Sclerosing polidocanol injections of small vessels to treat the chronic painful tendon.

The chronic painful tendon (tendinopathy, tendinosis) is generally considered difficult to treat, not seldom causing long-term disability and sometimes ending the sports or work carreér. Most common sites for tendinopathy are the Achilles-, patellar-, extensor carpi radialis brevis (ERCB)-, and supraspinatus tendons. The origin of pain has for many years been unknown, but recently, by using ultrasound (US) + colour Doppler (CD), immunohistochemical analyses of tendon biopsies, and diagnostic injections of local anaestesia, we found a close relationship between areas with vasculo-neural ingrowth and tendon pain. Sensory nerves (Substance-P-SP and Calcitonin Gene Related Peptide-CGRP) were found inside and outside the vascular wall. In following clinical studies we have demonstrated good short-and mid-term clinical results using treatment with US+CD-guided sclerosing polidocanol injections, targeting the area with neovessels outside the tendon. Two-year follow ups have showed remaining good clinical results, and sonographically signs of remodelling with a significantly thinner tendon with a more normal structure. Whether the effects of polidocanol are mediated through destruction of neovessels, activity on nerves or a combination, is under evaluation.

Current physical activity is related to bone mineral density in males but not in females.

The purpose of the present study was to investigate the association between high-, medium-, and low-impact physical activity in males and females at the time of peak bone mineral density in young adulthood. The cohort consisted of 62 male medical students (aged 28.1 +/- 3.9) and 62 female medical students (aged 25.1 +/- 3.9). The bone mineral density (aBMD, g/cm (2)) of the total body, femoral neck, and lumbar spine, and the bone mineral content (BMC, grams) and area (cm (2)) of the femoral neck and lumbar spine was measured using dual energy X-ray absorptiometry. Volumetric BMD (vBMD, mg/cm (3)) of the femoral neck and lumbar spine was estimated. The total amount of physical activity per week, which was recorded in a questionnaire, was divided into high-impact, medium-impact, and low-impact activity. In the male cohort, hours of high-impact physical activity per week was associated with aBMD and BMC of all sites (r=0.27 - 0.53, p<0.05) and bone area of the femoral neck (r=0.38, p<0.01). Total amount of physical activity per week was associated with aBMD of the total body and femoral neck, BMC of femoral neck and lumbar spine, femoral neck vBMD, and the lumbar spine area (p<0.05 for all). Using multiple linear regression, high-impact physical activity was independently associated with aBMD (beta=0.27, p<0.05) and BMC (beta=0.34, p<0.01) of the femoral neck. In the female cohort there was no association between amount or type of physical activity to aBMD, BMC, vBMD, or the bone area of any site. Instead body weight, lean body mass, or fat mass were significantly related to aBMD and all BMC sites in this group. The results of the present study suggest that present physical activity level has a stronger relation to different aspects of bone mass in the male compared to the female adult skeleton.

Relationships between physical activity and physical capacity in adolescent females and bone mass in adulthood.

This study investigates whether physical activity and physical performance in adolescence are positively related to adult bone mineral density (BMD). In 1974, physical activity, endurance, and muscular strength were measured in 204 randomly selected female students, age 16.1 +/- 0.3 year (range 15-17 years). Twenty years later, 36 of the women volunteered to undergo a measurement of their BMD. Women who were members in a sports club in adolescence had significantly higher adult BMD (mean differences of 5% to 17% depending on site) compared with subjects who were not engaged in a sports club. Furthermore, women with persistent weight-bearing activity in adulthood had significantly higher BMD compared with women who had stopped being active or had never been active. The differences ranged between 5% and 19% with the highest difference found in trochanter BMD. Stepwise regression analyses showed that membership in a sports club at baseline was a significant independent predictor of BMD in the total body, lumbar spine, legs, trochanter, and femoral neck, explaining 17-26% of the variation in BMD. Change in body weight was a strong independent predictor of BMD of the total body and arms, explaining 8% of the variation in both sites. In addition, running performance at baseline was an independent predictor of total body BMD, whereas the two-hand lift performance significantly predicted BMD of the total body, legs and trochanter. The hanging leg-lift and handgrip were both significant predictors of arm BMD. In conclusion, membership in a sports club and site-specific physical performance in adolescence together with the change in body weight were significantly associated with adult BMD in premenopausal women.

Positive short-term subjective effect of sports drink supplementation during recovery.

