Håkan Gauffin

Altered movement and muscular-activation patterns during the one-legged jump in patients with an old anterior cruciate ligament rupture

We studied nine patients with an isolated, unrepaired rupture of the anterior cruciate ligament to evaluate whether well-rehabilitated patients with an old rupture of the anterior cruciate ligament had adapted their patterns of motor control in situations that provoke knee instability and if the possible adaptation results in a measurable decrease of the deteriorating sagittal shear load. The study was performed by means of a movement analysis system with synchronized force plate and electromyographic recordings. A different movement and muscular-activation pattern was found for the injured leg compared to the noninjured when performing a one-legged jump for distance. An internal knee model was developed and implemented. In that way, a simultaneously decreased capsuloligamentous sagittal load at the landing moment was shown.

The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction

Background This cross-sectional study aimed to examine whether appraisal of knee function, psychological and demographic factors were related to returning to the preinjury sport and recreational activity following anterior cruciate ligament (ACL) reconstruction. Method 164 participants completed a questionnaire battery at 1–7 years after primary ACL reconstruction. The battery included questionnaires evaluating knee self-efficacy, health locus of control, psychological readiness to return to sport and recreational activity, and fear of reinjury; and self-reported knee function in sport-specific tasks, knee-related quality of life and satisfaction with knee function. The primary outcome was returning to the preinjury sport or recreational activity. Results At follow-up, 40% (66/164) had returned to their preinjury activity. Those who returned had more positive psychological responses, reported better knee function in sport and recreational activities, perceived a higher knee-related quality of life and were more satisfied with their current knee function. The main reasons for not returning were not trusting the knee (28%), fear of a new injury (24%) and poor knee function (22%). Psychological readiness to return to sport and recreational activity, measured with the ACL-Return to Sport after Injury scale (was most strongly associated with returning to the preinjury activity). Age, sex and preinjury activity level were not related. Conclusions Less than 50% returned to their preinjury sport or recreational activity after ACL reconstruction. Psychological readiness to return to sport and recreation was the factor most strongly associated with returning to the preinjury activity. Including interventions aimed at improving this in postoperative rehabilitation programmes could be warranted to improve the rate of return to sport and recreational activities.

Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms A 3-Year Follow-up of a Prospective, Randomized Study

Background: The optimal treatment for middle-aged patients with knee pain and meniscal lesions has been extensively debated. Most previous studies have revealed only short-term beneficial results of knee arthroscopic surgery. The authors have previously shown a positive benefit of knee arthroscopic surgery and an exercise program after 1 year when compared with an exercise program alone. Purpose: To evaluate if knee arthroscopic surgery combined with an exercise program provided an additional long-term benefit after 3 years compared with an exercise program alone in middle-aged patients with meniscal symptoms. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients, aged 45 to 64 years, 150 were randomized to (1) a 3-month exercise program (nonsurgery group) or (2) the same as group 1 plus knee arthroscopic surgery within 4 weeks (surgery group). The primary outcome was the change in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscore of pain between baseline and the 3-year follow-up. Results from the 1-year follow-up have been published previously. Results: Both treatment groups improved significantly in the KOOS pain subscore at 3 years’ follow-up in the intention-to-treat and as-treated analyses (P < .001). The between-group difference for the change in the KOOS pain subscore between baseline and the 3-year follow-up was no longer statistically significant, neither in the intention-to-treat analysis (7.6 points; 95% CI, –0.6 to 15.9; P = .068) nor in the as-treated analysis (5.3 points; 95% CI, –3.1 to 13.8; P = .216). The factorial analysis of the effect of the intervention and age, onset of pain, and mechanical symptoms indicated that older patients improved more, regardless of treatment, and surgery may be more beneficial for patients without mechanical symptoms (as-treated analysis). The effect of the predictive factors on the KOOS pain subscore was uncertain because of the small sample size in the subgroup analyses. Conclusion: The benefit of knee arthroscopic surgery, seen at 1 year in middle-aged patients with meniscal symptoms, was diminished at 3 years and was no longer statistically significant. Clinical Relevance: Knee arthroscopic surgery may be beneficial for middle-aged patients with meniscal symptoms in addition to an exercise program. Older age and absence of mechanical symptoms should not be contraindications to surgery. Registration: NCT01288768 (ClinicalTrials.gov identifier)

Translation and testing of measurement properties of the Swedish version of the IKDC subjective knee form

To translate to Swedish language and cross‐culturally adapt the IKDC‐SKF and to test the measurement properties of the Swedish version of IKDC‐SKF in ACL‐injured patients undergoing reconstruction surgery.The translation and cross‐cultural adaption was performed according to guidelines. Seventy‐six patients with an ACL injury filled out the IKDC‐SKF and other questionnaires before ACL reconstruction and at 4, 6, and 12 months after surgery. A total of 203 patients from the Swedish ACL Registry participated at 8 months post‐operative. Measurement properties were tested according to the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.The Swedish IKDC‐SKF had high internal consistency (Cronbach′s alpha=0.90) and test‐retest reliability (ICC2,1=0.92, CI 95%: 0.81‐0.97, P<.001). A single factor solution accounted for 46.1% of the variance in IKDC‐SKF scores. Criterion validity was moderate to high. All ten predefined hypotheses for hypothesis testing were confirmed. The six hypotheses for responsiveness testing were confirmed. The effect size was 1.8, the standardized response mean was 1.9, the and minimal clinically important difference was 13.9 points.The Swedish version of the IKDC‐SKF had good measurement properties and can be recommended for use in a population of ACL‐deficient patients undergoing ACL reconstruction.

