Per HolmichCopenhagen University Hospital, Amager-Hvidovre, Denmark · Sports Orthopedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Amager-Hvidovre University Hospital
Per Holmich
Professor, DMSc
About
364
Publications
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Introduction
Publications
Publications (364)
Objective:
To investigate the relationship between repeated clinical measures and the progression of rehabilitation of male athletes with acute adductor injuries.
Design:
Prospective observational cohort study.
Methods:
Male athletes with acute adductor injuries received a standardized criteria-based rehabilitation program with four repeated c...
Capsular closure in femoroacetabular impingement syndrome (FAIS) patients during hip arthroscopy procedures is debated. The Danish Hip Arthroscopy Registry (DHAR) contains data to perform matched-cohort analyses. The purpose of this study is to evaluate 1-year subjective outcome data from DHAR after hip arthroscopy for FAIS with capsular closure an...
INTRODUCTION: The aim of this study was to establish whether diabetes mellitus (DM) affects the prognosis for patients with a frozen shoulder.
METHODS: In this prospective two-year follow-up study, we included 235 patients with newly diagnosed unilateral frozen shoulder. Among the 235 patients, 34 (14%) were diagnosed with DM prior to their inclus...
Background
Elongation of the Achilles tendon after rupture is a frequent complication. The Achilles Tendon Length Measure (ATLM) and the Achilles Tendon Resting Angle (ATRA) are indirect length measures using the resting angle of the ankle. Copenhagen Achilles Length Measure (CALM) is a direct ultrasound measure. The purpose of this study was to ex...
To the Editor In the light of consensus statements and adoption of common terminology from world groin pain experts,¹,2 we were surprised by both title and content of the article “Groin Pain Syndrome Known as Sports Hernia: A Review” by Zuckerbraun et al.³ Groin pain in athletes can originate from many different anatomical structures but is most co...
Background:
An individualized treatment algorithm (Copenhagen Achilles Rupture Treatment Algorithm (CARTA)) based on the ultrasonographic appearance of an acute Achilles tendon rupture has been developed aiming to select the correct patients for operative and non-operative treatment. The objective of this study is to investigate if this individual...
Background:
The Danish Hip Arthroscopy Registry (DHAR) started as a web-based prospective registry in 2012. The aim of this study was to evaluate and report epidemiologic and perioperative data from 5,333 procedures and to describe the development of the DHAR.
Methods:
The DHAR collects data from patients prospectively at the time of inclusion (...
PurposeStudies suggest that women have worse treatment outcome than men after acute Achilles tendon rupture (ATR). The aim of this study was to investigate if sex and age affect treatment outcome after ATR.Methods
The study was performed as a registry study in the Danish Achilles tendon Database. The primary outcome was change in the Achilles tendo...
The Nordic Hamstring exercise reduces hamstring strain injuries in football and other sports, but the exercise is not well adopted in practice. Barriers from practitioners include fear of performance decrements, due to lack of specificity of the exercise with high speed running. However, in theory, increased eccentric hamstring strength could trans...
Background
Osgood-Schlatter disease (OSD) affects 1 in 10 adolescents. There is a lack of evidence-based interventions, and passive approaches (eg, rest and avoidance of painful activities) are often prescribed.
Purpose
To investigate an intervention consisting of education on activity modification and knee-strengthening exercises designed for ado...
Background
Immobilization of the ankle joint has been suggested as a key element in the pathogenesis leading to deep vein thrombosis (DVT).
Purpose
To investigate whether early controlled ankle motion (ECM) could reduce the incidence of DVT compared with immobilization (IM) in the treatment of acute Achilles tendon rupture.
Study Design
Randomize...
Background: An individualized treatment algorithm (Copenhagen Achilles Rupture Treatment Algorithm - CARTA) based on the ultrasonographic appearance of an acute Achilles tendon rupture has been developed aiming to select the correct patients for operative and non-operative treatment. The objective of this study is to investigate if this individuali...
Background: An individualized treatment algorithm (Copenhagen Achilles Rupture Treatment Algorithm - CARTA) based on the ultrasonographic appearance of an acute Achilles tendon rupture has been developed aiming to select the correct patients for operative and non-operative treatment. The objective of this study is to investigate if this individuali...
Background
Time to return-to-sport (RTS) after acute adductor injuries varies among athletes, yet we know little about which factors determine this variance.
