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Clausen SH, Skou ST, Boesen MP, Radev DI, Kurt EY, Damsted C, Hölmich P, Lind M, Tørring S, Isaksen C, Varnum C, Englund M, Thorlund JB. Two-year MRI-defined structural damage and patient-reported outcomes following surgery or exercise for meniscal tears in young adults. Br J Sports Med 2023; 57:1566-1572. [PMID: 37879858 DOI: 10.1136/bjsports-2023-107352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To investigate potential differences in structural knee joint damage assessed by MRI and patient-reported outcomes (PROMs) at 2-year follow-up between young adults randomised to early surgery or exercise and education with optional delayed surgery for a meniscal tear. METHODS A secondary analysis of a multicentre randomised controlled trial including 121 patients (18-40 years) with an MRI-verified meniscal tear. For this study, only patients with 2-year follow-up were included. The main outcomes were the difference in worsening of structural knee damage, assessed by MRI using the Anterior Cruciate Ligament OsteoArthrits Score, and the difference in change in the mean score of four Knee Injury and Osteoarthritis Outcome Score (KOOS4) subscales covering pain, symptoms, function in sport and recreation, and quality of life, from baseline to 2 years. RESULTS In total, 82/121 (68%) patients completed the 2-year follow-up (39 from the surgical group and 43 from the exercise group). MRI-defined cartilage damage had developed or progressed in seven (9.1%) patients and osteophytes developed in two (2.6%) patients. The worsening of structural damage from baseline to 2-year follow-up was similar between groups. The mean (95% CI) adjusted differences in change in KOOS4 between intervention groups from baseline to 2 years was -1.4 (-9.1, 6.2) points. The mean improvement in KOOS4 was 16.4 (10.4, 22.4) in the surgical group and 21.5 (15.0, 28.0) in the exercise group. No between group differences in improvement were found in the KOOS subscales. CONCLUSIONS The 2-year worsening of MRI-defined structural damage was limited and similar in young adult patients with a meniscal tear treated with surgery or exercise with optional delayed surgery. Both groups had similar clinically relevant improvements in KOOS4, suggesting the choice of treatment strategy does not impact 2-year structural knee damage or PROMs. TRIAL REGISTRATION NUMBER NCT02995551.
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Affiliation(s)
- Stine Haugaard Clausen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Center for Muscle and Joint Health, Odense, Denmark
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Center for Muscle and Joint Health, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Mikael Ploug Boesen
- Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Dimitar Ivanon Radev
- Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Engin Yeter Kurt
- Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Camma Damsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Center for Muscle and Joint Health, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Per Hölmich
- Department of Orthopedic Surgery, Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Copenhagen University Hospital, Amager-Hvidovre Hospital, Copenhagen, Denmark
| | - Martin Lind
- Department of Orthopedics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Sofus Tørring
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christin Isaksen
- Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Claus Varnum
- Department of Orthopaedic Surgery, Lillebaelt Hospital, Vejle, Denmark
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Center for Muscle and Joint Health, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Boie S, Krog J, Tørring S, Bor IP. Life-threatening necrotizing myometritis, due to Group A streptococcus - still a life-threatening condition. Clin Case Rep 2015; 3:291-3. [PMID: 25984307 PMCID: PMC4427370 DOI: 10.1002/ccr3.217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/19/2014] [Indexed: 11/14/2022] Open
Abstract
Puerperal infection with Group A streptococcus (GAS) can present with few symptoms and rapidly progress to a life-threatening condition. Often, the infection can be treated with antibiotics. Delay in diagnosis increases risk of sepsis, multiorgan failure, and death. GAS infection is a differential diagnose for all postpartum women with unexplained symptoms.
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Affiliation(s)
- Sidsel Boie
- Department of Obstetrics and Gynecology, Regional Hospital RandersSkovlyvej 1, 8900, Randers, Denmark
| | - Jan Krog
- Department of Anesthesia, Regional Hospital of RandersSkovlyvej 1, 8900, Randers, Denmark
| | - Sofus Tørring
- Department of Radiology, Regional Hospital of RandersSkovlyvej 1, 8900, Randers, Denmark
| | - Isil Pinar Bor
- Department of Obstetrics and Gynecology, Regional Hospital RandersSkovlyvej 1, 8900, Randers, Denmark
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Abstract
It is well-known that burns can result in hypertrophic reddening, thick, itching scars with contractions. Since 1978 the Burns Unit in Copenhagen has treated this condition with Jobst pressure garments. The patients are regularly controlled in the Jobst day-clinic by a team consisting of a surgeon, physiotherapist, occupational therapist and a nurse. Close to 500 patients have been treated and controlled in the clinic for periods of half a year to one and a half years and, in a few cases, for 3 years.
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