Decreasing incidence of knee arthroscopy in Sweden between 2002 and 2016: a nationwide register-based study.

BACKGROUND AND PURPOSE: Several randomized trials have demonstrated the lack of effect of arthroscopic lavage as treatment for knee osteoarthritis (OA). These results have in turn resulted in a change in Swedish guidelines and reimbursement. We aimed to investigate the use of knee arthroscopies in Sweden between 2002 and 2016. Patient demographics, regional differences, and the magnitude of patients with knee OA undergoing knee arthroscopy were also analyzed. PATIENTS AND METHODS: Trends in knee arthroscopy were investigated using the Swedish Hospital Discharge Register (SHDR) to conduct a nationwide register-based study including all adults (>18 years of age) undergoing any knee arthroscopy between 2002 and 2016. RESULTS: The total number of knee arthroscopies performed during the studied period was 241,055. The annual surgery rate declined in all age groups, for males and females as well as patients with knee OA. The incidence dropped from 247 to 155 per 105 inhabitants. Over 50% of arthroscopies were performed in metropolitan regions. CONCLUSION: We showed a dramatic decline in knee arthroscopy. There is variability in the surgery rate between males and females and among the regions of Sweden.

Younger patients and smokers report a higher level of pain after knee arthroscopy: a clinical and experimental study including synovial metabolism.

PURPOSE: Factors associated with post-surgical pain are not fully explored. The aim of this study was to identify determinants of postoperative pain after arthroscopic surgery of the knee. Synovial tissue metabolism was analysed by microdialysis and the association with individual and peri-surgical factors to identify determinants important for pain management and thus patient satisfaction. METHODS: Cross-sectional study of 57 patients (22 women) with median age of 39 years. All patients were operated on with arthroscopic surgery of the knee and monitored postoperatively with synovial microdialysis. The cross-sectional cohort was investigated to determine local tissue levels of inflammatory and metabolic compounds along with postoperative pain experience. MEASUREMENTS: pain was determined by visual analogue scale (VAS). Postoperative synovial tissue levels of prostaglandin E2 (PGE2), glucose, and glycerol were measured by microdialysis in the knee synovium. Patients reporting VAS ≥ 4 received rescue pain medication with systemic opioids. RESULTS: Initial results indicated that patients with pain (interpreted as having VAS ≥ 4), i.e. those receiving rescue medication with systemic opioids, were of a younger age (p = 0.04), lower body weight (p = 0.02), had a lower BMI (p = 0.04) and/or were smokers (p = 0.02). A closer analysis using multinomial logistic regression showed a significantly higher amount of pain in smokers (p = 0.01) and patients of a younger age (p = 0.02). A significant correlation was also found between VAS and duration of surgery (p = 0.007). No significant correlation could be found between VAS and synovial levels of PGE2, glycerol and glucose, but a statistically significant decline with time of PGE2 in both groups. CONCLUSIONS: The results from this study show a significantly higher frequency of pain, post-surgery among younger patients (p = 0.02) and smokers (p = 0.01), as well as an association between pain and length of surgery (p = 0.007). These findings point out individual factors useful for the prediction of postoperative pain after arthroscopic surgery and are clinically important for personalized pain management. LEVEL OF EVIDENCE: II.

[¼Shermer's neck« is a rare injury in long-distance cycle races. Association with diplopia described for the first time]. / ¼Shermer's neck« sällsynt skada vid långdistans-cykellopp - Association med diplopi beskrivs för första gången.

Shermer's neck was first described in 1983 in an ultra-distance cyclist and it is often associated with neck pain (in our patient diplopia as first symptom) and exhaustion and impaired neck motor function with inability to extend the neck against gravity. The diplopia, for the first time described in connection with Shermer's neck, was accentuated when elevating the eyes and looking at distance, most likely reflecting exhaustion in the elevator muscles of the eye. Shermer's neck usually appears after 800 km of non-stop bike racing. Risk factors include former neck injuries, staying low in aerobars for a long time, and wearing helmet light/cameras. Prevention includes neck strength training, muscle stretching, raising of handle bars and different kinds of chin support. The most important treatment is rest and not riding a bike. In our patient the diplopia was normalized after 4 hours of sleep. It can take 2-14 days to regain full neck motor function. The possibility of developing Shermer's neck and diplopia (¼Berglund's diplopia«) must be taken into account when many untrained individuals participate in popular shorter races over about 300 km.