AIM: The aim of this study was to investigate the effects of a naturally composed sports drink containing proteins and carbohydrates used during recovery in competitive badminton players. The hypothesis was that the use of a recovery drink would lead to positive subjective effects, enhanced physical performance and less signs of overtraining. METHODS: During an in-door season 18 badminton players were instructed to drink at least 250 mL of a given sports drink immediately after each training or playing session. The study design was prospective double blind crossover with one active drink and one placebo. The active drink was based on natural products containing whey and orange juice, and the placebo was made of diluted apple juice. Evaluation of effects was done with laboratory tests, self-registered values and field tests. RESULTS: The players perceived statistically significant short-term subjective positive effects after using the active drink, compared with after using placebo. The blood hemoglobin concentration was also higher after the period with active drink. There were no other differences concerning other laboratory tests (leg strength, endurance, body fat percent, lean arm and leg masses), self-registered values (body weight, pulse, training amount and intensity) or field tests (speed, explosive effort, grip strength, endurance and POMS) between the periods with the different sports drinks. CONCLUSIONS: Supplementation with a sports drink during recovery showed a significant short-term subjective positive effect compared with placebo. However, no effects were seen on physical performance or signs of overtraining.

A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopathy.

OBJECTIVES: This non-randomised pilot study investigated the effect of eccentric quadriceps training on 17 patients (22 tendons) with painful chronic patellar tendinopathy. METHODS: Two different eccentric exercise regimens were used by subjects with a long duration of pain with activity (more than six months). (a) Nine consecutive patients (10 tendons; eight men, one woman; mean age 22 years) performed eccentric exercise with the ankle joint in a standard (foot flat) position. (b) Eight patients (12 tendons; five men, three women; mean age 28 years) performed eccentric training standing on a 25 degrees decline board, designed to increase load on the knee extensor mechanism. The eccentric training was performed twice daily, with three sets of 15 repetitions, for 12 weeks. Primary outcome measures were (a) 100 mm visual analogue scale (VAS), where the subject recorded the amount of pain during activity, and (b) return to previous activity. Follow up was at 12 weeks, with a further limited follow up at 15 months. RESULTS: Good clinical results were obtained in the group who trained on the decline board, with six patients (nine tendons) returning to sport and showing a significantly reduced amount of pain over the 12 week period. Mean VAS scores fell from 74.2 to 28.5 (p = 0.004). At 15 months, four patients (five tendons) reported satisfactory results (mean VAS 26.2). In the standard squat group the results were poor, with only one athlete returning to previous activity. Mean VAS scores in this group were 79.0 at baseline and 72.3 at 12 weeks (p = 0.144). CONCLUSION: In a small group of patients with patellar tendinopathy, eccentric squats on a decline board produced encouraging results in terms of pain reduction and return to function in the short term. Eccentric exercise using standard single leg squats in a similar sized group appeared to be a less effective form of rehabilitation in reducing pain and returning subjects to previous levels of activity.

Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up.

OBJECTIVE: To prospectively investigate tendon thickness and tendon structure by ultrasonography in patients treated with eccentric calf muscle training for painful chronic Achilles tendinosis located at the 2-6 cm level in the tendon. METHODS: The patients were examined with grey scale ultrasonography before and 3.8 years (mean) after the 12 week eccentric training regimen. At follow up, a questionnaire assessed present activity level and satisfaction with treatment. RESULTS: Twenty six tendons in twenty five patients (19 men and six women) with a mean age of 50 years were followed for a mean of 3.8 years (range 1.6-7.75). All patients had a long duration of painful symptoms (mean 17.1 months) from chronic Achilles tendinosis before treatment. At follow up, 22 of 25 patients were satisfied with treatment and active in Achilles tendon loading activities at the desired level. Ultrasonography showed that tendon thickness (at the widest part) had decreased significantly (p<0.005) after treatment (7.6 (2.3) v 8.8 (3) mm; mean (SD)). In untreated normal tendons, there was no significant difference in thickness after treatment (5.3 (1.3) mm before and 5.9 (0.8) mm after). All tendons with tendinosis had structural abnormalities (hypoechoic areas and irregular structure) before the start of treatment. After treatment, the structure was normal in 19 of the 26 tendons. Six of the seven patients with remaining structural abnormalities experienced pain in the tendon during loading. CONCLUSIONS: Ultrasonographic follow up of patients with mid-portion painful chronic Achilles tendinosis treated with eccentric calf muscle training showed a localised decrease in tendon thickness and a normalised tendon structure in most patients. Remaining structural tendon abnormalities seemed to be associated with residual pain in the tendon.

