A screening instrument for side dominance in competitive adolescent alpine skiers.

Previous research has shown that high school ski students injure their left anterior cruciate ligament (ACL) more often than their right ACL, and that a prevention program focusing on equal load to the right and left ski turns prevents ACL injuries. Whether the injuries were in the dominant or non-dominant side of ski students was not determined but may be important knowledge to ski coaches for future design of ski-specific training programs. There is no gold standard on how to investigate the dominant side of alpine skiers. Therefore, the aim of this study was to develop a screening instrument consisting of five questions for identifying side dominance and to evaluate side dominance in competitive adolescent alpine skiers. First, 121 competitive adolescent alpine skiers answered the questions on side dominance using a test-retest design. The questions were: which hand/arm (left/right) or foot/leg (left/right) one uses as the first choice when writing, throwing, kicking a ball, jumping over a fence and stair-climbing. A question about safer/better ski turn to the left or to the right was also added. Second, 274 skiers answered the questions at one occasion. A very good agreement was shown in writing and throwing and kicking a ball, and a fair agreement was shown in jumping over a fence and stair climbing. A total of 243 skiers reported right-sided dominance, and seven skiers reported left-sided dominance. One hundred and nineteen of the 121 skiers who took part in the test-retest design answered the question safer/better ski turn, and of those 70 (59%) reported that they had a safer/better ski turn to one side than to the other side. However, the side was not consistent between the two test occasions, and the question did not correlate with side dominance. A combination of the three questions "What hand/arm do you use as first choice when writing?" "What hand/arm do you use as first choice when throwing?" and "What foot/leg do you use as first choice when kicking a ball?", may be used to decide side dominance in adolescent alpine skiers. Most adolescent alpine skiers reported right-sided dominance.

Home training with or without joint mobilization compared to no treatment: a randomized controlled trial.

[Purpose] To investigate if joint mobilization in patients with subacromial pain syndrome has additional benefits to a home training program on shoulder function and pain, and to compare home training to no physical therapy. [Participants and Methods] Eighty-nine primary care patients (mean age 45 years) with subacromial pain syndrome during an average of 23 weeks. Home training was performed twice a day during a 12 week period. One of the intervention groups received add-on shoulder joint mobilization to the home training. A third group did not receive any physical therapy. Constant-Murley score, pain and active range of motion was evaluated at baseline, 6 weeks, 12 weeks and 6 months. [Results] The total Constant-Murley score revealed no significant differences between groups at any time point. All groups improved over time. The add-on joint mobilization group reached clinical important change at 12 weeks. The subscale pain showed that both intervention groups reported less pain after 12 weeks compared to the reference group. [Conclusion] Home training is not superior to no treatment evaluated with the total Constant-Murley score. However, home training with or without add-on joint mobilization may decrease pain compared to no treatment.

Bilateral ultrasound findings in patients with unilateral subacromial pain syndrome.

BACKGROUND: Subacromial pain syndrome is a common musculoskeletal shoulder problem. The accuracy of clinical tests is low and techniques such as ultrasound and magnetic resonance imaging have been added to set up a diagnosis. Previous researchers have usually only examined the symptomatic shoulder. However, there might be similar findings in the asymptomatic shoulder. OBJECTIVE: The aim of the present study was to investigate the prevalence of structural abnormalities of both shoulders in patients with clinically diagnosed unilateral subacromial pain syndrome using diagnostic ultrasound. METHODS: Bilateral ultrasound examinations were performed in 115 consecutive patients, 54 men and 61 women. The patients were recruited from primary care centers in the area of Stockholm, Sweden. RESULTS: Abnormal ultrasound findings were found in both shoulders and increased with age (p = .0004). Bursitis was the most common ultrasound finding and significantly more prevalent in the symptomatic shoulder compared to the asymptomatic shoulder (90%:74%; p = .0021), though 73% of the bursitis were bilateral. Supraspinatus is the most vulnerable tendon of the rotator cuff in both shoulders. In terms of partial-thickness tears and tendinosis, the tendon was affected more commonly in the symptomatic shoulder compared to the asymptomatic shoulder (30%:14%: 14%; p = .0026) and (24%:10%; p = .0054), respectively, but for calcification no significant difference between the shoulders was found (18%:12%; 0.1988). CONCLUSION: Ultrasound detected shoulder abnormalities were present in both symptomatic and asymptomatic shoulders. Bursitis and partial-thickness tears were more common in the affected shoulder when compared to the unaffected shoulder. Ultrasound as well as clinical examination findings and patient´s history should be taken into consideration when diagnosing patients with subacromial pain syndrome.

