Secondary surgeries 20 years after surgical and non-surgical treatment of ACL rupture: A population-based cohort study.

BACKGROUND: Studies with less than 10 years of follow-up have demonstrated no difference between surgical and non-surgical treatment after an anterior cruciate ligament (ACL) rupture; however, long-term effects remain unclear. The aim of this study was to compare the risk of long-term secondary surgical procedures after primary surgical and non-surgical treatment for ACL ruptures. METHODS: Patients aged 18-35, registered in the Danish National Patient Registry with an ACL rupture between January 1, 1996 and December 31, 2000 with a minimum of 20 years follow-up were included. The surgically treated group was defined as receiving an ACL reconstruction within 1 year after diagnosis. Major secondary surgical procedures were defined as subsequent ACL surgeries (reconstruction/revision), arthroplasty, deep infection, arthrodesis, or amputation. Minor secondary surgical procedures were defined as meniscal surgery, synovectomy, and manipulation under anesthesia (MUA). Multivariate regression analysis was performed to assess relative risk (RR), adjusted for age and sex. The results are reported with 95% confidence intervals. RESULTS: 7,539 patients had an ACL rupture; 1,970 patients were surgically treated. In the surgically treated group, 5.9% of patients underwent major secondary surgeries; this was 6.1% in the non-surgically treated group, yielding an adjusted RR of 1.05 (0.85;1.30). There were 43.9% minor secondary surgeries in the surgically treated group and 49.1% in the non-surgically treated group, yielding an adjusted RR of 1.29 (1.20;1.39). CONCLUSIONS: No significant differences in the rate of major secondary surgical procedures between the groups, the non-surgical group was associated with a higher risk of minor secondary surgeries.

Knee Arthroscopy Cohort Southern Denmark (KACS): protocol for a prospective cohort study.

BACKGROUND: Meniscus surgery is a high-volume surgery carried out on 1 million patients annually in the USA. The procedure is conducted on an outpatient basis and the patients leave the hospital a few hours after surgery. A critical oversight of previous studies is their failure to account for the type of meniscal tears. Meniscus tears can be categorised as traumatic or non-traumatic. Traumatic tears (TT) are usually observed in younger, more active individuals in an otherwise 'healthy' meniscus and joint. Non-traumatic tears (NTT) (ie, degenerative tears) are typically observed in the middle-aged (35-55 years) and older population but the aetiology is largely unclear. Knowledge about the potential difference of the effect of arthroscopic meniscus surgery on patient symptoms between patients with traumatic and NTT is sparse. Furthermore, little is known about the natural time course of patient perceived pain, function and quality of life after meniscus surgery and factors affecting these outcomes. The aim of this prospective cohort study is to investigate the natural time course of patient-reported outcomes in patients undergoing meniscus surgery, with particular emphasis on the role of type of symptom onset. METHODS/DESIGN: This prospective cohort study enrol patients assigned for meniscus surgery. At the baseline (PRE surgery), patient characteristics are assessed using an email-based questionnaire also comprising several validated questionnaires assessing general health, knee-specific characteristics and patient's expectations of the surgery. Follow-up will be conducted at 12 and 52 weeks after meniscus surgery. The major outcomes will be differences in changes, from before to 52 weeks after surgery, in each of the five domains on the Knee injury and Osteoarthritis Outcome Score (KOOS) between patients undergoing surgery for traumatic compared with non-traumatic meniscus tears. DISSEMINATION: The study findings will be disseminated in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT01871272.

[Endovascular treatment of ruptured splenic artery aneurysm]. / Endovaskulaert behandlet rumperet aneurisme på arteria lienalis.

Splenic artery aneurysms (SAA) are traditionally treated surgically, but endovascular techniques are becoming increasingly popular. A 64 year-old male with chest pain and low blood pressure was admitted under suspicion of AMI. A CT scan showed a 56 mm SAA with signs of rupture. The patient was treated with endovascular embolisation of the SAA with coils. Blood pressure and haemoglobin levels were stabilized and the patient was discharged. In the case of rupture the treatment of choice seems to be endovascular.