, mean age 33 years) were examined. The specimens were evaluated by using antibodies against the general nerve marker protein gene-product 9.5 (PGP 9.5) and the sensory neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP), and immunohistochemistry. It was observed that the arteries, and to some extent the small vessels, in the loose paratendinous connective tissue were supplied with PGP 9.5- as well as SP- and CGRP-innervations. There was a marked PGP 9.5-like immunoreaction (LI), and to some extent also SP- and CGRP-LI, in the large nerve fascicles in this tissue. In the tendon tissue proper, PGP 9.5-LI was detected in nerve fibers located in the vicinity of some of the blood vessels and in thin nerve fascicles. There was a low degree of SP- and CGRP-innervation in the tendon tissue proper. The observations give a morphologic correlate for the occurrence of nerve-mediated effects in the patellar tendon. Particularly it seems as if there is a marked nerve-mediated regulation of the blood vessels supplying the tendon, at the level where they course in the loose paratendinous connective tissue.

  • 13.
    Danielson, Patrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi.
    Andersson, Gustav
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi.
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Forsgren, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi.
    Marked sympathetic component in the perivascular innervation of the dorsal paratendinous tissue of the patellar tendon in arthroscopically treated tendinosis patients.2008Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 16, nr 6, s. 621-6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    During the recent years, a few studies have shed new light on the innervation patterns of the human patellar tendon, but the area of the loose paratendinous connective tissue dorsal to the proximal tendon proper has yet not been investigated. That is a drawback, since this is the area targeted in promising treatment regimens of chronic painful patellar tendinosis, namely sclerosing Polidocanol injection therapy, and a new surgical method conforming to ultrasound and color Doppler guided arthroscopic shaving, directed at neovessels found in the region. The present study thus aimed at investigating the paratendinous area dorsal to the proximal patellar tendon proper in seven patients being operated for tendinosis. Biopsies were collected through the new arthroscopic technique, approaching the tendon from the dorsal side. Samples were investigated using immunohistochemistry with antibodies delineating general (PGP 9.5), sensory (SP/CGRP), and sympathetic (TH/NPY) nerve patterns, and also antibodies against alpha1- and alpha2A-adrenoreceptors. Both small and large blood vessels had a marked perivascular innervation (PGP 9.5). Surprisingly, this perivascular innervation was found only to a very limited extent to correspond to sensory nerves, while there were marked immunoreactions for sympathetic markers. Adrenoreceptor immunoreactions frequently occurred in blood vessel walls. In conclusion, this study demonstrates, for the first time, the innervation patterns of the area dorsal to the patellar tendon in man. It shows that the area investigated is under marked influence by the sympathetic nervous system. Thus, sympathetic effects are likely to occur for blood vessels of the area, which is interesting since color Doppler has revealed that vessels of this area ("neovessels") display a pathologically high blood flow in tendinosis. The findings are discussed in relation to aspects of vascular regulation, and to pain symptoms of tendinosis.

  • 14.
    Fahlström, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Jonsson, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Chronic Achilles tendon pain treated with eccentric calf-muscle training2003Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 11, nr 5, s. 327-333Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Injuries involving the Achilles tendon and manifested as chronic tendon pain are common, especially among recreational athletes. In a pilot study on a small group of patients with chronic painful midportion Achilles tendinosis, eccentric calf-muscle training was shown to give good clinical results. The aim of this prospective study was to investigate if the previously achieved good clinical results could be reproduced in a larger group of patients, and also to investigate the effects of eccentric calf-muscle training in patients with chronic insertional Achilles tendon pain. Seventy-eight consecutive patients, having chronic painful Achilles tendinosis at the mid-portion (2–6 cm level) in a total of 101 tendons (55 unilateral and 23 bilateral), and thirty consecutive patients with chronic insertional Achilles tendon pain in 31 tendons (29 unilateral and one bilateral) were treated with eccentric calf-muscle training for 12 weeks. Most patients were recreational athletes. Evaluation of the amount of tendon pain during activity was recorded on a visual analogue scale (VAS), before and after treatment. In 90 of the 101 Achilles tendons (89%) with chronic painful mid-portion Achilles tendinosis, treatment was satisfactory and the patients were back on their reinjury activity level after the 12-week training regimen. In these patients, the amount of pain during activity, registered on the VAS-scale (mean±SD), decreased ignificantly from 66.8±19.4 to 10.2±13.7. On the contrary, in only ten of the tendons (32%) with chronic insertional Achilles tendon pain was treatment satisfactory, with a significant decrease on the VAS-scale (mean±SD), from 68.3±7.0 to 13.3±13.2. Our conclusion is that treatment with eccentric calf-muscle training produced good clinical results in patients with chronic painful mid-portion Achilles tendinosis, but not in patients withchronic insertional Achilles tendon pain.

