Showing papers by "Pekka Kannus published in 2000"

Long-Term Prognosis of Patients With Achilles Tendinopathy An Observational 8-Year Follow-up Study

Abstract: To determine the long-term outcome of patients treated nonoperatively for acute or subchronic (duration of the symptoms before initiation of the treatment less than 6 months) Achilles tendinopathy, we performed a follow-up analysis on 83 of 107 patients an average 8 +/- 2 (SD) years after the initial contact. The analysis included a questionnaire, clinical examination, performance tests, muscle strength measurement, and ultrasonographic examination. Twenty-four of the 83 patients (29%) had to be operated on during the follow-up period. Seventy patients (84%) had full recovery of their activity level, and at 8 years' follow-up 78 patients (94%) were asymptomatic or had only mild pain with strenuous exercise. However, a clear side-to-side difference between the involved and the uninvolved sides was observed on the performance test, clinical examination, and ultrasonography. Also, 34 patients (41%) started to suffer from overuse symptoms in the initially uninvolved Achilles tendon. The results of our 8-year follow-up showed that the long-term prognosis of patients with acute-to-subchronic Achilles tendinopathy is favorable as determined by subjective and functional assessments. In the clinical and ultrasonographic examinations, mild-to-moderate changes were observed rather frequently in both the involved and initially uninvolved Achilles tendons, but the occurrence of these changes was not clearly related to the patients' symptoms.

Chronic Achilles tendon overuse injury: complications after surgical treatment. An analysis of 432 consecutive patients.

Abstract: We analyzed the complications after surgical treatment of Achilles tendon overuse injuries in 432 consecutive patients. The patients underwent a clinical examination 2 weeks, and 1, 2, and 5 months after the surgery. If a complication appeared, the patient was followed up clinically for at least 1 year. There were 46 (11%) complications in the 432 patients: 14 skin edge necroses, 11 superficial wound infections, 5 seroma formations, 5 hematomas, 5 fibrotic reactions or scar formations, 4 sural nerve irritations, 1 new partial rupture, and 1 deep vein thrombosis. Fourteen patients with a complication had reoperations: four patients for skin edge necrosis, two for superficial wound infection, two for seroma formation, one for hematoma formation, two for fibrotic reaction or scar formation, two for sural nerve irritation, and one for a new partial rupture. About every 10th patient treated surgically for chronic Achilles tendon overuse injury suffered from a postoperative complication that clearly delayed rec...

Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970-1997 and alarming projections for the new millennium.

Abstract: The purpose of our epidemiologic study was to determine the current trend in the number and incidence of osteoporotic pelvic fractures in Finland, a country with a Caucasian population of 5 million. Thus, all Finns 60 years of age or older who were admitted to hospitals in 1970-1997 for primary treatment of a first osteoporotic pelvic fracture were selected from The National Hospital Discharge Register. In each year of the study, the number and the age-specific and age-adjusted incidences of fractures were expressed as the number of. patients per 100,000 individuals. The total number of osteoporotic pelvic fractures increased considerably in Finland during the study period, from 128 in 1970 to 913 in 1997, an average increase of 23% a year. The corresponding fracture incidence (per 100,000 persons 60 years of age or older) was 20 in 1970 and 92 in 1997. The mean age of the patients also increased, from 74 years (1970) to 80 years (1997). Despite this, the age-adjusted incidence of osteoporotic pelvic fractures also showed a steady increase from 1970 to 1997: in women, from 31 to 103, and in men, from 13 to 38 (relative increases were 232% and 192%, respectively). If this trend continues, the current number of osteoporotic pelvic fractures in this country (about 900 fractures per year) may treble by the year 2030 (about 2,700 fractures per year). We conclude that the number of osteoporotic pelvic fractures in elderly Finns is increasing at a rate that cannot be explained simply by demographic changes and therefore effective preventive measures should be urgently initiated to control the increasing burden of these age-related fractures.

Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970-1998 and alarming projections for the new millennium.

Abstract: We determined the current trends in the number and incidence of osteoporotic fractures of the proximal humerus in Finland by collecting from the National Hospital Discharge Register all patients 60 years of age or more who were admitted to Finnish hospitals in 1970-1998 for primary treatment of such fractures. The fracture was defined osteoporotic if it was caused by a low-energy trauma only, i.e., a fall from standing height or less. The number and incidence (per 10(5) persons) of fractures increased sharply from 208 (number) and 32 (incidence) in 1970 to 1,105 and 110 in 1998. Even after the age-adjustment, the incidence of fractures showed a clear increase: in women from 50 in 1970 to 133 in 1998, and in men from 14 in 1970 to 49 in 1998. If this trend continues, there will be three times more osteoporotic fractures of the proximal humerus in Finland in the year 2030 than there were in 1998.

Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin

Abstract: Traditional dogma would have it that pain in tendinopathy arises through one of two mechanisms. Firstly, it may result from inflammation in “tendinitis”. Secondly, it may be due to separation of collagen fibres in more severe forms of tendinopathy. The latter situation parallels the mechanism of pain with collagen separation after an acute grade I or II ligament injury (fig 1). Despite the wide acceptance of these two classical models of pain production, a number of studies provide data inconsistent with either theory. Consider first the inflammation mechanism. Histopathological examination of surgical specimens from patients with chronic tendon pain are devoid of inflammatory cells.1 This applies to tissue from the Achilles, patellar, lateral elbow, medial elbow, and rotator cuff tendons. Furthermore, prostaglandin E2 (a marker of the inflammatory process) is no more abundant in patients with Achilles tendon pain than in normal controls.2 Unfortunately, the collagen separation theory does not hold up under scrutiny either. The following five observations about pain and collagen in the patellar tendon are inexplicable. ( a ) Patients who have patellar tendon allograft anterior cruciate ligament reconstruction have minimal donor site knee pain, yet …

Physical activity and osteoporotic hip fracture risk in men.

Abstract: Background Physical activity has been related to reduced risk of osteoporotic hip fractures, but the evidence among men is weak. Objective To determine the association between baseline leisure physical activity and future risk of osteoporotic hip fracture in men. Methods At baseline in 1975 our prospective study cohort included 3262 men who were 44 years or older and did not have chronic disease restricting their ability to exercise. At baseline, physical activity was assessed by a questionnaire. Hip fractures were followed for 21 years, or from the age of 50 years for subjects who were initially younger than 50 years. Results The hazard ratio of osteoporotic hip fracture, adjusted for other possible predictors (height, body mass index, baseline diseases, smoking, use of alcohol, work-related physical activity, and occupational group), in men participating in vigorous physical activity compared with men not participating was 0.38 (95% confidence interval, 0.16-0.91) (P=.03). Conclusion These results provide further evidence that there is an inverse association between baseline physical activity and future hip fracture risk among men.

Continuously Increasing Number and Incidence of Fall-Induced, Fracture-Associated, Spinal Cord Injuries in Elderly Persons

Abstract: Background: Although osteoporosis, falls, and fractures among older adults are said to be a continuously increasing public health problem, reliable epidemiological information on their secular trends is very limited. Objective: To determine the current trend in the number and incidence of fall-induced, fracture-associated, spinal cord injuries in a typical white population (Finland, a country with about 5 million inhabitants). Methods: All Finns aged 50 years or older who were admitted to hospitals from January 1, 1970, through December 31, 1995, for primary treatment of an acute fallinduced, fracture-associated, spinal cord injury were selected from the National Hospital Discharge Register. Similar patients aged 20 through 39 years served as a reference group. In each year of the study, the number and the age-specific and age-adjusted incidences of injuries were expressed as the number of patients per 100000 persons. Results: The total number of fall-induced, fractureassociated, spinal cord injuries of Finnish older adults increased considerably during the study period, from 60 in 1970 to 419 in 1995 (an average increase of 24% annually). The corresponding injury incidence was 5 in 1970 and 27 in 1995. The age-adjusted incidence of these injuries also increased from 1970 to 1995: in women, from 5 to 29, and in men, from 7 to 17 (relative increases were 480% and 143%, respectively). In the reference group, no trend changes by time were observed. Conclusions: In Finnish persons aged 50 years or older, the number of fall-induced, fracture-associated, spinal cord injuries shows a rise with a rate that cannot be explained merely by demographic changes. The finding shows an increasing influence of osteoporosis and falls on health and well-being of our older adults, and therefore, vigorous preventive measures are needed to control this development. Arch Intern Med. 2000;160:2145-2149

Tenascin-C in the pathobiology and healing process of musculoskeletal tissue injury.

Abstract: Tenascin-C (TN-C) is a hexabrachion-shaped extracellular matrix (ECM) protein which has very restricted expression in normal musculoskeletal tissues, but is expressed in large quantities in these tissues during embryogenesis as well as during regenerative and healing processes. TN-C is an elastic protein which has a number of binding sites for other extracellular matrix proteins as well as for cell membrane adhesion receptors. In addition, it can be stretched to several times its resting length, the ability of which is attributed to the stretch-induced unfolding of its fibronectin type III domains. In the musculoskeletal tissues, TN-C is present in the regions where high mechanical forces are transmitted from one tissue component to another, such as the myotendinous and osteotendinous junctions. Not surprisingly, it was recently presented that the expression of TN-C in the musculoskeletal tissues is regulated by the mechanical strain applied to their cells. Thus, taking into account the flexible structure of the TN-C and its site-specific expression pattern at sites exposed to heavy mechanical loads, TN-C is likely to play an important role in providing elasticity to the musculoskeletal tissues. This feature has a special significance in the degenerative and regenerative processes where the normal biomechanical environment of the musculoskeletal tissue is temporarily interrupted by injury. The rapidly increasing understanding of the structure and function of the ECM protein TN-C may well bring important insights into the clinical treatment of sports injuries in the future.

