Joint movements are essential for the function of human body during the activities of daily living and sports. The movement of human joints varies from normal to those which have an increased range of joint movement (gymnasts) to those with extreme disabling laxity in patients with a connective tissue disorder (Ehlers Danlos Syndrome). “Hypermobility" is most commonly used to describe excessive movement. Hypermobility was assessed by using the current criteria of the Beighton score for signs and the Brighton criteria for symptoms of hypermobility in a group of orthopaedic patients attending the specialist knee and shoulder injury clinics. The Beighton score was found to be higher in patients attending for primary ACL reconstruction (mean 2.9, p = 0.002) and revision ACL reconstruction (mean 4, p < 0.001) when compared with the control group. Hypermobility was a risk factor for the failure of ACL reconstruction (30% vs 0%). The mean Beighton score was higher in both the primary shoulder dislocation group (mean difference 1.8, p=0.001) and the recurrent shoulder dislocation group (mean difference 1.4, p=0.004). Bone defects were studied on the CT scan following shoulder dislocations. There was no correlation between hypermobility and the bone defects. The bone defect was a risk factor for recurrent shoulder instability (48% vs 16%). A material testing system was used to assess the tissue laxity of discarded hamstring tendon and shoulder capsule obtained during stabilisation procedures. The mean gradient of slope for both tendon and capsule graphs was 23.8 (range 3.08-52.63). The tissue laxity was compared to the Beighton score, however no correlation was detected between the Beighton score and the gradient of the tissue laxity. An electronic goniometer was used to measure the angle of the MCP joint of the little finger, whilst a force plate system simultaneously measured the force required to hyperextend the MCP joint. The little finger MCP joints of each hand were assessed in this manner in a group of patients undergoing primary ACL reconstruction or open shoulder stabilization. The mean force required to produce the 40 degrees angle at the little finger MCP joint was 0.04 kg with a range from 0-0.11 kg. There was a positive correlation between the gradient of tissue laxity and the force required to produce 40 degrees angle at the little finger of the dominant hand. The expression of Collagen V and Small leucine rich proteoglycans (Decorin and Biglycan) was studied in the skin, hamstring tendon and shoulder capsule of the patients described above attending with shoulder or knee instability. These patients had different levels of hypermobility (as assessed by the Beighton score) and symptoms of hypermobility (as assessed by the Brighton criteria to diagnose Benign Joint Hypermobility Syndrome). The weaker tendon group was found to have a lower mean Beighton score, while the weaker skin group had a higher mean Beighton score. Collagen V expression was higher in the skin dermal papillae of the weaker group. The Beighton Scores were higher in patients with ACL and shoulder injuries. Hypermobility was a risk factor for the failure of ACL reconstruction. There was no correlation between hypermobility and the bone defects on the CT scan following shoulder dislocation. Bone defects were a risk factor for recurrence. There was no correlation between the Beighton Score and the tissue laxity. There was a correlation between the tissue laxity and the clinical assessment of laxity at the little finger MCPJ by using a force- goniometer system. There was a correlation between the collagen V expression in the dermal papillae of the skin and the Beighton score.

Title: The Effect of Kinesiotaping on Postural Stabilization in Patients after ACL Reconstruction Aim: The main aim of the thesis was to evaluate, whether postural stabilization of patients after ACL reconstruction followed by kinesiotaping of the knee joint will be improved or decreased. Also the difference in postural stability of operated and un-operated lower extremity was evaluated. Methods: The thesis included 10 subjects. Each of them was from 4 to 6 weeks after ACL reconstruction, BTB technique. All subjects regularly attended group exercise in CLPA s.r.o. Every subject completed five measurements of postural somatooscilography, before exercise with kinesiotape and without, after exercise completed with kinesiotape, and after five days before and after exercise without kinesiotape. The values were saved by Microswing 6.0 and analyzed by Posturomed Commander. Then the values were evaluated by Microsoft Office Excel and statistic procedures were done by XLSTAT. Results: The measurement confirmed an effect of kinesiotaping on improvement of postural stabilization. Immediately after the application of the tape five out of seven parameters were improved. Participating in the exercise unit revealed an improving trend of postural stabilization, in comparison with the results before exercise. There...

