Jon Karlsson

Institute of Clinical Science

INTRODUCTION A societal challenge is to deliver healthcare supporting a sustainable development, acknowledging the complexity in the affected ecological-economic-social systems. Globally and in Sweden around 10% of GDP is devoted to healthcare. Within healthcare, around 10% of total costs are associated to diabetes. Globally, 537 million people liv...

Efforts to improve research standards in orthopaedics, sports medicine, physical therapy, and rehabilitation are ongoing. Rrehabilitation andomized Controlled Trials (RCTs) are widely regarded as the gold standard for the collection of primary data. Similarly, systematic reviews, due to their methodological rigor, have become the gold standard for...

The recovery process after tibial plateau fractures varies, with some patients experiencing persistent gait asymmetries for a long period of time. The aim of this study is to analyse knee joint kinematics and kinetics post-fracture using a linear mixed-effects model, assessing 26 participants over 24 months (aged 45, range 26–63), and an age-matche...

Background Acute ankle sprains represent one of the most common traumatic injuries to the musculoskeletal system. Many individuals with these injuries experience unresolved symptoms such as instability and recurrent sprains, leading to chronic ankle instability (CAI), which affects their ability to maintain an active lifestyle. While rehabilitation...

Background Smaller intercondylar notch sizes have been consistently associated with a predisposition for primary anterior cruciate ligament tears. Purpose To evaluate the association between intercondylar notch size, graft size, and postoperative complications, including knee stiffness and return to the operating room, after primary anatomic anter...

Recognizing and addressing the controversies surrounding using patient‐reported outcome measures (PROMs) is crucial for enhancing evaluation standards in clinical studies in orthopedics, sports medicine, and rehabilitation. The article comprehensively described the challenges of using PROMs to evaluate knee conditions in these fields. Apart from de...

Purpose The medial collateral ligament of the ankle, or deltoid ligament, can be injured in up to 40% of patients who sustain an ankle inversion sprain. Reporting injuries of the deltoid ligament is not easy due to confusion in the current anatomical descriptions, with up to 16 fascicles described, with variable frequencies. The purpose of this stu...

The collaboration of physical therapists and surgeons, including individual patients' perspectives, is key for a successful outcome—however, this is particularly underreported in many congresses, publications and clinical practice. Orthopaedic surgeons talk about surgery and physical therapists talk about physical therapy. Although enhanced teamwor...

Deep learning is a subset of artificial intelligence (AI) with enormous potential to transform orthopaedic surgery. As has already become evident with the deployment of Large Language Models (LLMs) like ChatGPT (OpenAI Inc.), deep learning can rapidly enter clinical and surgical practices. As such, it is imperative that orthopaedic surgeons acquire...

OBJECTIVE: To compare the time to return to sport (RTS) between patients who did and did not suffer a second anterior cruciate ligament (ACL) injury after ACL reconstruction. DESIGN: Etiology systematic review with meta-analysis. LITERATURE SEARCH: Cochrane Library, Embase, Medline, AMED, and PEDro databases were searched in August 2021 and again i...

A large space still exists for improving the measurements used in orthopaedics and sports medicine, especially as we face rapid technological progress in devices used for diagnostic or patient monitoring purposes. For a specific measure to be valuable and applicable in clinical practice, its reliability must be established. Reliability refers to th...

Purpose The purpose of this study was to evaluate differences in rehabilitation-specific outcomes between paediatric patients, adolescents and young adults within the first 2 years after anterior cruciate ligament (ACL) reconstruction. A further aim was to determine whether patient age was associated with an increased risk of not achieving symmetri...

Effective communication within the realm of scientific publishing remains pivotal for the broad dissemination of research findings and new clinical insights to the global medical community. The integration of visual and textual elements has gained prominence as an instrumental means to facilitate comprehension and bridge cognitive divides across di...