Knee function 30 years after ACL reconstruction: a case series of 60 patients.

Background and purpose - Until now, there have been no studies beyond 30 years after anterior cruciate ligament (ACL) reconstruction. We report knee function a mean 31 years after ACL reconstruction.Patients and methods - This cohort comprised a case series of 60 patients with a mean follow-up of 31 years (28-33) after ACL reconstruction. Patients were evaluated with the International Knee Documentation Committee (IKDC) objective assessment, Knee injury Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale, radiography, and MRI.Results - 30 patients showed an intact ACL graft and 30 a ruptured or missing ACL graft. 40 patients had osteoarthritis in the tibiofemoral compartment and 24 patients in the patellofemoral compartment. Patients with intact ACL grafts scored higher than those with ruptured or missing ACL grafts when it comes to KOOS Sport/Rec. The Hodges Lehmann estimated median difference between groups was 15 (95% CI 0-35). The KOOS scores were lower in the group with ruptured or missing ACL grafts when compared with a healthy-knee reference group of males in terms of Pain, mean difference -8 (CI -15 to -1), Symptoms, mean difference -18 (CI -27 to -9), and Sport/Rec, mean difference -21 (CI -34 to -8). In the group with intact ACL grafts, the KOOS score was lower than a healthy-knee reference group of males in terms of Symptoms, mean difference -12 (CI -21 to -3). Scores for all subgroups of KOOS were higher in patients without osteoarthritis. The IKDC overall clinical assessment outcome was worse in patients with a ruptured or missing ACL graft. The Hodges Lehmann estimated median difference between groups was 1 (CI 0-1).Interpretation - Patients with an intact ACL graft reported higher sports activity and recreation, as measured with KOOS, than patients with a ruptured or missing ACL graft. Patients with severe osteoarthritis reported lower sports activity and recreation, as measured with KOOS.

Guided exercises with or without joint mobilization or no treatment in patients with subacromial pain syndrome: A clinical trial.

BACKGROUND: Graded resistance training is the recommended treatment for patients with subacromial pain syndrome. It is debated whether adding joint mobilization will improve the outcome. The aim of this study was to evaluate the clinical outcome of guided exercises with or without joint mobilization, compared with controls who did not receive any treatment. METHODS: A 3-armed controlled trial in a primary care setting. A total of 120 patients, with clinically diagnosed subacromial pain syndrome, were randomized into guided exercise groups with and without additional joint mobilization, and a control group that did not receive any treatment. Data were analysed at baseline, 6 weeks, 12 weeks and 6 months. Primary outcome was the Constant-Murley score, and secondary outcomes were pain and active range of motion. RESULTS: Shoulder function improved in all groups, as measured with the Constant-Murley score. At 12 weeks and 6 months the exercise groups improved significantly compared with the control group (p ≤ 0.05). Add-on joint mobilization resulted in decreased pain in active range of motion at 6 and 12 weeks compared with guided exercise or no treatment (p ≤ 0.05). Range of motion increased over time in all 3 groups. CONCLUSION: In patients with subacromial pain syndrome guided exercises improved shoulder function compared with no treatment. Add-on joint mobilization decreased pain in the short-term compared with exercise alone or no treatment.

Prevention of Anterior Cruciate Ligament Injuries in Competitive Adolescent Alpine Skiers.

Anterior cruciate ligament (ACL) injury is one of the most serious injuries among Swedish alpine ski high school students. An ACL injury forces the skier to stop skiing for several months, and some skiers even have to give up their skiing career. Therefore, an ACL injury prevention program might play an important role for alpine skiers. In the present study ski high school students have been followed in terms of ACL injuries during 1-2 ski seasons between 2006/2007 and 2012/2013. Alpine skiers studying at the Swedish ski high schools during the ski seasons 2011/2012 and 2012/2013 received a specific ACL injury prevention program (n = 305), while alpine skiers who attended a Swedish ski high school between the ski seasons 2006/2007 and 2010/2011 served as controls (n = 431). The prevention program was based on earlier studies and included indoor and outdoor exercises on snow focusing on core stability and neuromuscular control. Alpine skiing is an equilateral sport. Therefore, the goal of the prevention was to encourage the skiers to practice these exercises in order to perform equally good on both legs. The outcome measure consisted of the number and incidence of ACL injuries. The 2 years of prevention resulted in 12 ACL injuries (3.9%) compared with 35 ACL injuries during the control period (8.1%). The absolute risk rate showed a decreased incidence rate of -0.216 [CI -0.001-(-0.432)]/100 months attending a ski high school in favor of the intervention group. A prevention program focusing on the skier's ability to perform neuromuscular exercises equally good on both legs led to a reduction of ACL injuries.

