May Arna Godaker Risberg

• Urhausen, Anouk; Grindem, Hege; Ingelsrud, Lina Holm; Roos, Ewa M.; Silbernagel, Karin Grävare & Snyder-Mackler, Lynn [Show all 7 contributors for this article] (2024). Patient Acceptable Symptom State Thresholds for IKDC-SKF and KOOS at the 10-Year Follow-up After Anterior Cruciate Ligament Injury: A Study From the Delaware-Oslo ACL Cohort. Orthopaedic Journal of Sports Medicine (OJSM). ISSN 2325-9671. 12(5). doi: 10.1177/23259671241250025.
• Urhausen, Anouk; Grindem, Hege; Engebretsen, Lars; Grävare Silbernagel, Karin; Axe, Michael J. & Snyder-Mackler, Lynn [Show all 7 contributors for this article] (2024). The Delaware-Oslo ACL Cohort treatment algorithm yields superior outcomes to usual care 9-12 years after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 32(2), p. 214–222. doi: 10.1002/ksa.12039.
• Fosdahl, Merete Aarsland; Berg, Bjørnar; Risberg, May Arna; Øiestad, Britt Elin & Holm, Inger (2023). Body Mass Index, Quality of Life and Activity Limitation Trajectories over 2 Years in Patients with Knee or Hip Osteoarthritis: A Dual Trajectory Approach Based on 4265 Patients Included in the AktivA Quality Register. Journal of Clinical Medicine. ISSN 2077-0383. 12(22). doi: 10.3390/jcm12227094. Full text in Research Archive
• Øiestad, Britt Elin; Årøen, Asbjørn; Røtterud, Jan H; Østerås, Nina; Jarstad, Even & Grotle, Margreth [Show all 7 contributors for this article] (2023). The efficacy of strength or aerobic exercise on quality of life and knee function in patients with knee osteoarthritis. A multi-arm randomized controlled trial with 1-year follow-up. BMC Musculoskeletal Disorders. ISSN 1471-2474. 24(1). doi: 10.1186/s12891-023-06831-x. Full text in Research Archive Show summary

  Objective: To evaluate the efficacy of strength exercise or aerobic exercise compared to usual care on knee-related quality of life (QoL) and knee function at 4 months and 1 year in individuals with knee osteoarthritis. Methods: A three-arm randomized controlled trial (RCT) compared 12 weeks of strength exercise or aerobic exercise (stationary cycling) to usual care supervised by physiotherapists in primary care. We recruited 168 participants aged 35–70 years with symptomatic knee osteoarthritis. The primary outcome was The Knee Injury and Osteoarthritis Outcome Score (KOOS) QoL at 1 year. Secondary outcomes were self-reported function, pain, and self-efficacy, muscle strength and maximal oxygen uptake (VO2max) at 4 months and 1 year. Results: There were no differences between strength exercise and usual care on KOOS QoL (6.5, 95% CI -0.9 to 14), or for aerobic exercise and usual care (5.0, 95% CI -2.7 to 12.8), at 1 year. The two exercise groups showed better quadriceps muscle strength, and VO2max at 4 months, compared to usual care. Conclusion: This trial found no statistically significant effects of two exercise programs compared to usual care on KOOS QoL at 1 year in individuals with symptomatic and radiographic knee osteoarthritis, but an underpowered sample size may explain lack of efficacy between the intervention groups and the usual care group.

• Holden, Melanie; Hattle, Miriam; Runhaar, Jos; Riley, Richard D; Healey, Emma L. & Quicke, Jonathan [Show all 50 contributors for this article] (2023). Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis . The Lancet Rheumatology. doi: 10.1016/S2665-9913(23)00122-4. Full text in Research Archive
• Arhos, Elanna K.; Pohlig, Ryan T.; Di Stasi, Stephanie; Risberg, May Arna; Snyder-Mackler, Lynn & Silbernagel, Karin Grävare (2023). Clinically Relevant Subgroups Among Athletes Who Have Ruptured Their Anterior Cruciate Ligaments: A Delaware-Oslo Cohort Study. Arthritis care & research. ISSN 2151-464X. 75(9), p. 1914–1924. doi: 10.1002/acr.25089. Full text in Research Archive
• Winj, Stan; Hannink, Gerjon; Østerås, Håvard; Risberg, May Arna; Roos, Ewa M. & Hare, Kristoffer B. [Show all 12 contributors for this article] (2023). Arthroscopic partial meniscectomy vs non-surgical or sham treatment in patients with MRI-confirmed degenerative meniscus tears: a systematic review and meta-analysis with individual participant data from 605 randomised patients. Osteoarthritis and Cartilage. ISSN 1063-4584. 31(5), p. 557–566. doi: 10.1016/j.joca.2023.01.002. Full text in Research Archive
• Whittaker, Jackie L.; Culvenor, Adam G.; Juhl, Carsten Bogh; Berg, Bjørnar; Bricca, Alessio & Filbay, Stephanie Rose [Show all 38 contributors for this article] (2022). OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis. British Journal of Sports Medicine. ISSN 0306-3674. 56(24), p. 1393–1405. doi: 10.1136/bjsports-2022-106299. Full text in Research Archive
• Urhausen, Anouk; Berg, Bjørnar; Øiestad, Britt Elin; Whittaker, Jackie L.; Culvenor, Adam G. & Crossley, Kay M. [Show all 8 contributors for this article] (2022). Measurement properties for muscle strength tests following anterior cruciate ligament and/or meniscus injury: What tests to use and where do we need to go? A systematic review with meta-analyses for the OPTIKNEE consensus. British Journal of Sports Medicine. ISSN 0306-3674. 56(24), p. 1422–1431. doi: 10.1136/bjsports-2022-105498. Show summary

  Objectives: Critically appraise and summarise the measurement properties of knee muscle strength tests after anterior cruciate ligament (ACL) and/or meniscus injury using the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist. Design: Systematic review with meta-analyses. The modified Grading of Recommendations Assessment, Development and Evaluation-guided assessment of evidence quality. Data sources: Medline, Embase, CINAHL and SPORTSDiscus searched from inception to 5 May 2022. Eligibility criteria for selecting studies: Studies evaluating knee extensor or flexor strength test reliability, measurement error, validity, responsiveness or interpretability in individuals with ACL and/or meniscus injuries with a mean injury age of ≤30 years. Results: Thirty-six studies were included involving 31 different muscle strength tests (mode and equipment) in individuals following an ACL injury and/or an isolated meniscus injury. Strength tests were assessed for reliability (n=8), measurement error (n=7), construct validity (n=27) and criterion validity (n=7). Isokinetic concentric extensor and flexor strength tests were the best rated with sufficient intrarater reliability (very low evidence quality) and construct validity (moderate evidence quality). Isotonic extensor and flexor strength tests showed sufficient criterion validity, while isometric extensor strength tests had insufficient construct and criterion validity (high evidence quality). Conclusion: Knee extensor and flexor strength tests of individuals with ACL and/or meniscus injury lack evidence supporting their measurement properties. There is an urgent need for high-quality studies on these measurement properties. Until then, isokinetic concentric strength tests are most recommended, with isotonic strength tests a good alternative.

• Pedersen, Marie; Grindem, Hege; Berg, Bjørnar; Engebretsen, Lars; Axe, Michael J. & Snyder-Mackler, Lynn [Show all 7 contributors for this article] (2022). Four Distinct 5-Year Trajectories of Knee Function Emerge in Patients Who Followed the Delaware-Oslo ACL Cohort Treatment Algorithm. American Journal of Sports Medicine. ISSN 0363-5465. 50(11), p. 2944–2952. doi: 10.1177/03635465221116313. Full text in Research Archive Show summary

  Background: Impairments and dysfunction vary considerably after anterior cruciate ligament (ACL) injury, and distinct subgroups may exist. Purpose: (1) To identify subgroups of patients with ACL injury who share common trajectories of patient-reported knee function from initial presentation to 5 years after a treatment algorithm where they chose either ACL reconstruction (ACLR) plus rehabilitation or rehabilitation alone. (2) To assess associations with trajectory affiliation. Study Design: Cohort study; Level of evidence, 3. Methods: We included 276 patients with a acute first-time complete unilateral ACL injury. All patients underwent a 5-week neuromuscular and strength training program before a shared decision-making process about treatment. Within their latest attended follow-up, 62% of patients had undergone early ACLR (<6 months after the 5-week program), 11% delayed ACLR (>6 months after the 5-week program), and 27% progressive rehabilitation alone. Patients completed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) at inclusion, after the 5-week program, and at 6 months, 1 year, 2 years, and 5 years after ACLR or completion of the 5-week program (patients treated with rehabilitation alone). We used group-based trajectory modeling to identify trajectories of IKDC-SKF and multinomial logistic regression to assess associations with trajectory affiliation. Results: Four distinct trajectories of IKDC-SKF were identified: Low (n = 22; 8.0% of the cohort), Moderate (n = 142; 51.4%), High (n = 105; 38.0%), and High Before Declining (n = 7; 2.5%). The High trajectory had higher scores at inclusion than the Moderate trajectory, but both improved considerably within 1 year and had thereafter stable high scores. The High Before Declining trajectory also started relatively high and improved considerably within 1 year but experienced a large deterioration between 2 and 5 years. The Low trajectory started low and had minimal improvement. New knee injuries were important characteristics of the High Before Declining trajectory, concomitant meniscal injuries were significantly associated with following the Low (vs Moderate) trajectory, and early/preoperative quadriceps strength and hop symmetry (measured at inclusion) were significantly associated with following the High (vs Moderate) trajectory. Conclusion: We identified 4 distinct 5-year trajectories of patient-reported knee function, indicating 4 subgroups of patients with ACL injury. Importantly, 88% of the patients who followed our treatment algorithm followed the Moderate and High trajectories characterized by good improvement and high scores. Due to eligibility criteria and procedures in our cohort, we can only generalize our model to athletes without major concomitant injuries who follow a similar treatment algorithm. Concomitant meniscal injuries and new knee injuries were important factors in the unfavorable Low and High Before Declining trajectories. These associations were exploratory but support the trajectories’ validity. Our findings can contribute to patient education about prognosis and underpin the importance of continued secondary injury prevention.

