Adolescents with prior patellar dislocation report affected quality of life and function, as measured using the Banff Patella Instability Instrument, Kujala and EQ-5D-5L index scores.

PURPOSE: We aimed to establish patient-reported outcome measure (PROM) reference data for a cohort of patients with prior patellar dislocation without previous knee surgery. METHODS: All inhabitants of the Faroe Islands aged 15-19 years were sent an online survey via secure email to establish a national cohort. They were asked to answer questions regarding demographics, whether they had prior patellar dislocation and to complete the PROMs: the Banff Patella Instability Instrument (BPII), Kujala, Marx activity and EQ-5D-5L questionnaires. Participants who had undergone knee surgery were excluded. Participants who had prior patellar dislocation underwent radiographic examinations to diagnose trochlear dysplasia. The study included three cohorts: the general population, prior patellar dislocation and prior patellar dislocation and trochlear dysplasia cohorts. RESULTS: Of the 3749 individuals contacted, 1119 completed the survey and responded to at least one PROM. Of these, 102 reported a history of patellar dislocation and 57 of them had trochlear dysplasia. All PROMs, except the Marx score, reflected a worse quality of life and function after patellar dislocation than in the general population cohort; this was most pronounced in the BPII. The percentage of people experiencing problems in EQ-5D-5L dimensions was higher in the patellar dislocation and trochlear dysplasia cohorts than in the general population cohort in all EQ-5D-5L domains, except anxiety/depression. CONCLUSION: Adolescents who had patellar dislocation reported reduced quality of life and function according to the BPII, Kujala and EQ-5D-5L index values, as well as all EQ-5D-5L domains, except for anxiety/depression. However, their activity levels remained high. LEVEL OF EVIDENCE: Level III.

High prevalence of patellar dislocation and trochlear dysplasia in a geographically and genetically isolated society: an observational national cohort study from the Faroese Knee Cohort.

BACKGROUND AND PURPOSE: We aimed to calculate the prevalence of patellar dislocation (PD) and trochlear dysplasia (TD) in a national cohort aged 15-19 years in the Faroe Island. PATIENTS AND METHODS: All inhabitants in the Faroe Islands aged 15-19 years were invited to answer an online survey, including demographics and questions regarding prior PD. Participants with prior PD were invited for radiographs and MRI of both knees to be taken. Trochlear dysplasia was defined as one of the following: Dejour type A-D on radiographs, lateral trochlear inclination angle (LTI) < 11°, or trochlear depth < 3 mm on MRI. RESULTS: 3,749 individuals were contacted, 41 were excluded, and 1,638 (44%) completed the survey. 146 reported a prior PD (the PD cohort) and 100 accepted to participate and have radiographs and MRI taken of both knees (the clinical PD cohort), 76 of whom were diagnosed with TD. The national prevalence of PD was 8.9%. The national prevalence of symptomatic TD was 6.8%. The prevalence of TD in the clinical PD cohort was 76%. TD was bilateral in 78% of TD patients, but only 27% of patients with bilateral TD had PD in both knees. CONCLUSION: The prevalence of PD in the Faroe Islands is found to be very high. The national prevalence of TD and the prevalence of TD in participants with prior PD is high, indicating a potential genetic influence.

[Sunflower oil is efficient for removing bitumen in asphalt burn of head and hands].

This case report describes a 56-year-old male asphalt worker who was admitted to the emergency department after a work accident, where a pipe exploded and splashed 160 °C hot bitumen over his face and hands. Bitumen is the black adhesive component in asphalt, and it is soluble in oil. It was successfully removed with sunflower oil without damaging the skin. The patient only got a second-degree burn on his left hand and first-degree burns on the right hand and face. He was discharged three days after admission, and there was no durable injury.

The Influence of Graft Fixation Methods on Revision Rates After Primary Anterior Cruciate Ligament Reconstruction.

BACKGROUND: The method of graft fixation in primary anterior cruciate ligament (ACL) reconstruction is important for initial stability of the graft. Poor graft fixation can result in failure of the reconstruction. The effect of ACL graft fixation principles and fixation implant combinations on the risk of revision after ACL reconstruction is not well understood. PURPOSE: The study aimed to compare the risk of revision among 4 categories of femoral fixation divided by their principle of function using a hamstring tendon (HT) graft only. Furthermore, this study aimed to compare the risk of revision among the most frequently used combinations (tibia and femur) of graft fixation implants in a national patient cohort. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The authors divided the femoral fixation constructs into 4 categories by their principle of function: cortical suspensory fixation, adjustable cortical suspensory fixation, intratunnel transfixation, and interference screw (aperture) fixation. Data on revision rates and graft fixation methods were extracted from the Danish ACL Reconstruction Registry. The study included patients who underwent primary ACL reconstruction with either an HT or patellar tendon (PT) graft and were followed up at 2 to 10 years. Revision rates at 2-year and full follow-up were extracted for the category of graft fixation in the femur as well as for the most common implant combinations (those involving >175 patients). Patients with infrequently used fixation devices were excluded from this analysis. The HT group included 14 frequently used combinations (n > 175), and there were 2 such combinations in the PT group. A total of 13,200 ACL reconstructions were included in the study. For ACL reconstruction with an HT graft, there were 4680 with cortical suspensory fixation, 577 with adjustable cortical suspensory fixation, 5921 with intratunnel transfixation, and 617 with interference screw fixation. There were 1405 ACL reconstructions with a PT graft. RESULTS: When only comparing primary ACL reconstructions using an HT graft, cortical suspensory fixation exhibited a significantly higher risk of revision at 2-year follow-up than the other categories of femoral fixation (hazard ratio [HR], 1.24 [95% CI, 1.07-1.44]; P < .05). Intratunnel transfixation exhibited a significantly lower risk of revision (HR, 0.83 [95% CI, 0.73-0.94]; P < .05). Comparing the most frequently used femoral/tibial fixation implant combinations with the mean risk of revision, Endobutton/Intrafix and Endobutton/Biosure PEEK for HT grafts exhibited an increased risk of revision, with an relative risk (RR) of 1.36 (95% CI, 1.03-1.81; P < .05) and 1.55 (95% CI, 1.15-2.09; P < .05), respectively. The Atlantech metal screw/metal screw and Softsilk/Softsilk combinations (both for PT grafts) exhibited a significantly decreased risk of revision, with an RR of 0.41 (95% CI, 0.18-0.91; P < .05) and 0.36 (95% CI, 0.15-0.87; P < .05), respectively. CONCLUSION: When comparing ACL graft fixation methods in the 4 categories using an HT graft, cortical suspensory fixation was found to have a significantly increased risk of revision, while intratunnel transfixation exhibited a lower risk of revision. Both Endobutton/Intrafix and Endobutton/Biosure PEEK implant combinations exhibited a significantly higher risk of revision. For PT grafts, Atlantech metal screw/metal screw and Softsilk/Softsilk exhibited a significantly lower risk of revision.