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Background and purpose - No consensus exists on when to perform arthroscopic partial meniscectomy in patients with a degenerative meniscal tear. Since MRI and clinical tests are not accurate in detecting a symptomatic meniscal lesion, the patient's symptoms often play a large role when deciding when to perform surgery. We determined the prevalence and severity of self-reported knee symptoms in patients eligible for arthroscopic partial meniscectomy due to a degenerative meniscal tear. We investigated whether symptoms commonly considered to be related to meniscus injury were associated with early radiographic signs of knee osteoarthritis. Patients and methods - We included individual baseline items from the Knee injury and Osteoarthritis Outcome Score collected in 2 randomized controlled trials evaluating treatment for an MRI-verified degenerative medial meniscal tears in 199 patients aged 35-65 years. Each item was scored as no, mild, moderate, severe, extreme, and at least "mild" considering the symptoms present. Early radiographic signs of osteoarthritis, defined as a Kellgren and Lawrence grade of at least 1, were seen in 70 patients. Results - At least monthly knee pain, pain during stair walking and when twisting on the knee, and lack of confidence in knee was present in at least 80% of the patients. Median severity was at least moderate for knee pain, pain when twisting on the knee, pain walking on stairs, lack of confidence in knee, and clicking. Mechanical symptoms such as catching were rare. Early radiographic signs of osteoarthritis were associated with an increased risk of self-reported swelling, catching, and stiffness later in the day; the odds ratio was 2.4 (95% CI 1.2-4.9), 2.3 (1.2-4.3), and 2.3 (1.1-5.0), respectively. Interpretation - Middle-aged patients with a degenerative medial meniscus tear reported symptoms commonly associated with knee osteoarthritis. Frequent knee pain, presence of lack of confidence in the knee, and clicking did not distinguish those with a meniscal tear alone from those with early radiographic knee OA. Our findings support the notion that symptoms reported by those with a degenerative meniscal tear represent early signs of knee osteoarthritis.

Hensikt: Hensikten var å beskrive type øvelser, etterlevelse, dosering og endring i smerte- og funksjonsnivå for et styrketreningsprogram for pasienter med symptomatisk kneartrose. Design: Pre-post design. Materiale: Femtito pasienter mellom 35 og 70 år med symptomatisk og røntgenologisk mild til moderat kneartrose ble inkludert. Metode: Et 12 ukers styrketreningsprogram ble implementert med treningsdagbøker for å innhente data på type øvelser, dosering, og etterlevelse. Utfallsmål var isokinetisk quadriceps muskelstyrke, pasientrapporterte utfallsmål: Knee injury and Osteoarthritis Outcome Score (KOOS), smerteskala (NRS), global endring i funksjon (GRC) og fysisk aktivitet. Resultater: Gjennomsnittlig antall gjennomførte nevromuskulære- og styrkeøvelser per uke var henholdsvis 7,9 ±3,6 og 12,5±3,3. Det var 73% som hadde gjennomført ≥80% av antall treningsøkter. Pasientene hadde gjennomsnittlig 36±25% økning i motstand for kneekstensjonsøvelsen fra uke 1 til uke 12. Det var en høysignifikant økning i quadriceps muskelstyrke, men kun 18% hadde en økning utover minste observerbare endring (MDC). Det var henholdsvis 67%, 18% og 15% som rapporterte at de var bedre, uforandret eller verre i kneet sammenlignet med oppstart. Redusert smertenivå ble rapportert hos 22% av pasientene (NRS). Konklusjon: Majoriteten av pasientene (73%) gjennomførte ≥ 80% av treningsøktene, men dosen var antagelig for lav, da en liten andel pasienter (18%) oppnådde en klinisk relevant økning i quadriceps muskelstyrke og gjennomsnittlig ingen klinisk relevant bedring i pasientrapportert funksjon (KOOS). Purpose: Describe types, adherence, and dosage of exercises and outcomes for a strength-training program in patients with mild to moderate knee osteoarthritis. Design: Pre-post design. Material: Fifty-two patients between 35 and 70 years with mild to moderate symptomatic knee osteoarthritis were included. Methods: A 12-week strength-training program including training diaries was implemented. The following outcome measures were used: isokinetic quadriceps muscle strength test, the Knee Osteoarthritis Outcome Score (KOOS), the Numeric rating Scale (NRS) for pain, global rating of change in function (GRC) and the self-reported questionnaire for physical activity. Results: A mean of 7.9 ±3.6 and 12.5±3.3 for neuromuscular- and strength exercises, respectively, were performed per week. Seventy-three percent of the patients completed ≥80% of the exercise sessions. There was a mean increase of 36±25% in resistance for leg extension exercise during the leg extension exercise during the 12-week program. But only 18% achieved a change above a minimal detectable change for quadriceps muscle strength. Sixty-seven percent reported a change in function (GRC) and 22% a reduction in pain (NRS). Conclusion: This 12-week strength-training program had satisfactory adherence, but the doses were probably too low to gain clinical relevant changes in quadriceps muscle strength and in patient reported outcomes. Finansiering: Fond til etter- og videreutdanning av fysioterapeuter, Norges forskningsråd og Helse Sør-Øst RHF, Diakonhjemmet Sykehus og OsloMet – storbyuniversitetet. Ingen interessekonflikter oppgitt. Clinicaltrial.gov: NCT01682980.