• Berg, Bjørnar; Urhausen, Anouk; Øiestad, Britt Elin; Whittaker, Jackie L.; Culvenor, Adam G. & Roos, Ewa M. [Show all 9 contributors for this article] (2022). What tests should be used to assess functional performance in youth and young adults following anterior cruciate ligament or meniscal injury? A systematic review of measurement properties for the OPTIKNEE consensus. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2022-105510.
• Johnson, Jessica L.; Boulton, Aaron J.; Spindler, Kurt P.; Huston, Laura J.; Spalding, Tim & Asplin, Laura [Show all 8 contributors for this article] (2022). Creating Crosswalks for Knee Outcomes After ACL Reconstruction Between the KOOS and the IKDC-SKF. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 104(8), p. 723–731. doi: 10.2106/JBJS.20.02233. Show summary

  Background: Anterior cruciate ligament (ACL) registries do not all use the same patient-reported outcome measures, limiting comparisons and preventing pooling of data for meta-analysis. Our objective was to create a statistical crosswalk to convert cohort and registry mean Knee Injury and Osteoarthritis Outcome Scores (KOOS) to International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF) scores and vice versa to allow these comparisons. Methods: Data from 3 ACL registries were pooled (n = 14,412) and were separated into a training data set (70% of the sample) or a validation data set (30% of the sample). The KOOS and the IKDC-SKF scores were available prior to the operation and at 1, 2, and 5 or 6 years postoperatively. We used equipercentile equating methods to create crosswalks in the training data set and examined accuracy in the validation data set as well as bootstrapping analyses to assess the impact of sample size on accuracy. Results: Preliminary analyses suggested that crosswalks could be attempted: large correlations between scores on the 2 measures (r = 0.84 to 0.94), unidimensionality of scores, and subpopulation invariance were deemed sufficient. When comparing actual scores with crosswalked scores in the validation data set, negligible bias was observed at the group level; however, individual score deviations were variable. The crosswalks are successful for the group level only. Conclusions: Our crosswalks successfully convert between the KOOS and the IKDC-SKF scores to allow for a group-level comparison of registry and other cohort data.

• Kobayashi, Sarah; Allen, Kelli; Bennell, Kim; Bowden, Jocelyn L.; Briggs, Andrew M. & Burgess, Annette [Show all 13 contributors for this article] (2022). A Framework to Guide the Development of Health Care Professional Education and Training in Best Evidence Osteoarthritis Care. Clinics in Geriatric Medicine. ISSN 0749-0690. 38(2), p. 361–384. doi: 10.1016/j.cger.2021.11.008.
• Berg, Bjørnar; Roos, Ewa M.; Kise, Nina Jullum; Engebretsen, Lars; Holm, Inger & Risberg, May Arna (2021). Muscle strength and osteoarthritis progression after surgery or exercise for degenerative meniscal tears: Secondary analyses of a randomized trial. Arthritis care & research. ISSN 2151-464X. doi: 10.1002/acr.24736. Full text in Research Archive Show summary

  Objective: To evaluate muscle strength changes following partial meniscectomy or exercise therapy for degenerative meniscal tears and the relationship between baseline muscle strength and osteoarthritis progression. Methods: Secondary analysis of a randomized trial (n=140 participants). Isokinetic quadriceps and hamstrings strength (peak torque [N·m/kg] and total work [J/kg]) were assessed at baseline, three-, 12-month, and five-year follow-up. Between-group differences were analyzed using intention-to-treat linear mixed models. The relationship between baseline muscle strength and osteoarthritis progression (Kellgren and Lawrence, ≥1 grade increase) were assessed using logistic regression models. Results: We found statistically significant between-group differences favoring exercise therapy at three months (quadriceps: -0.30 N·m/kg, 95% CI -0.40, -0.20; hamstrings: -0.10 N·m/kg, 95% CI -0.15, -0.04) and 12 months (quadriceps: -0.13 N·m/kg, 95% CI -0.23, -0.03; hamstrings: -0.08 N·m/kg, 95% CI -0.14, -0.03). At five years, between-group differences were -0.10 N·m/kg (95% CI -0.21 to 0.01) for quadriceps and -0.07 N·m/kg (95% CI -0.13 to -0.01) for hamstrings. Quadriceps muscle weakness at baseline was associated with knee osteoarthritis progression over five years: adjusted odds ratio of 1.40 for every 0.2 N·m/kg decrease (95% CI 1.15 to 1.71). The adjusted odds ratio for hamstrings was 1.14 (95% CI 0.97-1.35) for every 0.1 N·m/kg decrease. Conclusion: Exercise therapy was effective in improving muscle strength at three and 12-month follow-up compared to partial meniscectomy, but the effect was attenuated at five years. Quadriceps muscle weakness at baseline was associated with higher odds of osteoarthritis progression over five years.

• Pedersen, Marie; Grindem, Hege; Johnson, Jessica L.; Engebretsen, Lars; Axe, Michael J. & Snyder-Mackler, Lynn [Show all 7 contributors for this article] (2021). Clinical, Functional, and Physical Activity Outcomes 5 Years Following the Treatment Algorithm of the Delaware-Oslo ACL Cohort Study. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 103(16), p. 1473–1481. doi: 10.2106/JBJS.20.01731. Show summary

  Background: Anterior cruciate ligament (ACL) injuries can be treated with or without ACL reconstruction (ACLR), and more high-quality studies evaluating outcomes after the different treatment courses are needed. The purpose of the present study was to describe and compare 5-year clinical, functional, and physical activity outcomes for patients who followed our decision-making and treatment algorithm and chose (1) early ACLR with preoperative and postoperative rehabilitation, (2) delayed ACLR with preoperative and postoperative rehabilitation, or (3) progressive rehabilitation alone. Early ACLR was defined as that performed ≤6 months after the preoperative rehabilitation program, and late ACLR was defined as that performed >6 months after the preoperative rehabilitation program. Methods: We included 276 patients from a prospective cohort study. The patients had been active in jumping, pivoting, and cutting sports before the injury and sustained a unilateral ACL injury without substantial concomitant knee injuries. The patients chose their treatment through a shared decision-making process. At 5 years, we assessed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale, sports participation, quadriceps muscle strength, single-legged hop performance, and new ipsilateral and contralateral knee injuries. Results: The 5-year follow-up rate was 80%. At 5 years, 64% of the patients had undergone early ACLR, 11% had undergone delayed ACLR, and 25% had had progressive rehabilitation alone. Understandably, the choices that participants made differed by age, concomitant injuries, symptoms, and predominantly level-I versus level-II preinjury activity level. There were no significant differences in any clinical, functional, or physical activity outcomes among the treatment groups. Across treatment groups, 95% to 100% of patients were still active in some kind of sports and 65% to 88% had IKDC-SKF and KOOS scores above the threshold for a patient acceptable symptom state. Conclusions: Patients with ACL injury who were active in jumping, pivoting, and cutting sports prior to injury; who had no substantial concomitant knee injuries; and who followed our decision-making and treatment algorithm had good 5-year knee function and high sport participation rates. Three of 4 patients had undergone ACLR within 5 years. There were no significant differences in any outcomes among patients treated with early ACLR, delayed ACLR, or progressive rehabilitation alone.

• Moksnes, Håvard; Ardern, Clare L.; Kvist, Joanna; Engebretsen, Lars; Risberg, May Arna & Myklebust, Grethe [Show all 7 contributors for this article] (2021). Assessing implementation, limited efficacy, and acceptability of the BEAST tool: A rehabilitation and return-to-sport decision tool for nonprofessional athletes with anterior cruciate ligament reconstruction. Physical Therapy in Sport. ISSN 1466-853X. 52, p. 147–154. doi: 10.1016/j.ptsp.2021.08.011. Full text in Research Archive Show summary

  Objectives: To assess the implementation, limited efficacy, and acceptability of the BEAST (better and safer return to sport) tool – a rehabilitation and return-to-sport (RTS) decision tool after anterior cruciate ligament reconstruction (ACLR) in nonprofessional athletes. Design: Prospective cohort. Participants: 43 nonprofessional pivoting sport athletes with ACLR. Main outcome: Clinician- and athlete-experienced implementation challenges (implementation), changes in quadriceps power, side hop and triple hop performance from 6 to 8 months after ACLR (limited efficacy), athletes’ beliefs about the individual rehabilitation and RTS plans produced by the BEAST tool (acceptability). Results: The BEAST tool was developed and then implemented as planned for 39/43 (91%) athletes. Hop and quadriceps power performance improved significantly, with the largest improvement in involved quadriceps power (standardised response mean 1.4, 95% CI:1.1–1.8). Athletes believed the rehabilitation and RTS plan would facilitate RTS (8.2 [SD: 2.0]) and reduce injury risk (8.3 [SD: 1.2]; 0 = not likely at all, 10 = extremely likely). Conclusion: The BEAST tool was implemented with few challenges and adjustments were rarely necessary. Athletes had large improvements in quadriceps power and hop performance on the involved leg. Athletes believed that the individual rehabilitation and RTS plans produced by the tool would facilitate RTS and reduce injury risk.

• Pedersen, Marie; Grindem, Hege; Berg, Bjørnar; Gunderson, Ragnhild; Engebretsen, Lars & Axe, Michael J. [Show all 8 contributors for this article] (2021). Low Rates of Radiographic Knee Osteoarthritis 5 Years After ACL Reconstruction or Rehabilitation Alone: The Delaware-Oslo ACL Cohort Study. Orthopaedic Journal of Sports Medicine (OJSM). ISSN 2325-9671. 9(8), p. 1–10. doi: 10.1177/23259671211027530. Full text in Research Archive
• Berg, Bjørnar; Roos, Ewa M.; Kise, Nina Jullum; Engebretsen, Lars; Holm, Inger & Risberg, May Arna (2021). On a Trajectory for Success—9 in Every 10 People With a Degenerative Meniscus Tear Have Improved Knee Function in the 2 Years After Treatment: A Secondary Exploratory Analysis of a Randomized Controlled Trial. Journal of Orthopaedic and Sports Physical Therapy. ISSN 0190-6011. 51(6), p. 289–297. doi: 10.2519/jospt.2021.10025. Show summary

  Objective: To identify trajectories of patient-reported knee function over five years in patients with degenerative meniscal tears, and to explore whether baseline characteristics were associated with trajectories of sport and recreational function. Design: Prospective cohort study. Methods: We conducted a secondary exploratory analysis of the randomized controlled Odense-Oslo Meniscectomy versus Exercise (OMEX) trial. Patient-reported knee function was assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, three, 12, and 24 months, and five years. We used group-based trajectory modeling to identify subgroups who followed distinctive patterns of change. Multinomial logistic regression was used to examine the association of demographic, knee function- and disease-related factors with KOOS sport and recreational function (sport/rec) trajectories. Results: We analyzed data from 140 participants. We identified three trajectories for all KOOS subscales: (i) low, minimal improvement (10%-12% of the participants), (ii) moderate, gradual improvement (20%-36%), and (iii) high, early improvement (53%-70%). Baseline prognostic factors for deteriorating function in sport and recreational activities were higher BMI, poorer mental health, greater knee pain, lower perceived knee function, poorer quadriceps and hamstrings muscle strength, poorer functional performance, more meniscal extrusion, and having radiographic signs of knee osteoarthritis. Conclusion: We found three distinct trajectories of patient-reported knee function over five years: (i) low, minimal improvement, (ii) moderate, gradual improvement, (iii) high, early improvement. Nine in every 10 participants improved at least gradually over two years after diagnosis of a degenerative meniscus tear.