Purpose
To investigate the association between initial clinical and imaging examination findings and time to RTS in male athletes with acute adductor injuries.
Study Design
Cohort study (Pro...
Lower limb apophysitis cause long-term pain, decrease in function, and can reduce or completely hinder participation in sports and physical activity, yet there is little knowledge on the long-term consequences for health. Our objective with this investigation is to capture self-reported health-status for all adults having been diagnosed with lower...
Supplementary File to our Rapid Response in BMJ regarding the paper: "Arthroscopic hip surgery compared with physiotherapy and activity modification for the treatment of symptomatic femoroacetabular impingement: multicentre randomised controlled trial"
Figure 1. Revised meta-analyses and forest plots on the effect of operative versus nonoperative treatment of femoroacetabular impingement syndrome using a random-effects REstricted Maximum Likelihood model (upper forest plot) and a fixed-effects inverse-variance model (lower forest plot). Positive International Hip Outcome Tool-33 (iHOT-33) scores...
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 th...
Background
Despite being one of the most common sports injuries, there are no criteria-based rehabilitation programs published for acute adductor injuries.
Purpose
To evaluate return-to-sport (RTS) outcomes and reinjuries after criteria-based rehabilitation for athletes with acute adductor injuries.
Study Design
Cohort study; Level of evidence, 2...
There is no agreement on how to classify, define or diagnose hip-related pain—a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how t...
Patellofemoral pain (PFP) is a common complaint among young sports active adolescents. This study evaluated the longitudinal changes in pro-nociceptive and anti-nociceptive mechanisms in young adolescents with PFP, their impact on prognosis and responsiveness to treatment. Adolescents (N=151, aged 10-14 years) diagnosed with PFP were compared to ag...
Study design:
Cross-sectional study.
Background:
Patellofemoral pain (PFP) and Osgood-Schlatter disease (OSD) are common in adolescents, but we lack knowledge on these conditions and their impact in young adolescents (<15 years).
Objectives:
Compare pain, physical activity, quality of life, strength and knee function between adolescents with P...
This review summarises the present knowledge of diagnosing and treating hip joint pain. The results of joint preserving surgery are good in symptomatic patients with hip dysplasia, acetabular retroversion or impingement (cam or pincer) without signs of osteoarthritis. Confirmation of intraarticular pathology as the cause of symptoms is established...
The time‐loss definition of injury is commonly adopted in epidemiological groin‐injury studies in football, with a significant risk of underestimating the impact of these injuries. This study investigated the extent of groin problems, beyond the time‐loss approach, over a full Spanish football season. Players from 17 amateur male teams were followe...
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 clini...
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...
IntroductionDiagnosing groin pain in athletes is challenging due to the close proximity of multiple anatomic structures, the lack of a golden reference standard, and the widespread use of different terminology for similar conditions. These issues were highlighted in a previous Delphi study whereby 23 groin pain experts had poor inter-rater agreemen...
Background
Early controlled motion (ECM) of the ankle is widely used in the non-operative treatment of acute Achilles tendon rupture, although its safety and efficacy have not been investigated properly in a randomised set-up.
Purpose/Aim of the study
To investigate if ECM of the ankle was superior to immobilisation in the treatment of acute Achil...
Background:
Evaluation of hip muscle function is considered an important part of the examination and treatment of physically active subjects with hip and groin pain. However, methods to reliably measure explosive hip muscle strength are lacking.
Hypothesis/purpose:
The purpose was to investigate the reliability of a clinically available set-up u...
Purpose
The primary objective was to examine the reliability of the Copenhagen Achilles length measure (CALM) in patients with an Achilles tendon rupture and secondary to examine the reliability of Achilles tendon resting angle (ATRA) and Achilles tendon length measure (ATLM).
Method
The study was executed as a cross-sectional study on two differe...
Background
Moderate to severe (grade 3-4) hip joint cartilage injury seems to impair function in patients with femoroacetabular impingement syndrome.
Purpose
To investigate whether demographic and radiographic factors were associated with moderate to severe hip joint cartilage injury.
Study Design
Cross-sectional study; Level of evidence, 3.
Met...
Objectives
To evaluate current practice in the treatment of proximal hamstring tendon avulsions and identify decision-making preferences.
Methods
An invitation to an anonymous e-survey containing 32 questions was sent to 3475 members of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) and the European...
