Contact allergy to haptens in the Swedish baseline series: Results from the Swedish Patch Test Register (2010 to 2017).

BACKGROUND: Allergic contact dermatitis has considerable public health impact and causative haptens vary over time. OBJECTIVES: To report the prevalence of contact allergy to allergens in the Swedish baseline series 2010 to 2017, as registered in the Swedish Patch Test Register. METHODS: Results and demographic information for patients tested with the Swedish baseline series in 2010 to 2017 were analysed. RESULTS: Data for 21 663 individuals (females 69%) were included. Females had significantly more positive patch tests (54% vs 40%). The reaction prevalence rates were highest for nickel sulfate (20.7%), fragrance mix I (7.1%), Myroxylon pereirae (6.9%), potassium dichromate (6.9%), cobalt chloride (6.8%), methylchloroisothiazolinone/methylisothiazolinone (MCI/MI; 6.4%), MI (3.7%), colophonium (3.5%), fragrance mix II (3.2%), and formaldehyde (3.2%). Myroxylon pereirae reaction prevalence increased from 5% in 2010 to 9% in 2017 and that for methyldibromo glutaronitrile from 3.1% to 4.6%. MCI/MI and MI reactions decreased in prevalence after 2014. Nickel reaction prevalence decreased among females aged 10 to 19 years. CONCLUSIONS: Nickel remains the most common sensitizing agent, with reaction prevalence decreasing among females younger than 20 years. The changes in MCI/MI and MI reaction prevalence mirrored those in Europe. The register can reveal changes in contact allergy prevalence over time among patients patch tested in Sweden.

Revision surgery in anterior cruciate ligament reconstruction: a cohort study of 17,682 patients from the Swedish National Knee Ligament Register.

PURPOSE: To investigate the association between surgical variables and the risk of revision surgery after ACL reconstruction in the Swedish National Knee Ligament Register. METHODS: This cohort study was based on data from the Swedish National Knee Ligament Register. Patients who underwent primary single-bundle ACL reconstruction with hamstring tendon were included. Follow-up started with primary ACL reconstruction and ended with ACL revision surgery or on 31 December, 2014, whichever occurred first. Details on surgical technique were collected using an online questionnaire. All group comparisons were made in relation to an "anatomic" reference group, comprised of essential AARSC items, defined as utilization of accessory medial portal drilling, anatomic tunnel placement, visualization of insertion sites and pertinent landmarks. Study end-point was revision surgery. RESULTS: A total of 108 surgeons (61.7%) replied to the questionnaire. A total of 17,682 patients were included [n = 10,013 males (56.6%) and 7669 females (43.4%)]. The overall revision rate was 3.1%. Older age as well as cartilage injury evident at index surgery was associated with a decreased risk of revision surgery. The group using transtibial drilling and non-anatomic bone tunnel placement was associated with a lower risk of revision surgery [HR 0.694 (95% CI 0.490-0.984); P = 0.041] compared with the anatomic reference group. The anatomic reference group showed no difference in risk of revision surgery compared with the transtibial drilling groups with partial anatomic [HR 0.759 (95% CI 0.548-1.051), n.s.] and anatomic tunnel placement [HR 0.944 (95% CI 0.718-1.241), n.s.]. The anatomic reference group showed a decreased risk of revision surgery compared with the transportal drilling group with anatomic placement [HR 1.310 (95% CI 1.047-1.640); P = 0.018]. CONCLUSION: Non-anatomic bone tunnel placement via transtibial drilling resulted in the lowest risk of revision surgery after ACL reconstruction. The risk of revision surgery increased when using transportal drilling. Performing anatomic ACL reconstruction utilizing eight selected essential items from the AARSC lowered the risk of revision surgery associated with transportal drilling and anatomic bone tunnel placement. Detailed knowledge of surgical technique using the AARSC predicts the risk of ACL revision surgery. LEVEL OF EVIDENCE: III.

Efficacy of Magnetic Resonance Imaging and Clinical Tests in Diagnostics of Wrist Ligament Injuries: A Systematic Review.

PURPOSE: To investigate the diagnostic performance of magnetic resonance imaging (MRI) and clinical provocative tests on injuries to the triangular fibrocartilage complex (TFCC), the scapholunate (SL) ligament, and the lunotriquetral (LT) ligament. METHODS: An electronic literature search of articles published between January 1, 2000, and February 28, 2014, in PubMed, Embase, and the Cochrane Library was carried out in April 2014. Only studies of the diagnostic performance of MRI and clinical provocation tests using wrist arthroscopy as the gold standard were eligible for inclusion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guided the extraction and reporting of data. The methodologic quality of the included articles was assessed with the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The primary outcome measure was the negative predictive value (NPV) of wrist MRI and provocative wrist tests, which was defined as the probability of an intact wrist ligament given a negative investigation. The question was whether negative results of MRI or provocative tests were enough to safely discontinue further investigation with arthroscopy. A minimum NPV of 95% was considered a clinically relevant cutoff value. The secondary outcome measures were the positive predictive value (PPV), sensitivity, and specificity. RESULTS: A total of 7 articles (327 patients with MRI and 105 patients with clinical tests) were included in this systematic review. The included articles displayed heterogeneity regarding participants, diagnostic methods, and study design. Seven articles investigated the diagnostic performance of MRI, whereas 1 article investigated clinical testing. The NPVs of MRI were as follows: TFCC, 37% to 90%; SL ligament, 72% to 94%; and LT ligament, 74% to 95%. The NPVs of clinical tests were 55%, 74%, and 94% for the TFCC, SL ligament, and LT ligament, respectively. Only 1 study reached the predetermined cutoff value for the primary outcome measure (NPV ≥95%) but only for MRI of the LT ligament; this study also reached a borderline-cutoff NPV of 94% for MRI of the SL ligament. Another study reached borderline-cutoff NPVs of 94% both for MRI and for clinical tests of the LT ligament. CONCLUSIONS: A negative result from MRI is unable to rule out the possibility of a clinically relevant injury to the TFCC, SL ligament, or LT ligament of the wrist. Clinical provocation wrist tests were of limited diagnostic value. The current gold standard--wrist arthroscopy--remains the preferred diagnostic technique with sufficient conclusive properties when it comes to wrist ligament injuries. LEVEL OF EVIDENCE: Level II, systematic review of Level II diagnostic studies.

No difference in revision rates between single- and double-bundle anterior cruciate ligament reconstruction: a comparative study of 16,791 patients from the Swedish national knee ligament register.

PURPOSE: The purpose was to compare revision rates and patient-reported outcomes between single- and double-bundle anterior cruciate ligament (ACL) reconstructions. METHODS: All patients from the Swedish National Knee Ligament Register from 2005 through 2011 who underwent primary ACL reconstruction with hamstring autografts were included. Patients with concomitant injuries, except meniscal and chondral injuries, were excluded. By December 31, 2011, 16,791 primary isolated ACL reconstructions had been registered, of which 16,281 were single-bundle and 510 were double-bundle. Cumulative revision rates were estimated using Kaplan-Meier analysis. The Knee injury and Osteoarthritis Outcome Score (KOOS) and EQ-5D were calculated at 1- and 2-year follow-ups. RESULTS: The revision rate showed no statistically significant differences between the groups (P = .30). Over the 7-year observation period, 347 single-bundle (2.1%) and 8 double-bundle (1.6%) ACL reconstructions were revised. No significant differences in the KOOS or EQ-5D were found between the groups postoperatively. In addition, there were no differences in postoperative improvements in the KOOS or EQ-5D at 1- and 2-year follow-ups. CONCLUSIONS: Revision rates after single- and double-bundle ACL reconstructions were low. No differences were found in revision rates, KOOS, and EQ-5D between the 2 techniques. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Timing of surgery of the anterior cruciate ligament.

PURPOSE: We aimed to perform a systematic review of the literature concerned with timing of surgery after anterior cruciate ligament injury. METHODS: A systematic electronic search in Medline through PubMed, Embase, and the Cochrane Library was carried out in October 2011. All English-language randomized controlled clinical trials, prospective comparative cohort studies, and prognostic and diagnostic studies published from January 1995 to August 2011 were eligible for inclusion. All articles addressing timing of surgery were eligible for inclusion regardless of injury-to-surgery interval, graft type, surgical technique, or rehabilitation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guided the reporting and data abstraction. Methodologic quality of all included articles was carefully assessed. RESULTS: We included 22 articles (3,583 patients) in the systematic review. Study design, research methodology, surgical technique, and outcome measurements differed greatly among included articles. The injury-to-surgery interval, classified as early and delayed, ranged from within 2 days to 7 months and 3 weeks to 24 years, respectively. Eight articles promoted early reconstruction, whereas the majority of articles found no difference in outcome between early and delayed surgery. Two articles were inconclusive. CONCLUSIONS: There were few or no differences in subjective and objective outcomes related to timing of anterior cruciate ligament reconstruction. LEVEL OF EVIDENCE: Level II, systematic review of Level I and II studies.