Peer review is an essential process to ensure that scientific articles meet high standards of methodology, ethics and quality. The peer-review process is a part of the academic mission for physicians in the university setting. The work of reviewers is of great value for authors, as it gives constructive criticism and improves manuscript quality bef...

Acute ankle ligament injuries, especially in the athletic population, are very common. Chronic lateral ankle ligament instability develops in approximately 10–30% of all patients who have previously sustained an acute ligament injury. Ligament injuries can be divided into grades I–III, depending on how serious the injury is. Non-surgical treatment,...

Purpose: Variations in femoral and tibial bony morphology have been associated with higher clinical grading and increased quantitative tibial translation, but not tibial acceleration, during the pivot shift test following anterior cruciate ligament (ACL) injury. The purpose of this study was to determine the impact of femoral and tibial bony morph...

The Achilles tendon often withstands extensive power and is commonly subject to acute ruptures and chronic overuse pathologies. The incidence of Achilles tendon ruptures and Achilles tendinopathy is increasing, and a thorough clinical examination is essential in establishing the diagnosis. To fully recover from Achilles tendon rupture and Achilles...

Patient expectations should always be discussed prior to surgery or any other medical treatment because realistic assumptions of a treatment's outcomes are essential to weighing the options. There is plenty of scientific evidence in the literature regarding more complex issues or this type of daily practice, but there are many cases in which the ev...

The meta-analysis has become one of the predominant studies designs in orthopaedic literature. Within recent years, the network meta-analysis has been implicated as a powerful approach to comparing multiple treatments for an outcome of interest when conducting a meta-analysis (as opposed to two competing treatments which is typical of a traditional...

This Article provides recommendations on which Checklists to use when reporting new medical research and appropriate Risk of Bias Tools when assessing research quality.

Meta-analyses by definition are a subtype of systematic review intended to quantitatively assess the strength of evidence present on an intervention or treatment. Such analyses may use individual-level data or aggregate data to produce a point estimate of an effect, also known as the combined effect, and measure precision of the calculated estimate...

Survival analyses are a powerful statistical tool used to analyse data when the outcome of interest involves the time until an event. There is an array of models fit for this goal; however, there are subtle differences in assumptions, as well as a number of pitfalls, that can lead to biased results if researchers are unaware of the subtleties. As l...

Up to 50% of patients who suffer an anterior cruciate ligament (ACL) injury receive or opt for rehabilitation alone as initial treatment in Scandinavia. Knowledge of whether patients treated with rehabilitation alone after ACL injury are satisfied is lacking. This study aimed to explore the experiences of patients treated with rehabilitation alone...

Deep learning has the potential to be one of the most transformative technologies to impact orthopedic surgery. Substantial innovation in this area has occurred over the past 5 years, but clinically meaningful advancements remain limited by a disconnect between clinical and technical experts. That is, it is likely that few orthopedic surgeons posse...

No abstract available.

Rationale: More research is needed to uncover the effectiveness of combined strength and foam-rolling interventions to prevent running-related injuries. Objectives: To evaluate effectiveness of an 18-week general strength and foam-rolling intervention on the incidence of running-related injuries. Method: This is an 18-week observational compar...

Purpose: This study aimed to evaluate posterolateral tibial plateau impaction fractures and how they contribute to rotatory knee laxity using quantitative pivot shift analysis. It was hypothesised that neither the presence of nor the degree of involvement of the plateau would affect rotatory knee laxity in the ACL-deficient knee. Methods: A retr...

A meta-analysis is the quantitative synthesis of data from two or more individual studies and are as a rule an important method of obtaining a more accurate estimate of the direction and magnitude of a treatment effect. However, it is imperative that the meta-analysis be performed with proper, rigorous methodology to ensure validity of the results...

Hip pain is difficult to assess and structured diagnostics is important. To facilitate the evaluation of hip pain, we recommend dividing hip pain between intra- and extra-articular pain, where the latter further can be divided into different entities. Plain radiographics are warranted before referral to orthopaedic specialist. Furthermore, the need...