The main purpose of this secondary analysis was to compare the proportion of athletes with moderate-to-extreme difficulties in eight specific sport activities in athletes with optimal versus impaired sport performance after a hip arthroscopy for femoroacetabular impingement syndrome. Subjects were identified in a nationwide registry and invited to...
Introduction:
Acute Achilles tendon rupture is a severe injury causing functional deficits and sick leave. Data from the Danish Achilles tendon Database (DADB) can help us monitor and optimise treatment. The aim of this study was to investigate the completeness and data validity in the DADB.
Methods:
The study was performed as a registry study c...
Background:
Patellofemoral pain (PFP) affects 7% of adolescents, especially those who are highly active. Exercise-focused treatments show limited effect and overlook activity modification and load management. As many adolescents continue at high levels of sports despite pain, a new strategy addressing this problem is warranted.
Purpose:
To inves...
Intra-articular and extra-articular causes of hip and/or groin pain often coexist making diagnosis of a specific primary source of hip and/or groin pain difficult. In recent years clinical entities have been defined for the most common extra-articular causes of groin pain. Although extra-articular sources of groin pain may not be the primary cause...
The hip joint is surrounded by a large amount of muscles acting in synergy to produce and absorb forces including providing hip joint stability. Morphological alterations of the hip joint and/or muscle function may compromise hip joint stability and alter the distribution of forces across the joint potentially leading to overload of intra- and/or e...
Groin injuries, both long-standing and acute, constitute a major proportion of sport injuries. The diagnosis is based on a clinical entity approach and relies on a comprehensive examination using standardized clinical tests. Treatment of both long-standing and acute groin injuries is focused on structured exercise therapy and load management. An ex...
Introduction
To study if Diabetes Mellitus (DM) affects the severity of a frozen shoulder prognosis.
Methods
In this 2 year follow-up study patients from three participating hospitals with newly diagnosed frozen shoulder were consecutively included and asked to fill out a questionnaire: at time of diagnosis and at 6-, 12- and 24 months follow-up....
Background
Acute Achilles tendon rupture (ATR) can be treated operatively or non-operatively. An evidence based selection tool is needed to guide choice of treatment.
Purpose
To investigate if treatment selection in patients with ATR can be guided by Amlang’s ultrasound classification (AmC) or the Copenhagen Achilles Length Measurement (CALM).
Me...
Background
Deep vein thrombosis (DVT) following acute Achilles tendon rupture (ATR) is common (up to 34%) and potentially dangerous. Immobilization (IM) is thought to be an important factor in the pathogenesis.
Purpose of the study
To investigate if early controlled ankle motion ECM could reduce the incidence of DVT compared to IM in the treatment...
Introduction
To investigate if increased Tibial tubercle – Trochlear Groove distance (TT-TG) measured on axial MRI is due to lateralization of the tibial tubercle or medialization of the trochlear groove.
Methods
65 knees (28 normal (NK), 25 with trochlear dysplasia (TD) and 12 with patellar dislocation without TD (PD)) were examined. The medial b...
Background
Early controlled ankle motion (ECM) is widely used in the non-operative treatment of acute Achilles tendon rupture although its safety and efficacy has not been investigated properly in a randomized setup.
Purpose/aim of the study
To investigate if ECM of the ankle was superior to immobilization (IM) in the treatment of acute Achilles t...
Introduction
Studies suggest that women have worse treatment outcome than men after acute Achilles tendon rupture (ATR). Few studies have assessed the influence of age and comorbidity on treatment outcome after ATR. The aim of the study was to investigate if gender, age and comorbidity affect patient reported outcome following ATR.
Materials and m...
Introduction
The aim was to study whether six weeks of intensive dance exposure (Swan Lake rehearsals) is a significant contributor to structural changes, symptoms, clinical signs and pain in the Achilles tendon (AT).
Materials and methods
Ballet dancers from The Royal Danish Ballet Company (aged 18–41) were invited (n=79) of which sixty-three (80...
Introduction
Elongation of the Achilles tendon after rupture is a frequent and overlooked complication. The Achilles Tendon Length Measure (ATLM) and the Achilles Tendon Resting Angle (ATRA) are indirect length measures using the resting angle of the ankle. Copenhagen Achilles Length Measure (CALM) is a direct ultrasound measure. Examination of the...