• Cronström, Anna; Risberg, May Arna; Englund, Martin Trøan; Tiderius, Carl Johan; Önnerfjord, Patrik & Struglics, André [Show all 10 contributors for this article] (2020). Is good muscle function a protective factor for early signs of knee osteoarthritis after anterior cruciate ligament reconstruction? The SHIELD cohort study protocol. Osteoarthritis and Cartilage Open. ISSN 2665-9131. 2(4). doi: 10.1016/j.ocarto.2020.100102.
• Holm, Inger; Pripp, Are Hugo & Risberg, May Arna (2020). The Active with OsteoArthritis (AktivA) Physiotherapy Implementation Model: A Patient Education, Supervised Exercise and Self-Management Program for Patients with Mild to Moderate Osteoarthritis of the Knee or Hip Joint. A National Register Study with a Two-Year Follow-Up. Journal of Clinical Medicine. ISSN 2077-0383. 9(10). doi: 10.3390/jcm9103112. Full text in Research Archive
• Wijn, Stan R.W.; Rovers, Maroeska M.; Rongen, Jan J.; Østerås, Håvard; Risberg, May Arna & Roos, Ewa M. [Show all 11 contributors for this article] (2020). Arthroscopic meniscectomy versus non-surgical or sham treatment in patients with MRI confirmed degenerative meniscus lesions: A protocol for an individual participant data meta-analysis. BMJ Open. ISSN 2044-6055. 10(3). doi: 10.1136/bmjopen-2019-031864. Full text in Research Archive
• Arhos, Elanna K.; Thoma, Louise M.; Grindem, Hege; Logerstedt, David; Risberg, May Arna & Snyder-Mackler, Lynn (2020). Association of Quadriceps Strength Symmetry and Surgical Status with Clinical Osteoarthritis 5 Years after Anterior Cruciate Ligament Rupture. Arthritis care & research. ISSN 2151-464X. 74(3), p. 386–391. doi: 10.1002/acr.24479. Show summary

  Objective: The objective of this study was to examine the association of quadriceps strength symmetry and surgical status (ACL reconstruction or nonoperative management) with early clinical knee OA 5 years after ACL injury or reconstruction. Methods: 204/300 athletes were analyzed 5 years after ACL injury or reconstruction (ACLR). Quadriceps strength was measured and reported as a limb symmetry index. We identified participants with early clinical knee OA using criteria that two of four Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales score ≤85% (Luyten et al. 2018). We calculated odds ratios (OR) and 95% confidence intervals (CI) using logistic regression, adjusted for age, sex, meniscal injury, and BMI, to examine the associations between quadriceps strength and surgical status with clinical knee OA. Results: 21% of participants met KOOS criteria for clinical knee OA (Luyten et al. 2018). For every 1% increase in quadriceps limb symmetry index, there was 4% lower odds of clinical OA (adjusted OR 0.96, 95% CI 0.93‐0.99) at 5 years. Surgical status was not associated with clinical knee OA (adjusted OR 0.58, 95% CI 0.23, 1.50). Conclusions: More symmetrical quadriceps strength, but not surgical status, 5 years after ACL injury or reconstruction was associated with lower odds of clinical knee OA.

• Impellizzeri, Franco M.; Jones, Denise M.; Griffin, Damian; Harris-Hayes, Marcie; Thorborg, Kristian & Crossley, Kay M. [Show all 39 contributors for this article] (2020). Patient-reported outcome measures for hip-related pain: a review of the available evidence and a consensus statement from the International Hip-related Pain Research Network, Zurich 2018. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2019-101456. Full text in Research Archive Show summary

  Hip-related pain is a well-recognised complaint among active young and middle-aged active adults. People experiencing hip-related disorders commonly report pain and reduced functional capacity, including difficulties in executing activities of daily living. Patient-reported outcome measures (PROMs) are essential to accurately examine and compare the effects of different treatments on disability in those with hip pain. In November 2018, 38 researchers and clinicians working in the field of hip-related pain met in Zurich, Switzerland for the first International Hip-related Pain Research Network meeting. Prior to the meeting, evidence summaries were developed relating to four prioritised themes. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of PROMs to assess disability in young and middle-aged active adults with hip-related pain. Our process to gain consensus had five steps: (1) systematic review of systematic reviews; (2) preliminary discussion within the working group; (3) update of the more recent high-quality systematic review and examination of the psychometric properties of PROMs according to established guidelines; (4) formulation of the recommendations considering the limitations of the PROMs derived from the examination of their quality; and (5) voting and consensus. Out of 102 articles retrieved, 6 systematic reviews were selected and assessed for quality according to AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Two showed moderate quality. We then updated the most recent review. The updated literature search resulted in 10 additional studies that were included in the qualitative synthesis. The recommendations based on evidence summary and PROMs limitations were presented at the consensus meeting. The group makes the following recommendations: (1) the Hip and Groin Outcome Score (HAGOS) and the International Hip Outcome Tool (iHOT) instruments (long and reduced versions) are the most appropriate PROMs to use in young and middle-aged active adults with hip-related pain; (2) more research is needed into the utility of the HAGOS and the iHOT instruments in a non-surgical treatment context; and (3) generic quality of life measures such as the EuroQoL-5 Dimension Questionnaire and the Short Form Health Survey-36 may add value for researchers and clinicians in this field. We conclude that as none of the instruments shows acceptable quality across various psychometric properties, more methods studies are needed to further evaluate the validity of these PROMS—the HAGOS and iHOT—as well as the other (currently not recommended) PROMS.

• Pedersen, Marie; Johnson, Jessica L; Grindem, Hege; Magnusson, Karin; Snyder-Mackler, Lynn & Risberg, May Arna (2020). Meniscus or Cartilage Injury at the Time of Anterior Cruciate Ligament Tear Is Associated With Worse Prognosis for Patient-Reported Outcome 2 to 10 Years After Anterior Cruciate Ligament Injury: A Systematic Review. Journal of Orthopaedic and Sports Physical Therapy. ISSN 0190-6011. 50(9), p. 490–502. doi: 10.2519/jospt.2020.9451. Show summary

  Objectives: (1) To assess prognostic factors for patient-reported outcome measures (PROMs) and physical activity 2 to 10 years after anterior cruciate ligament reconstruction (ACLR) or anterior cruciate ligament (ACL) injury, and (2) to assess differences in prognostic factors between patients treated with ACLR and with rehabilitation alone. Design: Prognosis systematic review. Literature Search: Systematic searches were performed in PubMed, Web of Science, and SPORTDiscus. Study Selection Criteria: We selected prospective cohort studies and randomized clinical trials that included adults or adolescents undergoing either ACLR or rehabilitation alone after ACL rupture. Studies had to assess the statistical association between potential prognostic factors (factors related to patient characteristics, injury, or knee symptoms/function measured at baseline or within 1 year) and outcomes (PROMs and physical activity). Data Synthesis: Our search yielded 997 references. Twenty studies met the inclusion criteria. Seven studies with low or moderate risk of bias remained for data synthesis. Results: Moderate-certainty evidence indicated that concomitant meniscus and cartilage injuries were prognostic factors for worse PROMs 2 to 10 years after ACLR. Very low–certainty evidence suggested that body mass index, smoking, and baseline PROMs were prognostic factors for worse outcome. Very low–certainty evidence suggested that female sex and a worse baseline Marx Activity Rating Scale score were prognostic factors for a worse Marx Activity Rating Scale score 2 to 10 years after ACLR. There was a lack of studies on prognostic factors after rehabilitation alone. Conclusion: Concomitant meniscus and cartilage injuries were prognostic factors for worse long-term PROMs after ACLR. The certainty was very low for other prognostic factors.

• Kemp, Joanne L.; Østerås, Nina; Mathiessen, Alexander; Nordsletten, Lars; Agricola, Rintje & Waarsing, Jan H [Show all 8 contributors for this article] (2020). Relationship between cam morphology, hip symptoms, and hip osteoarthritis: the Musculoskeletal pain in Ullersaker STudy (MUST) cohort. HIP International. ISSN 1120-7000. p. 1–8. doi: 10.1177/1120700020943853.
• Johnson, Jessica L; Irrgang, James J.; Risberg, May Arna & Snyder-Mackler, Lynn (2020). Comparing the Responsiveness of the Global Rating Scale With Legacy Knee Outcome Scores: A Delaware-Oslo Cohort Study. American Journal of Sports Medicine. ISSN 0363-5465. doi: 10.1177/0363546520924817. Full text in Research Archive Show summary

  Background: The selection of patient-reported outcome measures (PROMs) is essential for obtaining meaningful information to treat a patient, determine a plan of care, and make clinical decisions; however, the process of selecting PROMs for clinical care is difficult, with the need to balance these multiple factors. Variation makes it difficult to compare data across providers and studies. Hypothesis/Purpose: The purpose was to determine the responsiveness of 4 PROMs via effect size and the presence of a ceiling effect in the 5 years after anterior cruciate ligament reconstruction (ACLR). We hypothesized that the single-item Global Rating Scale (GRS) would have an effect size and ceiling effect similar to the commonly used legacy PROMs. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Of the 300 participants, 218 had ACLR, completed postoperative progressive criterion-based rehabilitation early after surgery, and were followed for 5 years. We collected data based on the GRS, the Knee Outcome Survey–Activities of Daily Living Scale (KOS-ADLS), the International Knee Documentation Committee–Subjective Knee Form (IKDC-SKF), and the KOOS (Knee injury and Osteoarthritis Outcome Score) before and after training and at 6, 12, 24, and 60 months after ACLR. Results: The IKDC-SKF had the largest effect sizes and lowest ceiling effects. The GRS had a similar size and change in both effect size and ceiling effect when compared with the longer PROMs. The GRS and IKDC-SKF had a correlation of 0.72, and the GRS had a minimal detectable change of 2.9 or 4.8, depending on methodology. Conclusion: The GRS responded similarly to the IKDC-SKF, KOS-ADLS, and KOOS and was responsive to patient change. The ease of use and patient-specific nature of the question means that it may be appropriate to use the GRS in clinical care as a consistent measure throughout the course of rehabilitation.

• Grindem, Hege; Engebretsen, Lars; Axe, Michael; Snyder-Mackler, Lynn & Risberg, May Arna (2020). Activity and functional readiness, not age, are the critical factors for second anterior cruciate ligament injury : the Delaware-Oslo ACL cohort study. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2019-100623. Full text in Research Archive Show summary

  Objective: To elucidate the relationships between age, return to level I sport (RTS) within the first postoperative year, passing RTS criteria and second anterior cruciate ligament (ACL) injury. Methods: In a prospective cohort study, 213 athletes were followed for 2 years after ACL reconstruction to record second ACL injuries. Independent variables were age, passing RTS criteria and level I RTS within the first postoperative year (vs later or no RTS). We defined passing RTS criteria as ≥90 on the Knee Outcome Survey — Activities of Daily Living Scale, global rating scale of function and quadriceps strength/hop test symmetry. Results: The follow-up rate was >87% for all outcomes. In multivariable analysis, level I RTS within the first postoperative year and passing RTS criteria were highly associated with second ACL injury (level I RTS HR: 6.0 (95% CI: 1.6 to 22.6), pass RTS criteria HR: 0.08 (95% CI: 0.01 to 0.6)), while age was not (age HR: 0.96 (95% CI: 0.89 to 1.04)). Athletes <25 years had higher level I RTS rates in the first postoperative year (60.4%) than older athletes (28.0%). Of those who returned to level I sport in the first postoperative year, 38.1% of younger and 59.1% of older athletes passed RTS criteria. Conclusion: High rates of second ACL injury in young athletes may be driven by a mismatch between RTS rates and functional readiness to RTS. Passing RTS criteria was independently associated with a lower second ACL rate. Allowing more time prior to RTS, and improving rehabilitation and RTS support, may reduce second ACL injury rates in young athletes with ACL reconstruction.