Open versus arthroscopic repair of the triangular fibrocartilage complex: a systematic review.

BACKGROUND AND PURPOSE: To investigate the outcome of open versus arthroscopic repair of injuries of the triangular fibrocartilage complex (TFCC). METHODS: An electronic literature search of articles published between January 1, 1985, and May 26, 2016, in PubMed, Embase, and the Cochrane Library was carried out in May 2016 and updated in March and December 2017. Studies comparing open and arthroscopic repair of TFCC injury with a mean follow up of more than 1 year were eligible for inclusion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guided the extraction and reporting of data. The methodological quality of the included articles was assessed with the Cochrane Collaboration's tool for assessing risk of bias. The primary outcome measure was the rate of postoperative distal radioulnar joint (DRUJ) re-instability. Secondary outcome measures were range of motion (ROM), grip strength, residual pain, functional wrist scores and the rates of complications and re-operations. RESULTS: A total of 868 articles were identified by the electronic search. After duplicate removal and subsequent study selection, a total of two studies were included in this systematic review. The methodological quality of the included articles displayed risks of bias. There was no difference in DRUJ re-instability between open and arthroscopic repair of the TFCC. There were no differences in obtained postoperative ROM, grip strength or values in functional outcome scores, between open and arthroscopic TFCC repair in the two included studies, except for the Disability of the Arm Shoulder and Hand (DASH) questionnaire - in favor of arthroscopic surgery - in one of the included studies. CONCLUSIONS: This systematic review shows comparable results between open and arthroscopic repair of the TFCC, in terms of DRUJ re-instability and functional outcome scores. There is insufficient evidence to recommend one technique over the other in clinical practice. There is an immense lack of comparison studies with high level of evidence in the area of wrist ligament repair and reconstruction, including TFCC-injuries and DRUJ-instability.

Patient predictors of early revision surgery after anterior cruciate ligament reconstruction: a cohort study of 16,930 patients with 2-year follow-up.

BACKGROUND: Revision surgery is one of the most important endpoints during follow-up after anterior cruciate ligament (ACL) reconstruction. PURPOSE: To investigate if commonly known patient factors can predict revision surgery after ACL reconstruction. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: This prospective cohort study was based on data from the Swedish National Knee Ligament Register during the period of January 1, 2005, through December 31, 2013. Patients who underwent primary ACL reconstruction with hamstring tendon or bone-patellar tendon-bone autografts were included. Follow-up started on the date of primary ACL reconstruction, and follow-up ended with ACL revision surgery, after 24 months of follow-up, or on December 31, 2013, whichever occurred first. The analyzed patient variables were activity at the time of injury, sex, age, height, weight, body mass index, smoking, and the use of smokeless tobacco. The primary study endpoint was revision surgery, defined as replacement of a primary ACL reconstruction. Relative risk (RR) and 95% CIs were calculated and adjusted for confounding factors using multivariate statistics. RESULTS: A total of 16,930 patients were included (males, n=9767 [57.7%]; females, n=7163 [42.3%]). The 2-year revision rate was 1.82% (95% CI, 1.62%-2.02%). There was no significant difference between male and female revision rates (1.74% [95% CI, 1.48%-2.00%] vs 1.93% [95% CI, 1.61%-2.25%], P=.383). In both males and females there was a significantly increased risk of revision surgery associated with soccer playing and adolescence (age 13-19 years) (males: RR=1.58 [95% CI, 1.12-2.23], P=.009 and RR=2.67 [95% CI, 1.91-3.73], P<.001, respectively; females: RR=1.43 [1.01-2.04], P=.045 and RR=2.25 [95% CI, 1.57-3.24], P<.001, respectively). A combination of these predictors were associated with a further increased risk of revision surgery (males: RR=2.87 [95% CI, 1.79-4.60], P<.001; females: RR=2.59 [95% CI, 1.69-3.96], P<.001). CONCLUSION: Soccer players and adolescents had an increased risk of revision surgery after ACL reconstruction, with a respective factor of 1.5 and 2.5. Individuals with a combination of these 2 predictors carried an almost 3-fold higher risk of revision surgery. There were no significant associations for sex, height, weight, body mass index, or tobacco use.