  • 15.
    Fahlström, Martin
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Lorentzon, Ronny
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Alfredson, Håkan
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Painful conditions in the Achilles tendon region: a common problem in middle-aged competitive badminton players.2002Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 10, nr 1, s. 57-60Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Overuse injuries are the most frequent type in badminton, generally localized in the legs. An earlier study found 32% of young Swedish elite badminton players to have experienced disabling pain in the Achilles tendon region during the previous 5 years. The present investigation examined the prevalence and characteristics of painful conditions in the Achilles tendon region in 32 middle-aged competitive badminton players by means of questionnaire and physiotherapist's examination. Pain in the Achilles tendon region was reported by 44%, either presently or during the past 5 years, generally localized in the middle portion of the tendon. Symptoms had lasted 2 weeks-1 year (96 days). On the competition days 22% of the reported pain currently in the region. Age was found to be correlated to Achilles tendon pain, but there was no relationship between symptoms of pain and body mass index, gender, training quantity, or years of playing badminton. In conclusion, Achilles tendon pain seems to be relatively common among Swedish middle-aged competitive badminton players, particularly in the older ones.

  • 16.
    Ferry, Tomas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Bergström, Ulrica
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Hedström, Erik M
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Zeisig, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Epidemiology of acute knee injuries seen at the Emergency Department at Umeå University Hospital, Sweden, during 15 years2014Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 22, nr 5, s. 1149-1155Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To describe the incidence and injury distribution of knee injuries in the general population of a European setting. METHODS: Retrospective study of all knee injuries registered at the Emergency Department at Umeå University Hospital, Sweden, during 1995-2009 in relation to age, sex, diagnosis, location and activity at the time of injury, mechanism of injury, and treatment and/or follow-up plan. RESULTS: During 1995-2009, 12,663 knee injuries were registered, 8 % of all injuries. The incidence of knee injuries resulting in a visit to the Emergency Department was six cases per 1,000 person years. One-third of all injuries occurred during sports. And 30 % were 15-24 years. More men than women were injured during sporting activities and women were mostly injured during transportation. CONCLUSION: Knee injuries in a general population are common and the injury distribution varies with age and sex. Sports activities and young age were prominent features of the injured population. LEVEL OF EVIDENCE: IV.

  • 17.
    Gisslén, Karl
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Ohberg, Lars
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Diagnostisk radiologi.
    Alfredson, Håkan
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Is the chronic painful tendinosis tendon a strong tendon?: a case study involving an Olympic weightlifter with chronic painful Jumper's knee.2006Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 14, nr 9, s. 897-902Artikel i tidskrift (Refereegranskat)
  • 18. Henricson, Anders
    et al.
    Wojtowicz, Radek
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Nilsson, Kjell G
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Crnalic, Sead
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Uncemented or cemented femoral components work equally well in total knee arthroplasty2019Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, nr 4, s. 1251-1258Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To study the pattern of migration and clinical results up to 10 years of uncemented versus cemented fixation of the femoral component in total knee arthroplasty.

    METHODS: Randomized controlled trial was conducted of 41 patients (23 women, 18 men) under the age of 60 years using radiostereometric analysis.

