Lars-Petter Ness Granan

• Ekholdt, Christopher; Granan, Lars-Petter Ness; LUNDELAND, BÅRD; Stubhaug, Audun & Meier, Kaare (2025). The neuromodulation registry survey: A web-based survey to identify and describe characteristics of European medical patient registries for neuromodulation therapies in chronic pain treatment. Scandinavian Journal of Pain. ISSN 1877-8860. 25(1). doi: 10.1515/sjpain-2025-0025. Full text in Research Archive Show summary

  Objectives This survey aims to identify and describe the characteristics of registries for neuromodulation implantations used to treat chronic pain in Europe. Neuromodulation therapies such as spinal cord stimulation (SCS) are employed to treat chronic pain through implantable medical devices. These therapies are considered effective and are part of standard care in many countries. Registries can provide valuable real-world data to complement randomized controlled clinical trials. Materials and methods We conducted a web-based survey to gather information on registries monitoring neuromodulation implants for chronic pain treatment, and the survey was sent to 101 European centers. Results We received responses from 47 centers across 17 European countries. Of these, 27 centers reported using a registry for neuromodulation therapies to treat pain, which this study is based upon. National registries exist in Belgium, the Netherlands, the UK, as well as a national registry solution in France. Non-national registries were identified in Denmark, Finland, Norway, Spain, Sweden, Switzerland, and Turkey. We present an overview on data types collected from different registries. Categories of variables collected are quite consistent across registries and are mostly in line with recommendations for chronic pain. The primary objective of the registries is most commonly measuring clinical outcomes and complications, while guideline adherence is less commonly monitored. The most frequently reported challenge is the lack of personnel for planning, designing, and funding for running the registries. Conclusions We identified 27 centers utilizing neuromodulation registries for chronic pain treatment, with 23 providing detailed data. Although the survey’s limitation is its findings are not generalizable to all registries, the findings offer key insights for the establishment and growth of registries in neuromodulation. Registries primarily aim to investigate the clinical and patient-reported outcomes, though variability in other clinical data collection remains a challenge for benchmarking and guideline adherence. Significant financial and organizational hurdles exist, which can be addressed through cooperative initiatives.

• Farnes, Nadine; Granan, Lars-Petter Ness; Jacobsen, Henrik Børsting; Stubhaug, Audun & vambheim, Sara Magelssen (2024). Associations of long-term clinical recovery and improved quality of life across ICD-11 chronic pain categories in a real-world registry study. European Journal of Pain. ISSN 1090-3801. doi: 10.1002/ejp.2250. Full text in Research Archive Show summary

  Background There is little knowledge of what factors are needed for successful chronic pain management. We aim to identify psychosocial and treatment predictors of clinical recovery and improved quality of life (QOL) at 12-month follow-up across three chronic pain groups, based on the International Classification of Diseases-11: neuropathic pain, secondary non-neuropathic pain, and primary pain. Furthermore, we investigate baseline differences across diagnostic groups. Methods The sample included baseline and 12-month follow-up data from 1056 chronic pain patients from the Oslo University Hospital's Pain Registry. Logistic regression models investigated longitudinal associations between psychosocial and treatment characteristics, and the outcome measures clinical recovery and improved QOL. Characteristics were compared across the diagnostic groups. Results Increased odds of clinical recovery and improved QOL were seen in patients receiving invasive treatment (OR = 8.04, 95% CI = 3.50–19.40; OR = 5.47, 95% CI = 2.42–12.86), while decreased odds of clinical recovery were seen for secondary non-neuropathic pain patients with pain-related disability (0.05, 95% CI = 0.01–0.29). In comparing baseline characteristics, neuropathic pain patients had lower QOL, and more severe insomnia compared to the other groups. Conclusion Invasive treatment modalities were strongly associated with clinical recovery and improved QOL. Although this could be due to patient selection, it does warrant further examination as an intervention alternative for chronic pain. Intervention efficacy, risk factors and predictors of clinical recovery across diagnostic groups should be further investigated through longitudinal RCTs. Significance This observational study indicates a potential advantage in sustained recovery for pre-selected individuals with chronic pain who undergo invasive treatments. The relationship between sustained recovery and psychosocial factors differs across neuropathic, secondary non-neuropathic, and primary pain patients. This suggests that employing ICD-11 for classifying patients into mechanistically distinct pain groups could inform the evaluation and management of chronic pain. Furthermore, factors previously identified as negative indicators for long-term outcomes in chronic pain cohorts were not clinically significant in this study.