• Berg, Bjørnar; Roos, Ewa M.; Englund, Martin; Kise, Nina Jullum; Tiulpin, Aleksei & Saarakkala, Simo [Show all 10 contributors for this article] (2020). Development of osteoarthritis in patients with degenerative meniscal tears treated with exercise therapy or surgery: a randomized controlled trial. Osteoarthritis and Cartilage. ISSN 1063-4584. doi: 10.1016/j.joca.2020.01.020. Full text in Research Archive Show summary

  Objective: To evaluate progression of individual radiographic features 5 years following exercise therapy or arthroscopic partial meniscectomy as treatment for degenerative meniscal tear. Design: Randomized controlled trial including 140 adults, aged 35–60 years, with a magnetic resonance image verified degenerative meniscal tear, and 96% without definite radiographic knee osteoarthritis. Participants were randomized to either 12-weeks of supervised exercise therapy or arthroscopic partial meniscectomy. The primary outcome was between-group difference in progression of tibiofemoral joint space narrowing and marginal osteophytes at 5 years, assessed semi-quantitatively by the OARSI atlas. Secondary outcomes included incidence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis, medial tibiofemoral fixed joint space width (quantitatively assessed), and patient-reported outcome measures. Statistical analyses were performed using a full analysis set. Per protocol and as treated analysis were also performed. Results: The risk ratios (95% CI) for progression of semi-quantitatively assessed joint space narrowing and medial and lateral osteophytes for the surgery group were 0.89 (0.55–1.44), 1.15 (0.79–1.68) and 0.77 (0.42–1.42), respectively, compared to the exercise therapy group. In secondary outcomes (full-set analysis) no statistically significant between-group differences were found. Conclusion: The study was inconclusive with respect to potential differences in progression of individual radiographic features after surgical and non-surgical treatment for degenerative meniscal tear. Further, we found no strong evidence in support of differences in development of incident radiographic knee osteoarthritis or patient-reported outcomes between exercise therapy and arthroscopic partial meniscectomy.

• Reiman, Michael P.; Agricola, Rintje; Kemp, Joanne L.; Heerey, Joshua J.; Weir, Adam & van Klij, Pim [Show all 43 contributors for this article] (2020). Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. British Journal of Sports Medicine. ISSN 0306-3674. 54(11), p. 631–641. doi: 10.1136/bjsports-2019-101453. Full text in Research Archive
• Risberg, May Arna; Holth, Guro & Øiestad, Britt Elin (2019). Styrketreningsprogram for kneartrosepasienter: Hva er adekvat dosering for å oppnå effekt av behandling? Fysioterapeuten. ISSN 0016-3384. 9, p. 28–33.
• Emery, Carolyn A.; Whittaker, Jackie L.; Mahmoudian, Armaghan; Lohmander, L. Stefan; Roos, Ewa M. & Bennell, Kim L. [Show all 26 contributors for this article] (2019). Establishing outcome measures in early knee osteoarthritis. Nature Reviews Rheumatology. ISSN 1759-4790. 15(7), p. 438–448. doi: 10.1038/s41584-019-0237-3. Show summary

  The classification and monitoring of individuals with early knee osteoarthritis (OA) are important considerations for the design and evaluation of therapeutic interventions and require the identification of appropriate outcome measures. Potential outcome domains to assess for early OA include patient-reported outcomes (such as pain, function and quality of life), features of clinical examination (such as joint line tenderness and crepitus), objective measures of physical function, levels of physical activity, features of imaging modalities (such as of magnetic resonance imaging) and biochemical markers in body fluid. Patient characteristics such as adiposity and biomechanics of the knee could also have relevance to the assessment of early OA. Importantly, research is needed to enable the selection of outcome measures that are feasible, reliable and validated in individuals at risk of knee OA or with early knee OA. In this Perspectives article, potential outcome measures for early symptomatic knee OA are discussed, including those measures that could be of use in clinical practice and/or the research setting.

• Kemp, Joanne L.; Risberg, May Arna; Mosler, Andrea Britt; Harris-Hayes, Marcie; Serner, Andreas & Moksnes, Håvard [Show all 42 contributors for this article] (2019). Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018. British Journal of Sports Medicine. ISSN 0306-3674. p. 1–8. doi: 10.1136/bjsports-2019-101458. Full text in Research Archive Show summary

  The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain; (2) patient-reported outcome measures for hip-related pain; (3) measurement of physical capacity for hip-related pain; (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors such as load magnitude, number of repetitions and sets, duration of whole programme, duration of contractile element of exercise, duration of one repetition, time under tension, rest between repetitions, range of motion through which the exercise is performed, and rest between exercise sessions should be reported. (ii) Research should investigate the optimal frequency, intensity, time, type, volume and progression of exercise therapy. (iii) Research should examine the effect of patient education in people with hip-related pain. (iv) Research should investigate the effect of other treatments used in people with hip-related pain (for example: manual therapy, medications, injections). (v) Research should examine the impact of comorbidities and social determinants on treatment effectiveness in people with hip-related pain. Clinicians and researchers working with young to middle-aged active adults with hip-related pain may use these consensus recommendations to guide, develop, test and implement individualised, evidence-based physiotherapist-led rehabilitation programmes.

• Warholm, Kristian Marstrand; Råbøl, Åsmund Lindvik; Løken, Sverre Bertrand; Ludvigsen, Tom; Agricola, Rintje & Tariq, Rana [Show all 8 contributors for this article] (2019). Langtidsoppfølging (6–13 år) etter hofteartroskopi med PROMS og røntgen funn. Pasienter fra Oslo universitetssykehus, 2019: Høstmøteboken - vitenskapelig program og abstrakter. Norsk Ortopedisk Forening. ISSN 978-82-994275-1-7. Show summary

  Innledning: Artroskopisk behandling av Femoroacetabular Impingement Syndrome (FAIS) har globalt hatt progressiv vekst siden starten av 90-tallet. Det eksisterer lite forskning på området med langtidsoppfølging av pasientrapporterte utfallsmål (PROMS) og radiologiske forandringer. Formålet med denne studien var å undersøke PROMS og radiologiske forandringer hos pasienter operert for FAIS mellom 2004 og 2011.

• Mosler, Andrea Britt; Kemp, Joanne; King, Matthew; Lawrenson, Peter R; Semciw, Adam & Freke, Matthew D. [Show all 40 contributors for this article] (2019). Standardised measurement of physical capacity in young and middle-aged active adults with hip-related pain: recommendations from the first International Hip-related Pain Research Network (IHiPRN) meeting, Zurich, 2018. British Journal of Sports Medicine. ISSN 0306-3674. p. 1–9. doi: 10.1136/bjsports-2019-101457. Show summary

  Hip-related pain can significantly impact quality of life, function, work capacity, physical activity and family life. Standardised measurement methods of physical capacity of relevance to young and middle-aged active adults with hip-related pain are currently not established. The aim of this consensus paper was to provide recommendations for clinical practice and research on standardised measurement methods of physical capacity in young and middle-aged active adults with hip-related pain. Four areas of importance were identified: (1) clinical measures (range of motion, muscle strength, functional impairments), (2) laboratory-based measures (biomechanics and muscle function (muscle activity, size and adiposity)), (3) physical activity, and (4) return to sport/performance. The literature was reviewed, and a summary circulated to the working group to inform discussion at the consensus meeting. The working group developed clinical and research recommendations from the literature review, which were further discussed and modified within the working group at the consensus meeting. These recommendations were then presented to all 38 International Hip-related Pain Research Network (IHiPRN) participants for further discussion, refinement and consensus voting. Therefore, the recommendations voted on were based on a combination of current evidence and expert opinion. The consensus meeting voted on 13 recommendations, six of which were clinically orientated, and seven more research specific. We recommended that clinicians working with young and middle-aged active adults with hip-related pain assess strength using objective methods of measurement, and clinically assess performance of functional tasks, including walking and running. Physical activity should be quantified using both self-reported and objective measures, and patient expectations of recovery should be quantified prior to treatment. It was recommended that return to physical activity (including sport and occupation) be quantified, and sport-specific activities should be assessed prior to return to sport. The IHiPRN participants were uncertain regarding recommendations for range of motion assessment. Research recommendations were that the measurement properties of range of motion, strength and functional performance tests be investigated, reported and improved in both clinical and research settings. Reporting of movement-related parameters (biomechanics and muscle function) should be standardised and the relationship among movement-related parameters, symptoms, function, quality of life, and intra-articular and imaging findings should be investigated. Quantification of return to physical activity (including sport and occupational demands) is required in future research, and the return to sport continuum should be used. Future research is required to determine the best criteria for rehabilitation progression and return to physical activity following hip-related pain management.