    RESULTS: About two-thirds of the cemented implants and half of the uncemented implants stabilized between 2 and 10 years, while the remainder displayed a small annual increase of maximum total point motion of 0.09-0.10 mm/year. At 10 years there were no statistically significant differences in migration or clinical results between the groups.

    CONCLUSION: Uncemented fixation with titanium fiber mesh coating of the femoral component in total knee arthroplasty works equally as well as cemented fixation up to 10 years. An annual migration of 0.1 mm seems compatible with excellent long-term performance.

    LEVEL OF EVIDENCE: I.

  • 19.
    Jonsson, Per
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Wahlström, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi.
    Ohberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Eccentric training in chronic painful impingement syndrome of the shoulder: results of a pilot study2006Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 14, nr 1, s. 76-81Artikel i tidskrift (Refereegranskat)
  • 20.
    Lorentzon, Ronny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Hildingsson, Christer
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Treatment of deep cartilage defects of the patella with periosteal transplantation1998Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 6, nr 4, s. 202-208Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Twenty-six consecutive patients (19 men and 7 women) with a mean age of 31.5 years (range 19-52 years) who suffered from an isolated full-thickness cartilage defect of the patella (area ranged from 0.75 to 20.0 cm2) and disabling knee pain were treated with autologous periosteal transplantation (without any chondrocytes). The duration of symptoms was 59 months (range 11-144 months). During the first 5 postoperative days all patients were treated with continuous passive motion (CPM). This was followed by active motion, slowly progressive strength training, and slowly progressive weight-bearing. After a mean follow-up of 42 months (range 24-76 months), 17 patients (65%) were graded as excellent (were painfree), 8 patients (31%) as good (had pain with strenuous knee-loading activities), and 1 patient as poor (had pain at rest). Twenty-two patients (85%) had returned to their previous occupation. Twelve patients (46%) had resumed sports or recreational activities at their former level. Repeated magnetic resonance imaging (MRI) investigations showed progressive, and finally complete, filling of the articular defects. Biopsies taken in five randomly selected cases showed hyaline-like cartilage. Patients with full-thickness cartilage defects of the patella and disabling knee pain can be treated with autologous periosteal transplantation (without any chondrocytes), followed by CPM, and slowly progressive strength training and weight-bearing. We believe this is a good method to accomplish regeneration of articular cartilage and satisfactory clinical results.

  • 21.
    Lysholm, Jack
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Henriksson, Marketta
    Tegner, Yelverton
    In memoriam Jan Gillquist 1934-20162016Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, nr 9, s. 2719-2720Artikel i tidskrift (Övrigt vetenskapligt)
  • 22.
    Made, Curt
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap.
    Elmqvist, Lars-Gunnar
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap.
    Telemark skiing injuries: an 11-year study2001Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 9, nr 6, s. 386-391Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study evaluated telemark injuries in a Swedish ski area in terms of injury ratio, location, and causes over time. During the seasons of 1989-2000 all injured telemark skiers (n=94) who attended the medical center in Tärnaby, Sweden, within 48 h after the accident were registered and asked to fill in an injury form. A control group of noninjured telemark skiers were interviewed in the season of 1999-2000. The most common cause of injury was fall (70%) and the injury ratio was 1.2. There was a higher proportion of beginners in the injured population, and they had a fall/run ratio of 0.7, compared with 0.3 for average and advanced skiers. Ankle/foot injuries were most common (28% of injuries) followed by knee (20%) and head/neck (17%). The ankle/foot injuries decreased from 35% to 22% in the seasons 1989-1995 to 1995-2000. Beginners had more ankle/foot injuries than skilled participants. The severity of ankle/foot injuries classified as the Abbreviated Injury Scale group 2 or higher decreased from 33% to 21% during the study period. Twenty-seven percent used plastic and 73% leather boots. We found no association between boot material and ankle/foot injuries. The proportion of high boots with two or more buckles was 51%. High boots appeared to be protective against ankle/foot injuries. The proportion of high boots increased from 24% to 67% during the study period. Thus ankle/foot injuries were the most common injury location, but have decreased over time. The severity of these injuries has also decreased. A possible explanation could be the increased use of high boots.

