Publications by authors named "Håvard Visnes"

8 Publications

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Low annual hospital volume of anterior cruciate ligament reconstruction is not associated with higher revision rates.

Knee Surg Sports Traumatol Arthrosc 2021 Jul 8. Epub 2021 Jul 8.

Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway.

Purpose: Surgery performed in low-volume centres has been associated with longer operating time, longer hospital stays, lower functional outcomes, and higher rates of revision surgery, complications and mortality. This has been reported consistently in the arthroplasty literature, but there is a paucity of data regarding the relationship between surgical volume and outcome following anterior cruciate ligament (ACL) reconstruction. The purpose was to compare ACL reconstruction failure rates between hospitals performing different annual surgical volumes.

Methods: All patients from the Norwegian Knee Ligament Register having primary autograft ACL reconstruction between 2004 and 2016 were included. Hospital volume was divided into quintiles based on the number of ACL reconstructions performed annually, defined arbitrarily as: 1-12 (V1), 13-24 (V2), 25-49 (V3), 50-99 (V4) and ≥ 100 (V5) annual procedures. Kaplan-Meier estimated survival curves and survival percentages were calculated with revision ACL reconstruction as the end point. Secondary outcome measures included (1) mean change in Knee Injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) and Sport subsections from pre-operative to 5-year follow-up and (2) subjective failure defined as KOOS QoL < 44.

Results: Twenty thousand eight hundred and fifty patients met the inclusion criteria and 1195 (5.7%) underwent subsequent revision ACL reconstruction over the study period. Revision rates were lower in the lower volume hospitals compared with the higher volume hospitals (p < 0.001). There was no clinically significant difference in improvement between pre-operative and 5-year follow-up KOOS scores between hospital volume categories, but a higher proportion of patients having surgery at lower volume hospitals reported a subjective failure. Patients in the lower volume categories (V1-3) were more often male and older compared to the higher volume hospitals (V4-5). Concomitant meniscal injuries and participation in pivoting sports were most common in V5 compared with V1 (p < 0.001). Median operative time decreased as hospital volume increased, ranging from 90 min at V1 hospitals to 56 min at V5 hospitals (p < 0.001).

Conclusion: Patients having ACL reconstruction at lower volume hospitals had a lower rate of subsequent revision surgery relative to higher volume hospitals. However, complications occurred more frequently, operative duration was longer, and the number of patients reporting a subjective failure of ACL reconstruction was highest at these lower volume hospitals.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1007/s00167-021-06655-zDOI Listing
July 2021

Chronic hyperglycemia, hypercholesterolemia, and metabolic syndrome are associated with risk of tendon injury.

Scand J Med Sci Sports 2021 May 8. Epub 2021 May 8.

Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Copenhagen University Hospital - Bispebjerg and Frederiksberg and Center for Healthy Aging, Institute of Sports Medicine Copenhagen, University of Copenhagen, Copenhagen, Denmark.

Tendon injury is a considerable problem affecting both physically active and sedentary people. The aim of this study was to examine the relationship between markers for metabolic disorders (hyperglycemia, hypercholesterolemia, and metabolic syndrome) and the risk of developing tendon injuries requiring referral to a hospital. The Copenhagen City Heart Study is a prospective study of diabetic and non-diabetic individuals from the Danish general population with different physical activity levels. The cohort was followed for 3 years via national registers with respect to tendon injuries. Data from 5856 individuals (median age 62 years) were included. The overall incidence of tendon injury in both upper and lower extremities that required an out-patient or in-house visit to a hospital was ~5.7/1000 person years. Individuals with elevated HbA1c (glycated hemoglobin) even in the prediabetic range (HbA1c>5.7%) had a ~3 times higher risk of tendon injury in the lower extremities only, as compared to individuals with normal HbA1C levels. Hypercholesterolemia (total cholesterol>5 mmol/L) increased risk of tendon injury in the upper extremities by ~1.5 times, and individuals with metabolic syndrome had ~2.5 times higher risk of tendon injury in both upper and lower extremities. In conclusion, these data demonstrate for the first time in a large cohort with different physical activity levels that the indicators for metabolic syndrome are a powerful systemic determinant of tendon injury, and two of its components, hyperglycemia and hypercholesterolemia, each independently make tendons susceptible for damage and injury.
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http://dx.doi.org/10.1111/sms.13984DOI Listing
May 2021

How to translate and locally adapt a PROM. Assessment of cross-cultural differential item functioning.