Oestrogen receptor alpha gene polymorphism is related to aortic valve sclerosis in postmenopausal women.

OBJECTIVES: Aortic valvular sclerosis (AS) is an inflammatory process and not a result of normal ageing. The sclerotic process is accelerated by risk factors such as smoking and high cholesterol levels. The genetic factors for the development of AS are however unknown. Therefore the purpose of the present study was to investigate whether polymorphisms in the oestrogen receptor alpha (ORalpha) gene and in the transforming growth factor beta (TGF-beta1) gene were related to the presence of AS in postmenopausal women. DESIGN: Case-control study. SUBJECTS AND METHODS: Relationships were tested between polymorphisms in the ORalpha gene defined by the restriction enzymes PvuII and XbaI, and in the TGF-beta1 gene defined by AocI, and AS, lipid levels, and lipoprotein(a) [Lp(a)] in 41 postmenopausal female patients and 41 age- and sex-matched controls. These polymorphisms were also tested in relation to lipid levels and Lp(a), in 99 healthy Caucasian girls, aged 16.9 +/- 1.2 years. RESULTS: In the postmenopausal patients and age-matched controls, the PvuII polymorphism was independently associated with an increased risk of AS [odds ratio (OR) = 3.38; 95% confidence interval (CI) 1.13-10.09). A genotype defined by at least one restriction site in the PvuII polymorphism and two restriction sites in the TGF-beta1 polymorphism was related to a highly significantly increased risk of AS (OR = 4.58; 95% CI 1.68-12.51). In the adolescent female cohort, presence of two restriction sites in the PvuII polymorphism was associated with higher levels of total cholesterol (TC) (P = 0.02), and low-density lipoprotein cholesterol (LDL) (P = 0.04). CONCLUSIONS: We have demonstrated that the PvuII polymorphism in the ORalpha gene is related to both the presence of AS in postmenopausal women and to lipid levels in adolescent females, suggesting that this polymorphism may influence the risk of AS partly by affecting lipid levels.

Predictors of radiological progression and changes in hand bone density in early rheumatoid arthritis.

OBJECTIVE: To identify predictors for radiological and functional outcome and bone loss in the hands in early rheumatoid arthritis (RA) during the first 2 yr of disease and to study the relationship between these variables. METHODS: An inception cohort of consecutively recruited patients was examined at baseline and after 12 and 24 months using X-rays of hands and feet, clinical [28-joint count, Health Assessment Questionnaire (HAQ), global visual analogue scale (VAS), grip strength] and laboratory (erythrocyte sedimentation rate, C-reactive protein, markers of bone formation and resorption) measurements and dual-energy X-ray absorptiometry measurements of the hands. RESULTS: Joint destruction increased significantly during the study, with the Larsen score at baseline as the strongest predictor. Radiological progression and bone loss over 24 months were significantly retarded in patients responding to therapy. The effects of the shared epitope and initial high inflammatory activity on radiological progression were overridden by the therapeutic response. Radiological progression correlated significantly with bone loss. Global VAS, Larsen score and HAQ at inclusion significantly predicted change in HAQ over time. CONCLUSIONS: Radiological progression and bone loss were retarded by early therapeutic response. Bone loss was related to radiological progression.

TNF-alpha gene polymorphism and plasma TNF-alpha levels are related to lumbar spine bone area in healthy female Caucasian adolescents.