  • 23.
    Mafi, Nader
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Lorentzon, Ronny
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis.2001Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 9, nr 1, s. 42-47Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In a previous uncontrolled pilot study we demonstrated very good clinical results with eccentric calf muscle training on patients with painful chronic Achilles tendinosis located at the 2-6 cm level in the tendon. In the present prospective multicenter study (Sundsvall and Umeå) patients with painful chronic Achilles tendinosis at the 2-6 cm level in the tendon were randomized to treatment with either an eccentric or a concentric training regimen for the calf muscles. The study included 44 patients, with 22 patients (12 men, 10 women; mean age 48 years) in each treatment group. The amount of pain during activity (jogging or walking) was recorded by the patients on a visual analogue scale, and patient satisfaction was assessed before and after treatment. The patients were instructed to perform their eccentric or concentric training regimen on a daily basis for 12 weeks. In both types of treatment regimen the patients were told to do their exercises despite experiencing pain or discomfort in the tendon during exercise. The results showed that after the eccentric training regimen 82% of the patients (18/22) were satisfied and had resumed their previous activity level (before injury), compared to 36% of the patients (8/22) who were treated with the concentric training regimen. The results after treatment with eccentric training was significantly better (P<0.002) than after concentric training. The good clinical results previously demonstrated in the pilot study with eccentric calf muscle training on patients with chronic Achilles tendinosis, were thus reproduced in this multicenter, showing superior results to treatment with concentric training.

  • 24.
    Markström, Jonas L.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Tengman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    ACL-reconstructed and ACL-deficient individuals show differentiated trunk, hip, and knee kinematics during vertical hops more than 20 years post-injury2018Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, nr 2, s. 358-367Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Little is known regarding movement strategies in the long term following injury of the anterior cruciate ligament (ACL), and even less about comparisons of reconstructed and deficient knees in relation to healthy controls. The present purpose was to compare trunk, hip, and knee kinematics during a one-leg vertical hop (VH) ~20 years post-ACL injury between persons treated with surgery and physiotherapy (ACLR), solely physiotherapy (ACLPT), and controls (CTRL). Between-leg kinematic differences within groups were also investigated.

    METHODS: Sixty-six persons who suffered unilateral ACL injury on average 23 ± 2 years ago (32 ACLR, 34 ACLPT) and 33 controls performed the VH. Peak trunk, hip, and knee angles during Take-off and Landing phases recorded with a 3D motion capture system were analysed with multivariate statistics.

    RESULTS: Significant group effects during both Take-off and Landing were found, with ACLPT differing from CTRL in Take-off with a combination of less knee flexion and knee internal rotation, and from both ACLR and CTRL in Landing with less hip and knee flexion, knee internal rotation, and greater hip adduction. ACLR also presented different kinematics to ACLPT and CTRL in Take-off with a combination of greater trunk flexion, hip flexion, hip internal rotation, and less knee abduction, and in Landing with greater trunk flexion and hip internal rotation. Further, different kinematics and hop height were found between legs within groups in both Take-off and Landing for both ACL groups, but not for CTRL.

    CONCLUSION: Different kinematics for the injured leg for both ACL groups compared to CTRL and between treatment groups, as well as between legs within treatment groups, indicate long-term consequences of injury. Compensatory mechanisms for knee protection seem to prevail over time irrespective of initial treatment, possibly increasing the risk of re-injury and triggering the development of osteoarthritis. Detailed investigation of movement strategies during the VH provides important information and a more comprehensive evaluation of knee function than merely hop height. More attention should also be given to the trunk and hip in clinics when evaluating movement strategies after ACL injury.

    LEVEL OF EVIDENCE: Prospective cohort study, Level II.

