Korsbandsregistret och Fotboll

Size: px

Start display at page:

Download "Korsbandsregistret och Fotboll"

Horatio Johns
7 years ago
Views:

1 Korsbandsregistret och Fotboll Magnus Forssblad Capio Artro Clinic Centrum för idrottsskadeforskning och utbildning, Karolinska Intstitutet

2 Skillness vs ethics? FOR CERTAIN we are all skilled, interested and capable surgeons when performing ACL reconstructions with high tech methods, latest graft choice and more and more double-bundle technique BUT can we as good doctors really recommend a 15 years old girl to return to football after an ACL reconstruction?

ACL reconstructions with high tech methods, latest graft choice and more and

5 ACL can t be treated as ONE injury there is a great variation I s o l a t e d P r e v i o u s M e n i s c u s C a r t i la g e O e d e m a L i g a m e n t O t h e r i n j Operative technique Rehabilitation Motivation Healing response Patient cost-benefit analysis Age, gender

a L i g a m e n t O t h e r i n j Operative technique Rehabilitation

6 We treat the instability not the ACLinjury! In general all ACL-injuries don t need surgery but is it possible to continue with football at any level without surgery?

7 Stability for athlete A 1. ACL Injury 2. Non operative rehab 3. ACL reconstruction Walking Running Tennis Alpine skiing Football

8 Stability for athlete B 1. ACL Injury 2. Non operative rehab Walking Running Tennis Alpine skiing Football

9 High risk of new knee injury in elite footballers with previous ACL injury. Waldén M, Hägglund M, Ekstrand J. Br J Sports Med The Swedish male professional league (310 players) was studied during Twenty-four players (8%) had a history of 28 ACL injuries in 27 knees (one re-rupture). These players had a higher incidence of new knee injury of any type than the players without ACL injury 4.2 vs 1.0 injuries per 1000 hours, p = 0.02.

Twenty-four players (8%) had a history of 28 ACL injuries in 27 knees (one re-rupture).

10 Risk for new ACL injury Study (n) Median age Followup time % ACLgraft inj % Opp ACL inj Salmon (612) 28 5 yr Shelbourne (887) 28 (pts > 18 yrs 5 yr Shelbourne (1415) 21 (all ages) 5 yr Artro Clinic (6801) 28 (all ages) > 2 yr

7 Shelbourne (887) 28 (pts > 18 yrs 5 yr 1.7 3.

11 600 Age Gender Total 500 Axelrubrik Female Male

12 Age Gender Football non Football Female football Male Football Female other Male Other

other Male Other 50 0 1 4 7 10 13 16 19 22

13 Män+Kvinnor Alla Revision 05% 04% 03% 02% % 00%

14 Män+Kvinnor Alla Andra knät 05% 04% 03% 02% 01% %

15 Män+Kvinnor Alla Revision + Andra knät 10% 09% 08% 07% 06% 05% 04% 03% 02% % 00%

16 Fotboll Män+Kvinnor Alla 06% Revision 05% 04% 03% 02% % 00%

17 Fotboll Män+Kvinnor Alla Andra knät 06% 05% 04% 03% 02% 01% %

18 Fotboll Män+Kvinnor Alla Revision + Andra knät 12% 10% 08% 06% 04% % 00%

19 Fotboll Män+Kvinnor år Revision 10% 09% 08% 07% 06% 05% 04% 03% 02% 01% 00% Summa

20 Fotboll Män+Kvinnor år Andra knät 10% 09% 08% 07% 06% 05% 04% 03% 02% 01% 00% Summa

21 Fotboll Män+Kvinnor år Revision + andra knät 18% 16% 14% 12% 10% 08% 06% 04% % 00%

22 Individual Cost-Benefit-Analysis Costs Rehabilitation, Sickleave Pain, Swelling, Dysfunction Reinjuries, Rerupture Osteoarthritis Benefits Social factors Performing different sports Wellness, Fitness Economy (Top athletes) Should I return to sports?

23 Data from surgery Etiology Previous injuries Associated injuries Methods (graft, fixation) Meniscus- and cartilage surgery Surgery time, antibiotics, thrombosis prophylaxis

24 Preop scores KOOS score Pain Knee symptoms ADL Function sport and recreation Knee related Quality Of Life

25 Postop evaluation Koos, EQ-5 1, 2, 5 and 10 years postop Endpoint TKR Option for objective evaluation KT-1000, Manual Lachman, One hop test

27 Etiology Primary ACL YEAR Football/soccer 42 % 44 % Skiing 12 % 12 % Floor ball 9 % 9 % European Handball 5 % 6 % = =

28 Unique Database for football research Primary ACL reconstructions 5674 Etiology = Football 1980 Females 3694 Males 800 Revisions 479 Reoperation (Meniscus, Infection)

29 Preliminary Data XBase 2009 YEAR Clinics Primary ACL Male/Female 56/44 % 58/42 % Age Male/Female 28/26 28/25 Revision ACL Male/Female 59/41 % 58/42 % Age Male/Female 30/27 29/24 Reoperations Double Bundle

30 Grafts (Primary ACL) YEAR Hamstrings 81 % 84 % 87 % 93 % 95 % BTB 18 % 15 % 12 % 6 % 4 % Others 1 % 1 % 1 % 1 % 1 %

31 Overall KOOS results

32 Revisions improves between 1 and 2 year follow up

33 2 years KOOS results for Double Bundle (50 pts) vs HT (5300)

34 Football vs non Football

35 Football vs non Football < 20 yrs

36 Football vs non Football < 20 yrs Män Kvinnor

37 New web portal for injury registration Open for all teams in Sweden Register all match/training Register training/match exposure for all players Module for injurycard Module for patient records Online statistics for all users

40 Highlights Always online Medical records follows the players Club transfer (After players approval) When playing with National teams Anti Doping Option to export Whereabouts Statistics online for all users

41 Vänta inte med besluten!

ANTERIOR CRUCIATE LIGAMENT INJURY PREVENTION IN NEW ZEALAND. Barry Tietjens Unisports Sports Medicine Auckland

ANTERIOR CRUCIATE LIGAMENT INJURY PREVENTION IN NEW ZEALAND Barry Tietjens Unisports Sports Medicine Auckland NO DISCLOSURES ACL INJURY PREVENTION Knee injuries involving the ACL are common in sport ACL