Groin pain is common in athletes and may be caused by many different pathologies. Consequently, the condition can be clinically challenging to diagnose and treat. Until recently, no agreement regarding terminology and classification of groin pain has been available. However, recent consensus and research on athletes with groin pain have improved th...
After anterior cruciate ligament (ACL) reconstruction, 30% of the patients aged 20 years and younger experience a second injury. Studies imply, that with the right rehabilitation and testing many of these injuries can be prevented. Return to play should not be allowed until nine months after surgery at the earliest and should be based on relevant t...
Background and purpose — Larger prospective studies investigating periacetabular osteotomy (PAO) with patient-reported outcome measures developed for young patients are lacking. We investigated changes in patient-reported outcome (PRO), changes in muscle–tendon pain, and any associations between them from before to 1 year after PAO.
Patients and me...
Purpose
The psychometric properties of the shoulder pain and disability index (SPADI) have been extensively evaluated using classical test theory, but very few studies have applied Rasch analysis. The purpose of this study was to validate the Danish version using Rasch analysis.
Methods
Responses to the SPADI from 229 patients (48% female, mean ag...
Purpose::
This cross-sectional study aimed to investigate the association between hamstring muscle peak torque and rapid force capacity (rate of torque development: RTD) versus sprint performance in elite youth football players.
Methods::
Thirty elite academy youth football players (16.75 ± 1.1 years, 176.9 ± 6.7 cm, 67.1 ± 6.9 kg) were included...
Objectives:
The objective of this study was to estimate the prevalence of undiagnosed diabetes mellitus in patients with newly diagnosed frozen shoulder (FS) and study whether diabetes mellitus increases the severity of FS disease.
Methods:
Patients with newly diagnosed FS were consecutively included in this case-control study. Patients who were...
Background and purpose — Knowledge of physical activity profiles among patients with hip dysplasia is lacking. We investigated whether patients with hip dysplasia change physical activity profile from before to 1 year after periacetabular osteotomy. Furthermore, we investigated associations between change in accelerometer-based physical activity an...
Background:
The Copenhagen Hip and Groin Outcome Score (HAGOS) was recently found valid, reliable, and responsive for patients undergoing hip arthroscopy. However, it is currently unknown to what degree patients undergoing hip arthroscopy improve and/or normalize their HAGOS result within the first year after surgery.
Purpose:
First, to use HAGO...
Introduction:
Hip dysplasia is characterized by reduced acetabular coverage of the femoral head leading to an increased mechanical load on the hip joint and the acting hip muscles. Potentially, the muscles and tendons functioning close to the hip joint may present with overuse-related ultrasonography findings. The primary aim was to report the pre...
Background:
A recent systematic review found that 87% of athletes return to sport after hip surgery for femoroacetabular impingement syndrome. However, the proportion of athletes returning to preinjury sport at their preinjury level of sport is less clear.
Purpose:
The main purpose of this study was to determine the rate of athletes returning to...
After anterior cruciate ligament (ACL) reconstruction, 30% of the patients aged 20 years and younger experience a second injury. Studies imply, that with the right rehabilitation and testing many of these injuries can be prevented. Return to play should not be allowed until nine months after surgery at the earliest and should be based on relevant t...
Background
Groin injuries represent a considerable problem in male football. Previous groin-specific prevention programmes have not shown a significant reduction in groin injury rates. An exercise programme using the Copenhagen Adduction exercise increases hip adduction strength, a key risk factor for groin injuries. However, its preventive effect...
Introduction:
Short-term outcome after hip arthroscopy for femoroacetabular impingement (FAI) has been reported to improve hip function and decrease pain. Only few midterm and long-term studies have been published. The objective of this study was to report midterm results in a consecutive cohort and to study the relation between cartilage lesions...
Background
Biomechanical studies show varying results regarding the elongation of adjustable fixation devices. This has led to growing concern over the stability of the ToggleLoc with ZipLoop used in anterior cruciate ligament (ACL) reconstruction (ACLR) in vivo.
Purpose/Hypothesis
The purpose of this study was to compare passive knee stability 1...
Hip and groin pain is prevalent in handball players constituting up to 12.5% and 11% of all overuse and acute injuries, respectively, recorded during a full handball season. Of these, adductor-related groin pain is the most common cause of hip and groin pain. The diagnosis of groin pain related to musculotendinous structures should follow the DOHA...