  • 25. Naili, Josefine E
    et al.
    Iversen, Maura D.
    Esbjörnsson, Anna-Clara
    Hedström, Margareta
    Schwartz, Michael H.
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Broström, Eva W.
    Deficits in functional performance and gait one year after total knee arthroplasty despite improved self-reported function2017Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 25, nr 11, s. 3378-3386Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The current literature lacks sufficient information about improvements in gait patterns and function after total knee arthroplasty (TKA) and whether patients return to full function. This study evaluated change in gait, performance-based function, and self-reported function 1 year after TKA in patients with symptomatic knee osteoarthritis and how these aspects interrelate.

    METHODS: A total of 28 patients (64 % female) with knee osteoarthritis, with a mean age of 66 (±7) years, and 25 age- and gender-matched controls participated in this prospective cohort study. Three-dimensional gait analysis generated comprehensive measures of kinematic and kinetic gait deviations, respectively. Participants completed the Five Times Sit-to-Stand (5STS) test, and the self-reported questionnaire Knee Injury and Osteoarthritis Outcome Score (KOOS), at baseline prior to surgery and 1 year after TKA.

    RESULTS: Kinetic gait deviations of both the operated and non-operated limb persisted in patients with knee osteoarthritis at 1 year after surgery, while kinematic gait patterns were comparable to controls. Performance on the 5STS and KOOS scores in patients with knee osteoarthritis improved significantly 1 year after surgery (effect size 0.5-1.5), but did not reach the level of controls. Ten patients with knee osteoarthritis (36 %) exceeded the minimally detectable change on the 5STS.

    CONCLUSION: Measures of overall gait patterns and the 5STS revealed improvements in function 1 year after TKA, but were not restored to the level of healthy controls. Based on change in 5STS performance, we identified patients with substantial improvements in gait patterns. Self-reported measures of function could not detect differences between patients improving in 5STS performance and those who did not. These findings highlight the use of the 5STS in clinical practice since improvement on this test seems to follow the reduction in gait pattern deviations.

    LEVEL OF EVIDENCE: II.

  • 26. Stålman, Anders
    et al.
    Sköldenberg, Olof
    Martinez-Carranza, Nicolas
    Roberts, David
    Högström, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Sports Medicine Umeå AB.
    Ryd, Leif
    No implant migration and good subjective outcome of a novel customized femoral resurfacing metal implant for focal chondral lesions2018Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, nr 7, s. 2196-2204Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Managing focal cartilage injuries in the middle-aged patient poses a challenge. Focal prosthetic inlay resurfacing has been proposed to be a bridge between biologics and conventional joint arthroplasty. Patient selection and accurate implant positioning is crucial to avoid increased contact pressure to the opposite cartilage surface. A customized femoral condyle implant for focal cartilage injuries was designed to precisely fit each patient’s individual size and location of damage. The primary objective was to assess implant safety profile, surgical usability of the implant and instruments, and implant migration with radiostereometric analysis (RSA). Methods: Ten patients 36–56 years with focal chondral defects, ICRS 3–4 of the femoral cartilage and failed earlier conservative or surgical interventions with VAS pain > 40. The patients were followed for 2 years with subjective outcome measures (VAS, EQ5D, KOOS) and RSA. The customized implant and guide instruments were manufactured by computer-aided design/computer-aided manufacturing (CAD/CAM) techniques using MRI data. Results: VAS, EQ5D and KOOS showed improvements that reached significance for VAS (p ≤ 0.001), Tegner (p = 0.034) and the KOOS subscores ADL (p = 0.0048), sport and recreation (p = 0.034) and quality of life (p = 0.037). VAS and KOOS scores improved gradually at 3, 6 and 12 months. The improvements in EQ5D, KOOS pain and KOOS symptoms did not reach statistical significance. No infections, deep venous thrombosis or other complications occured in the postoperative period. No radiographic signs of damage to the opposing tibial cartilage was noted. The surgical usability of implants and instruments were good. RSA did not show any implant migration. Conclusion: This is the first clinical report of a new customized, focal knee resurfacing system. The short-term implant safety and patient-related outcome measures showed good-to-excellent results. Level of evidence: Prospective case series, Level 4.