OBJECTIVE: The cytokine tumor necrosis factor alpha (TNF-alpha) is an important regulator of bone metabolism. Polymorphisms in the promoter region of the TNF-alpha gene at positions -308 and -863 have been identified. We investigated whether these polymorphisms and circulating TNF-alpha levels were related to bone mineral density and bone area in adolescent girls. DESIGN: Bone mineral density (BMD), bone area (BA), anthropometric characteristics and biochemical analyses were measured in adolescent girls and compared with regard to TNF-alpha genotype. METHODS: Allelic variants of the TNF-alpha gene in 97 girls, aged 16.9+/-1.2 years (mean+/-S.D.), were identified using polymerase chain reaction and the restriction endonucleases NcoI and TaiI. Bone mineral density and bone area of the femoral neck, lumbar spine and total body were measured using dual energy X-ray absorptiometry. RESULTS: Carriers of the rare -863 A allele (n=25) had higher body weight (P=0.03), lumbar spine BMD (P=0.02), and larger total BA (P=0.03), femoral neck area (P<0.05), and lumbar spine area (P=0.01). The independent predictors of BMD and BA were investigated using multiple regression. The TNF-alpha-863 genotypes (beta=0.18, P=0.03) and the TNF-alpha plasma levels (beta=0.19, P=0.04) independently predicted BA of the lumbar spine but not BA or BMD of any other measured sites. No statistically significant differences in body constitution parameters, biochemical parameters, bone density, or bone area at the measured skeletal sites were found when comparing the groups defined by the allelic variants at position -308 (P=0.17-0.84). CONCLUSIONS: We found the TNF-alpha-863 polymorphism and the TNF-alpha plasma levels to be independent predictors of lumbar spine area in healthy Caucasian adolescent females.

Injuries in adolescent female players in European football: a prospective study over one outdoor soccer season.

In this prospective study, injuries in 153 adolescent female soccer players were recorded during one outdoor season (April-October). The overall injury incidence rate was 6.8 per 1000 h soccer (games and practice) and the incidence rate of traumatic injury 9.1 and 1.5 per 1000 player-hours in games and practice, respectively. Sixty-three players (41%) sustained 79 injuries. Sixty-six percent of the injuries were traumatic and 34% were overuse injuries. Most of the traumatic injuries occurred during games. Eighty-nine percent of the injuries were located in the lower extremities and 42% occurred in the knee or ankle. The most frequent type of injury was ankle sprain (22.8%). Forty-one percent of the traumatic injuries and 56% of the ankle sprains were re-injuries. Most of the injuries were of moderate severity (52%), while 34% were minor and 14% were major. Most of the major injuries were traumatic such as knee ligament injuries and ankle sprains.

In vivo microdialysis and immunohistochemical analyses of tendon tissue demonstrated high amounts of free glutamate and glutamate NMDAR1 receptors, but no signs of inflammation, in Jumper's knee.

This investigation describes, to our knowledge, the first experiment where the microdialysis technique was used to study certain metabolic events in human patellar tendons in combination with immunohistochemical analyses of tendon biopsies. In five patients (four men and one woman) with a long duration (range 12-36 months) of pain symptoms from Jumper's knee (localized tenderness in the patellar tendon verified as tendon changes with ultrasonography or MRI), and in five controls (four men and one woman) with normal patellar tendons, a standard microdialysis catheter was inserted into the patellar tendon under local anestesia. The local concentrations of glutamate (excitatory neurotransmitter) and prostaglandin E2 (PGE2) were registered under resting conditions. Samplings were done every 15 min during a 2 h period. In all individuals (patients and controls) biopsies were taken for immunohistochemical analyses. The results showed that it was possible to detect and measure the concentrations of glutamate and PGE2 in the patellar tendon with the use of microdialysis technique. There were significantly higher concentrations of free glutamate, but not PGE2, in tendons with tendinosis compared to normal tendons. In the biopsies, there were no inflammatory cell infiltrates, but, for the first time, it was shown that there was immunoreaction for the glutamate receptor NMDAR1 in association with nerve structures in human patellar tendons. These findings altogether indicate that glutamate might be involved in painful Jumper's knee, and further emphasizes that there is no chemical inflammation (normal PGE2 levels) in this chronic condition.

Vitamin D receptor gene polymorphism is related to bone density, circulating osteocalcin, and parathyroid hormone in healthy adolescent girls.

