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Biomedical subjects

Lars Engebretsen

Publications and source records attributed to Lars Engebretsen.

33 records · Page 2Linked to original sources
PubMed2004

Use of a synthetic bone void filler to augment screws in osteopenic ankle fracture fixation.

INTRODUCTION: Sufficiently stable constructs may be difficult to obtain with ankle fractures in patients with severe osteopenic bone. Augmentation of the osteosynthesis with a new synthetic bone void filler may help to solve this problem, and it can improve the clinical outcome. MATERIALS AND METHODS: A prospective, open-label study was performed in two surgical clinics in Norway. In 37 of 42 selected patients with Weber type B ankle fractures showing clinical and radiologic signs of osteopenic bone, at least one screw was found to be stripping during open reduction and internal fixation (ORIF). All the stripped screws were augmented with the bone void filler, and tightness was assessed clinically afterwards. All patients were followed up for 2 years. Successful healing of the fracture after 3 months and absence of radiographic movement of the augmented screws were assessed relative to the plate and the bone. Safety was assessed by recording adverse events and abnormal haematology findings. RESULTS: All 86 augmented screws were clinically tight after augmentation. After 3 months, all fractures healed, and 1 augmented and 1 non-augmented screw appeared to be radiographically loose. After 2 and 6 months, respectively, deep wound infections occurred in 2 patients (5%), necessitating antibiotic treatment, revision surgery and implant removal. After 2 years, all patients had resumed their normal daily activities, and none of the augmented screws showed signs of loosening. CONCLUSIONS: Augmentation of bone screws with this new synthetic bone void filler was an effective means of gaining screw anchorage. Screw stabilisation with the new synthetic bone void filler proved to be safe and effective in the ORIF of ankle fractures in patients with osteopenic bone.

Aged↗
PubMed2004

Injury mechanisms for anterior cruciate ligament injuries in team handball: a systematic video analysis.

OBJECTIVE: To describe the mechanisms for anterior cruciate ligament injuries in female team handball. STUDY DESIGN: Descriptive video analysis. METHODS: Twenty videotapes of anterior cruciate ligament injuries from Norwegian or international competition were collected from 12 seasons (1988-2000). Three medical doctors and 3 national team coaches systematically analyzed these videos to describe the injury mechanisms and playing situations. In addition, 32 anterior cruciate ligament-injured players in the 3 upper divisions in Norwegian team handball were interviewed during the 1998-1999 season to compare the injury characteristics between player recall and the video analysis. RESULTS: Two main injury mechanisms for anterior cruciate ligament injuries in team handball were identified. The most common (12 of 20 injuries), a plant-and-cut movement, occurred in every case with a forceful valgus and external or internal rotation with the knee close to full extension. The other main injury mechanism (4 of 20 injuries), a 1-legged jump shot landing, occurred with a forceful valgus and external rotation with the knee close to full extension. The results from the video analysis and questionnaire data were similar. CONCLUSIONS: The injury mechanism for anterior cruciate ligament injuries in female team handball appeared to be a forceful valgus collapse with the knee close to full extension combined with external or internal rotation of the tibia.

Adult↗
PubMed2004

Physical fitness, injuries, and team performance in soccer.

PURPOSE: To investigate the relationship between physical fitness and team success in soccer, and to test for differences in physical fitness between different player positions. METHODS: Participants were 306 male soccer players from 17 teams in the two highest divisions in Iceland. Just before the start of the 1999 soccer season, the following variables were tested: height and weight, body composition, flexibility, leg extension power, jump height, and peak O2 uptake. Injuries and player participation in matches and training were recorded through the 4-month competitive season. Team average physical fitness was compared with team success (final league standing) using a linear regression model. Physical fitness was also compared between players in different playing positions. RESULTS: A significant relationship was found between team average jump height (countermovement jump and standing jump) and team success (P = 0.009 and P = 0.012, respectively). The same trend was also found for leg extension power (P = 0.097), body composition (% body fat, P = 0.07), and the total number of injury days per team (P = 0.09). Goalkeepers demonstrated different fitness characteristics from outfield players. They were taller and heavier, more flexible in hip extension and knee flexion, and had higher leg extension power and a lower peak O2 uptake. However, only minor differences were observed between defenders, midfield players, and attackers. CONCLUSION: Coaches and medical support teams should pay more attention to jump and power training, as well as preventive measures and adequate rehabilitation of previous injuries to increase team success.