Background: The number of studies with a large cohort of patients that primarily focus on patient-reported outcomes after ACL reconstruction in children and adolescents is limited. The purpose of the present study was to determine whether patient age affects the proportion of patients that achieve a patient-acceptable symptom state (PASS) on the K...

Introduction Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects, plays an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for retur...

Purpose: The purpose of this study was to evaluate whether generalized joint hypermobility (GJH) influences postoperative results, including return to sport, patientreported outcomes, functional performance (hop tests), muscular strength, and the occurrence of ACL re-injury, in patients 1 year after anterior cruciate ligament (ACL) reconstruction....

Objectives To evaluate activity level, sports career and injuries in young elite alpine and ogul skiers five years after High school graduation. Methods All students (n=76) at Åre Ski Academy High school (National Sports High school) were invited to participate in this prospective study at baseline. Two skiers were excluded. They answered question...

Background Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain, which can prevent ice hockey players from sports participation. Hip arthroscopy is often performed to relieve pain and enable the player to return to sport (RTS) and return to performance (RTP). Purpose To determine the RTS and RTP rates for ice hockey players a...

Background The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartila...

Background Delayed treatment of Achilles tendon ruptures is generally due to either misdiagnosis or patient delay. When the treatment is delayed more than 4 weeks, the rupture is defined as “chronic”, and almost always requires more invasive surgery and longer rehabilitation time compared with acute Achilles tendon ruptures. There is insufficient k...

Purpose Achilles tendon ruptures are termed chronic after a delay in treatment for more than 4 weeks. The literature advocates surgical treatment with reconstruction to regain ankle push-off strength. The preferred technique is, however, still unknown and is often individualized. This study aims to present the technique and clinical outcome of an e...

Objectives To compare the proportion of patients with anterior cruciate ligament (ACL) injury reporting an acceptable symptom state, between non-surgical and surgical treatment during a 10-year follow-up. Methods Data were extracted from the Swedish National Knee Ligament Registry. Exceeding the Patient Acceptable Symptom State (PASS) for the Knee...

Purpose: The aim of this study was to evaluate the clinical outcome at 5-year follow-up of a one-step procedure combining anterior cruciate ligament (ACL) reconstruction and partial meniscus replacement using a polyurethane scaffold for the treatment of symptomatic patients with previously failed ACL reconstruction and partial medial meniscectomy....

Achilles tendinopathy is a common overuse injury, especially among runners. It should be divided into midportion Achilles tendinopathy and insertional Achilles tendinopathy, as the treatments are different. Achilles tendinopathy is a clinical diagnosis, which includes a combination of pain, swelling and stiffness. If pain is located 2-6 cm above th...

Abstract Background Chronic Achilles tendon rupture is associated with persistent weakness at push-off with the affected foot and poor balance, resulting in significant alterations to normal gait. Surgical repair is the most common treatment for improving gait in patients with a Chronic Achilles tendon rupture, but, to date, the outcomes have not b...

Background Although comparable clinical and functional outcomes have been reported after nonsurgical and surgical anterior cruciate ligament (ACL) treatment, few studies have investigated the effects of early versus late ACL reconstruction with initial rehabilitation. Purpose To determine patient-reported knee function in patients who initially un...

Purpose: Correct placement of the femoral and tibial tunnels in the anatomic footprint during anterior cruciate ligament reconstruction (ACLR) is paramount for restoring rotatory knee stability. Recent studies have looked at surgeon volume and its outcomes on procedures such as total knee arthroplasty and infection rates, but only few studies have...

Background The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartila...

Background: An international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to present the consensus statements on osteochondral lesions of the tibial plafond (OLTP) and on ankle insta...

A trend within the orthopedic community is rejection of the belief that “one size fits all.” Freddie Fu, among others, strived to individualize the treatment of anterior cruciate ligament (ACL) injuries based on the patient’s anatomy. Further, during the last two decades, greater emphasis has been placed on improving the outcomes of ACL reconstruct...