• Reimer, Lisa Cecilie; Jakobsen, Stig; Mortensen, Louise; Dalgas, Ulrik; Jacobsen, Julie Sandell & Søballe, Kjeld [Show all 11 contributors for this article] (2019). Efficacy of periacetabular osteotomy followed by progressive resistance training compared to progressive resistance training as non-surgical treatment in patients with hip dysplasia (PreserveHip) - a protocol for a randomised controlled trial. BMJ Open. ISSN 2044-6055. 9(12), p. 1–8. doi: 10.1136/bmjopen-2019-032782. Full text in Research Archive
• Svinøy, Odd-Einar; Bergland, Astrid; Risberg, May Arna; Pripp, Are Hugo & Hilde, Gunvor (2019). Better before–better after: efficacy of prehabilitation for older patients with osteoarthritis awaiting total hip replacement—a study protocol for a randomised controlled trial in South-Eastern Norway. BMJ Open. ISSN 2044-6055. 9(12), p. 1–8. doi: 10.1136/bmjopen-2019-031626.
• Capin, Jacob John; Failla, Mathew; Zarzycki, Ryan; Dix, Celeste; Johnson, Jessica L & Smith, Angela H [Show all 10 contributors for this article] (2019). Superior 2-Year Functional Outcomes Among Young Female Athletes After ACL Reconstruction in 10 Return-to-Sport Training Sessions: Comparison of ACL-SPORTS Randomized Controlled Trial With Delaware-Oslo and MOON Cohorts. Orthopaedic Journal of Sports Medicine (OJSM). ISSN 2325-9671. 7(8). doi: 10.1177/2325967119861311. Full text in Research Archive Show summary

  Background: Outcomes after anterior cruciate ligament reconstruction (ACLR) are not uniformly good and are worse among young female athletes. Developing better rehabilitation and return-to-sport training programs and evaluating their outcomes are essential. Purpose: (1) Test the effect of strength, agility, plyometric, and secondary prevention (SAPP) exercises with and without perturbation training (SAPP + PERT) on strength, hops, function, activity levels, and return-to-sport rates in young female athletes 1 and 2 years after ACLR and (2) compare 2-year functional outcomes and activity levels among young female athletes in the Anterior Cruciate Ligament Specialized Post-Operative Return-to-Sports (ACL-SPORTS) trial to homogeneous cohorts who completed criterion-based postoperative rehabilitation alone (Multicenter Orthopaedic Outcomes Network [MOON]) and in combination with extended preoperative rehabilitation (Delaware-Oslo). Study Design: Randomized controlled trial, Level of evidence, 1; and cohort study, Level of evidence, 3. Methods: A total of 40 level 1 and level 2 female athletes were enrolled after postoperative impairment resolution 3 to 9 months after primary ACLR. Participants were randomized to 10 SAPP or SAPP + PERT sessions and were tested 1 and 2 years after ACLR on quadriceps strength, hop tests, functional outcomes, and return-to-sport rates. Participants were then compared with homogeneous cohorts of young (<25 years) female athletes who completed criterion-based postoperative rehabilitation alone (MOON) and in combination with extended preoperative rehabilitation (Delaware-Oslo) on 2-year functional outcomes. Results: No significant or meaningful differences were found between SAPP and SAPP + PERT, so groups were collapsed for comparison with the other cohorts. At 2-year follow-up, ACL-SPORTS had the highest scores (P < .01) on the Marx activity rating scale (ACL-SPORTS, 13.5 ± 3.3; Delaware-Oslo, 12.5 ± 2.7; MOON, 10.6 ± 5.1); International Knee Documentation Committee Subjective Knee Evaluation Form (96 ± 7, 92 ± 9, and 84 ± 14, respectively); and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales for Pain (98 ± 4, 94 ± 9, and 90 ± 10, respectively), Symptoms (94 ± 6, 90 ± 9, and 83 ± 14, respectively), Activities of Daily Living (100 ± 1, 99 ± 4, and 96 ± 7, respectively), Sports and Recreation (94 ± 8, 86 ± 15, and 82 ± 17, respectively), and Quality of Life (89 ± 14, 78 ± 18, and 76 ± 19, respectively). The Patient Acceptable Symptom State threshold on the KOOS–Sports and Recreation was achieved by 100% of the ACL-SPORTS cohort compared with 90% of Delaware-Oslo and 78% of MOON (P = .011). Conclusion: Although perturbation training provided no added benefit, 10 sessions of return-to-sport training, compared with criterion-based postoperative rehabilitation alone, yielded statistically significant and clinically meaningfully higher 2-year functional outcomes among young, high-level female athletes after ACLR.

• Lien-Iversen, Teodor; Morgan, Daniel Barklin; Jensen, Carsten; Risberg, May Arna; Engebretsen, Lars & Viberg, Bjarke (2019). Does surgery reduce knee osteoarthritis, meniscal injury and subsequent complications compared with non-surgery after ACL rupture with at least 10 years follow-up? A systematic review and meta-analysis. British Journal of Sports Medicine. ISSN 0306-3674. 54(10), p. 1–8. doi: 10.1136/bjsports-2019-100765. Full text in Research Archive
• Weldingh, Eirik; Johnsen, Marianne Bakke; Hagen, Kåre Birger; Østerås, Nina; Risberg, May Arna & Natvig, Bård [Show all 11 contributors for this article] (2019). The Maternal and Paternal Effects on Clinically and Surgically Defined Osteoarthritis. Arthritis & Rheumatology. ISSN 2326-5191. 71(11), p. 1844–1848. doi: 10.1002/art.41023. Full text in Research Archive
• Kise, Nina Jullum; Aga, Cathrine; Engebretsen, Lars; Roos, Ewa M.; Tariq, Rana & Risberg, May Arna (2019). 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. American Journal of Sports Medicine. ISSN 0363-5465. 47(10), p. 2402–2411. doi: 10.1177/0363546519858602. Full text in Research Archive
• Lie, Marthe Mehu; Risberg, May Arna; Storheim, Kjersti; Engebretsen, Lars & Øiestad, Britt Elin (2019). What's the rate of knee osteoarthritis 10 years after anterior cruciate ligament injury? An updated systematic review. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2018-099751. Show summary

  This updated systematic review reports data from 2009 on the prevalence, and risk factors, for knee osteoarthritis (OA) more than 10 years after anterior cruciate ligament (ACL) tear.MethodsWe systematically searched five databases (PubMed, EMBASE, AMED, Cinahl and SPORTDiscus) for prospective and retrospective studies published after 1 August 2008. Studies were included if they investigated participants with ACL tear (isolated or in combination with medial collateral ligament and/or meniscal injuries) and reported symptomatic and/or radiographic OA at a minimum of 10 years postinjury. We used a modified version of the Downs and Black checklist for methodological quality assessment and narrative synthesis to report results. The study protocol was registered in PROSPERO.ResultsForty-one studies were included. Low methodological quality was revealed in over half of the studies. At inclusion, age ranged from 23 to 38 years, and at follow-up from 31 to 51 years. Sample sizes ranged from 18 to 780 participants. The reported radiographic OA prevalence varied between 0% and 100% >10 years after injury, regardless of follow-up time. The studies with low and high methodological quality reported a prevalence of radiographic OA between 0%–100%and 1%–80%,respectively. One study reported symptomatic knee OA for the tibiofemoral (TF) joint (35%), and one study reported symptomatic knee OA for the patellofemoral (PF) joint (15%). Meniscectomy was the only consistent risk factor determined from the data synthesis.ConclusionRadiographic knee OA varied between 0% and 100% in line with our previous systematic review from 2009. Symptomatic and radiographic knee OA was differentiated in two studies only, with a reported symptomatic OA prevalence of 35% for the TF joint and 15% for PF joint. Future cohort studies need to include measurement of symptomatic knee OA in this patient group.

• Thoma, Louise M.; Grindem, Hege; Logerstedt, David; Axe, Michael; Engebretsen, Lars & Risberg, May Arna [Show all 7 contributors for this article] (2019). 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. American Journal of Sports Medicine. ISSN 0363-5465. 47(4), p. 807–814. doi: 10.1177/0363546519825500. Full text in Research Archive Show summary

  Background: Some athletes demonstrate excellent dynamic stability after anterior cruciate ligament (ACL) rupture and return tosport without ACL reconstruction (ACLR) (copers). Others demonstrate persistent instability despite rehabilitation (noncopers) andrequire surgical stabilization. Testing to determine coper classification can identify potential copers early after rupture. It is unclearhow coper classification changes after a brief intervention and how early classification relates to long-term outcomes.Purpose:(1) To evaluate the consistency of early coper classification (potential coper vs noncoper) before and after progressiveneuromuscular and strength training (NMST) among athletes early after acute ACL rupture and (2) to evaluate the association ofearly coper classification with 2-year success after ACL rupture.Study Design:Cohort study; Level of evidence, 2.Methods:This was a prospective analysis from the Delaware-Oslo ACL Cohort Study, composed of athletes consecutively enrolledearly after ACL rupture. Participants (n = 271) were tested and classified as potential copers or noncopers according to established cri-teria before and after a 10-session NMST program. Success 2 years after ACLR or nonoperative rehabilitation was defined as meeting orexceeding sex- and age-matched norms for knee function, no ACL graft rupture, and 1 episode of giving way within the previous year.The McNemar test evaluated changes in coper classification pre- to posttraining. Logistic regression adjusted for baseline characteristicswas used to evaluate the association of early coper classification and surgical status with 2-year success.Results:Of 300 athletes enrolled, 271 (90%) completed the posttraining data collection, and 219 (73%) returned for the 2-year fol-low-up. The coper classifications were different between time points: nearly half of those classified initially as noncopers becamepotential copers (P\.001). At the 2-year follow-up, 66% of the ACLR group and 74% of the nonoperative group were successful.Athletes who were potential copers posttraining and chose ACLR or nonoperative rehabilitation had 2.7 (95% CI, 1.3-5.6) and 2.9(95% CI, 1.2-7.2) times the odds of success, respectively, as compared with noncopers who chose ACLR.Conclusion:Coper classification improved after NMST; more athletes became potential copers. Athletes who were potential co-pers after NMST were more likely to succeed 2 years later regardless of whether they had surgery, strongly supporting the addi-tion of NMST before ACLR. Persistent noncopers fared poorly, indicating that more intensive rehabilitation may be needed.

• Ekås, Guri Ranum; Mjelde, Marit; Larmo, Arne Feilberg; Moksnes, Håvard; Grindem, Hege & Risberg, May Arna [Show all 7 contributors for this article] (2019). 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. American Journal of Sports Medicine. ISSN 0363-5465. 47(7), p. 1557–1566. doi: 10.1177/0363546519837935. Show summary

  Background: The rate of secondary knee injuries after pediatric anterior cruciate ligament (ACL) injury is uncertain, and previous studies are limited because of poor methodology. Purpose: To evaluate the incidence of new meniscal injuries since the initial diagnostic magnetic resonance imaging (MRI) of young adults who sustained a pediatric ACL injury. In addition, to evaluate meniscal and cartilage injuries in the index knee and contralateral knee injuries on MRI at final follow-up (9.5 years). Furthermore, to assess leg length and alignment based on long-leg radiographs. Study Design: Case series; Level of evidence, 4. Methods: Study population at final follow-up included 47 young adults who sustained a pediatric ACL injury before age 13 years. They were followed prospectively since the time of injury for a mean 9.5 years at final follow-up. Imaging included diagnostic MRI of the index knee and 3.0-T MRI of both knees at 1-, 2-, and 9.5-year follow-up, in addition to long-leg radiographs at final follow-up. Forty-three patients underwent active rehabilitation without ACL reconstruction initially; 4 were treated with initial ACL reconstruction. At final follow-up, 27 (57%) had undergone ACL reconstruction. Results: Fourteen patients had meniscal tears in the index knee at final follow-up (prevalence, 30%). The majority of these were in the same location as previously repaired tears (n = 9). Between diagnostic MRI and final follow-up, 16 patients had sustained new meniscal tears to a healthy meniscus (incidence, 34%). At final follow-up, meniscal injuries recorded at baseline or during follow-up were no longer visible and appeared healed in 17 patients (20 tears). MRI at final follow-up showed cartilage injuries in the index knee of 13 patients (28%) and contralateral injuries in 8 patients (meniscus, n = 2; cartilage, n = 5; subchondral fracture, n = 1). Two patients had a leg-length difference >15 mm, and 3 had side-to-side difference in knee alignment >5°. Conclusion: The incidence of new meniscal tears after pediatric ACL injury was 34% during a mean follow-up period of 9.5 years. At final follow-up, 27 patients (57%) had normal menisci, and none had developed knee osteoarthritis. Primary active rehabilitation, close follow-up, and delayed surgery if needed may be a viable and safe treatment option for some pediatric ACL injuries.