Scand J Med Sci Sports 2021 May 5;31(5):999-1008. Epub 2020 Nov 5.

Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.

Translating patient-reported outcome measures (PROMs) can alter the meaning of items and undermine the PROM's psychometric properties (quantified as cross-cultural differential item functioning [DIF]). The aim of this paper was to present the theoretical background for PROM translation, adaptation, and cross-cultural validation, and assess how PROMs used in sports medicine research have been translated and adapted. We also assessed DIF for the Knee Injury and Osteoarthritis Outcome Score (KOOS) across Danish, Norwegian, and Swedish versions. We conducted a search in PubMed and Scopus to identify the method of translation, adaptation, and validation of PROMs relevant to musculoskeletal research. Additionally, 150 preoperative KOOS questionnaires were obtained from the Scandinavian knee ligament reconstruction registries, and cross-cultural DIF was evaluated using confirmatory factor analysis and Rasch analysis. There were 392 studies identified, describing the translation of 61 PROMs. Ninety-four percent were performed with forward-backward technique. Forty-nine percent used cognitive interviews to ensure appropriate wording, understandability, and adaptation to the target culture. Only two percent were validated according to modern test theory. No study assessed cross-cultural DIF. One KOOS subscale showed no cross-cultural DIF, two had DIF with respect to some (but not all) items, and thus conversion tables could be constructed, and two KOOS subscales could not be pooled. Most PROM translations are of undocumented quality, despite the common conclusion that they are valid and reliable. Scores from three of five KOOS subscales can be pooled across the Danish, Norwegian, and Swedish versions, but two of these must be adjusted for DIF.
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http://dx.doi.org/10.1111/sms.13854DOI Listing
May 2021

Norwegican Cartilage Project - a study protocol for a double-blinded randomized controlled trial comparing arthroscopic microfracture with arthroscopic debridement in focal cartilage defects in the knee.

BMC Musculoskelet Disord 2016 07 16;17:292. Epub 2016 Jul 16.

Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Background: Focal lesions to the articular cartilage in the knee might have demolishing consequences to the knee. There exists a wide range of possible surgical procedures targeting these injuries, however no significant differences have been found between these procedures. This may support that the improvement is a result of rehabilitation, and not the surgery itself. Arthroscopic microfracture (MF) treatment has gained popularity, and has become the treatment of choice in patients with knee cartilage defects globally. In this study we want to increase knowledge, both clinical and economic, about arthroscopic microfracture (AF) compared to arthroscopic debridement (AD) and physical rehabilitation both in the short run, and in the long run.

Methods/design: To compare arthroscopic microfracture with arthroscopic debridement and physiotherapy for the treatment of focal cartilage lesions in the knee, a long-term, double-blinded, randomized controlled multicenter trial will be conducted. A total of 114 men and non-pregnant women with a symptomatic focal full thickness cartilage lesion in the knee less than 2 cm2 will be included in the study. The two treatment allocations will receive identical rehabilitation, which is made up of 3 phases: accommodation, rehabilitation and return to activity. Follow up is 24 months, where all will be invited to participate in late follow ups after 5 and 10 years. The Knee Injury and Osteoarthritis Outcome Score (KOOS) knee-related quality of life (QoL) subscore is the primary endpoint. Clinical parameters, questionnaires and radiologic modalities (Magnetic Resonance Imaging (MRI) and x-ray) will be used as secondary endpoints.