Childhood deaths and injuries in Finland in 1971–1995

Abstract: BACKGROUND: This study examined the recent nationwide trends for the absolute number and the age- and sex-specific incidence rates of the fatal and serious non-fatal injuries among 0-14 year old children in Finland in 1971-1995. METHODS: We selected from Official Cause-of-Death Statistics and National Hospital Discharge Register children aged 0-14 years who died or required treatment at a hospital department because of an injury in 1971-1995. The number of Finnish children was 1.1 million in 1971, and 1.0 million in 1995. RESULTS: During the entire study period injuries were the leading cause of death in children aged 1-14 years, but not in infants. However, in these years the incidence (per 100 000 people) of fatal injuries in Finnish children decreased considerably in all age groups and both sexes, in girls from 20.1 in 1971 to 4.6 in 1995, and in boys from 36.7 in 1971 to 9.3 in 1995. In 1995, 41% of all the injurious deaths among 0-14 year old Finnish children were motor vehicle accidents, 12% were drownings, and 24% intentional injuries. The overall number and incidence of serious non-fatal injuries among Finnish children showed no clear trend change in 1971-1995. The mean hospitalization time of injured children shortened between 1971 and 1995, from 7.4 days to 2.7 days. CONCLUSIONS: We conclude that the number and incidence of fatal childhood injuries have decreased dramatically in Finland between 1971 and 1995. The reasons for this positive development are multifactorial, but improved traffic safety and trauma care are probably very important. In children's serious non-fatal injuries the development has not been so encouraging and therefore children's injury prevention should receive continuous intense attention. Language: en

Anterior knee pain 7 years after an anterior cruciate ligament reconstruction with a bone‐patellar tendon‐bone autograft

Abstract: In order to evaluate the occurrence and predicting factors of anterior knee pain in patients after an anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft, a functional, clinical and radiographic evaluation was performed on 91 patients on average 7 years after the surgery. Also, the isokinetic muscle torque was measured. At 7 years, anterior knee pain, as classified by the International Knee Documentation Committee (IKDC), was absent in 40 patients, mild in 47 patients, and moderate in 4 patients. None was classified as suffering from severe anterior knee pain. In the logistic regression analysis of predicting factors (forward-stepping), knee extension torque deficit of the operated limb was the only factor that showed significant association with anterior knee pain. The other objective measurements of the knee (flexion torque deficit, range of motion, stability evaluation, and radiographic evaluation of the knee) were not associated with anterior knee pain. Subjectively and not surprisingly, the patients without anterior knee pain were more often satisfied with the overall outcome than the patients with anterior knee pain. Also, the Lysholm and Marshall knee scores and the final outcome in the IKDC rating scale were significantly better in patients without than with anterior knee pain.

Use of imaging data for predicting clinical outcome

Abstract: Editor,—We would like to air three points that arise from the paper Sonographic incidence of tendon microtears in athletes with chronic Achilles tendinosis.1 Firstly, unfortunately the word “partial” has been omitted from the conclusion (abstract). The conclusion currently reads “There appears to be an association between microtear formation and Achilles tendon rupture”. The distinction needs to be made, as the paper's Take home message concludes with the words “There may be a …

Sports and exercise medicine in Finland

Abstract: Sports and exercise medicine has a long tradition in Finland. Organised medical care of athletes has been available since the 1930s. The Finnish Society of Sports Medicine was founded in 1939 and is probably the oldest nationwide sports medicine society in the world. Today, the society has about 500 physician members (5.2 million population) and publishes, along with the Finnish Society of Sports Physical Therapists, its own journal (three or four issues a year) and, together with the other Scandinavian societies, the international peer reviewed journal Scandinavian Journal of Medicine and Science in Sports (six issues a year). Organisation of instructional courses, seminars, and symposia on sports and exercise medicine is also an important part of the work of the Finnish Society. Every other year, one of the Scandinavian societies organises the international Scandinavian Congress on Medicine and Science in Sports (300–600 participants). In 1998, this congress was held in Finland. In 1946, the first sports medical centre was opened at the Olympic Stadium of Helsinki. In 1956, a similar unit was founded in Turku. Today, Finland has six sports and exercise medicine research centres funded by the Ministy of Education (Helsinki, Turku, Tampere, Jyvaskyla, Oulu, and Kuopio). Each has a staff of between five and …

Unintentional injury deaths in an adult Finnish population from 1971-1997.

Abstract: We investigated the trends in age-standardized rates (per 100,000 persons-years) of unintentional injury deaths in adult Finns from 1971-1997. In 1971, the leading category of unintentional injury resulting in death among Finnish men was road traffic accidents (age-standardized death rate 47 per 100,000 person-years). This rate has declined sharply, reaching 13 per 100,000 person-years in 1997. Simultaneously, the rate of fall-induced death among men gradually increased from 17/100,000 person-years in 1971 to 21/100,000 person-years in 1997. In 1997 the death rate from falls in men was greater than that of any other category of injury. In 1971, traffic caused fewer deaths in women (rate 17/100,000 person-years) than men, and declined from there to a rate of 6/100,000 person-years in 1997. Concurrently the rate of fall-induced deaths in women also decreased, from 27/100,000 person-years in 1971 to 17/100,000 person-years in 1997. Falling, however, was the leading cause of injury-related death in 1997. Thus, in the period 1971-1997, falls replaced road traffic accidents as the leading cause of unintentional injury death in Finland.