Natural corollaries and recovery after acute Anterior Cruciate Ligament (ACL) injury – the NACOX cohort study protocol

Woman doing gym excersise — Rehab on gym after knee injury

Anterior cruciate ligament (ACL) injury can result in joint instability, decreased functional performance, reduced physical activity and quality of life, and an increased risk for post-traumatic osteoarthritis. Despite the development of new treatment techniques and extensive research, the complex and multifaceted nature of ACL injury and its consequences are yet to be fully understood.

Overall aim of the NACOX study is to investigate the natural corollaries and recovery after an ACL injury.

There are five main study objectives:

To assess biological, psychological and social factors and their relationships to the natural corollaries and recovery after acute ACL injury
To evaluate the choice of treatment after acute ACL-injury (i.e. ACL reconstruction, ACLR or non-ACL reconstruction, non-ACLR)
To evaluate the return to sport after acute ACL injury
To study knee problems in the short and long term after acute ACL-injury
To identify proxies (biomarkers and structural risk factors) for early detection of symptomatic and radiographic osteoarthritis

This is a multi-centre prospective prognostic cohort study of patients with acute ACL injury. At 7 sites in Sweden, patients aged 15-40 years are included within 6 weeks after primary ACL injury. Patients complete questionnaires at multiple occasions over the 3 years following injury or the 3 years following ACL reconstruction (for participants who have surgical treatment). In addition, a subgroup of 131 patients are followed with clinical examinations, several imaging modalities, and biological samples.

The last patient was included 15th October 2019. In total, 142 patients have been included from Linköping and 136 from the other sites together.

Publications

Joanna Kvist, Håkan Gauffin, Hanna Tigerstrand Grevnerts, Clare Ardern, Martin Hägglund, Anders Stalman, Richard Frobell (2018)

Natural corollaries and recovery after acute ACL injury: the NACOX cohort study protocol

BMJ Open , Vol.8 Continue to DOI

Ann-Sofi Björkman, Seppo K. Koskinen, Maria Lindblom, Anders Persson (2020)

Diagnostic accuracy of dual-energy CT for detection of bone marrow lesions in the subacutely injured knee with MRI as reference method

Acta Radiologica , Vol.61 , s.749-759 Continue to DOI

Research group

Principal investigator

Co-investigators

Martin Hägglund

Professor

Sofi Sonesson

Senior Associate Professor, Head of Division, Head of Unit

External Co-investigators

Håkan Gauffin, MD, PhD, Department of Orthopaedics, Linköping University, Linköping, Sweden
Richard Frobell, PhD, Associate Professor, Orthopedics, Clinical Sciences Lund, Lund University, Sweden
Anders Stålman, MD PhD, Capio ArtroClinic, Stockholm Sports Trauma Research Center, Sophiahemmet, Stockholm

Collaborators

External Collaborators

Michael A Bowes, Sr Director Clinical Applications, Imorphics Ltd, Manchester, UK
Ann-Sofi Björkman, MD Center for Medical Image Science and Visualization (CMIV), Department of Radiology, Linköping University, Sweden
Victor Casula, PhD, Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland
Maria Lindblom, MD Center for Medical Image Science and Visualization (CMIV), Department of Radiology, Linköping University, Sweden
Anne Fältström, Physiotherapist, PhD, Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping
Seppo Koskinen, Professor in Medical Radiology at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet
Miika Nieminen, Professor, Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Finland

Financial support

The Swedish Research Council
The Swedish Research Council for Sport Science
The Medical Research Council of Southeast Sweden (FORSS)

Knee injuries in sports

Our research focus is on risk factors, treatment and consequences after sport injury, especially knee and anterior cruciate ligament (ACL) injury.

Treatment of meniscus injuries

Keyhole surgery has long been the most common treatment for suspected meniscus injury. But the benefits of the operation are now being questioned and instead replaced with training primarily for middle-aged and older people with knee pain.

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Sport without injury programme - SWIPE

Our research includes study of injury occurrence and risk factors in sports. We also evaluate the efficacy of injury preventive measures, and their effectiveness, including applicability in different sports and sporting populations.

Fysioterapeut behandlar ryggpatient på brits.

Human Movement Science

We improve knowledge of movement system function in healthy as well as individuals with functional impairments due to sickness of injury. Our research utilizes methods for measuring and analyzing the mechanisms required for function and activity.

Organisation

Department of Health, Medicine and Caring Sciences (HMV)

The research areas at HMV include experimental basic research to clinical, social and public health research. We conduct high-quality education in the sought-after care professions.

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Division of Prevention, Rehabilitation and Community Medicine (PRNV)

We are an interdisciplinary division that consists of three units: Occupational Therapy, Physiotherapy, and Clinical Medicine.

Faculty of Medicine and Health Sciences (MEDFAK)

The Faculty of Medicine and Health Sciences conducts research and education within medicine, healthcare and public health.

Natural corollaries and recovery after acute Anterior Cruciate Ligament (ACL) injury – the NACOX cohort study protocol

Publications