OPAL STUDY OPTIMIZING PATHWAY FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Abstract

Introduktion I forbindelse med rekonstruktion af forreste korsbånd er smertestillende anvendt for at reduce-re smerterne. Vores formål var at forbedre grundlaget for den postoperative smertebehandling ved at under-søge KOOS og smertetærsklen før operationen. Yderligere at undersøge de vivo metaboliske ændringer i skeletmuskulaturen. Metode 6 patienter (alder 19-32) med forreste korsbåndsskader var inkluderet i det prospektive kohorte stu-die fra den 19. oktober til den 7. december 2015. Patienterne gennemgik standard proceduren for rekonstruk-tion af forreste korsbånd. Før operation skulle patienterne udfylde spørgeskemaer for KOOS, EQ-5D-5L and PainDetect. Yderligere blev smertetærsklen og smertesensibiliteten undersøgt vha. et digitalt trykalgometer og et smertesimuli påført af en mekanisk klemme. Mikrodialyse blev brugt til at undersøge det vivo metaboliske ændring i skeletmuskulaturen gennem operati-onen Glukose, laktat, pyruvat, glycerol and laktate/pyruvate-ratio blev brugt som indikatorer for iskæmi i muskelvævet. Resultater I fire af fem KOOS subskaler reporterede forreste korsbånds patienter signifikant dårligere sammenlignet med den raske befolkningen. EQ-5D-5L viste xx. PD-Q før operationen viste at smerterne var nociceptive smerte. Før operationen patienterne angav høje værdier for smertetærsklen og der var ingen signifikante for-skelle på smertetærsklerne efter at der var blevet påført smertestimuli med den mekaniske klemme. Mikrodialyse viste høje stigninger i koncentrationerne af glycerol og L/P-ratio gennem operationen. Diskussion Med vores resultater fra KOOS, smertetærskelmålingerne og mikrodialyse, er der grundlag for en forbedring af smertebehandlingen. Der er stadig mange aspekter der skal undersøges før at vi kan lave en definitiv kon-klusion.

Objectives In the reconstruction of the anterior cruciate ligament (ACL) painkillers is used to reduce the amount of pain. Our aim was to improve the basis for postoperative paint treatment using KOOS and the pain threshold before surgery. Further investigate the vivo metabolic changes in the skeletal muscle. Methods 6 patients (age 19-32) with ACL lesion were included in the prospective cohort study from 19th October to 7th December 2015. The patients underwent the standard procedure for reconstruction of the ACL. Before surgery patients reported KOOS, EQ-5D-5L and PainDetect Questionnaires. Further the pain threshold and pain sensibility were investigated with a digital pressure pain threshold algometer (PPT) and the pain stimulus from a mechanic spring-clamp (MSC). MiD was used to investigate the vivo metabolic changes in the skeletal muscle tissue during the surgery and shortly after. Glucose, lactate, pyruvate and glycerol and lactate/pyruvate ratio (L/P ratio) was used as indicators of tissue ischemia. Results In four of the five KOOS subscales the ACL lesion patients scored significantly worse compared to the ref-erence population. EQ-5D-5L showed xx. PD-Q preoperative showed that the pain was nociceptive pain. Preoperatively patients reported high pressure point threshold (PPT) and there were none significant differ-ence before and after applying the pain stimulus. Microdialysis showed highly increase of the concentration of glycerol and L/P-ratio (lactate/pyruvate-ratio) during the operation. Discussion With our results from KOOS, pain threshold and microdialysis, there is a basis for an improvement the pain management. There are still many aspects that needed to be investigated before we can make a definitive conclusion. Key words ACL reconstruction, microdialysis, pain threshold, KOOS, EQ-5D, PainDetect

A master thesis from Aalborg University

OPAL STUDY OPTIMIZING PATHWAY FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION