1. Forskningskonferens ”Fotboll – forskningsrön och tillämpningar” – CIF
Korsbandsregistret
Forskningskonferens ”Fotboll – forskningsrön och tillämpningar” – CIF
20-21 Oktober 2010
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? 2

3. 3

5. ACL can’t be treated as “ONE” injury – there is a great variation
Car t i lage
Other inj
Isolated
Previous
Meniscus
Ligament
Oedema
Operative technique
Rehabilitation
Age, gender
Healing response
Patient cost-benefit analysis
Motivation 5

6. We treat the instability not the ACL-injury
We treat the instability not the ACL-injury! 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 7

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

9. High risk of new knee injury in elite footballers with previous ACL injury.
Waldén M, Hägglund M, Ekstrand J. Br J Sports Med 2006.
The Swedish male professional league (310 players) was studied during 2001.
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 hours, p = 0.02. 9

10. Risk for new ACL injury Study (n) Median age Follow-up time
% ACL-graft inj
% Opp ACL inj
Salmon (612) 28
5 yr
6.4
5.7
Shelbourne
(887)
28 (pts > 18 yrs
1.7
3.2
Shelbourne (1415)
21 (all ages)
4.3
5.3
Artro Clinic
(6801)
28 (all ages)
> 2 yr
3.0
4.4 10

12. Age Gender Football – non Football

13. Revision or new injury opposite knee All patients

15. Individual Cost-Benefit-Analysis
Costs
Benefits
Social factors
Performing different sports
Wellness, Fitness
Economy (Top athletes)
Rehabilitation, Sickleave
Pain, Swelling, Dysfunction
Reinjuries, Rerupture
Osteoarthritis
“Should I return to sports?” 15

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

17. Preop scores KOOS score Pain Knee symptoms ADL
Function sport and recreation
Knee related “Quality Of Life”

18. 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

20. Etiology Primary ACL = = YEAR 2008 2009 Football/soccer 42 % 44 %
Skiing % 12 %
Floor ball 9 % 9 %
European Handball 5 % 6 % = =

21. Unique Database for football research 2005-2009
13503 Primary ACL reconstructions
5674 Etiology = Football
1980 Females
3694 Males
800 Revisions
479 Reoperation (Meniscus, Infection)

22. 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

23. Grafts (Primary ACL) YEAR 2005 2006 2007 2008 2009
Hamstrings 81 % 84 % 87 % 93 % 95 %
BTB 18 % 15 % 12 % 6 % 4 %
Others 1 % 1 % 1 % 1 % 1 %

24. Overall KOOS results

25. Revisions improves between 1 and 2 year follow up

26. 2 years KOOS results for Double Bundle (50 pts) vs HT (5300)

27. Football vs non Football

28. Football vs non Football < 20 yrs

29. Football vs non Football < 20 yrs
Män
Kvinnor

30. 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

33. 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

34. Vänta inte med besluten!