Background:
The high injury incidence during match-play in female adolescent football is a major concern. In football, males and females play matches with the same football size. No studies have investigated the effect of football size on injury incidence in female adolescent football. Thus, the aim of the present study was to investigate the effe...
Purpose:
Predictors of outcome after femoroacetabular impingement (FAI) surgery are not well-documented. This study presents data from the Danish Hip Arthroscopy Registry (DHAR) for such analyses. The purpose of this study was to identify predictors of poor outcome after FAI surgery in a Danish FAI population. The primary hypothesis was that older...
What’s cutting edge in sports medicine?, Norway, februar 2, 2018, 16:45 – 18:00.
Introduction
Groin problems are highly prevalent in male football players. Previous groin-specific prevention programs have shown no effect on groin injury rates. However, a single-exercise approach targeting hip adduction strength has not been tested previously.
Aim...
Background:
Musculoskeletal hip/groin screening tests are commonly performed to detect at-risk individuals. Bony hip morphology is considered a potential intrinsic risk factor but has not been examined prospectively.
Purpose:
To evaluate the association between intrinsic risk factors identified from musculoskeletal and radiographic screening tes...
Purpose: Subacromial impingement syndrome (SIS) is associated with low self-reported shoulder function, impairments in shoulder strength and range of motion (ROM), and pain. It is not known how the symptomatology associated with SIS is reflected in the choice of treatment. This study compares self-reported shoulder function, shoulder strength, ROM,...
Synopsis
Groin pain is common in athletes who participate in multidirectional sports and has traditionally been considered a difficult problem to understand, diagnose, and manage. This may be due to sparse historical focus on this complex region in sports medicine. Until recently, there has been little agreement regarding terminology, definitions,...
Background:
Subacromial impingement syndrome (SIS) is a painful, and often long lasting, shoulder condition affecting patient function and quality of life. In a recent study, we observed major strength impairments in shoulder external rotation and abduction (~30%) in a population of patients with pronounced and long-lasting SIS. However, the curre...
Background Impaired patient-reported shoulder function and pain, external-rotation strength, abduction strength, and abduction range-of-motion (ROM) is reported in patients with subacromial impingement (SIS). However, it is unknown how much strength and ROM improves in real-life practice settings with current care. Furthermore, outcomes of treatmen...
Introduction
Hip arthroscopy has become a standard procedure in the treatment of hip joint pain not related to osteoarthritis or dysplasia in the young and active patient. There has been increasing focus on the contribution of the hip capsule to function and on stability following hip arthroscopy. It has been suggested that capsular closure after h...
Background:
Reduced lower extremity muscle strength as well as reduced lower extremity muscle pre-activity (defined as muscular activity just prior to initial ground contact) during high-risk movements are factors related to increased risk of non-contact ACL injury in adolescent female athletes. A strong relationship exists between muscle strength...
Background:
Hip adductor muscle weakness and a history of groin injury both have been identified as strong risk factors for sustaining a new groin injury. Current groin pain and age have been associated with hip adductor strength. These factors could be related, but this has never been investigated.
Purpose:
To investigate whether soccer athlete...
Objective
The preseason Nordic Hamstring Protocol (NHP) reduces hamstring strain injuries in football players. Despite persisting injury rates, elite clubs are reluctant to apply the NHP often over concerns of negative impacts on performance. This pilot study investigated if sprint or jump-performance outcomes tended to increase or decrease followi...
Hip and groin injuries in athletes can be confusing because of the lack of common terminology between different specialists and because of the rapidly evolving understanding of early hip disease brought about by advances in imaging and arthroscopy, which renders previous diagnoses questionable. However, a recent consensus meeting on the terminology...
This assessor-blinded, randomized controlled superiority trial investigated the efficacy of the 10-week Nordic Hamstring exercise (NHE) protocol on sprint performance in football players.
Thirty-five amateur male players (age: 17–26 years) were randomized to a do-as-usual control group (CG; n = 17) or to 10-weeks of supervised strength training usi...
The primary aim was to identify muscle-tendon-related pain in 100 patients with hip dysplasia. The secondary aim was to test whether muscle-tendon-related pain is associated with self-reported hip disability and muscle strength in patient with hip dysplasia. One hundred patients (17 men) with a mean age of 29 years (SD 9) were included. Clinical en...