  • 27. Sunding, Kerstin
    et al.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Werner, Suzanne
    Forssblad, Magnus
    Willberg, Lotta
    Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler: using a four-grade scale2016Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 24, nr 6, s. 1988-1996Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: In tendon research, using ultrasound (US), studies often refer to tendon thickness, structural abnormalities and neovascularisation. The reliability concerning these measurements and evaluations is seldom reported. The aim of this study was to assess the intra- and inter-observer reliability for quantitative measures (thickness) and qualitative evaluations (structure and neovascularisation) of symptomatic and asymptomatic Achilles and patellar tendons with US and colour Doppler using a modified Öhberg score.

    METHODS: Twenty-eight consecutive patients with symptomatic and asymptomatic Achilles (n = 27) and patellar tendons (n = 26) were included. Tendon anteroposterior thickness was measured. Tendon structure and neovascularisation were evaluated using a modified Öhberg score. US-images were evaluated twice by four independent observers.

    RESULTS: Mean thickness for Achilles and patellar tendons was 8.4 mm (±2.0) and 5.5 mm (±1.7), respectively. The reliability for measures of distance was high all over (ICC = 0.963-0.999). A moderate-strong correlation was found between observers concerning evaluation of neovascularisation (r = 0.767-0.992) and poor-moderate correlation concerning evaluation of structural changes (r = 0.379-0.837). Intra-observer reliability was moderate strong for evaluations of both tendon structure (k = 0.537-0.873) and neovascularisation (k = 0.639-0.864).

    CONCLUSIONS: With a strict method for how to measure tendon thickness and set criteria for evaluating structural changes and amount and distribution of neovascularisation, US and colour Doppler is a reliable method for evaluating Achilles and patellar tendons. The modified, 4-graded, Öhberg score was found to be a reproducible instrument for assessment of tendon structure and neovascularisation.

  • 28. Sunding, Kerstin
    et al.
    Willberg, Lotta
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Werner, Suzanne
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Forssblad, Magnus
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Sclerosing injections and ultrasound-guided arthroscopicshaving for patellar tendinopathy: good clinical results and decreased tendon thickness after surgery-a medium-term follow-up study2015Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 23, nr 8, s. 2259-2268Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Treatment of patellar tendinopathy/jumper's knee with ultrasound-guided sclerosing injections or ultrasound-guided arthroscopic shaving has shown good clinical short-term results. Former studies indicate that the tendon thickness and structure stays unaffected after successful treatment. The aim of this study was to evaluate the sonographic findings and clinical outcome 3-5 years after treatment of patellar tendinopathy with ultrasound-guided sclerosing injections or arthroscopic shaving.

    METHODS: Fifty-seven patellar tendons (43 patients) with chronic patellar tendinopathy were evaluated, with ultrasound, colour Doppler (CD) and visual analogue scale (VAS) for pain and satisfaction with treatment, 3-5 years after treatment. Functional status was evaluated with a single question-"Back in full loading activity?" yes or no.

    RESULTS: At endpoint (mean 46 months), there was a significant decrease in anteroposterior thickness of the proximal patellar tendon in patients treated with ultrasound-guided arthroscopic shaving but not after sclerosing injections. Tendon structure had improved, and CD local blood flow had diminished significantly in both groups. There were good clinical results with a significant decrease in VAS for pain after sclerosing injections (VAS 64 ± 18 → 17 ± 23) with 74 % satisfied patients and also after arthroscopic shaving (VAS 77 ± 16 → 13 ± 23) with 80 % satisfied patients. There were no significant differences in VAS between groups. A significant correlation between low local blood flow and high patient satisfaction was found.