Clinical evaluation and management of anterior cruciate ligament (ACL) injury is one of the most widely researched topics in orthopedic sports medicine, giving providers ample data on which to base their practices. The ACL is also the most commonly treated knee ligament. This study reports on current topics and research in clinical management of AC...

This chapter provides an overview of track and field injuries related to the calf, Achilles tendon, and peroneal tendons, including anatomy, epidemiology, sports dynamics, and physical demands. Moreover, it provides a framework for management of the most common pathologies related to the muscles and tendons of the lower leg.

PurposeOperative repair of Achilles tendon rupture may lead to complications, which influence outcome adversely. The aim of this study was to determine the incidence, impact and response to treatment of post-operative adhesions.Methods From February 2009 to 2021, 248 patients operated on with percutaneous or minimally invasive surgical repair have...

Level of evidence Editorial, Level V.

Purpose: Injury prevalence patterns for climbers have been presented in several papers but results are heterogenous largely due to a mix of included climbing disciplines and injury mechanisms. This study describes the distribution and pattern of acute traumatic climbing injuries sustained during outdoor climbing in Sweden. Methods: Patients that...

Background Previous studies have identified young age as a risk factor for anterior cruciate ligament (ACL) revision. However, few studies have looked separately at pediatric patients and adolescents with regard to outcomes after ACL reconstruction. Purpose To determine whether patient age at ACL reconstruction affects the risk of undergoing revis...

Background Chronic ruptures of the Achilles tendon may lead to symptomatic weakness, despite rehabilitation. Open reconstruction yields good outcome but has a high complication rate, notably wound problems. Endoscopically assisted free semitendinosus transfer restores ankle and preserves first metatarsophalangeal joint (MTPJ) function. Indications...

Subtalar instability remains a topic of debate, and its precise cause is still unknown. The mechanism of injury and clinical symptoms of ankle and subtalar instabilities largely overlap, resulting in many cases of isolated or combined subtalar instability that are often misdiagnosed. Neglecting the subtalar instability may lead to failure of conser...

Abstract Introduction Tibial plateau fractures involve the knee joint, one of the most weight-bearing joints in the body. Studies have shown that gait asymmetries exist several years after injury. Instrumental gait analysis, generating both kinematic and kinetic data from patients with tibial plateau fractures, is uncommon. Aim To examine walking a...

Abstract Background Most injuries in track and field are caused by overuse with conflicting reports concerning the underlying mechanisms. The purpose of this study was to evaluate how biomechanical and clinical factors relate to the risk of overuse injuries, and to investigate whether the relationships between potential risk factors and injury beco...

Purpose: Anterior cruciate ligament (ACL) graft failure is a complication that may require revision ACL reconstruction (ACL-R). Non-anatomic placement of the femoral tunnel is thought to be a frequent cause of graft failure; however, there is a lack of evidence to support this belief. The purpose of this study was to determine if non-anatomic femo...

There is an increasing demand to quantify the footprints, ecological, economic and social, in terms of the effect of different interventions in healthcare. The aim of this study was to compare two systems providing patients with diabetes with insoles in terms of their ecological, economic and social footprints. Prefabricated insoles (PRI) were comp...

The extensor retinaculum is a reinforcement of the anterior crural fascia. Usually includes the superior extensor retinaculum and inferior extensor retinaculum which are both in continuity with the anterior fascia of the leg.

In-time evaluation of treatment outcome is essential for adequate and timely adjustment of the treatment plan and to ensure optimal treatment outcomes in patients with chronic ankle instability. Correct assessment, however, is challenging due to the great number of variables contributing to the success, i.e. failure of treatment. In case of chronic...

Chronic lateral ankle instability is a common complaint after lateral ligament injury; developing in approximately 10–30% of all patients who have sustained a ligament injury. Nonsurgical treatment, including strength, agility, and reflex training is usually recommended as the first treatment choice and is considered successful to alleviate symptom...