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99 TYPE III AND V AC JOINT DISLOCATION SHOW NO
DIFFERENCE IN FUNCTIONAL OUTCOME AND RISK OF
SURGERY AT 1-YEAR FOLLOW-UP
1
Kristine Haugaard*,
2
Klaus Bak,
3
Dorthe Ryberg,
4
Omar Muharemovic,
1
Per Hölmich,
1
Kristoffer Weisskirchner Barfod.
1
Sports Orthopedic Research Center –Copenhagen (SORC-
C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård
Allé 30, Denmark;
2
Adeas Private Hospital, Øster Allé 42, Denmark;
3
Physical Medicine and
Rehabilitation Research-Copenhagen (PMR-C), Department of Physical and Occupational
Therapy, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, Hvidovre;
4
Department of Radiology, Centre for Functional and Diagnostic Imaging and Research,
Copenhagen University Hospital Hvidovre, Kettegård Allé 30, Denmark
10.1136/bmjsem-2023-sportskongres2023.32
Introduction Acromioclavicular(AC) joint dislocations are com-
mon injuries, but the need for surgery is debated. The objec-
tive of the study was to evaluate the result after acute
Rockwood type III and V AC joint dislocations managed non-
surgically with the option of delayed surgical intervention.
Materials and Methods This was a prospective cohort study
with clinical, radiological and patient-reported outcome assess-
ment at baseline and 6w, 3m, 6m and 1y after acute AC joint
dislocation. Inclusion criteria were patients aged 18–60 with
acute AC joint dislocation and >50% superior displacement
of the clavicle. All patients were treated non-surgically with 3
months of home-based training and with the option of
delayed surgical intervention. At baseline, patients were graded
as Rockwood type III or V based on the coracoclavicular dif-
ference. The primary outcome was the Western Ontario
Shoulder Instability Index (WOSI). Secondary outcome was
surgery yes/no.
Results Ninety-five patients, male:female ratio 9.6:1, mean age
39.5 (range 18–59), were included. 57 patients were Rock-
wood type III and 38 patients were type V. There were no
statistically significant differences in WOSI between patients
with type III and V injuries at any time-point. Nine patients
(9.5%) were referred for surgery at an average of 189 days
(range 75–358) after the injury; 7 type III and 2 type V
(p=0.31). Patients eventually referred for surgery had signifi-
cantly worse WOSI at 6w, 3m and 6m.
Conclusion Non-surgical management of Rockwood type III
and V injuries shows similar and overall satisfactory results
with 91% recovering well without the need of surgery.
101 ASSOCIATION BETWEEN HIP MUSCLE FUNCTION AND
HIP-SPECIFIC PATIENT-REPORTED OUTCOMES IN
PATIENTS WITH LONGSTANDING HIP AND GROIN PAIN
Anders Pålsson*, Jenny Älmquist Nae. Lund University, Baravägen 3, Sweden
10.1136/bmjsem-2023-sportskongres2023.33
Introduction Decreased hip muscle strength and poor patient-
reported outcomes are common in patient with longstanding
hip and groin pain. However, the association between hip
muscle strength and patient-reported outcomes is less known.
The aim the study was to investigate the association between
hip muscle strength and hip-specific patient-reported outcomes
in patients with longstanding hip and groin pain.
Materials and Methods Seventy-two patients were recruited
from an orthopaedic department. Isometric hip muscle
strength was measured with a handheld dynamometer in
adduction and extension. Patient reported outcomes was meas-
ured with Hip and Groin Outcome Score (HAGOS). Linear
regression examined the association between hip muscle
strength and each HAGOS subscale. The regression models
were adjusted for sex, age, BMI, and activity level.
Results Greater isometric hip muscle strength in adduction was
associated with better HAGOS score in the subscales; pain,
and activity in daily life (B=12.4–12.5, p£0.037) but not for
the subscales; symptoms, physical function in sports, participa-
tion, and quality of life (QOL) (B=-0.5–9.7, p0.154).
Greater isometric hip muscle strength in extension was associ-
ated with better HAGOS score for the subscales; symptoms,
pain, and activity in daily life (B=7.2–12.3, p £0.034), but
not for the subscales; physical function in sports, participation,
or QOL (B=5.2–6.6, p 0.084).
Conclusions Greater isometric hip muscle strength seems to be
associated with better patients-reported symptoms, pain, and
physical activity in daily life. The result of this study high-
lights the importance of considering hip strength in the reha-
bilitation of patients with longstanding hip and groin pain.
105 LOOP TAPING FOR HEEL FAT PAD SYNDROME: A
RANDOMIZED CONTROLLED CROSSOVER CLINICAL
TRIAL
1,2
Alison Chang*,
1,3
Thomas Sørensen,
4
Katrine Skov,
1,4,5
Michael Rathleff,
1,5
Henrik Riel,
1,5
Kristian Lyng,
4,6
Marianne Christensen.