Temperature-sensitive release of prostaglandin E2 and diminished energy requirements in synovial tissue with postoperative cryotherapy: a prospective randomized study after knee arthroscopy.

BACKGROUND: Local external cooling of the surgical field after joint surgery is intended to enhance recovery and to facilitate the use of outpatient surgery by reducing pain and improving mobility. We hypothesized that the effects of postoperative cooling and compression after knee arthroscopy would be reflected in changes in the concentrations of metabolic and inflammatory markers in the synovial membrane. METHODS: Forty otherwise healthy patients who were to undergo knee arthroscopy were included in the study, and half were randomized to receive postoperative cooling and compression. Microdialysis of the synovial membrane was performed postoperatively, and the concentrations of prostaglandin E2 (PGE2), glucose, lactate, glycerol, and glutamate as well as the ethanol exchange ratio (which indicates blood flow) were measured. The temperature of the knee was monitored, and postoperative pain was assessed by the patient with use of a visual analog scale, a numeric rating scale, and the need for rescue medication. RESULTS: Application of the cooling and compression device after knee arthroscopy significantly lowered the temperature in the operatively treated knee (as measured on the skin, within the joint capsule, and intra-articularly). The cooling and compression appeared to decrease inflammation, as indicated by a temperature-sensitive decrease in the PGE2 concentration. The hypothermia also decreased the metabolic rate of the synovial tissue and thus decreased energy requirements, as shown by the stability of the lactate concentration over time despite the decreased blood flow that was indicated by the increasing ethanol exchange ratio. No effect of the compression and cooling on postoperative pain was detected. CONCLUSIONS: Local cryotherapy and compression after knee arthroscopy significantly lowered the temperature in the knee postoperatively, and the synovial PGE2 concentration was correlated with the temperature. Since PGE2 is a marker of pain and inflammation, the postoperative local cooling and compression appeared to have a positive anti-inflammatory effect.

Special attention to the weight-control strategies employed by Olympic athletes striving for leanness is required.

BACKGROUND: Optimization of body weight and composition is a key priority for elite athletes striving for a competitive advantage. The present investigation was designed to characterize various parameters related to weight control in Olympic competitors. DESIGN: Cross-sectional study. SETTING: Research unit at a University Hospital. PARTICIPANTS: 223 athletes (125 men and 98 women, with only 1 drop-out), all members of the Swedish teams participating in the Olympic Games of 2002 and 2004. MAIN OUTCOME MEASUREMENTS: Self-reported body weight and height, from which BMI was calculated, variation in weight during the year prior to Olympic competition, and self-reported weight control strategies by questionnaire. The athletes were divided into two groups on the basis of whether their sporting discipline emphasized leanness or not. RESULTS: The athletes participating in disciplines that emphasize leanness demonstrated a lower mean BMI (22.7 +/- 2.7 vs 3.7 +/- 2.3 for nonlean athletes, P < 0.05), greater variation in weight (5.3% vs 4.7%, P < 0.05), more frequent attempts to lose weight (P < 0.001), longer total training time (P < 0.001), a higher training load yet weighed more than they desired at the time of competition. These differences were most evident in male athletes. Furthermore, 9.4% of lean athletes reported previously suffering from an eating disorder, in comparison to 2.7% of the nonlean athletes (P < 0.05). More athletes in disciplines emphasizing leanness also reported being ill during the prior 3 month period (38.5% vs 21.6%, P < 0.05). CONCLUSIONS: This investigation reveals that the weight control practices employed by Olympic athletes participating disciplines that emphasize leanness appear to be suboptimal. Counseling concerning weight control could be used as a tool to prevent illness and enhance performance.