Adolescent↗
PubMed2004

Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial.

BACKGROUND: New methods have been used, with promising results, to treat full-thickness cartilage defects. The objective of the present study was to compare autologous chondrocyte implantation with microfracture in a randomized trial. We are not aware of any previous randomized studies comparing these methods. METHODS: Eighty patients without general osteoarthritis who had a single symptomatic cartilage defect on the femoral condyle in a stable knee were treated with autologous chondrocyte implantation or microfracture (forty in each group). We used the International Cartilage Repair Society, Lysholm, Short Form-36 (SF-36), and Tegner forms to collect data. An independent observer performed a follow-up examination at twelve and twenty-four months. Two years postoperatively, arthroscopy with biopsy for histological evaluation was carried out. The histological evaluation was done by a pathologist and a clinical scientist, both of whom were blinded to each patient's treatment. RESULTS: In general, there were small differences between the two treatment groups. At two years, both groups had significant clinical improvement. According to the SF-36 physical component score at two years postoperatively, the improvement in the microfracture group was significantly better than that in the autologous chondrocyte implantation group (p = 0.004). Younger and more active patients did better in both groups. There were two failures in the autologous chondrocyte implantation group and one in the microfracture group. No serious complications were reported. Biopsy specimens were obtained from 84% of the patients, and histological evaluation of repair tissues showed no significant differences between the two groups. We did not find any association between the histological quality of the tissue and the clinical outcome according to the scores on the Lysholm or SF-36 form or the visual analog scale. CONCLUSIONS: Both methods had acceptable short-term clinical results. There was no significant difference in macroscopic or histological results between the two treatment groups and no association between the histological findings and the clinical outcome at the two-year time-point. LEVEL OF EVIDENCE: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

Adult↗
PubMed2003

Considerations on sample size and power calculations in randomized clinical trials.

Many studies in orthopaedics and sports medicine have not considered sample size or statistical power as important issues in study design. This article addresses the importance of a sample size calculation in randomized clinical trials and the components of the calculations that researchers must consider in their preliminary planning of an investigation. The types of data being collected, level of significance, types I and II errors, and power are also addressed.

Humans↗
PubMed2003

Practical aspects of randomization and blinding in randomized clinical trials.

Randomization and blinding are important tools in determining the effectiveness of a new intervention and ensuring the validity of a clinical trial. However, randomness and haphazardness are not equivalent. Randomization cannot overcome poor experimental design or technique. Several types of randomization including historical controls and pseudorandomization are discussed, as well as methods of treatment allocation, stratification, and minimization techniques. The importance of decreasing bias and the advantages and disadvantages of blinding in randomized clinical trials are also covered.

Bias↗
PubMed2003

Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons.

OBJECTIVE: To assess the effect of a neuromuscular training program on the incidence of anterior cruciate ligament injuries in female team handball players. DESIGN: Prospective intervention study. SETTING: Female team handball: Division I-III in Norway. PARTICIPANTS: Players from the three top divisions: control season (1998-1999), 60 teams (942 players); first intervention season (1999-2000), 58 teams (855 players); second intervention season (2000-2001), 52 teams (850 players). INTERVENTION: A five-phase program (duration, 15 min) with three different balance exercises focusing on neuromuscular control and planting/landing skills was developed and introduced to the players in the autumn of 1999 and revised before the start of the season in 2000. The teams were instructed in the program and supplied with an instructional video, poster, six balance mats, and six wobble boards. Additionally, a physical therapist was attached to each team to follow up with the intervention program during the second intervention period. MAIN OUTCOME MEASURES: The number of anterior cruciate ligament injuries during the three seasons and compliance with the program. RESULTS: There were 29 anterior cruciate ligament injuries during the control season, 23 injuries during the first intervention season (OR, 0.87; CI, 0.50-1.52; p = 0.62), and 17 injuries during the second intervention season (OR, 0.64; CI, 0.35-1.18; p = 0.15). In the elite division, there were 13 injuries during the control season, six injuries during the first intervention season (OR, 0.51; CI, 0.19-1.35; p = 0.17), and five injuries in the second intervention season (OR, 0.37; CI, 0.13-1.05; p = 0.06). For the entire cohort, there was no difference in injury rates during the second intervention season between those who complied and those who did not comply (OR, 0.52; CI, 0.15-1.82; p = 0.31). In the elite division, the risk of injury was reduced among those who completed the anterior cruciate ligament injury prevention program (OR, 0.06; CI, 0.01-0.54; p = 0.01) compared with those who did not. CONCLUSIONS: This study shows that it is possible to prevent anterior cruciate ligament injuries with specific neuromuscular training.