Discussion: This is an ongoing multicenter study with a high level of evidence to compare arthroscopic microfracture with arthroscopic debridement and physiotherapy for the treatment of isolated symptomatic full thickness cartilage lesions in the knee joint.

Trial Registration: ClinicalTrials.gov ID: NCT02637505 (December 15, 2015).
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http://dx.doi.org/10.1186/s12891-016-1156-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947343PMC
July 2016

Mechanical properties of the patellar tendon in elite volleyball players with and without patellar tendinopathy.

Br J Sports Med 2013 Sep 5;47(13):862-8. Epub 2013 Jul 5.

Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Norway.

Background: Although differences in mechanical properties between symptomatic and healthy tendons have been observed for the Achilles tendon, the impact of tendinopathy on patellar tendon mechanics is not fully documented. The aim of the present case-control study was to assess the mechanical properties of the tendon and jump performance in elite athletes with and without patellar tendinopathy.

Methods: We identified 17 male volleyball players with patellar tendinopathy and 18 healthy matched controls from a 5-year prospective cohort study on junior elite volleyball players. Outcome variables included three measures of maximal vertical jump performance and ultrasound-based assessments of patellar tendon cross-sectional area, stiffness and Young's modulus.

Results: The proximal cross-sectional area of the patellar tendon was significantly larger in the tendinopathic group (133 ± 11 vs 112 ± 9 mm(2), respectively; p < 0.001). Pathological tendons presented lower stiffness (2254 ± 280 vs 2826 ± 603 N/mm, respectively; p = 0.006) and Young's modulus (0.99 ± 0.16 vs 1.17 ± 0.25 GPa, respectively; p = 0.04) than healthy tendons. However, the difference between the countermovement jump height and the squat jump height (3.4 ± 2.2 vs 1.2 ± 1.5 cm, p = 0.005) was significantly higher in the tendinopathic group compared with the control group.

Conclusions: Patellar tendinopathy is associated with a decrease in the mechanical and material properties of the tendon in elite athletes subjected to a high volume of jumping activity. However, compared with their healthy counterparts, tendinopathic volleyball players have a better ability to utilise the stretch-shortening cycle when jumping.
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http://dx.doi.org/10.1136/bjsports-2013-092275DOI Listing
September 2013

Jumper's knee paradox--jumping ability is a risk factor for developing jumper's knee: a 5-year prospective study.

Br J Sports Med 2013 May 11;47(8):503-7. Epub 2012 Oct 11.

Oslo Sports Trauma Research Center, Oslo, Norway.

Background: The 'jumper's knee paradox', where symptomatic athletes appear to perform better in a counter movement jump (CMJ) compared to asymptomatic controls in previous case-control studies is not fully understood.

Aim: The aim was to examine the relationship between jumping ability and change of jumping ability as potential risk factors for developing jumper's knee.

Methods: A 5-year prospective cohort study among elite volleyball players, aged 16-18. Jump tests were done on a portable force plate at the time of inclusion and semiannually. Jumper's knee was diagnosed based on a standardised clinical examination.

Results: All 150 students (68 males and 82 females) were included and 28 developed jumper's knee (22 males and 6 females). At the time of inclusion, male athletes who went on to develop jumper's knee had significantly better results in CMJ (38.0±5.8 cm) compared to asymptomatic males (34.6±5.5 cm, p=0.03), while no difference was detected in standing jump (SJ: jumper's knee: 30.3±7.4 cm, asymptomatic: 28.1±6.1 cm, p=0.23). In a multivariate logistic regression analysis corrected for gender and previous volleyball training, the OR was 2.09 (1.03-4.25) per cm difference in CMJ at the time of inclusion. Our results did not reveal any significant differences in the change in jumping ability between the groups, although both groups improved their jump performance.