• Holm, Inger; Risberg, May Arna; Roos, Ewa M. & Thorgaard Skou, Søren (2019). A pragmatic approach to the implementation of osteoarthritis guidelines has fewer potential barriers than recommended implementation frameworks. Journal of Orthopaedic and Sports Physical Therapy. ISSN 0190-6011. 49(1), p. 1–4. doi: 10.2519/jospt.2019.0601. Show summary

  Translating evidence-based treatment recommendations and guidelines into feasible delivery in routine care is an essential objective to improve quality of care. Nevertheless, guidelines are underused, and many physical therapists and other professionals continue to offer low-value care modalities, providing the patients with treatment options of little to no benefit. In contrast to low-value interventions, evidence-based treatment guidelines for osteoarthritis (OA) recommend information, exercise, and weight control. The authors discuss the feasibility of a pragmatic approach to implementation of clinical guidelines that facilitates improved quality of care for management of OA

• Ekås, Guri Ranum; Moksnes, Håvard; Grindem, Hege; Risberg, May Arna & Engebretsen, Lars (2019). Coping With Anterior Cruciate Ligament Injury From Childhood to Maturation: A Prospective Case Series of 44 Patients With Mean 8 Years’ Follow-up. American Journal of Sports Medicine. ISSN 0363-5465. 47(1), p. 22–30. doi: 10.1177/0363546518810750. Full text in Research Archive Show summary

  Background: There is no consensus regarding the best treatment approach for skeletally immature children with anterior cruciate ligament (ACL) injuries. High-quality studies with long-term follow-up are lacking, and evidence to support decision making is limited. Purpose: To evaluate functional and patient-reported outcome, surgical history, and complications among young adults who sustained an ACL injury before the age of 13 years and were treated with active rehabilitation and the option of delayed ACL reconstruction if needed. Study Design: Case series; Level of evidence, 4. Methods: Forty-six children aged <13 years with a total intrasubstance ACL injury were included. None of these patients had additional injuries that warranted early surgery. At final follow-up at a mean 8 years after the time of injury, 44 patients remained in the study. The same test battery was conducted at baseline, 1 and 2 years, and final follow-up at approximately 18 years of age. The test battery included functional tests (hop tests and isokinetic muscle strength tests of quadriceps and hamstrings), patient-reported outcome measures (including the Knee injury and Osteoarthritis Outcome Score and the International Knee Documentation Committee Subjective Knee Form), and clinical examination. Medical records were reviewed to assess surgical history and complications. Results: At a mean 8 years of follow-up, 24 patients (55%) had undergone ACL reconstruction, and 16 (36%) had undergone meniscal surgery. Quadriceps muscle strength symmetry was >90% for 30 patients (68%). Mean leg symmetry indexes for hop and strength tests were consistently >90%, except for the single-hop test and hamstrings muscle strength for ACL-reconstructed knees. Mean ± SD International Knee Documentation Committee scores were 86.3 ± 13.7 for the ACL-reconstructed knees and 90.6 ± 11.8 for the nonreconstructed knees. At final follow-up, forty patients (91%) remained active in sports, but 29 (66%) restricted their activity level to nonpivoting sports. Conclusion: Active rehabilitation may have a role in treatment of children with ACL injury. Approximately 50% of children may cope well, even to adulthood, without a surgical intervention. The other half may develop instability that warrants ACL reconstruction, and one-third may require meniscal surgery.

• Kise, Nina Jullum; Roos, Ewa M.; Stensrud, Silje; Engebretsen, Lars & Risberg, May Arna (2018). The 6-m timed hop test is a prognostic factor for outcomes in patients with meniscal tears treated with exercise therapy or arthroscopic partial meniscectomy: a secondary, exploratory analysis of the Odense–Oslo meniscectomy versus exercise (OMEX) trial. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. p. 1–10. doi: 10.1007/s00167-018-5241-7. Full text in Research Archive Show summary

  Purpose: To identify the prognostic factors for 2-year patient-reported outcomes in middle-aged patients with degenerative meniscal tears treated with exercise therapy (ET) or arthroscopic partial meniscectomy (APM). Methods: One hundred and seven patients, with mean age 49.6 (SD 6.2) years and BMI 25.7 (SD 3.7), were included in this analysis of data from the OMEX trial (http://www.clinicaltrials.gov NCT01002794). Linear and Poisson regression models were built to explore the associations between potential prognostic factors (patient characteristics, knee function-related and disease-related factors) and 2-year patient-reported outcomes: the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales Pain, Symptoms, ADL, Sport/Rec, QoL and 5-point Global Rating of Change scales for knee pain (GRC Pain) and function (GRC Function). Analyses were performed for the whole cohort and for the two treatment groups (n = 55 and 52) with adjustments for age, sex, BMI and baseline KOOS. Results: For the whole cohort, a 1-s better baseline 6-m timed hop test result was associated with 3.1–7.1 points better 2-year scores for all KOOS subscales (95% CIs 1.1–5.2 to 4.1–10.1 points). A 1.61–2.80 s better test was associated with scores equivalent to previously calculated clinical relevant differences for each KOOS subscale. For the groups of patients treated with ET and APM, respectively, 2.09–3.60 s and 0.63–1.99 s better tests were associated with clinical relevant differences. For the whole cohort, a 1-s better test was associated with 26% (95% CI 15–38%) and 22% (95% CI 11–34%) higher possibility for better or much better GRC Pain and Function scores. Patients treated with ET had 17% (95% CI 2–33%) increased possibility for better or much better GRC Pain score, and patients treated with APM had 65% (95% CI 32–108%) and 70% (95% CI 38–109%) increased possibility for better or much better GRC Pain and Function scores. Conclusions: The 6-m timed hop test result was a significant prognostic factor for 2-year patient-reported outcomes in middle-aged patients with degenerative meniscal tears, especially in those treated with APM.

• Risberg, May Arna; Steffen, Kathrin; Nilstad, Agnethe; Myklebust, Grethe; Kristianslund, Eirik & Moltubakk, Marie M. [Show all 7 contributors for this article] (2018). Normative Quadriceps and Hamstring Muscle Strength Values for Female, Healthy, Elite Handball and Football Players. Journal of Strength and Conditioning Research. ISSN 1064-8011. 32(8), p. 2314–2323. doi: 10.1519/JSC.0000000000002579. Full text in Research Archive Show summary

  This study presents normative values for isokinetic knee extension and flexion muscle strength tests in 350 elite, female, handball (n = 150) and football (n = 200) players. Isokinetic concentric muscle strength tests at 60°·sec−1 were recorded bilaterally using a dynamometer. Peak torque (in Newton meter [N·m]), body mass normalized peak torque (N·m·kg−1), and hamstring to quadriceps ratio (H:Q ratio) for dominant and nondominant legs were recorded. The female elite players were 20.9 ± 4.0 years, started playing at the elite level at the age of 18.2 ± 2.7 years, with a mean of 9.7 ± 2.2 hours of weekly in-season training. Handball players demonstrated greater quadriceps muscle strength compared with football players (11.0%) (p < 0.001), also when normalized to body mass (4.1%) (p = 0.012), but not for weight-adjusted hamstring muscle strength. The H:Q ratio was higher on the dominant compared with the nondominant leg for handball players only (p = 0.012).The H:Q ratio was significantly lower for handball players (0.58) compared with football players (0.60) (p < 0.02). These normative values for isokinetic knee extension and flexion torques of healthy, elite, female handball and football players can be used to set rehabilitation goals for muscle strength after injury and enable comparison with uninjured legs. Significantly greater quadriceps muscle strength was found for handball players compared with football players, also when normalized to body mass.

• Ekås, Guri Ranum; Moksnes, Håvard; Grindem, Hege; Risberg, May Arna & Engebretsen, Lars (2018). Langtidsoppfølging av barn med korsbåndsskade før 13 års alder, Høstmøteboken 2018 - Vitenskapelig program og abstrakter. Norsk ortopedisk forening.
• Ekås, Guri Ranum; Moksnes, Håvard; Grindem, Hege; Larmo, Arne; Mjelde, Marit & Risberg, May Arna [Show all 7 contributors for this article] (2018). Knepatologi hos unge voksne etter fremre korsbåndsskade før 13 års alder, Høstmøteboken 2018 - Vitenskapelig program og abstrakter. Norsk ortopedisk forening.
• Kise, Nina Jullum; Roos, Ewa M.; Stensrud, Silje; Engebretsen, Lars & Risberg, May Arna (2018). Seks-meter hinke-test på tid er prognostisk for to-års resultater hos pasioenter med degenerative meniskrupturer, Høstmøteboken 2018 - Vitenskapelig program og abstrakter. Norsk ortopedisk forening.
• Kise, Nina Jullum; Aga, Cathrine; Engebretsen, Lars; Roos, Ewa M.; Tariq, Rana & Risberg, May Arna (2018). Degenerative meniskrupturer: Kan pre-operative MR-funn og artroskopiske funn predikere knefunksjon etter 1-2 år? Høstmøteboken 2018 - Vitenskapelig program og abstrakter. Norsk ortopedisk forening.
• Holtedahl, Robin; Brox, Jens Ivar; Aune, Arne Kristian; Nguyen, Daniel; Risberg, May Arna & Tjomsland, Ole (2018). Changes in the rate of publicly financed knee arthroscopies: An analysis of data from the Norwegian patient registry from 2012 to 2016. BMJ Open. ISSN 2044-6055. 8(6), p. 1–6. doi: 10.1136/bmjopen-2017-021199. Full text in Research Archive Show summary

  Objective: To examine rates of publicly financed knee arthroscopic surgery in Norway between 2012 and 2016. Design: Analysis of anonymised data from the National Patient Registry. Interventions: Beginning in 2012, South-Eastern Norway Regional Health Authority implemented administrative measures to bring down rates of knee arthroscopy. Similar measures were not introduced in the other three Regional Health Authorities. Main outcome measures: We analysed annual national rates of publicly financed knee arthroscopies in 2012 and 2016. We compared the rates in South-Eastern Norway Regional Health Authority with corresponding rates in the rest of the country. Variations by county, public hospital versus publicly reimbursed private hospital, gender and age were also assessed. Results: The overall annual rate of arthroscopic procedures declined by 33% from 2012 to 2016, from 310 to 207 per 100 000 inhabitants, respectively. Hospitals in South-Eastern Norway Regional Health Authority reported a 48% reduction, compared with mean 13% in the other three Regional Health Authorities. In public hospitals, rates decreased nationally by 42%, while rates in publicly reimbursed private hospitals increased by 12%. Rates in publicly reimbursed private hospitals decreased by 30% in South-Eastern Norway Regional Health Authority but increased by 63% in the other Regional Health Authorities. The proportion of patients ≥50 years (excluding meniscal repairs) in Norway was 54% in 2012 and fell to 46% in 2016. Average rates per county varied by a factor of 3:1. Conclusion: We report a marked overall reduction of knee arthroscopic procedures from 2012 to 2016 in publicly funded hospitals. The largest decrease was reported in South-Eastern Norway Regional Health Authority, and this coincides in time with implemented administrative measures. The results suggest that the trend of increasing rates of knee arthroscopies can be reversed through purposeful professional and administrative interventions.