Adult↗
PubMedDate not supplied

Performance characteristics of volleyball players with patellar tendinopathy.

BACKGROUND: Patellar tendinopathy is assumed to result from chronic tendon overload. There may be a relationship between tendon pain and jumping ability. HYPOTHESIS: There is no difference in performance characteristics between volleyball players with patellar tendinopathy and those without. STUDY DESIGN: Prospective cohort study. METHOD: We examined the performance of the leg extensor apparatus in high-level male volleyball players with patellar tendinopathy (N = 24) compared with a control group (N = 23) without knee symptoms. The testing program consisted of different jump tests with and without added load, and a composite jump score was calculated to reflect overall performance. RESULTS: The groups were similar in age, height, and playing experience, but the patellar tendinopathy group did more specific strength training and had greater body weight. They scored significantly higher than the control group on the composite jump score (50.3 versus 39.2), and significant differences were also observed for work done in the drop-jump and average force and power in the standing jumps with half- and full-body weight loads. CONCLUSIONS: Greater body weight, more weight training, and better jumping performance may increase susceptibility to patellar tendinopathy in volleyball players.

Adult↗
PubMedDate not supplied

The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon.

BACKGROUND: Quantitative descriptions of the attachment sites of the main posterolateral knee structures have not been performed. PURPOSE: To qualitatively and quantitatively determine the anatomic attachment sites of these structures and their relationships to pertinent bony landmarks. STUDY TYPE: Cadaveric study. METHODS: Dissections were performed and measurements taken on 10 nonpaired fresh-frozen cadaveric knees. RESULTS: The fibular collateral ligament had an average femoral attachment slightly proximal (1.4 mm) and posterior (3.1 mm) to the lateral epicondyle. Distally, it attached 8.2 mm posterior to the anterior aspect of the fibular head. The popliteus tendon had a constant broad-based femoral attachment at the most proximal and anterior fifth of the popliteal sulcus. The popliteus tendon attachment on the femur was always anterior to the fibular collateral ligament. The average distance between the femoral attachments of the popliteus tendon and fibular collateral ligament was 18.5 mm. The popliteofibular ligament had two divisions-anterior and posterior-in all cases. The average attachment of the posterior division was 1.6 mm distal to the posteromedial aspect of the tip of the fibular styloid process and the anterior division attached 2.8 mm distal to the anteromedial aspect of the tip of the fibular styloid process. CONCLUSIONS: These structures had a consistent attachment pattern. This information will prove useful in the study of anatomic repair and reconstruction of the posterolateral structures of the knee.

Aged↗
PubMedDate not supplied

Clinical, functional, and radiologic outcome in team handball players 6 to 11 years after anterior cruciate ligament injury: a follow-up study.

BACKGROUND: Long-term outcome after anterior cruciate ligament injury among top-level pivoting athletes is unknown. PURPOSE: To evaluate outcome among competitive team handball players after anterior cruciate ligament injury. STUDY DESIGN: Prospective cohort study. METHODS: A previously studied group of 86 elite players who had an anterior cruciate ligament rupture were invited to participate in follow-up evaluations a mean of 7.8 years later. RESULTS: Among the 57 operatively treated patients who returned for follow-up, 33 (58%) returned to team handball at their preinjury level, compared with 18 of 22 (82%) in the nonoperative group. Eleven of the 50 players (22%) who continued playing reinjured their anterior cruciate ligament when playing team handball. The overall Lysholm score was 85 +/- 13 in both groups, but the five players classified as poor were all operatively treated. Nearly half of the players had an International Knee Documentation Committee classification of abnormal or severely abnormal. There were significant differences between the injured and uninjured leg in functional (2.5% to 8%), strength (3.8% to 10.1%), and KT-1000 arthrometer tests (27%). In the operatively treated group, 11 developed radiologic gonarthrosis, compared with 6 in the nonoperatively treated group. There was no correlation between radiologic findings and pain scores. CONCLUSION: A more restrictive attitude regarding return to competitive pivoting sports after anterior cruciate ligament injury may be warranted.

