Anterior cruciate ligament reconstruction and concomitant procedures in Finland between 2004 and 2018 based on national registers.

BACKGROUND AND PURPOSE: We aimed to assess the incidence of anterior cruciate ligament reconstruction (ACLR) and concomitant procedures in Finland. PATIENTS AND METHODS: We identified all the patients who underwent ACLR between 2004 and 2018 in Finland using national registry data. Patients with an ICD-10 diagnosis code S83.5 and the NOMESCO operation codes NGE30 or NGE35 were included. We recorded the patient's age, sex, Charlson comorbidity index, and concomitant procedures. NGE30 or NGE35 was defined as the main procedure and all other procedures attached to this procedure were included as concomitant procedures. RESULTS: Our study included 37,224 ACLRs. The overall incidence of ACLR was 46 (95%CI 34-62) per 105 person-years. This increased from 38 per 105 person-years in 2004 to its peak of 53 in 2014 before decreasing to 47 by 2018. Male patients had a higher overall incidence of ACLR than female patients (61 [CI 47-78] vs. 32 [CI 22-45] per 105 person-years, respectively). However, this difference changed over time: for the males, a decrease in ACLR incidence was observed after 2014, whereas for the females, the trend increased throughout the study period. For both sexes, the highest incidence of ACLRs was in the age group 16-29 years (159 and 71 per 105 person-years, respectively). Concomitant procedures were performed at the time of ACLR in 32% of cases. CONCLUSION: While the total incidence of ACLR decreased slightly from 2014 to 2018, it increased among women over the full study period, which might be due to increased female participation in contact sports. Special attention should be given to girls' and women's ACL rupture prevention and treatment.

Return to work following anterior cruciate ligament reconstruction.

BACKGROUND AND PURPOSE: Amongst people of working age, the return to work (RTW) after anterior cruciate ligament (ACL) reconstruction is an important marker of success of surgery. We determined when patients are able to return to work after ACL reconstruction and identified factors that are associated with the timing of RTW. PATIENTS AND METHODS: We used logistic regression analyses to examine patient-related factors that may be associated with the length of RTW (above vs. below the median 59 days) after arthroscopic ACLR in a large cohort of patients working in the public sector in Finland (n = 803; n = 334 male, n = 469 female; mean age 41 years [SD 8.6]). RESULTS: The mean length of RTW was 65 days (SD 41). Higher odds ratios (OR) were observed for age groups 40-49 and ≥ 50 years compared with ≤ 30 years old (OR 2.0, 95% confidence interval 1.3-3.1 and 2.0, 1.2-3.4, respectively); for lower level non-manual and manual work compared with higher level non-manual work (3.0, 2.0-4.3 and 4.9, 3.4-7.0, respectively); and for those who had been on sick leave > 30 days in the preceding year (2.0, 1.4-2.9). Sex, comorbid conditions, preceding antidepressant treatment and concomitant procedures were not associated with the length of RTW. INTERPRETATION: Factors associated with prolonged sick leave beyond the median time of 59 days are higher age, lower occupational status, and preoperative sick leaves.

Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial.

OBJECTIVE: To assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus. METHODS: In this multicentre, randomised, participant-blinded and outcome assessor-blinded, placebo-surgery controlled trial, 146 adults, aged 35-65 years, with knee symptoms consistent with degenerative medial meniscus tear and no knee osteoarthritis were randomised to APM or placebo surgery. The primary outcome was the between-group difference in the change from baseline in the Western Ontario Meniscal Evaluation Tool (WOMET) and Lysholm knee scores and knee pain after exercise at 24 months after surgery. Secondary outcomes included the frequency of unblinding of the treatment-group allocation, participants' satisfaction, impression of change, return to normal activities, the incidence of serious adverse events and the presence of meniscal symptoms in clinical examination. Two subgroup analyses, assessing the outcome on those with mechanical symptoms and those with unstable meniscus tears, were also carried out. RESULTS: In the intention-to-treat analysis, there were no significant between-group differences in the mean changes from baseline to 24 months in WOMET score: 27.3 in the APM group as compared with 31.6 in the placebo-surgery group (between-group difference, -4.3; 95% CI, -11.3 to 2.6); Lysholm knee score: 23.1 and 26.3, respectively (-3.2; -8.9 to 2.4) or knee pain after exercise, 3.5 and 3.9, respectively (-0.4; -1.3 to 0.5). There were no statistically significant differences between the two groups in any of the secondary outcomes or within the analysed subgroups. CONCLUSIONS: In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.