Higher frequency of osteoarthritis in patients with ACL graft rupture than in those with intact ACL grafts 30 years after reconstruction.

PURPOSE: The aim was to assess the results of anterior cruciate ligament (ACL) reconstruction regarding graft failure, knee laxity, and osteoarthritis (OA) from a longterm perspective. It was hypothesized that intact ACL graft reduces the risk for increased OA development. METHODS: The cohort comprised 60 patients with a median follow-up 31 (range 28-33) years after ACL reconstruction. They were evaluated with magnetic resonance imaging, radiography, KT-1000 arthrometer and the pivot shift test. RESULTS: Out of the 60 patients, 30 (50%) showed an intact ACL graft and 30 (50%) a ruptured or absent ACL graft. Patients with ruptured ACL grafts had more medial tibiofemoral compartment OA than those with an intact ACL graft (p = 0.0003). OA was asymmetric in patients with ruptured ACL grafts with more OA in the medial than in the lateral tibiofemoral compartment (p = 0.013) and the patellofemoral compartment (p = 0.002). The distribution of OA between compartments was similar in patients with an intact ACL graft. KT-1000 values of anterior knee laxity were higher in patients with ruptured compared to those with intact ACL grafts (p = 0.012). Side-to-side comparisons of anterior knee laxity showed higher KT-1000 values in patients with ruptured ACL graft (p = 0.0003) and similar results in those with intact graft (p = 0.09). The pivot shift grade was higher in the group with a ruptured ACL graft (p < 0.0001). CONCLUSIONS: Median 31 (range 28-33) years after ACL reconstruction, 50% of the patients showed an intact ACL graft and no side-to-side difference regarding anterior knee laxity. Patients with ruptured ACL grafts had more OA of the medial tibiofemoral compartment than those with intact ACL grafts. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.

Risk Factors for Anterior Cruciate Ligament Injury in Competitive Adolescent Alpine Skiers.

BACKGROUND: There is a high risk for anterior cruciate ligament (ACL) injuries in alpine skiers. To reduce or try to prevent these injuries, intrinsic and extrinsic risk factors need to be identified. PURPOSE: To identify possible intrinsic and extrinsic ACL injury risk factors among competitive adolescent alpine skiers. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Between 2006 and 2009, a cohort of 339 alpine ski students (176 male, 163 female) from Swedish ski high schools were prospectively observed in terms of ACL injuries. First-time ACL injuries were recorded. In September, prior to each ski season, the skiers were clinically examined according to a specific knee protocol. RESULTS: Overall, 11 male and 14 female skiers sustained a total of 25 first-episode ACL injuries. The majority of injuries occurred in the left knee (P < .05). Skiers who had participated in alpine skiing for >13 years (hazard ratio, 0.83; 95% CI, 0.68-1.00; P < .05) had a reduced risk of sustaining an ACL injury. Eighteen ACL injuries occurred during training, 12 in the technical discipline of giant slalom, and 8 in slalom. Fourteen skiers reported not to be fatigued at all at the time of injury, and 8 skiers reported that they were somewhat fatigued. CONCLUSION: ACL injuries occurred more often in the left knee than the right. This should be taken into consideration in the design of ACL injury prevention programs. Those who reported a higher number of active years in alpine skiing showed a reduced risk of sustaining an ACL injury. No other factor among those studied could be identified as an independent risk factor for ACL injury.

Physical performance tests - a relationship of risk factors for muscle injuries in elite level male football players.

The purpose of the present study was to investigate whether there is a relationship between the outcome of preseason physical performance tests and the risk of sustaining lower extremity muscle injuries within the same season, in male football players at elite level. This is a cohort study of a male football team (63 players) from the first league in Swe-den. The football players are prospectively followed, in terms of muscle injuries of the lower extremity during five seasons between 2010 and 2014. All muscle injuries were evaluated and diagnosed with ultraso-nography. The following physical performance tests were included: squats, chin-ups, YoYo intermittent recovery level 2, counter movement jump, squat jump, standing long jump, sprint, one leg squat test, and a functional movement screen. A total of 86 muscle injuries occurred during the study period. No significant correlation was found between the results of the physical performance tests and muscle injuries of the lower extremity. None of the evaluated tests predicted the risk of sus-taining muscle injuries of the lower extremity. We conclude that muscle injury risk factors are more complex than solely related to the results of the preseason physical performance tests.

