300
Cases per 100 000 inhabitants
250 200 150 Total Women Men
Figure 72 Sweden
100 50 0
98
99
00
01
02
03
04
05
06
07
08
09
10
11
Knee arthroscopy in patients age 40 and older with osteoarthritis or degenerative meniscus lesion per 100 000 inhabitants. Age-standardised. Source: National Patient Register, National Board of Health and Welfare
significantly over time, while the percentage based on degenerative meniscus lesion has increased. More than 50 000 MRIs of the knee have been performed every year. The result may have been overdiagnosis of degenerative meniscus lesion, perhaps increasing the number of arthroscopic procedures for the past 10 years. An analysis shows that approximately 4 800 of the 9 300 arthroscopic procedures in question were based on the primary diagnosis of osteoarthritis, which is inconsistent with the national musculoskeletal guidelines. The remaining 4 500 operations were performed on the basis of degenerative meniscus lesion. The number of patients diagnosed with degenerative meniscus lesion whose symptoms are primarily due to osteoarthritis remains an open question. A recently published Swedish study suggests that 30 per cent of these patients require arthroscopy after completion of physiotherapeutic rehabilitation. One source of statistical uncertainty is underreporting to the National Patient Register, particularly with respect to private care providers and outpatient treatment. Thus, the national trend in recent years is difficult to interpret. The decrease in 2011 may be the result of poorer reporting. The number of procedures in counties with large private arthroscopic units may have been underestimated. Underreporting by public clinics is most likely when it comes to outpatient care.
73 Revision Operations after Anterior Cruciate Ligament Surgery (ACL) Anterior cruciate ligament injury is a serious condition that often prevents young people from performing heavy labour or engaging in strenuous exercise in the absence of proper treatment. The incidence of the ACL injuries is unknown. Recent Swedish studies suggest 80 cases per 100 000 inhabitants (approximately 7 200 people), somewhat higher than previous assessments. For one reason or another, almost half of the people with anterior cruciate ligament injury never undergo surgery.
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