Functional results of total-knee arthroplasty versus medial unicompartmental arthroplasty: two-year results of a randomised, assessor-blinded multicentre trial.

OBJECTIVE: The primary objective of the trial was to assess the clinical effectiveness of medial unicompartmental knee arthroplasty versus total knee arthroplasty in patients with isolated medial osteoarthritis of the knee. DESIGN: Prospective, randomised, 2 years, assessor-blind, multicentre, superiority trial. SETTING: The patients were enrolled between December 2015 and May 2018 from the outpatient clinics of three public high-volume arthroplasty hospitals (Finland). PARTICIPANTS: We recruited 143 patients with symptomatic-isolated medial osteoarthritis of the knee needing an arthroplasty procedure. All the patients were suitable for both unicompartmental and total knee arthroplasties. Population was selected as the end-stage-isolated medial osteoarthritis. INTERVENTIONS: All patients, randomized 1:1, received a medial unicompartmental arthroplasty or a total knee arthroplasty through a similar midline skin incision. Patients were blinded to the type of arthroplasty for the whole 2 years of follow-up. MAIN OUTCOME MEASURES: Primary outcome measure was between-group differences in the Oxford Knee Score (OKS) and secondary outcome Knee injury and Osteoarthritis Score (KOOS) at 2 years postoperatively. The changes within and between the groups were analysed with analysis of variance for repeated measurements. RESULTS: The primary outcome was comparable for medial unicompartmental arthroplasty and total knee arthroplasty at 2 years. The mean difference in the OKS between the groups was 1.6 points (95% CI -0.7 to 3.9). In the KOOS subscales, the mean difference between the groups was 0.1 points (95% CI -4.8 to 5.0) for pain, 7.8 points (95% CI 1.5 to 14.0) for symptoms, 4.3 points (95% CI -0.6 to 9.2) for function in daily living, 4.3 points (95% CI -3.0 to 11.6) for function in sports, and 2.1 points (95% CI -4.8 to 9.1) for knee-related quality of life. CONCLUSIONS: The recovery after unicompartmental knee arthroplasty was faster compared with total knee arthroplasty, but unicompartmental arthroplasty did not provide a better patient-reported outcome at 2 years. TRIAL REGISTRATION NUMBER: NCT02481427.

Short-term survival of cementless Oxford unicondylar knee arthroplasty based on the Finnish Arthroplasty Register.

BACKGROUND: Cementless unicondylar knee arthroplasty (UKA) was introduced to secure long-term fixation and reduce the risk of revision. Experience with cementless UKA fixation is limited. METHODS: The short-term survival (up to five years) of cementless Oxford UKA was assessed using data from the Finish Arthroplasty Register and was compared with that of cemented Oxford 3 UKA and total knee arthroplasty (TKA). Datawere obtained, from the Finnish Arthroplasty Register, on 1076 cementless Oxford UKAs and 2279 cemented Oxford 3 UKAs performed for primary osteoarthritis in 2005-2015. The Kaplan-Meier method, with revision for any reason as the endpoint, was used to assess the survival of these two UKA groups, and the results were compared with that of 65,563 cemented TKAs treated for primary osteoarthritis over the same period. The risk of revision of both Oxford prostheses was compared using Cox regression model, with adjustment for age and sex, with the cemented TKA group as reference. RESULTS: The three-year survival was 93.7% for the cementless Oxford, 92.2% for the cemented Oxford 3, and 97.3% for the cemented TKA. The corresponding figures at five years were 92.3%, 88.9%, and 96.6%, respectively. The revision rate for both the cementless Oxford and the cemented Oxford 3 was significantly increased when compared with the cemented TKA (P < 0.001). CONCLUSIONS: The survival of the cementless Oxford method was higher than that of the cemented Oxford 3 in the short term. The overall survival of Oxford UKA was poor in comparison with contemporary TKAs.