BACKGROUND: Some athletes demonstrate excellent dynamic stability after anterior cruciate ligament (ACL) rupture and return to sport without ACL reconstruction (copers). Others demonstrate persistent instability despite rehabilitation (non-copers) and require surgical stabilization. Testing to determine coper classification can identify potential copers early after rupture. It is unclear how coper classification changes after a brief intervention, and how early classification relates to long-term outcomes. HYPOTHESIS/PURPOSE: (1) To evaluate the consistency of early coper classification (potential coper vs. non-coper) before and after progressive neuromuscular and strength training (NMST) in athletes early after acute ACL rupture and (2) to evaluate the association of early coper classification with two-year success after ACL rupture. STUDY DESIGN: Prospective cohort study METHODS: This was a prospective analysis from the Delaware-Oslo ACL cohort study, a cohort of athletes consecutively enrolled early after ACL rupture. Participants (n=271) were tested and classified as potential copers or non-copers using established criteria before and after a 10-session NMST program. Success two years after ACL reconstruction (ACLR) or non-operative rehabilitation (Non-Op) was defined as meeting/exceeding sex- and age-matched norms for knee function, no ACL graft rupture, and ≤1 episode of giving way within the previous year. McNemar’s test evaluated changes in coper classification pre- to post-training. Logistic regression adjusted for baseline characteristics was used to evaluate the association of early coper classification and surgical status with two-year success. RESULTS: Of 300 athletes enrolled, 271 (90%) completed the post-training data collection and 219 (73%) returned for the two-year follow-up. The coper classifications were different between timepoints; nearly half of those classified initially as non-copers became potential copers (p

Supplemental material, DS_10.1177_0363546519837935 for Knee Pathology in Young Adults After Pediatric Anterior Cruciate Ligament Injury: A Prospective Case Series of 47 Patients With a Mean 9.5-Year Follow-up by Guri Ranum Ekås, Marit Mjelde Laane, Arne Larmo, Håvard Moksnes, Hege Grindem, May Arna Risberg and Lars Engebretsen in The American Journal of Sports Medicine

Supplemental material, DS_10.1177_0363546519825500 for Coper Classification Early After Anterior Cruciate Ligament Rupture Changes With Progressive Neuromuscular and Strength Training and Is Associated With 2-Year Success: The Delaware-Oslo ACL Cohort Study by Louise M. Thoma, Hege Grindem, David Logerstedt, Michael Axe, Lars Engebretsen, May Arna Risberg and Lynn Snyder-Mackler in The American Journal of Sports Medicine

Supplemental material, DS_10.1177_0363546519858602 for Complex Tears, Extrusion, and Larger Excision Are Prognostic Factors for Worse Outcomes 1 and 2 Years After Arthroscopic Partial Meniscectomy for Degenerative Meniscal Tears: A Secondary Explorative Study of the Surgically Treated Group From the Odense-Oslo Meniscectomy Versus Exercise (OMEX) Trial by Nina Jullum Kise, Cathrine Aga, Lars Engebretsen, Ewa M. Roos, Rana Tariq and May Arna Risberg in The American Journal of Sports Medicine

Background: More than 50% of highly active patients with an anterior cruciate ligament (ACL) injury who choose nonsurgical treatment (active rehabilitation alone) have successful 2-year outcomes and comparable knee function to an uninjured population. Early predictive factors for a successful outcome may aid treatment decision making in this population. Purpose: To identify early predictors of a successful 2-year outcome in those who choose nonsurgical treatment of an ACL injury. Study Design: Cohort study; Level of evidence, 2. Methods: This prospective cohort study consisted of ACL-injured athletes who were consecutively screened for inclusion. A total of 300 patients were included from 2 sites (Oslo, Norway, and Delaware, USA), and the 118 patients who initially chose not to undergo ACL reconstruction were included. All patients participated in pivoting sports before the injury, and none had significant concomitant injuries. A successful 2-year outcome was defined as having 2-year International Knee Documentation Committee (IKDC) scores ≥15th normative percentile and not undergoing ACL reconstruction. Multivariable logistic regression models were built using demographic and knee function data (quadriceps muscle strength, 4 single-leg hop tests, IKDC score, and Knee Outcome Survey–Activities of Daily Living Scale [KOS-ADLS] score) collected at baseline or after a 5-week neuromuscular and strength training (NMST) rehabilitation program. Results: After 2 years, 52 of 97 (53.6%) patients had a successful outcome. In the multivariable baseline model, older age, female sex, better performance on the single-leg hop test, and a higher KOS-ADLS score were significantly associated with successful 2-year outcomes. After the 5-week NMST rehabilitation program, older age, female sex, and a higher IKDC score increased the odds of a successful 2-year outcome. The 2 models had comparable predictive accuracy (post-NMST area under the curve [AUC], 0.78 [95% CI, 0.68-0.88]; baseline AUC, 0.81 [95% CI, 0.72-0.89]). Conclusion: Clinicians and patients can be more confident in a nonsurgical treatment choice (active rehabilitation alone) in athletes who are female, are older in age, and have good knee function, as measured by single-leg hop tests and patient-reported outcome measures, early after an ACL injury. Prediction models that include measures of knee function, assessed either before or after rehabilitation, can estimate 2-year prognoses for nonsurgical treatment and thereby assist shared treatment decision making.

Supplemental material, DS_10.1177_0363546518810750 for Coping With Anterior Cruciate Ligament Injury From Childhood to Maturation: A Prospective Case Series of 44 Patients With Mean 8 Years’ Follow-up by Guri Ranum Ekås, Håvard Moksnes, Hege Grindem, May Arna Risberg and Lars Engebretsen in The American Journal of Sports Medicine