Muscle injuries of the dominant or non-dominant leg in male football players at elite level.

PURPOSE: The aim was to study possible differences of muscle injuries regarding type, localization and the extent of injury between the dominant and non-dominant leg in elite male football players. Another aim was to study the injury incidence of muscle injuries of the lower extremity during match and training. METHODS: Data were consecutively collected between 2007 and 2013 in a prospective cohort study based on 54 football players from one team of the Swedish first league. The injury incidence was calculated for both match and training, injuries to the hip adductors, quadriceps, hamstrings and triceps surae were diagnosed and evaluated with ultrasonography, and their length, depth and width were measured to determine the extent of structural muscle injuries. RESULTS: Fifty-four players suffered totally 105 of the studied muscle injuries. Out of these 105 injuries, the dominant leg was affected in 53 % (n = 56) of the cases. A significantly greater extent of the injury was found in the dominant leg when compared with the non-dominant leg with regard to structural injuries of the hamstrings. No other significant differences were found. CONCLUSIONS: Structural hamstring muscle injuries were found to be of greater extent in the dominant leg when compared with the non-dominant leg. This new finding should be taken into consideration when allowing the football player to return to play after leg muscle injuries. LEVEL OF EVIDENCE: IV.

The correlation between the imaging characteristics of hamstring injury and time required before returning to sports: a literature review.

Injuries to the hamstring muscles are common in athletes. Track and field, Australian football, American football and soccer are examples of sports where hamstring injuries are the most common. The purpose of this study was to investigate whether there is a correlation between a hamstring injury prognosis and its characteristics of imaging parameters. The literature search was performed in the databases PubMed and CINAHL, and eleven articles were included. Seven out of the 11 articles showed a correlation between the size of the hamstring injury and length of time required before returning to sports. Different authors have reported contrasting results about length of time required before returning to sports due to location of injury within specific muscle. Majority of the articles found hamstring strain correlated to an extended amount of time required before returning to sports.

Injury Profile in Swedish Elite Floorball.

BACKGROUND: Floorball is an indoor team sport with growing popularity worldwide characterized by rapid accelerations, decelerations, and cutting and pivoting movements. While injuries are common, there are few high-quality epidemiological investigations of floorball injuries. Therefore, the aim of this study was to determine the incidence and severity of injuries in male and female elite-level floorball players in Sweden. HYPOTHESIS: The incidence of injuries has not decreased; female players are more vulnerable to injury than male players. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Twelve floorball teams (6 male, 6 female) in the Swedish premiere leagues were followed for 1 year (preseason, game season, and the entire year). The team medical staff reported injury incidence, location, type (traumatic or overuse), and severity. Differences between male and female players were analyzed using the Mann-Whitney U test. RESULTS: The injury incidence was greater in female players during preseason (22.9 vs 7.4, P = 0.01), game season (39.5 vs 28.3, P = 0.002), as well as the whole year combined (33.9 vs 20.8, P = 0.02). The thigh was the most common injury location in male players and the ankle in female players. Overuse injuries were more common among men and were primarily back problems. Traumatic injuries were more common in women-mainly knee and ankle injuries. Most injuries were of mild severity. A greater number of anterior cruciate ligament injuries occurred in women (n = 11) than in men (n = 2). CONCLUSION: The injury incidence was significantly greater in female floorball players throughout the entire floorball year. Male players sustained mostly overuse injuries while female players suffered traumatic injuries. The majority of injuries in floorball were mild, irrespective of player sex. CLINICAL RELEVANCE: Knowledge of the incidence and severity of floorball injuries is an essential step in the sequence of injury prevention. Future research should focus on identifying injury mechanisms and risk factors for these injuries to develop injury prevention strategies.

Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler: using a four-grade scale.

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.

Muscle injuries of the lower extremity: a comparison between young and old male elite soccer players.