• Aga, Cathrine; Risberg, May Arna; Fagerland, Morten; Johansen, Steinar; Trøan, Ingrid & Heir, Stig [Show all 7 contributors for this article] (2018). No Difference in the KOOS Quality of Life Subscore Between Anatomic Double-Bundle and Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction of the Knee: A Prospective Randomized Controlled Trial With 2 Years’ Follow-up . American Journal of Sports Medicine. ISSN 0363-5465. 46(10), p. 2341–2354. doi: 10.1177/0363546518782454. Full text in Research Archive Show summary

  Background: The double-bundle reconstruction technique was developed to resemble the properties of the native anterior cruciate ligament (ACL) more closely than the conventional single-bundle technique. The clinical benefit of the operative procedure is controversial, and there is a need for studies with a focus on patient-reported outcomes (PROs). Study Design: Randomized controlled trial; Level of evidence, 1. Hypothesis: Anatomic double-bundle ACL reconstruction would be superior to anatomic single-bundle reconstruction regarding the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) subscore from baseline to 2-year follow-up. Methods: According to sample size calculations, 120 patients aged 18 to 40 years with a primary ACL injury of their knee were randomized to the anatomic double-bundle or anatomic single-bundle reconstruction groups. Patients with posterior cruciate ligament, posterolateral corner, or lateral collateral ligament injuries or with established osteoarthritis were excluded. Patients with residual laxity from a coexistent medial collateral ligament injury were excluded. Data were registered at baseline, 1 year, and 2 years. In 24 patients, postoperative 3-dimensional computed tomography was performed to verify the positioning of the bundles. The outcome measures were the change in KOOS subscores and the International Knee Documentation Committee 2000 subjective score, pivot-shift test result, Lachman test finding, KT-1000 arthrometer measurement, activity level, return-to-sports rate, and osteoarthritic changes on radiographs. A linear mixed model was used for the analysis of all the PROs, including the primary outcome. Results: The change in the KOOS QoL subscore from baseline to 2-year follow-up was not different between the double- and single-bundle groups (mean change, 29.2 points vs 28.7 points, respectively; –0.5-point difference; 95% CI, –8.4 to 7.4 points; P = .91). Neither were there any differences between the 2 groups in the remaining PROs, knee laxity measurements, or activity levels of the patients. Radiological signs of osteoarthritis were found in 2 patients. Eleven patients had a graft rupture: 8 in the single-bundle group and 3 in the double-bundle group (P = .16). Three-dimensional computed tomography of the knees verified the positioning of the anteromedial bundle, posterolateral bundle, and single-bundle grafts to be within acceptable limits. Conclusion: There was no difference in the KOOS QoL subscore, the remaining PROs, knee laxity measurements, or activity levels comparing the double- and single-bundle ACL reconstruction techniques. The number of bundles does not seem to influence clinical and subjective outcomes, as long as the tunnels are adequately positioned.

• Risberg, May Arna; Ageberg, Eva; Nilstad, Agnethe; Lund, Bent; Nordsletten, Lars & Løken, Sverre Bertrand [Show all 13 contributors for this article] (2018). Arthroscopic surgical procedures versus sham surgery for patients with femoroacetabular impingement and/or labral tears: Study protocol for a randomized controlled trial (HIPARTI) and a prospective cohort study (HARP). Journal of Orthopaedic and Sports Physical Therapy. ISSN 0190-6011. 48(4), p. 325–335. doi: 10.2519/jospt.2018.7931.
• Grindem, Hege; Wellsandt, Elizabeth; Failla, Mathew J.; Snyder-Mackler, Lynn & Risberg, May Arna (2018). Anterior Cruciate Ligament Injury—Who Succeeds Without Reconstructive Surgery? The Delaware-Oslo ACL Cohort Study. Orthopaedic Journal of Sports Medicine (OJSM). ISSN 2325-9671. 6(5). doi: 10.1177/2325967118774255. Full text in Research Archive Show summary

  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.

• Heerey, Josh; Risberg, May Arna; magnus, janicke; Moksnes, Håvard; Ødegaard, Thomas T. & Crossley, Kay [Show all 7 contributors for this article] (2018). Impairment-based rehabilitation following hip arthroscopy: Postoperative protocol for the HIP arthroscopy international randomized controlled trial. Journal of Orthopaedic and Sports Physical Therapy. ISSN 0190-6011. 48(4), p. 336–342. doi: 10.2519/jospt.2018.8002.
• Øiestad, Britt Elin; Holm, Inger & Risberg, May Arna (2018). Return to pivoting sport after ACL reconstruction: association with osteoarthritis and knee function at the 15-year follow-up. British Journal of Sports Medicine. ISSN 0306-3674. 52(18), p. 1199–1204. doi: 10.1136/bjsports-2017-097718. Full text in Research Archive Show summary

  Abstract Objectives To examine the associations between return to pivoting sport following ACL reconstruction (ACLR) and knee osteoarthritis (OA), and self-reported knee symptoms, function and quality of life after 15 years. Methods Study sample included 258 participants with ACLR 15 years previously. Return to pivoting sport (handball, soccer and basketball) data were collected by interviews, and symptomatic OA was defined as Kellgren and Lawrence grade ≥2 plus almost daily knee pain in the last month. Self-reported symptoms, function and quality of life were assessed with the Knee Injury and Osteoarthritis Outcome Score. Adjusted regression models were used to analyse the associations between return to pivoting sport and OA (present or not), and self-reported outcomes. P values ≤0.05 were considered statistically significant. Results Two hundred and ten (81%) participants (57% men) with a mean age of 39.1 (±8.7) years completed the 15-year follow-up, and 109 (52%) had returned to pivoting sport. Returning to pivoting sport was associated with less symptomatic OA (OR 0.28, 95% CI 0.09 to 0.89) and radiographic OA (OR 0.40, 95% CI 0.17 to 0.98), adjusted for age, sex, combined injury, self-reported knee function, and time between injury and surgery. Those who returned to pivoting sport had better function in activities of daily living (ADL). Conclusion The participants with ACLR who returned to pivoting sport had lower odds of knee OA and better self-reported ADL function. Further investigation is required to understand the clinical significance of these findings.

• Nawasreh, Zakariya; Logerstedt, David; Cummer, Kathleen; Axe, Michael J.; Risberg, May Arna & Snyder-Mackler, Lynn (2017). Do Patients Failing Return-to-Activity Criteria at 6 Months after Anterior Cruciate Ligament Reconstruction Continue Demonstrating Deficits at 2 Years? American Journal of Sports Medicine. ISSN 0363-5465. 45(5), p. 1037–1048. doi: 10.1177/0363546516680619.
• Hare, Kristoffer B.; Lohmander, L. Stefan; Kise, Nina Jullum; Risberg, May Arna & Roos, Ewa M. (2017). Middle-aged patients with an MRI-verified medial meniscal tear report symptoms commonly associated with knee osteoarthritis : A cross-sectional study of 199 patients. Acta Orthopaedica. ISSN 1745-3674. 88(6), p. 664–669. doi: 10.1080/17453674.2017.1360985. Show summary

  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.

• Nawasreh, Zakariya; Logerstedt, David; Cummer, Kathleen; Axe, Michael J.; Risberg, May Arna & Snyder-Mackler, Lynn (2017). Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery. British Journal of Sports Medicine. ISSN 0306-3674. 52(6). doi: 10.1136/bjsports-2016-097095. Show summary

  Background: Assessing athletes’ readiness is a key component for successful outcomes after ACL reconstruction (ACLR). Objectives: To investigate whether return-to-activity criteria, individually or in combination, at 6 months after ACLR can predict return to participation in the same preinjury activity level at 12 and 24 months after ACLR. Methods: Ninety-five level I/II participants completed return-to-activity criteria testing (isometric quadriceps index, single-legged hop tests, Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and Global Rating Score (GRS)) at 6 months after ACLR. The PASS group was defined as scoring >90% on all criteria and the FAIL group as scoring <90% on any criteria. At 12 and 24 months after ACLR, participants were asked if they had returned to participate in the same preinjury activity level or not. All return-to-activity criteria, except quadriceps index, were entered into the logistic regression model. Results: 81% and 84.4% of the PASS group returned to participation in the same preinjury activity level, while only 44.2% and 46.4% of the FAIL group returned at 12 and 24 months, respectively, after ACLR. The 6-meter timed hop, single hop and triple hop limb symmetry indexes; GRS; and KOS-ADLS individually predicted the outcome of interest at 12 months after ACLR (range: R2: 0.12–0.22, p<0.024). In combination, they explained 27% of the variance (p=0.035). All hop tests, individually, predicted the outcome of interest at 24 months after ACLR (range: R2: 0.26–0.37; p<0.007); in combination they explained 45% of the variance (p<0.001). Conclusion: Return to participation in the same preinjury activity level at 12 and 24 months after ACLR was higher in those who passed the criteria compared with those who failed. Individual and combined return-to-activity criteria predicted the outcomes of interest, with the hop tests as consistent predictors at 12 and 24 months after ACLR.

• Logerstedt, David; Scalzitti, David; Risberg, May Arna; Engebretsen, Lars; Webster, Kate & Feller, Julian [Show all 9 contributors for this article] (2017). Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain Revision 2017. Journal of Orthopaedic and Sports Physical Therapy. ISSN 0190-6011. 47(11), p. a1–a47. doi: 10.2519/jospt.2017.0303. Show summary

  The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to knee ligament sprain.