Perception of health problems among competitive runners: a qualitative study of cognitive appraisals and behavioral responses

Background: Approximately 2 of every 3 competitive runners sustain at least 1 health problem each season. Most of these problems are nontraumatic injuries with gradual onset. The main known risk indicator for sustaining a new running-related injury episode is a history of a previous injury, suggesting that behavioral habits are part of the causal mechanisms. Purpose: Identification of elements associated with purposeful interpretations of body perceptions and balanced behavioral responses may supply vital information for prevention of health problems in runners. This study set out to explore competitive runners’ cognitive appraisals of perceived symptoms on injury and illness and how these appraisals are transformed into behavior. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The study population consisted of Swedish middle- and long-distance runners from the national top 15 list. Qualitative research methods were used to categorize interview data and perform a thematic analysis. The categories resulting from the analysis were used to construct an explanatory model. Results: Saturation of the thematic classification required that data from 8 male and 6 female runners (age range, 20-36 years) were collected. Symptoms interpreted to be caused by illness or injury with a sudden onset were found to lead to immediate action and changes to training and competition programs (activity pacing). In contrast, perceptions interpreted to be due to injuries with gradual onset led to varied behavioral reactions. These behavioral responses were planned with regard to short-term consequences and were characterized by indifference and neglect of long-term implications, consistent with an overactivity behavioral pattern. The latter pattern was consistent with a psychological adaptation to stimuli that is presented progressively to the athlete. Conclusion: Competitive runners appraise whether a health problem requires immediate withdrawal from training based on whether the problem is interpreted as an illness and/or has a sudden onset. The ensuing behaviors follow 2 distinct patterns that can be termed “activity pacing” and “overactivity.”

Activity demands and instability are the most important factors for recommending to treat ACL injuries with reconstruction

PurposeThe purpose of the study was to (1) study and compare the factors that Swedish orthopaedic surgeons and physical therapists consider important for recommending ACL reconstruction and, (2) to assess how orthopaedic surgeons and physical therapists consider their own and each others, as well as patients’, roles are in the treatment decision.MethodsA web-based survey assessing the relevance of 21 predetermined factors, in the choice to recommend ACL reconstruction, was sent to orthopaedic surgeons and physical therapists. Respondents were also asked to rate the importance of the assessment made by themselves, the other clinician (physical therapists rated the importance of surgeons, surgeons rated the importance of physical therapists), and the patients’ preferences.ResultOrthopaedic surgeons agreed of eight, and physical therapists of seven factors as important in the choice to recommend ACL reconstruction. The factors both groups reported as important were; “patient’s wishes to return to contact/pivoting sports”, “instability in physical activity”, “instability in activities of daily living despite adequate rehabilitation”, “physically demanding occupation”, and “young age”. Both professions rated their own and each others assessments as well as patient’s wishes as important for the decision to recommend ACL reconstruction.ConclusionOrthopaedic surgeons and physical therapists agree about factors that are important for their decision to recommend ACL reconstruction, showing that both professions share a common ground in perceptions of factors that are important in recommending ACL reconstruction.Level of evidenceDiagnostic study: Level III.

mHealth Self-Report Monitoring in Competitive Middle- and Long-Distance Runners: Qualitative Study of Long-Term Use Intentions Using the Technology Acceptance Model

Background International middle- and long-distance running competitions attract millions of spectators in association with city races, world championships, and Olympic Games. It is therefore a major concern that ill health and pain, as a result of sports overuse, lead to numerous hours of lost training and decreased performance in competitive runners. Despite its potential for sustenance of performance, approval of mHealth self-report monitoring (mHSM) in this group of athletes has not been investigated. Objective The objective of our study was to explore individual and situational factors associated with the acceptance of long-term mHSM in competitive runners. Methods The study used qualitative research methods with the Technology Acceptance Model as the theoretical foundation. The study population included 20 middle- and long-distance runners competing at national and international levels. Two mHSM apps asking for health and training data from track and marathon runners were created on a platform for web survey development (Briteback AB). Data collection for the technology acceptance analysis was performed via personal interviews before and after a 6-week monitoring period. Preuse interviews investigated experience and knowledge of mHealth monitoring and thoughts on benefits and possible side effects. The postuse interviews addressed usability and usefulness, attitudes toward nonfunctional issues, and intentions to adhere to long-term monitoring. In addition, the runners’ trustworthiness when providing mHSM data was discussed. The interview data were investigated using a deductive thematic analysis. Results The mHSM apps were considered technically easy to use. Although the runners read the instructions and entered data effortlessly, some still perceived mHSM as problematic. Concerns were raised about the selection of items for monitoring (eg, recording training load as running distance or time) and about interpretation of concepts (eg, whether subjective well-being should encompass only the running context or daily living on the whole). Usefulness of specific mHSM apps was consequently not appraised on the same bases in different subcategories of runners. Regarding nonfunctional issues, the runners competing at the international level requested detailed control over who in their sports club and national federation should be allowed access to their data; the less competitive runners had no such issues. Notwithstanding, the runners were willing to adhere to long-term mHSM, provided the technology was adjusted to their personal routines and the output was perceived as contributing to running performance. Conclusions Adoption of mHSM by competitive runners requires clear definitions of monitoring purpose and populations, repeated in practice tests of monitoring items and terminology, and meticulousness regarding data-sharing routines. Further naturalistic studies of mHSM use in routine sports practice settings are needed with nonfunctional ethical and legal issues included in the evaluation designs.