Analysis of Variance↗
PubMedDate not supplied

Risk factors for injuries in football.

BACKGROUND: The injury risk in football is high, but little is known about causes of injury. PURPOSE: To identify risk factors for football injuries using a multivariate model. STUDY DESIGN: Prospective cohort study. METHODS: Participants were 306 male football players from the two highest divisions in Iceland. Before the 1999 football season started, the following factors were examined: height, weight, body composition, flexibility, leg extension power, jump height, peak O(2) uptake, joint stability, and history of previous injury. Injuries and player exposure were recorded throughout the competitive season. RESULTS: Older players were at higher risk of injury in general (odds ratio [OR] = 1.1 per year, P = 0.05). For hamstring strains, the significant risk factors were age (OR = 1.4 [1 year], P < 0.001) and previous hamstring strains (OR = 11.6, P <0.001). For groin strains, the predictor risk factors were previous groin strains (OR = 7.3, P = 0.001) and decreased range of motion in hip abduction (OR = 0.9 [1 degrees ], P = 0.05). Previous injury was also identified as a risk factor for knee (OR = 4.6) and ankle sprains (OR = 5.3). CONCLUSIONS: Age and previous injury were identified as the main risk factors for injury among elite football players from Iceland.

Adolescent↗
PubMedDate not supplied

Articular cartilage lesions in 993 consecutive knee arthroscopies.

BACKGROUND: Traumatic articular cartilage injuries heal poorly and may lead to development of osteoarthritis at a young age. This study estimates the number of patients who may benefit from one of the surgical methods of cartilage repair. METHODS: All patients undergoing knee arthroscopy during a 6-month period at three collaborating hospitals were consecutively evaluated according to the International Cartilage Repair Society (ICRS) knee form. The material consists of 993 consecutive knee arthroscopies in patients with median age of 35 years. RESULTS: Preoperative radiographs demonstrated degenerative changes in 13% of the knees. Articular cartilage pathology was found in 66% and a localized cartilage defect was found in 20% of the knees. A localized full-thickness cartilage lesion (ICRS grade 3 and 4) was observed in 11% of the knees. Of the localized full-thickness lesions, 55% (6% of all knees) had a size above 2 cm(2). CONCLUSION: Eleven percent of all knee arthroscopies show cartilage defects that may be suitable for cartilage repair procedures. However, the natural history of these lesions and the number of patients that will benefit from a cartilage repair procedure are so far unknown.

Adolescent↗
PubMedDate not supplied

Rule violations as a cause of injuries in male norwegian professional football: are the referees doing their job?

BACKGROUND: Foul play is an important cause of injury in football. Reduction of foul play and adherence to the laws of the game may be possible interventions to reduce the rate of injuries. PURPOSE: To evaluate how violations of the laws of the game contribute to injury and to investigate whether the decisions made by the referees are correct in high-risk situations. STUDY DESIGN: Prospective cohort study. METHODS: Videotapes and injury information were collected for 174 of 182 matches from the male Norwegian professional league during the 2000 season. Three Norwegian FIFA referees performed retrospective blinded evaluation of the 406 incidents. RESULTS: Less than one-third of the injuries identified on video and about 40% of the incidents with a high risk of injury resulted in a free kick being awarded. About 1 in 10 of these situations led to either a yellow or red card. The agreement between decisions made by the match referee and the expert referee panel was good, that is, their decisions agreed in 85% of the situations in which injury occurred. CONCLUSIONS: There may be a need for an improvement of the laws of the game of football to protect players from dangerous play.

Athletic Injuries↗