Conclusions: Volleyball players with a natural ability for jumping high are at an increased risk for developing jumper's knee.
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http://dx.doi.org/10.1136/bjsports-2012-091385DOI Listing
May 2013

The evolution of eccentric training as treatment for patellar tendinopathy (jumper's knee): a critical review of exercise programmes.

Br J Sports Med 2007 Apr 29;41(4):217-23. Epub 2007 Jan 29.

Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.

Background And Aim: Eccentric training has become a popular treatment for patellar tendinopathy. Our purpose was to review the evolution of eccentric strength training programmes for patellar tendinopathy with a focus on the exercise prescriptions used, to help clinicians make appropriate choices and identify areas needing further research.

Methods: A computerised search of the entire MEDLINE database was performed on 1 September 2006 to identify prospective and randomised clinical trials with a focus on clinical outcome of eccentric training for patellar tendinopathy.

Results: 7 articles with a total of 162 patients and in which eccentric training was one of the interventions, all published after 2000, were included. The results were positive, but study quality was variable, with small numbers or short follow-up periods. The content of the different training programmes varied, but most were home-based programmes with twice daily training for 12 weeks. A number of potentially significant differences were identified in the eccentric programmes used: drop squats or slow eccentric movement, squatting on a decline board or level ground, exercising into tendon pain or short of pain, loading the eccentric phase only or both phases, and progressing with speed then loading or simply loading.

Conclusion: Most studies suggest that eccentric training may have a positive effect, but our ability to recommend a specific protocol is limited. The studies available indicate that the treatment programme should include a decline board and should be performed with some level of discomfort, and that athletes should be removed from sports activity. However, these aspects need further study.
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http://dx.doi.org/10.1136/bjsm.2006.032417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658948PMC
April 2007

No effect of eccentric training on jumper's knee in volleyball players during the competitive season: a randomized clinical trial.

Clin J Sport Med 2005 Jul;15(4):227-34

Oslo Sports Trauma Research Center, University of Sport and Physical Education, Oslo, Norway.

Background: The effect of surgery on patellar tendinopathy (jumper's knee) is questionable, and conservative treatment protocols have not been properly documented.

Purpose: : The aim of this study was to investigate the effect of a newly developed eccentric training program for patellar tendinopathy in volleyball players during the competitive season.

Study Design: Randomized clinical trial.

Methods: Patients were recruited from male and female elite volleyball teams in Norway, and the diagnosis was based on clinical examination alone. Of 51 players diagnosed with patellar tendinopathy, 29 could be included in the study. The training group (n = 13) performed squats on a 25 degrees decline board as a home exercise program (3 x 15 repetitions twice daily) for a 12-week intervention period during the final half of the competitive season. The eccentric (downward) component was done on the affected leg. The control group (n = 16) trained as usual. The primary outcome was a symptom-based questionnaire developed specifically for patellar tendinopathy (Victorian Institute of Sport Assessment score), and patients were followed up before and after the intervention period, as well as after 6 and 30 weeks. All subjects self-recorded training to document their activity level (eccentric training, volleyball training, matches, other training).

Results: There was no change in Victorian Institute of Sport Assessment score during the intervention period in the training (pre, 71.1 +/- 11.3; post, 70.2 +/- 15.4) or control group (pre, 76.4 +/- 12.1; post, 75.4 +/- 16.7), nor was there any change during the follow-up period at 6 weeks or 6 months. The training group completed 8.2 +/- 4.6 weekly sessions of eccentric training during the intervention period (59% of the recommended volume), and there was no difference between groups in training or competition load.

Conclusion: There was no effect on knee function from a 12-week program with eccentric training among a group of volleyball players with patellar tendinopathy who continued to train and compete during the treatment period. Whether the training would be effective if the patients did not participate in sports activity is not known.
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http://dx.doi.org/10.1097/01.jsm.0000168073.82121.20DOI Listing
July 2005
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