Bone mineral density (BMD) in adolescence is under strong genetic control and may influence the risk of future osteoporosis and resulting fracture. We investigated the vitamin D receptor (VDR) gene polymorphisms ApaI, BsmI, FokI, and TaqI, in relation to BMD, circulating calcium, osteocalcin, and parathyroid hormone (PTH) concentrations in healthy Caucasian girls (n = 99; mean (+/- SD) age 16.9 +/- 1.2 years). BMD of the total body, femoral neck, and lumbar spine, and bone area of the femur, lumbar spine, and total body were measured using dual energy X-ray absorptiometry. BMD values were adjusted for age, body height, body weight, and physical activity. Using ANOVA, the ApaI genotype Aa had lower circulating levels of osteocalcin (P < 0.01), higher levels of PTH (P = 0.04), and there was a strong tendency toward a significantly higher lumbar spine BMD (P = 0.08) compared with aa subjects. BMD of the lumbar spine (P = 0.02), but not femoral neck or total body, was higher in Bb subjects compared with their bb counterparts. There was no difference in BMD at any measured site of the FokI alleles. There was a strong tendency for a higher BMD at the lumbar spine of Tt subjects compared with TT subjects (P = 0.05). Neither of the different VDR polymorphisms was related to BMD before adjustment for age, body weight, body height, and physical activity. In conclusion, VDR gene polymorphism, defined by ApaI, is related to differences in circulating osteocalcin and PTH, and BsmI is related to lumbar spine BMD in healthy adolescent girls. The results stress the importance of adjusting BMD for confounding factors, such as body weight and physical activity, in order to be able to find any genotype effect on BMD.

Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation.

Chronic Achilles tendinosis is a condition with unknown aetiology and pathogenesis, most often, but not always, associated with painful nodular thickening of the tendon. In this investigation, 28 tendons (21 patients) with a painful nodule located at the 2-6 cm level in the tendon, and 20 normal (pain-free) tendons, were examined with grey-scale ultrasonography combined with colour Doppler examination. In all tendons with a painful nodule, but not in any of the normal pain-free tendons, neovascularisation was seen in the area with tendon changes (localised widening of the tendon with focal hypo-echoic areas). In tendons with advanced changes, vessels were seen through the entire widened part of the tendons, and both arterial and venous blood flows were registered. The neovascularisation found in this investigation might have implications on the pathogenesis of chronic Achilles tendinosis.

Good clinical results but persisting side-to-side differences in calf muscle strength after surgical treatment of chronic Achilles tendinosis: a 5-year follow-up.

We have prospectively studied calf muscle strength (isokinetic concentric and eccentric muscle strength at 90 degrees/s and 225 degrees/s of angular velocity in 24 patients (17 males and 7 females, mean age 43.0 years) surgically treated for chronic Achilles tendinosis (at the 2-6 cm level in the tendon). The mean follow-up time was 5 years (range 31-82 months). Surgery was followed by immobilization in a weight-bearing below the knee plaster cast for 2-6 weeks, followed by a stepwise increasing strength training programme. Strength measurements (peak torque) were done preoperatively, and 1 and 5 (mean) years postoperatively. Preoperatively, concentric plantar flexion peak torque at 90 degrees/s and 225 degrees/s and eccentric plantar flexion torque at 90 degrees/s were significantly lower (12.3%, 19.7% and 8.5% respectively) on the injured side compared to the non-injured side. Postoperatively, at the 5-year follow-up, 22 out of 24 patients (92%) were satisfied with the operation and active at their desired level (running, tennis, badminton, walking). There was no significant increase in concentric and eccentric calf muscle strength postoperatively. Concentric plantar flexion peak torque at 90 degrees/s and 225 degrees/s and eccentric plantar flexion peak torque at 90 degrees/s were still significantly lower (7.2%, 8.6% and 8.8% respectively) on the injured side compared to the non-injured side. In conclusion it seems that the calf muscle strength deficit seen on the injured side preoperatively in this group of patients remains despite 92% of the patients being pain-free and active in sports or at recreational level after the operation. However, the percentage side-to-side difference is relatively low, and might not have any clinical relevance.

Glutamate NMDAR1 receptors localised to nerves in human Achilles tendons. Implications for treatment?

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.

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.

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.

Calcium sensing receptor gene polymorphism, circulating calcium concentrations and bone mineral density in healthy adolescent girls.