1
Department of Health Science and Technology,
Aalborg University, Denmark;
2
Department of Physical Therapy and Human Movement
Sciences, Northwestern University Feinberg School of Medicine, USA;
3
Department of
Physio- and Occupational Therapy, Lillebælt Hospital, University Hospital of Southern
Denmark, Denmark;
4
Department of Physiotherapy and Occupational Therapy, Aalborg
University Hospital, , Denmark;
5
Center for General Practice at Aalborg University, Denmark;
6
Interdisciplinary Orthopaedics, Aalborg University Hospital, Denmark
10.1136/bmjsem-2023-sportskongres2023.34
Introduction Heel fat pad syndrome (HFPS) is the second
leading cause of plantar heel pain. Clinical practice guidelines
recommend conservative treatments for HFPS (activity modifi-
cation, arch taping, and viscoelastic heel-cups). Alarmingly, the
evidence for managing HFPS is scant and no well-executed
randomised trials exist to support specific treatments. We aim
to examine the effect of a novel heel fat pad loop taping on
pain and function for HFPS.
Materials and Methods In this two-arm crossover, participant-
blinded RCT, participants with HFPS are block-randomized
into either AB or BA interventions (A=loop taping that
encircles/bunches the fat pad to centralize it and enhance its
fullness and resilience to compression, B=control taping that
mimic the loop taping without any force/pressure or attempt
to bunch/centralize the fat pad) with a 4-to-7-day between-
intervention washout period. The primary outcome is pain
during the most pain-aggravating activity selected by partici-
pants (30-sec single-leg standing or 20-meter barefoot walk-
ing). Secondary outcomes are worst pain in the past 24 hours,
foot health/function using the Foot Health Status Question-
naire, and global rating of change. We also assessed mechanis-
tic outcomes of ultrasound-measured heel fat pad thickness
and pressure-algometer-measured pressure pain thresholds.
Results This pre-registered RCT will be completed in Decem-
ber 2022. 19 participates are needed to detect a 2-point
greater pain reduction for loop vs. control taping. We have
eligibility-screened 17 participants, enrolled and completed
data collection in 2.
Conclusion Findings of this first RCT examining clinical and
mechanistic effects of loop taping will provide much-needed
Abstracts
A12 BMJ Open Sp Ex Med 2023;9(Suppl 1):A1–A16
Protected by copyright. on June 29, 2023 by guest.http://bmjopensem.bmj.com/BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2023-sportskongres2023.34 on 25 January 2023. Downloaded from
evidence on effective non-pharmacological managements of
HFPS.
107 A DECADE AFTER THE DELAWARE-OSLO ACL
TREATMENT ALGORITHM: WHAT ARE THE LONG-TERM
OUTCOMES?
1
Anouk Urhausen*,
1
Marie Pedersen,
2,3
Hege Grindem,
4
Naoaki Ito,
4,5
Elanna Arhos,
4
Angela Schmith,
4
Karin Silbernagel,
4,6
Michael Axe,
2,7
Lars Engebretsen,
4
Lynn Snyder-
Mackler,
1,7
May Arna Risberg.
1
Department of Sports Medicine, Norwegian School Of Sport
Sciences, Norway;
2
Oslo Sport Trauma Research Center, Norwegian School of Sport
Sciences, Norway;
3
Stockholm Sports Trauma Research Center, Department of Molecular
Medicine and Surgery, Karolinska Institutet, Sweden;
4
Department of Physical Therapy,
University of Delaware, USA;
5
Ohio State University, USA;
6
First State Orthopaedics, USA;
7
Division of Orthopedic Surgery, Oslo University Hospital, Norway
10.1136/bmjsem-2023-sportskongres2023.35
Introduction The Delaware-Oslo ACL treatment algorithm is
distinct as it includes progressive rehabilitation with repeated
functional testing, patient education and shared decision-mak-
ing about treatment. We described and compared 10-year
knee osteoarthritis and patient-reported outcomes in athletes
who followed our treatment algorithm and chose early (<6
months) anterior cruciate ligament reconstruction (ACLR) with
pre- and postoperative rehabilitation, delayed (>6 months)
ACLR with pre- and postoperative rehabilitation, and progres-
sive rehabilitation alone.
Materials and Methods We included 276 athletes with unilat-
eral ACL injury from a prospective cohort. Tibiofemoral
radiographs, the International Knee Documentation Committee
(IKDC) and the Knee injury and Osteoarthritis Outcome Score
(KOOS) subscales were assessed. Radiographic osteoarthritis
was defined as Kellgren and Lawrence (K&L) grade 2 and
symptomatic osteoarthritis as KOOS pain score £72 and K&L
grade 2.
Results At 10 years, 138 athletes had interpretable radio-
graphs, whereof 59% had chosen early ACLR, 14%
delayed ACLR, and 27% progressive rehabilitation alone.