Anterior cruciate ligament injury leads to increased sagittal tibial translation, and perceptions of instability and low confidence in the knee joint are common. Many patients have remaining problems despite treatment and are forced to lower their activity level and prematurely end their career in sports. The effect of ACL reconstruction and/or rehabilitation on dynamic knee stability is not completely understood. The overall aim of this thesis was to study the dynamic knee stability during and after rehabilitation in individuals with ACL injury. More specific aims were 1) to elaborate an evaluation method for muscle strength, 2) to evaluate the effect of exercises in closed and open kinetic chain, and 3) to evaluate dynamic knee stability in patients with ACL deficiency or ACL reconstruction. Sagittal tibial translation and knee flexion angle were measured using the CA‐4000 computerised goniometer linkage. Muscle activation was registered with electromyography. The intra‐ and inter‐rater reliability of 1 repetition maximum (RM) of seated knee extension was clinically acceptable. The inter‐rater reliability of 1RM of squat was also acceptable, but the intra‐rater reliability was lower. The systematic procedure for the establishment of 1RM that was developed can be recommended for use in the clinic. One specific exercise session including cycling and a maximum number of knee extensions and heel raises did not influence static or dynamic sagittal tibial translation in uninjured individuals. A comprehensive rehabilitation program with isolated quadriceps training in OKC led to significantly greater isokinetic quadriceps strength compared to CKC rehabilitation in patients with ACL deficiency. Hamstring strength, static and dynamic translation, and functional outcome were similar between groups. Five weeks after ACL reconstruction, seated knee extension produced more anterior tibial translation compared to the straight leg raise and standing on one leg. All exercises produced less or equal amount of anterior tibial translation as the 90N Lachman test. Five weeks after the ACL reconstruction the static and dynamic tibial translation in the ACL reconstructed knee did not differ from the tibial translation on the uninjured leg. Patients in the early phase after ACL injury or ACL reconstruction used a joint stiffening strategy including a reduced peak knee extension angle during gait and increased hamstring activation during activity, which reduces the dynamic tibial translation. Patients with ACL deficiency that completed a four months rehabilitation program used a movement pattern that was more close to normal.

Introduction: The anterior cruciate ligament (ACL) is a supporting ligament in the knee. ACL injuries are associated with concomitant meniscal tears and cartilage lesions. Aim: Our aim was to study the incidence of meniscal tears and cartilage lesions in patients with ACL injury and how it varies with time from injury to surgery Methods: This was a cohort study using the Swedish Knee Ligament Registry. We reviewed 479 patients who had ACL reconstruction in Region Örebro County between 2005-01-01 and 2019-03-19. Results: The incidence of meniscal tears was 33 %, cartilage lesions 18 %, both meniscal tears and cartilage lesions 29 %. The incidence of meniscal tears distributed over time from injury to surgery was 8 % for 0-3 months., 38 % for 4-12 months, 53 % for &gt; 12 months. The incidence of cartilage lesions was 8 % for 0-3 months, 45 % for 4-12 months, 47 % for &gt; 12 months. The incidence of both meniscal tears and cartilage lesions was 4 % for 0-3 months, 34 % for 4-12 months, 62 % for &gt; 12 months Conclusions: Patients treated with ACL reconstruction had an increased rate of concomitant damage to menisci and articular cartilage with increased time from injury to surgery, suggesting a benefit of early reconstructive interventions following an ACL injury. Male patients displayed a higher incidence in cartilage lesions than did female. Young age was associated with a higher incidence of meniscal tears, whereas an increasing of age was associated with an increased incidence of cartilage lesions.

Introduction: A successful return to sport (RTS) after anterior cruciate ligament reconstruction (ACL-R) demands optimal physical and psychological rehabilitation. Aim: Study the change in psychological readiness to RTS between three- and six-months post ACL-R, to associate psychological readiness to patient-reported knee function and identify factors associated to greater psychological readiness to RTS. The secondary aim was to examine how the Covid-19 pandemic has affected the patients’ rehabilitation. Methods: Prospective cohort study including patients with primary ACL-R recruited from the Swedish Knee Ligament register, age 16-40 and physically active on Tegner&gt;3. Demographics including pre-injury sport participation, psychological readiness reported with the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale, knee function reported with the subjective International Knee Documentation Committee (IKDC) and the impact on rehabilitation by Covid-19 were analyzed at three- and six-months post-surgery. ACL-RSI scores were compared, correlated to IKDC and univariate analysis was used to determine the association between factors and the psychological readiness to RTS. Results: 141 patients were analyzed (56 men, 85 women; median age 24 years), all were recreational or competitive athletes (median Tegner level 8). The psychological readiness progressed through rehabilitation, was correlated to subjective IKDC. No differences could be detected between ACL-RSI scores and included factors at six months post ACL-R. Covid-19 had an impact on 36% (40/112) of the patients’ rehabilitation. Conclusions: Psychological readiness improved after ACL-R and was significantly associated to self-reported knee function at six months post ACL-R. Covid-19 restrictions affected rehabilitation for one in every three participants.

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