OBJECTIVE: Bone mineral density (BMD) in adolescence is under strong genetic control. The calcium sensing receptor (CASR) is involved in the regulation of calcium homeostasis and bone resorption. The A986S polymorphism of the CASR has recently been associated with serum calcium levels, in one hitherto unconfirmed report. We investigated whether this polymorphism was related to BMD, circulating calcium and parathyroid hormone (PTH) concentrations in girls. DESIGN: BMD, plasma calcium and serum PTH were measured in adolescent girls and compared with regard to CASR genotype. METHODS: In 97 healthy Caucasian girls (mean age 16.9+/-1.2 years (mean+/-s.d.)), the A and S alleles were determined using PCR with a mismatched primer and the restriction enzyme BsaHI. BMD (g/cm) of the total body, humerus, femoral neck and lumbar spine was measured using dual energy X-ray absorptiometry. RESULTS: The genotype frequencies were 71% AA, 26% AS and 3% SS. The genotypes were divided into presence (29%) or absence of S allele (71%). Subjects with the S allele had higher levels of plasma calcium, corrected for albumin (2.17+/-0.06>2.14+/-0.06; P < 0.05, using independent samples t-test), lower BMD at the lumbar spine (P=0.02) and total body (P=0.04), and were significantly less physically active (2.9+/-2.6 vs 4.3+/-2.6 h/week; P=0.01) than the subjects lacking the S allele. PTH levels were not significantly different between the two allelic groups. A multiple regression analysis, including age, height, weight and physical activity, revealed that the CASR allelic variants were not independent predictors of BMD at any site measured (beta=-0.03-0.09; P>0.05). Physical activity was an independent predictor of BMD, was significantly different between the CASR genotypes, and could therefore have a role in explaining the difference in BMD between the CASR genotypes. CONCLUSIONS: The CASR alleles are related to BMD, but it cannot be definitely concluded whether the CASR polymorphism has a direct influence on BMD, or whether the differences in BMD were mediated via an influence of the amount of physical activity.

Autologous periosteum transplantation for the treatment of full thickness patellar cartilage defects.

Full-thickness patellar cartilage defects are often, but not always, associated with disabling anterior knee-pain and inability to take part in regular daily activities. There is no treatment of choice for this condition. It is well known that the cells in the cambium layer of the periosteum are pluripotent and can differentiate into hyaline (or hyaline-like) cartilage, especially if in a joint environment and under the influence of continous passive motion. In a few clinical studies autologous periosteum transplants alone have been used in the treatment of full thickness patellar cartilage defects. The results are varying. At our clinic, autologous periosteum transplantation alone, followed by continous passive motion (CPM) in the immediate postoperative period and non-weight bearing loading for 3 months, has shown promising clinical results. The best clinical results have been achieved on traumatic (fracture, contusion, dislocation) cartilage defects, where 83% of patients have been clinically graded as excellent or good at follow-up (> 2 years postoperatively). For non-traumatic patellar cartilage defects (chondromalacia NUD) the results are poor, with only 35% of patients being graded as excellent or good. Therefore, we believe that no-traumatic patellar cartilage defects (chondromalacia NUD) are less suitable for treatment with autologous periosteum transplants, and are at our clinic not any longer included for this type of treatment.

Bone mineral density and muscle strength in female ice hockey players.

The purpose of this study was to investigate bone mineral density (BMD) at different sites in female ice hockey players as well as to study the relationship between BMD, muscle strength, and body composition parameters. The study group consisted of 14 female ice hockey players (age 22.2 +/- 4.3 years) which was compared with 14 inactive females (age 21.5 +/- 3.8 years). The two groups were matched for age and weight. Areal bone mineral density was measured in total body, head, lumbar spine, femoral neck, Ward's triangle and the trochanter, using dual energy X-ray absorptiometry. Body composition parameters were derived from the total body scan. Isokinetic concentric peak torque of the left quadriceps and hamstrings muscles was measured using an isokinetic dynamometer. Compared to the inactive group, the ice hockey players had significantly higher BMD of all of the bone sites measured, except for the head, (total body 6.9%, head -2.6%, lumbar spine 8.9%, femoral neck 17.6%, Ward's triangle 20.4%, and trochanter 21.7%). The hockey players also had significantly higher peak torque in the quadriceps and hamstrings muscles. In the ice hockey group, a significant positive correlation was found between BMD of the femoral neck and hamstrings peak torque at 225 degreesisecond (r = 0.67, P < 0.01). In the inactive group, significant positive correlations were found between BMD and peak torque in the hamstrings muscles (90 degrees/second: r = 0.6-0.8, P<0.05 (total body, trochanter) and P<0.01 (spine, neck), 225 degrees/second: r = 0.5-0.8, P<0.05 (total body, Ward's triangle, trochanter) and P< 0,01 (spine, neck)). In the inactive group significant positive correlations was also found between lean body mass and BMD of the trochanter (r = 0.58, P < 0.05). In young females it appears that training and playing ice hockey might influence BMD and muscle strength in a positive direction. The correlation between BMD and muscle strength seems to weaken with increased exercise level.