PURPOSE: The aim of this study was to make a comparison between players in two age groups in an elite male soccer team regarding injury localisation within the muscle-tendon unit, injury size and muscle group in terms of muscle injuries of the lower extremity. METHODS: Cohort study based on data collected from a Swedish elite male soccer team during the seasons 2007-2012. In total, 145 muscle injuries were included. Injury localisation to the tendon or muscle, the size of haematoma and the affected muscle group were assessed using ultrasound. Age comparison was made between younger players (≤23 years) and older players (>23 years). RESULTS: No difference regarding injury localisation to either the tendon or the muscle, or the size of haematoma between the two age groups was found. However, the older group of players suffered a significantly higher number of injuries to the triceps surae than the younger players (p = 0.012). CONCLUSIONS: In a Swedish team of male soccer players at elite level, there was no difference between players 23 years or younger and players older than 23 years, in terms of injury distribution to muscles or tendons. Players older than 23 years sustained more injuries to triceps surae when compared with players 23 years or younger. The clinical relevance is to pay attention to muscle function of triceps surae in older players and to screen those players who may need an injury prevention programme. LEVEL OF EVIDENCE: II.

Physical self-esteem and personality traits in Swedish physically inactive female high school students: an intervention study.

BACKGROUND: Physical activity provides fundamental health benefits and plays a positive role in physical well-being. The aim of this present study was to investigate whether a 6-month physical activity program could influence physical self-esteem and frequency of physical activity in physically inactive female high school students in short- and long-term periods and whether personality traits were related to physical activity behaviour and compliance with the program. METHODS: The study was a cluster-randomised controlled intervention study including 104 physically inactive female high school students aged 16-19 years, 60 females in an intervention group and 44 females in a control group. The intervention group exercised at sport centres at least once per week during a 6-month period. Questionnaires were used for evaluation. RESULTS: At a 6-month follow up, the intervention group improved physical self-perception in all subdomains and significantly improved physical condition, physical self-worth and self-related health compared to the control group. At 1-year follow up, 25 females out of 53 females were still physically active, and all ratings remained almost the same as at the 6-month follow up. There were no particular personality traits that were dominant in the groups. CONCLUSION: A 6-month physical activity program can positively influence physical self-esteem and the frequency of physical activity, both from a short- and long-term perspective.

The correlation between anterior cruciate ligament injury in elite alpine skiers and their parents.

PURPOSE: The aim of this study was to investigate whether a familiar correlation with anterior cruciate ligament (ACL) injury exists between competitive alpine skiers and their parents. METHODS: All 593 (293 males, 300 females) elite alpine skiers who have studied at a Swedish alpine Ski High School during 2006 and 2012 answered a questionnaire whether they or their parents had suffered an ACL injury. A total of 418 skiers (70%) answered the questionnaire. RESULTS: Twenty-nine per cent (n = 19) out of the 65 ACL-injured skiers reported that they had a parent (mother or father) who have had an ACL injury. In skiers without an ACL injury (n = 353), the result was 18% (n = 64). An odds ratio of 1.95 (95% confidence interval 1.04-3.65) was found to suffer an ACL injury if you have a parent who has had an ACL injury compared with if you have a parent without any ACL injury. CONCLUSION: The findings of the current study demonstrated a family history to tear the ACL between alpine skiers who had studied at a Swedish Ski High School and ACL injuries of their parents. LEVEL OF EVIDENCE: III.

Sports injury prevention in Swedish elite floorball players: evaluation of two consecutive floorball seasons.

PURPOSE: The objective was to evaluate the effect of a psychological group-based injury prevention, which was implemented throughout the first season, after the second season, in Swedish elite floorball teams (males and females). The secondary objective was to evaluate the effect of the intervention over the two consecutive floorball seasons as a whole. METHODS: Twenty-three teams in the premier leagues for males and females volunteered and were allocated to an intervention group, n = 175 players, and a control group n = 171 players. The intervention group participated in psychological skills training during the first season. The control group did not receive any alternative treatment. Neither of the groups received any intervention during the second season. All injuries were registered and documented according to time-loss definition and classified into either traumatic or overuse injuries. RESULTS: Ninety-three players (27 %) sustained 119 injuries during the second season. The intervention group 0.31 (95 % CI 0.22-0.39) and the control group 0.41 (95 % CI 0.29-0.53) injuries/player. The injury incidence decreased in the intervention group and was lower than the control group. The analysis showed no statistical differences when comparing the intervention group and the control group neither after the second season nor after the two seasons together, Cohen's d 0.2. CONCLUSION: This group-based training showed a small effect size after the second year resulting in fewer injuries, especially severe injuries, in the intervention group compared to the control group. It is, therefore, important not to overlook the potential of a group-based psychological injury prevention programme.