    CONCLUSIONS: Tendon thickness decreased over time after ultrasound-guided arthroscopic shaving, and tendon structure and local blood flow decreased after both treatments. There were good, and similar, clinical results with both methods. LEVEL OF EVIDENCE: III.

  • 29.
    Söderman, Kerstin
    et al.
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Sjukgymnastik. Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Alfredson, Håkan
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Pietilä, Tom
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Werner, S
    Risk factors for leg injuries in female soccer players: a prospective investigation during one out-door season.2001Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 9, nr 5, s. 313-321Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The following possible risk factors for leg injuries in female soccer players were studied: age, anatomical alignment, generalized joint laxity, thigh muscle torque, muscle flexibility, ligamentous laxity of the knee and ankle joints, recent injuries, and duration of soccer exposure. A total of 146 players from 13 teams in the second and third Swedish divisions underwent clinical examination, isokinetic measurements of quadriceps and hamstring torques, and testing of postural sway of the legs. All soccer-related leg injuries resulting in absence from at least one scheduled practice session or game were recorded during one outdoor season (April-October). In 50 players there were 61 traumatic injuries, and 17 players sustained 19 overuse injuries. The overall injury incidence rate (traumatic and overuse) was 5.49/1000 h of soccer. Variables significantly increasing the risk of traumatic leg injuries included generalized joint laxity, low postural sway of the legs, hyperextension of the knee joint, and a low hamstring-to-quadriceps ratio during concentric action. Multivariate logistic regression showed hyperextension of the knee joint, a low postural sway, reduced H/Q ratio during concentric action, and a higher exposure to soccer to significantly increase the risk of traumatic leg injury. All five players who suffered an anterior cruciate ligament injury during the study period had a lower hamstring-to-quadriceps ratio during concentric action on the injured side than on their noninjured side.

  • 30.
    Söderman, Kerstin
    et al.
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Sjukgymnastik. Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Werner, S
    Pietilä, Tom
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Engström, B
    Alfredson, Håkan
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Balance board training: prevention of traumatic injuries of the lower extremities in female soccer players? A prospective randomized intervention study.2000Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 8, nr 6, s. 356-363Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This prospective randomized intervention investigated whether training on a balance board could reduce the amount of traumatic injuries of the lower extremities in female soccer players. A total of 221 female soccer players from 13 different teams playing in the second and third Swedish divisions volunteered to participate in the study. Seven teams (n = 121) were randomized to an intervention group and six teams (n = 100) to a control group and were followed during one outdoor season (April-October). Before and after the season muscle flexibility and balance/postural sway of the lower extremities were measured in the players. There were no significant differences in age, height, weight, muscle flexibility and balance/postural sway of the lower extremities between the intervention and the control group. During the season the players in the intervention group performed a special training program consisting of 10-15 min of balance board training in addition to their standard soccer practice and games. After a 37% drop-out the intervention group consisted of 62 players and the control group of 78 players. The results showed no significant differences between the groups with respect either to the number, incidence, or type of traumatic injuries of the lower extremities. The incidence rate of "major" injuries was higher in the intervention group than in the control group. Four of five anterior cruciate ligament injuries occurred in the intervention group, which means that we could not prevent severe knee injuries in female soccer players with balance board training. However, among the players who had been injured during the 3-month period prior to this investigation there were significantly more players from the control group than from the intervention group who sustained new injuries during the study period.