Predictors of contralateral anterior cruciate ligament reconstruction: a cohort study of 9061 patients with 5-year follow-up.

BACKGROUND: Identifying predictors of contralateral anterior cruciate ligament (ACL) reconstruction is important to focus preventive strategies and related research on high-risk groups. PURPOSE: To investigate predictors of contralateral ACL reconstruction in patients who have already undergone a primary ipsilateral reconstruction. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: This study was based on data from the Swedish National Knee Ligament Register from January 1, 2005, to December 31, 2013. Patients aged 13 to 59 years who underwent primary ipsilateral (index) ACL reconstruction with hamstring tendon or bone-patellar tendon-bone autografts were included. Follow-up started on date of index ACL reconstruction and ended either with primary contralateral ACL reconstruction, after 5 years of follow-up, or on December 31, 2013, whichever occurred first. The investigated variables were patient sex, age at index reconstruction, activity at the time of index injury, timing of surgery, graft selection, graft harvest site, and meniscal and chondral injury. The study end point was primary contralateral ACL reconstruction. Relative risks (RRs) and 95% CIs were calculated and adjusted for confounding factors using multivariate statistics. RESULTS: A total of 9061 participants were included (n = 5196 males [57.3%] and 3865 females [42.7%]), of which 270 participants (3.0%) underwent primary contralateral ACL reconstruction during the 5-year follow-up. There was no difference in contralateral reconstruction rates between males and females (3.0% vs 2.9%, P = .695). Age <20 years significantly increased the risk of contralateral reconstruction (males: RR = 2.4 [95% CI, 1.7-3.4] and females: RR = 2.9 [95% CI, 1.9-4.5]; P < .001). Among female patients undergoing reconstruction using autograft hamstring, harvest of a contralateral hamstring tendon significantly increased this risk (RR = 3.4 [95% CI, 1.4-7.9]; P = .006). CONCLUSION: In both male and female participants, age <20 years predicted an almost 3 times higher 5-year risk of contralateral ACL reconstruction. Among female participants undergoing reconstruction with autograft hamstring, a contralateral harvest predicted a more than 3 times higher 5-year risk of contralateral ACL reconstruction. Patient sex, activity at the time of index injury, graft selection, meniscal injury, and chondral injury were not predictors of contralateral ACL reconstruction.

Surgical Predictors of Early Revision Surgery After Anterior Cruciate Ligament Reconstruction: Results From the Swedish National Knee Ligament Register on 13,102 Patients.

BACKGROUND: An important objective of anterior cruciate ligament (ACL) registries is to detect and report early graft failure and revision surgery after ACL reconstruction. PURPOSE: To investigate surgical variables and identify predictors of revision surgery after ACL reconstruction. STUDY DESIGN: Prospective cohort study; Level of evidence, 2. METHODS: This prospective cohort study was based on data from the Swedish National Knee Ligament Register during the years 2005 through 2011. Eight surgical variables were investigated: graft selection, graft width, single-bundle or double-bundle techniques, femoral graft fixation, tibial graft fixation, injury-to-surgery interval, injuries to menisci, and injuries to cartilage. The primary endpoint was the 2-year incidence of revision surgery. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated and adjusted for confounders by use of multivariate statistics. RESULTS: A total of 13,102 patients were included (5541 women [42%] and 7561 men [58%]; P < .001). Hamstring tendon autografts accounted for 90% (11,764 patients) of all reconstructions, of which 96% were performed with a single-bundle technique (11,339 patients). Patellar tendon autografts accounted for the remaining 10% (1338 patients). At index reconstruction, observed injuries to menisci and cartilage were common (40% and 28%, respectively). The overall 2-year incidence of revision surgery was 1.60% (women, 1.57%; men, 1.63%; P = .854). Patients with metal interference screw fixation of a semitendinosus tendon autograft on the tibia had a significantly reduced risk of early revision surgery (RR = 0.32; 95% CI, 0.12-0.90; P = .031). CONCLUSION: Metal interference screw fixation of a semitendinosus tendon autograft on the tibia was an independent predictor of significantly lower 2-year incidence of revision surgery. Graft selection, graft width, a single-bundle or a double-bundle technique, femoral graft fixation, the injury-to-surgery interval, and meniscus injury were not predictors of early revision surgery.