A two- and five-year follow-up of clinical outcome after ACL reconstruction using BPTB or hamstring tendon grafts: a prospective intervention outcome study.

PURPOSE: The aim of the present study was to evaluate and compare objective and subjective outcome in patients 2 and 5 years after anterior cruciate ligament (ACL) reconstruction with either bone-patellar tendon-bone (BPTB) or hamstring grafts. The second aim was to report the prevalence of re- and contralateral ACL ruptures. METHODS: Sixty-eight patients (BPTB, n = 34 and hamstring graft, n = 34) were evaluated preoperatively, 2 and 5 years after ACL reconstruction. Anterior knee laxity and rotational knee joint stability, muscle torque, hop length, anterior knee pain, activity level and self-reported knee function and quality of life were evaluated within and between groups. The prevalence of re- and contralateral ACL ruptures was also recorded. RESULTS: No significant difference in anterior knee laxity, rotational knee joint stability, hop length anterior knee pain or knee function and quality of life were noted at the 5-year follow-up. No significant differences in concentric or eccentric quadriceps torque at 90°/s and 230°/s were found at any of the follow-ups between and within grafts. A significant group difference in hamstring torque 1.05 (0.02) for BPTB and 0.89 (0.02) for hamstring grafts, and in hop length (leg symmetry index) follow-up 0.94 (0.07) for BPTB compared to 0.99 (0.07) for hamstring grafts (P = 0.002) was found at the 2 year follow-up in favour of the BPTB graft, but not at the 5 year follow-up. A significant improvement over time, irrespective of graft, was found in the KOOS's subscales Sport/Rec and quality of life (P < 0.001). None of the patients, irrespective of group, returned to their pre-injury level of sport (P < 0.05). Over the five postoperative years, one man and eight women (13 %) (hamstring graft, n = 5 and BPTB graft, n = 4), sustained a total of 11 (16.2 %) new ACL ruptures: seven (10.2 %) re-ruptures and four (5.9 %) ruptures of the contralateral ACL. CONCLUSIONS: At the 5-year follow-up, there were no significant differences in terms of anterior knee laxity, rotational knee joint stability, muscle torque, anterior knee pain, hop performance, quality of life or activity level between patients who had undergone reconstruction with BPTB or hamstring grafts. None of the patients, irrespective of group, had returned to their pre-injury level of activity. Eight out of the nine patients who had sustained a second ACL rupture were women.

Factors associated with returning to football after anterior cruciate ligament reconstruction.

PURPOSE: The aim of the present investigation was to identify possible factors associated with returning to football on an average 3.2 ± 1.4 years after anterior cruciate ligament (ACL) reconstruction in both male and female football players. METHODS: The players were recruited from a patient database of football players that have undergone an ACL reconstruction between 2004 and 2007 at the Capio Artro Clinic, Sophiahemmet in Stockholm, Sweden. Special attention was paid to gender, age, type of graft for ACL reconstruction, associated injuries, anterior knee laxity, thigh muscle torques and symptoms/problems during, and/or after physical activity. In the beginning of the summer of 2009, 205 players (37.9 %) out of 541 players filled out a questionnaire designed to evaluate physical activity and knee function in a sports-specific setting. A detailed dropout analysis showed that females responded to a higher degree than males. No other significant differences between responders and non-responders were found. RESULTS: Fifty-four per cent (n = 111) had returned to football, and 46 % (n = 94) had not. Using logistic regression analyses, we found that the female gender (p = 0.036, OR 0.518), cartilage injury (p = 0.013, OR 0.368), and pain during physical activity (p = 0.002, OR 0.619) were significant negative predictors for returning to football after ACL reconstruction and rehabilitation. For players with all three significant factors, only 10 % returned to football compared to 76.5 % of those without any of these factors. CONCLUSIONS: Female gender, cartilage injury, and knee pain during physical activity were independent negative predictors for returning to football after ACL reconstruction. At a mean follow-up of 3.2 ± 1.4 years after ACL reconstruction, pain during physical activity was reported to be the most common symptom/problem in football players. The clinical relevance of this study is to improve the treatment of ACL injured football players focusing on female gender and knee pain. Furthermore, ACL injury prevention should be highlighted in football players, especially female players.

Sclerosing injections and ultrasound-guided arthroscopic shaving for patellar tendinopathy: good clinical results and decreased tendon thickness after surgery-a medium-term follow-up study.

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 â†’ 17 ± 23) with 74 % satisfied patients and also after arthroscopic shaving (VAS 77 ± 16 â†’ 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.