Across treatment groups, 12% had radiographic osteoar-
thritis and 1% had symptomatic OA. The mean±SD IKDC
score was 87±11 points, while the KOOS subscales ranged
between 76±20 (quality of life) and 98±4 (activities of
daily living) points. The KOOS sport and recreation score
was statistically significantly lower following delayed ACLR
compared to early ACLR (p=.002) or rehabilitation alone
(p=.004). No other outcomes differed between groups
(p>.2).
Conclusion Patients with ACL injuries who followed our treat-
ment algorithm had low rates of knee osteoarthritis and good
patient-reported outcomes at 10 years. Our findings reflect
outcomes after treatment as it occurs in clinical practice.
108 LOWER LIMB ATROPHY AND FATTY INFILTRATION
AFTER ACHILLES TENDON RUPTURE ASSESSED BY
COMPUTER TOMOGRAPHY
1,2
Simon Svedman*,
1
Malin Heijkenskjöld,
1,2
Paul Ackermann,
1,3
Hans Berg.
1
Department
of Orthopaedic Surgery, Karolinska University Hospital, Sweden;
2
Department of Molecular
Medicine and Surgery, Karolinska Institutet, Sweden;
3
Division of Orthopaedics and
Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska
Institutet, Sweden
10.1136/bmjsem-2023-sportskongres2023.36
Introduction In the aftermath of Achilles tendon rupture
(ATR) a period of immobilization is always needed. For
ATR, the immobilization period is normally 6–8weekswhich
can cause significant leg muscle deconditioning and muscle
weakness. Descriptive studies of limb deconditioning in the
early stages after ATR injury are lacking and could yield new
insights on how to best limit limb deconditioning after
injury.
Material and Methods 15 patients with unilateral non-oper-
ated ATR were included from a randomised controlled trial.
At 6 weeks after injury, all patients underwent computer
tomography investigation from mid-thigh to plantar foot.
Muscle CSA and attenuation were measured and associated
with both patient-reported- and functional outcome one year
after injury.
Results The soleus muscle of the injured limb contained at
mean 19.5% more intramuscular fat than the uninjured limb
at 6 weeks after injury(p<0.05). The lateral and medial gas-
trocnemius contained at mean 8.3% and 14.8% more fat than
the uninjured limb respectively (p>0.05). Mean CSA of the
uninjured lateral-, medial gastrocnemius and soleus were
11.4%, 8.4% and 6.7% larger than the injured limb
(p>0.05). No association between CSA or fatty infiltration
and patient outcome were observed. There was no association
between patient weightbearing during immobilization and
muscle deconditioning.
Conclusion Muscle deconditioning occur early after ATR. Sig-
nificant fatty infiltration in the muscle had occurred, with no
significant difference in muscle CSA. However, no significant
association to patient outcome were observed at one year,
which might be due to the low number of patients in this
study.
109 SUPERIOR OUTCOMES AFTER PROGRESSIVE PRE- AND
POSTOPERATIVE REHABILITATION COMPARED WITH
USUAL CARE 10 YEARS AFTER ANTERIOR CRUCIATE
LIGAMENT RECONSTRUCTION
1
Anouk Urhausen*,
1
Marie Pedersen,
2,3
Hege Grindem,
2,4
Lars Engebretsen,
5
Lynn Snyder-
Mackler,
1,4
May Arna Risberg.
1
Norwegian School Of Sport Sciences, Norway;
2
Oslo Sport
Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway, Norway;
3
Stockholm Sports Trauma Research Center, Department of Molecular Medicine and
Surgery, Karolinska Institutet, Sweden;
4
Division of Orthopedic Surgery, Oslo University
Hospital, Norway;
5
Department of Physical Therapy, University of Delaware, USA
10.1136/bmjsem-2023-sportskongres2023.37
Introduction Better two-year outcomes are achieved when
anterior cruciate ligament reconstruction (ACLR) is combined
with progressive preoperative and postoperative rehabilitation
than with usual care, but long-term outcomes are not investi-
gated. We therefore compared patient-reported outcomes 10
years after ACLR in patients who followed progressive preop-
erative and postoperative rehabilitation versus those who fol-
lowed usual care.
Materials and Methods We included patients from the Norwe-
gian arm of the Delaware-Oslo ACL cohort (progressive pre-
operative and postoperative rehabilitation, n=101) and the
Norwegian Knee Ligament Registry (usual care, n=3162).
Patients had primary unilateral ACLR using a patellar tendon
or hamstring autograft after 2006, no substantial concomitant
injuries, and were aged 13–40 years. The 10-year Knee
Injury and Osteoarthritis Outcome Score (KOOS) subscale
scores and proportion exceeding the patient-acceptable
Abstracts
BMJ Open Sp Ex Med 2023;9(Suppl 1):A1–A16 A13
Protected by copyright. on June 29, 2023 by guest.http://bmjopensem.bmj.com/BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2023-sportskongres2023.34 on 25 January 2023. Downloaded from