  • 31.
    Willberg, Lotta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Sunding, Kerstin
    Öhberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Forssblad, Magnus
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Sclerosing injections to treat midportion Achilles tendinosis: a randomised controlled study evaluating two different concentrations of Polidocanol.2008Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 16, nr 9, s. 859-864Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Two to three ultrasound (US) and colour Doppler (CD)-guided injections of the sclerosing substance Polidocanol (5 mg/ml) have been demonstrated to give good clinical results in patients with chronic midportion Achilles tendinopathy. This study aimed to investigate if a higher concentration of Polidocanol (10 mg/ml) would lead to a less number of treatments, and lower volumes, needed for good clinical results. Fifty-two consecutive Achilles tendons (48 patients, mean age 49.6 years) with chronic painful midportion Achilles tendinopathy, were randomised to treatment with Polidocanol 5 mg/ml (group A) or 10 mg/ml (group B). The patients and treating physician were blinded to the concentration of Polidocanol injected. All patients had structural tendon changes and neovascularisation in the Achilles midportion. Treatment was US + CD-guided injections targeting the region with neovascularisation (outside ventral tendon). A maximum of three treatments (6-8 weeks in between) were given before evaluation. Patients not satisfied after three treatments were given additional treatment with Polidocanol 10 mg/ml, up to five treatments. For evaluation, the patients recorded the severity of Achilles tendon pain during activity on a visual analogue scale (VAS), before and after treatment. Patient satisfaction with treatment was also assessed. At follow-up (mean 14 months) after three treatments, 18/26 patients in group A and 19/26 patients in group B were satisfied with the treatment and had a significantly reduced level of tendon pain (P < 0.05). After completion of the study, additional treatments with Polidocanol 10 mg/ml in the not satisfied patients resulted in 26/26 satisfied patients in both groups A and B. In summary, we found no significant differences in the number of satisfied patients, number of injections or volumes given, between patients treated with 5 or 10 mg/ml Polidocanol.

  • 32.
    Zeisig, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Natural course in tennis elbow-lateral epicondylitis after all?2012Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 20, nr 12, s. 2549-2552Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Tennis elbow is a common and difficult-to-treat condition largely because of lack of evidence. The natural history is unknown, but the condition is described as self-limiting. The objective of this case report is to describe the natural course of two control participants (pain free), who later developed tennis elbow, patient history, clinical findings, and ultrasound and colour Doppler examination before, during and after a period of tennis elbow.

  • 33.
    Zeisig, Eva
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Öhberg, Lars
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper.
    Alfredson, Hakan
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Extensor origin vascularity related to pain in patients with Tennis elbow2006Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 14, nr 7, s. 659-663Artikel i tidskrift (Refereegranskat)
  • 34.
    Zeisig, Eva
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Öhberg, Lars
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper.
    Alfredson, Håkan
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Sclerosing polidocanol injections in chronic painful tennis elbow: promising results in a pilot study2006Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 14, nr 11, s. 1218-1224Artikel i tidskrift (Refereegranskat)
  • 35. Åman, Malin
    et al.
    Forssblad, Magnus
    Larsén, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi.
    National injury prevention measures in team sports should focus on knee, head, and severe upper limb injuries2019Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, nr 3, s. 1000-1008Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To examine acute injuries in licensed floorball, football, handball, and ice hockey players in all ages nationwide in Sweden, and to identify the most common and severe injuries in each body location and recommend injury prevention measures.

    Methods: Using national sport insurance data from years 2006–2015 was the incidence and proportion of acute injuries, and injuries leading to permanent medical impairment (PMI), calculated in the four team sports. The most common injury type and injured body part was identified, with a particular focus of the severe injuries. Comparison between sexes was made.

    Results: In total, there were 92,162 registered injuries in all sports together. Knee injuries were most common, and also had the highest incidence of PMI, in all ball sports and in female ice hockey players. In male ice hockey, the most common injury was a dental and face injury, and PMI injuries were mostly in the shoulder. The most severe PMI injuries were rare and most often a face/eye injury in male floorball and ice hockey, a concussion in female ice hockey, and a knee injury in female floorball, and in both sexes in football and handball.

    Conclusions: To achieve the greatest impact in reducing the adverse effects of acute sport injuries nationwide in Sweden, preventive measures should focus on knee injuries in all the investigated team sports. The severe head/face and upper limb injuries also need attention. Protective equipment, neuromuscular training programs, rules enforcements, and fair-play interventions may reduce the incidence of injuries

  • 36.
    Öhberg, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Alfredson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis?2004Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 12, nr 5, s. 465-470Artikel i tidskrift (Refereegranskat)
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