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• Killingmo, Rikke Munk; Øiestad, Britt Elin; Risberg, May Arna; Maas, Esther & Grotle, Margreth (2024). Cost-effectiveness of strength exercise or aerobic exercise compared with usual care for patients with knee osteoarthritis: secondary results from a multiarm randomised controlled trial in Norway. BMJ Open. ISSN 2044-6055. 14(5). doi: 10.1136/bmjopen-2023-079704.
• Killingmo, Rikke Munk; Øiestad, Britt Elin; Risberg, May Arna; Maas, Esther & Grotle, Margreth (2024). Kostnadseffektiviteten av styrketrening eller aerob trening sammenlignet med vanlig behandling for pasienter med kneartrose en flerarmet randomisert kontrollert studie.
• Killingmo, Rikke Munk; Øiestad, Britt Elin; Risberg, May Arna; Maas, Esther & Grotle, Margreth (2023). Kostnadseffektiviteten av styrketrening eller aerob trening sammenlignet med vanlig behandling for pasienter med kneartrose en flerarmet randomisert kontrollert studie.
• Killingmo, Rikke Munk; Øiestad, Britt Elin; Risberg, May Arna; Maas, Esther & Grotle, Margreth (2023). Kostnadseffektiviteten av styrketrening eller aerob trening sammenlignet med vanlig behandling for pasienter med kneartrose en flerarmet randomisert kontrollert studie.
• Øiestad, Britt Elin; Årøen, Asbjørn; Røtterud, Jan Harald; Østerås, Nina; Jarstad, Even & Grotle, Margreth [Show all 7 contributors for this article] (2023). The efficacy of strength or aerobic exercise on quality of life and knee function in patients with knee osteoarthritis. A multi-arm randomized controlled trial with 1-year follow-up.
• Urhausen, Anouk; Pedersen, Marie; Grindem, Hege; Gunderson, Ragnhild B.; Aune, Arne Kristian & Engebretsen, Lars [Show all 11 contributors for this article] (2023). Lav grad av artrose og gode pasientrapporterte utfall 10 år etter korsbåndskade – Delaware-Oslo ACL kohorten .
• Aga, Cathrine; Trøan, Ingrid; Tariq, Rana; Heir, Stig; Risberg, May Arna & Johansen, Steinar [Show all 8 contributors for this article] (2023). Ingen forskjell i artroseutvikling etter 5 år - anatomisk Double-bundle versus Singlebundle ACL rekonstruksjons teknikk.
• Urhausen, Anouk; Pedersen, Marie; Grindem, Hege; Gunderson, Ragnhild B.; Aune, Arne Kristian & Engebretsen, Lars [Show all 11 contributors for this article] (2023). Lav grad av artrose og gode pasientrapporterte utfall 10 år etter korsbåndskade – Delaware-Oslo ACL kohorten.
• Øiestad, Britt Elin; Aarøen, Asbjørn; Røtterud, Jan Harald; Østerås, Nina; Jarstad, Even & Grotle, Margreth [Show all 7 contributors for this article] (2022). Effekten av to ulike treningsprogrammer på livskvalitet hos personer med kneleddsartrose. En randomisert kontrollert studie. .
• Øiestad, Britt Elin; Aarøen, Asbjørn; Røtterud, Jan Harald; Østerås, Nina; Jarstad, Even & Grotle, Margreth [Show all 7 contributors for this article] (2022). Effekten av to ulike treningsprogrammer på knerelatert livskvalitet hos personer med kneleddsartrose. En randomisert kontrollert studie.
• Urhausen, Anouk; Grindem, Hege & Risberg, May Arna (2022). Hvordan påvirker preoperativ og postoperativ rehabilitering knefunksjonen 10 år etter fremre korsbåndrekonstruksjon?
• Øiestad, Britt Elin; Årøen, Asbjørn; Røtterud, Jan H; Østerås, Nina; Jarstad, Even & Grotle, Margreth [Show all 7 contributors for this article] (2022). Effekt av to ulike treningsprogram for pasienter med symptomatisk kneartrose. En klinisk randomisert kontrollert studie.
• Urhausen, Anouk; Grindem, Hege & Risberg, May Arna (2022). Beregning av cutoffs for pasientrapporterte utfallsmål for tilfredsstillende knefunksjon 10 år etter en fremre korsbåndskade.
• Roos, Ewa M.; Risberg, May Arna & Little, C.B. (2021). Prevention and early treatment, a future focus for OA research. Osteoarthritis and Cartilage. ISSN 1063-4584. 29(12), p. 1627–1629. doi: 10.1016/j.joca.2021.10.007.
• Berg, Bjørnar; Roos, Ewa M.; Kise, Nina Jullum; Engebretsen, Lars; Holm, Inger & Risberg, May Arna (2021). Muskelstyrke og artroseprogresjon etter kirurgi eller treningsterapi for degenerative meniskrupturer: Sekundæranalyse av en randomisert studie.
• Aae, Tommy Frøseth; Karlsen, Tommy Aleksander; Bos-Haugen, Ida Kristin; Risberg, May Arna; Lian, Øystein Bjerkestrand & Brinchmann, Jan E. (2020). Evaluating plasma extracellular vesicle microRNAs as possible biomarkers for osteoarthritis. Osteoarthritis and Cartilage Open. ISSN 2665-9131. 1(3-4). doi: 10.1016/j.ocarto.2019.100018.
• Lund, Jonas; Risberg, May Arna & Øiestad, Britt Elin (2020). The association between physical fitness and self-efficacy in knee osteoarthritis.
• Lund, Jonas; Risberg, May Arna & Øiestad, Britt Elin (2020). The association between physical fitness and self-efficacy in patients with knee osteoarthritis.
• Reiman, Michael P.; Agricola, Rintje; Kemp, Joanne; Heerey, Joshua J.; Weir, Adam & van Klij, Pim [Show all 44 contributors for this article] (2020). Infographic. Consensus recommendations on the classification, definition and diagnostic criteria of hiprelated pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2020-102219.
• Øiestad, Britt Elin; Kristiansen, Sverre; Jarstad, Even & Risberg, May Arna (2020). PHYSICAL FITNESS IN INDIVIDUALS WITH KNEE OSTEOARTHRITIS COMPARED TO NORMATIVE DATA - A CROSSSECTIONAL STUDY.
• Berg, B.; Roos, Ewa M.; Kise, Nina Jullum; Engebretsen, Lars & Risberg, May Arna (2020). Response to Letter to the Editor: “Osteoarthritis progression after exercise therapy or meniscectomy in patients with degenerative meniscal tears”. Osteoarthritis and Cartilage. ISSN 1063-4584. 28(8), p. 1148–1149. doi: 10.1016/j.joca.2020.05.003.
• Risberg, May Arna (2020). How to protect long-term knee health after anterior cruciate ligament(ACL) injury.
• Lie, Marthe Mehu; Risberg, May Arna; Storheim, Kjersti; Engebretsen, Lars & Øiestad, Britt Elin (2019). What's the rate of knee osteoarthritis 10 years after anterior cruciate ligament injury? An updated systematic review.
• Hilde, Gunvor; Bergland, Astrid; Risberg, May Arna & Pripp, Are Hugo (2019). Better before-better after: efficacy of prehabilitation for older patients with osteoarthritis awaiting total hip replacement-a study protocol for a randomised controlled trial in South-Eastern Norway. BMJ Open. ISSN 2044-6055. doi: 10.1136/bmjopen-2019-031626.
• Capin, Jacob John; Snyder-Mackler, Lynn; Risberg, May Arna & Grindem, Hege (2019). Keep calm and carry on testing: A substantive reanalysis and critique of 'what is the evidence for and validity of return-to-sport testing after anterior cruciate ligament reconstruction surgery? A systematic review and meta-analysis'. British Journal of Sports Medicine. ISSN 0306-3674. p. 1–3. doi: 10.1136/bjsports-2019-100906.
• Kemp, Joanne L.; King, Matthew G; Barton, Christian; Schache, Anthony G.; Thorborg, Kristian & Roos, Ewa M. [Show all 18 contributors for this article] (2018). Is exercise therapy for femoroacetabular impingement in or out of FASHIoN? We need to talk about current best practice for the non-surgical management of FAI syndrome. British Journal of Sports Medicine. ISSN 0306-3674. p. 1–2. doi: 10.1136/bjsports-2018-100173.
• Øiestad, Britt Elin; Holm, Inger & Risberg, May Arna (2018). RETUR TIL VRIDNINGSIDRETT ETTER FREMRE KORSBÅNDSREKONSTRUKSJON: SAMMENHENG MED ARTROSE OG KNEFUNKSJON ETTER 15 ÅR. .
• Risberg, May Arna; Holm, Inger; Engebretsen, Lars & Nordsletten, Lars (2018). Pakkeforløp for pasienter med muskel- og skjelettplager? Tidsskrift for Den norske legeforening. ISSN 0029-2001. 138(17). doi: 10.4045/tidsskr.18.0709.
• Grindem, Hege; Failla, M; Wellsandt, Elizabeth; Snyder-Mackler, Lynn & Risberg, May Arna (2018). Anterior cruciate ligament injury: who succeeds without reconstructive surgery? . Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 26, p. 212–213.
• Pedersen, Marie; Risberg, May Arna; Snyder-Mackler, Lynn & Grindem, Hege (2018). Low return rates in athletes who choose acl surgery to enable return to sport . Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 26, p. 101–101.
• Risberg, May Arna; Tryggestad, C; Nordsletten, Lars; Engebretsen, Lars & Holm, Inger (2018). Active living with osteoarthritis - implementation of evidence-based guidelines as first-line treatment for patients with knee and hip osteoarthritis.
• Aga, Cathrine; Risberg, May Arna; Johansen, Steinar; Fagerland, M; Heir, Stig & Engebretsen, Lars (2018). No difference in the KOOS quality of life after two years, between anatomic Double-bundle and anatomic Single-bundle ACL reconstructed patients - a prospectively, randomised, controlled trial of 120 patients.
• Kemp, Joanne L. & Risberg, May Arna (2018). Significant Knowledge Gaps Between Clinical Practice and Research on Femoroacetabular Impingement: Are We on the Same Path? Journal of Orthopaedic and Sports Physical Therapy. ISSN 0190-6011. 48(4), p. 228–229. doi: 10.2519/jospt.2018.0103.
• Jahre, Henriette; Risberg, May Arna & Øiestad, Britt Elin (2017). ENDRING I FUNKSJON OG FYSISK FORM HOS PERSONER MED KNELEDDSARTROSE ETTER ET 12 UKERS STYRKETRENINGSPROGRAM.
• Berg, Bjørnar; Grindem, Hege; Risberg, May Arna & Øiestad, Britt Elin (2017). Symmetrisk quadricepsstyrke har sammenheng med god knefunksjon hos ikke-opererte ACL pasienter. The Delaware-Oslo Cohort Study.
• Øiestad, Britt Elin; Holm, Inger & Risberg, May Arna (2017). Retur til vridningsidrett etter fremre korsbåndsrekonstruksjon: sammenheng med artrose og knefunksjon etter 15 år.
• Lund, Marte; Risberg, May Arna; Jarstad, Even & Øiestad, Britt Elin (2017). Feasibility of two exercise programs for patients with mild to moderate knee osteoarthritis.
• Øiestad, Britt Elin; Holm, Inger & Risberg, May Arna (2017). Return to pivoting sport after ACL reconstruction: association with osteoarthritis and knee function at 15 years.
• Østerås, Nina; Hagen, Kåre Birger; Holm, Inger & Risberg, May Arna (2017). Samarbeid for bedre artrosebehandling. Fysioterapeuten. ISSN 0016-3384. 84(3), p. 32–34.

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