Natural corollaries and recovery after acute ACL injury: the NACOX cohort study protocol

Introduction Anterior cruciate ligament (ACL) injury can result in joint instability, decreased functional performance, reduced physical activity and quality of life and an increased risk for post-traumatic osteoarthritis. Despite the development of new treatment techniques and extensive research, the complex and multifaceted nature of ACL injury and its consequences are yet to be fully understood. The overall aim of the NACOX study is to evaluate the natural corollaries and recovery after an ACL injury. Methods and analysis The NACOX study is a multicentre prospective prognostic cohort study of patients with acute ACL injury. At seven sites in Sweden, we will include patients aged 15–40 years, within 6 weeks after primary ACL injury. Patients will complete questionnaires at multiple occasions over the 3 years following injury or the 3 years following ACL reconstruction (for participants who have surgical treatment). In addition, a subgroup of 130 patients will be followed with clinical examinations, several imaging modalities and biological samples. Data analyses will be specific to each aim. Ethics and dissemination This study has been approved by the regional Ethical committee in Linköping, Sweden (Dnr 2016/44-31 and 2017/221–32). We plan to present the results at national and international conferences and in peer-reviewed scientific journals. Participants will receive a short summary of the results following completion of the study. Trial registration number NCT02931084.

RECREATIONAL RUNNER' STRATEGIES TO COPE WITH INJURY AND ILLNESS DURING MARATHON RACE PREPARATIONS: CROSS-SECTIONAL STUDY IN SWEDEN

Background Running is one of the most popular forms of physical exercise worldwide. It is therefore discomforting that pain and overuse injuries are common among recreational runners. The coping concept is used to denote conscious efforts to solve personal and interpersonal problems, and seeking to master, minimize or tolerate stress or conflict. Objective To explore coping strategies associated with injury and illness management in runners. Design Cross-sectional study based on an online survey. Setting Recreational runners preparing for a marathon race. Patients (or Participants) Swedish recreational marathon runners. Interventions (or Assessment of Risk Factors) Age, sex, and coping strategies as measured by the Brief Cope instrument. Main Outcome Measurements Episodes of injury or illness lasting at least three weeks during the past 12 months. Results The response rate was 38% (317/833 runners). One out of five runners reported a pre-race health problem, with overuse injuries with gradual onset being the most frequent problem and the knee the most common localisation. No statistical differences between injured and non-injured runners were observed for any feature of the Brief Cope instrument. Runners having rested from running due to illness reported higher scores for the adaptive coping strategy active coping (p=0.020). They also reported lower scores for emotional support (p=0.020) and higher scores for the maladaptive coping strategy behavioural disengagement (p=0.041) than runners not having rested for illness. Conclusions An association between active coping and rest due to illness was found among recreational marathon runners. Illness, usually having a sudden onset, seem to motivate marathon runners to rest more strongly than overuse injuries that normally have a gradual onset. The results indicate that health problems with gradual onset call for different approaches for behavioural interventions and prevention than those with sudden onset. Coping strategies among recreational runners warrant further research based on longitudinal study designs.

Quantitative Analysis of Knee Movement Patterns Through Comparative Visualization

In this paper, we present a novel visualization approach for the quantitative analysis of knee movement patterns in time-varying data sets. The presented approach has been developed for the analysis of patellofemoral instability, which is a common knee problem, caused by the abnormal movement of the patella (kneecap). Manual kinematic parameter calculations across time steps in a dynamic volumetric data set are time-consuming and prone to errors as well as inconsistencies. To overcome these limitations, the proposed approach supports automatic tracking of identified features of interest (FOIs) in the time domain and, thus, facilitates quantitative analysis processes in a semiautomatic manner. Moreover, it allows us to visualize the movement of the patella in the femoral groove during an active flexion and extension movement, which is essential to assess kinematics with respect to knee flexions. To further support quantitative analysis, we propose kinematic plots and time-angle profiles, which enable comparative dynamics visualization. As a result, our proposed visualization approach facilitates better understanding of the effects of surgical interventions by quantifying and comparing the dynamics before and after the operations. We demonstrate our approach using clinical time-varying patellofemoral data, discuss its benefits with respect to quantification as well as medical reporting, and describe how to generalize it to other complex joint movements.