• Vambheim, Sara Magelssen; Hjellvik, Vidar; Odsbu, Ingvild; Skurtveit, Svetlana Ondrasova; Ekholdt, Christopher & Granan, Lars-Petter Ness [Show all 8 contributors for this article] (2024). Postoperative opioid use in Norway-a population-based observational study on patterns of long-term use. BMC Pharmacology and Toxicology. 25(1), p. 1–9. doi: 10.1186/s40360-024-00805-y. Full text in Research Archive Show summary

  Background The utilization patterns of opioid analgesics and the proportion of long-term opioid use after surgery in Norway is largely unknown. Methods This study aimed to estimate the proportion of one-year long-term prescription opioid use among all Norwegian postoperative opioid users. Complete data from central health registries (NPR, NorPD, Statistics Norway, CoDR) were linked via the personal identification number unique to all citizens. The study period was January 1st 2010 until December 31st 2019. Long-term opioid use was defined as at least two opioid dispensings within two subsequent 90-day periods, with a minimum average use of 10 MME/day for the first 90 days. Results The study population consisted of 693 495 post-operative opioid users (53.6% women), whereof 73.2% had not used opioids the year before surgery (new users). Among the postoperative opioid users, 3.8% were one-year long-term opioid users. The corresponding figures for new and previous opioid users were 0.4% and 13.1%, respectively. The highest proportions of long-term opioid use were found after transluminal endoscopy, eye surgery and assessments related to surgical procedures. In previous opioid users, the proportion of one-year long-term use was higher among women than men in all age groups, a difference that increased with age. Conclusions The proportion of postoperative long-term opioid use in Norway is generally low. We detected higher proportions of long-term opioid use after certain types of surgery, but our crude surgery definition warrants further examination. Previous opioid users pose a particular challenge in the management of postoperative pain. Trial registration The study used national health registry data from the period 2010–2019. A pre-registered analysis plan is available at Open Science Framework.

• Reme, Silje Endresen; Ljoså, Tone Marte; Stubhaug, Audun; Granan, Lars-Petter Ness; Falk, Ragnhild Sørum & Jacobsen, Henrik Børsting (2022). Perceived Injustice in Patients With Chronic Pain: Prevalence, Relevance, and Associations With Long-Term Recovery and Deterioration. Journal of Pain. ISSN 1526-5900. 23(7), p. 1196–1207. doi: 10.1016/j.jpain.2022.01.007. Full text in Research Archive Show summary

  The Injustice Experience Questionnaire (IEQ) assesses the degree to which chronic pain sufferers perceive injustice in relation to their pain. The aim of the current study was to assess the prevalence and relevance of the IEQ and its association to perceived recovery and deterioration in a naturalistic pain clinic population. Data was obtained from the Oslo University Hospital's Pain Registry. Among 2,950 patients, the prevalence of low (<19), medium (19-29) and high (30+) IEQ was 39%, 32% and 29% respectively. High levels of injustice were positively associated with a wide range of adverse health outcomes. Differences between those with high vs low levels of IEQ were clinically significant for most health outcomes. A Venn diagram analysis showed considerable, but not complete, overlap between IEQ, pain catastrophizing, psychological distress and severe pain intensity. High IEQ was associated with reduced clinical recovery (OR 0.6, 95% CI 0.4-0.9) and deterioration (OR 3.6, 95% CI 2.1-6.2) at 12-months follow-up, however, not when controlling for pain-related disability and pain intensity. We conclude that perceived injustice is a prevalent and clinically relevant phenomenon in a chronic pain clinic population, and that more knowledge is needed regarding its role as indicator of poor prognosis and target for tailored treatment.

• Ljoså, Tone Marte; Berg, Hanne Svardal; Jacobsen, Henrik Børsting; Granan, Lars-Petter & Reme, Silje Endresen (2021). Translation and validation of the Norwegian version of the Injustice Experience Questionnaire. Scandinavian Journal of Pain. ISSN 1877-8860. doi: 10.1515/sjpain-2021-0177. Full text in Research Archive
• Busse, Jason W.; Vankrunkelsven, Patrick; Zeng, Linan; Heen, Anja Fog; Merglen, Arnaud & Campbell, Fiona [Show all 22 contributors for this article] (2021). Medical cannabis or cannabinoids for chronic pain: A clinical practice guideline. The BMJ. 374. doi: 10.1136/bmj.n2040. Full text in Research Archive Show summary

  Abstract Clinical question: What is the role of medical cannabis or cannabinoids for people living with chronic pain due to cancer or non-cancer causes? Current practice: Chronic pain is common and distressing and associated with considerable socioeconomic burden globally. Medical cannabis is increasingly used to manage chronic pain, particularly in jurisdictions that have enacted policies to reduce use of opioids; however, existing guideline recommendations are inconsistent, and cannabis remains illegal for therapeutic use in many countries. Recommendation: The guideline expert panel issued a weak recommendation to offer a trial of non-inhaled medical cannabis or cannabinoids, in addition to standard care and management (if not sufficient), for people living with chronic cancer or non-cancer pain. How this guideline was created: An international guideline development panel including patients, clinicians with content expertise, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines using the GRADE approach. The MAGIC Evidence Ecosystem Foundation (MAGIC) provided methodological support. The panel applied an individual patient perspective. The evidence: This recommendation is informed by a linked series of four systematic reviews summarising the current body of evidence for benefits and harms, as well as patient values and preferences, regarding medical cannabis or cannabinoids for chronic pain. Understanding the recommendation: The recommendation is weak because of the close balance between benefits and harms of medical cannabis for chronic pain. It reflects a high value placed on small to very small improvements in self reported pain intensity, physical functioning, and sleep quality, and willingness to accept a small to modest risk of mostly self limited and transient harms. Shared decision making is required to ensure patients make choices that reflect their values and personal context. Further research is warranted and may alter this recommendation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

• Bratberg, Grete Helen; Leira, Kirsti; Granan, Lars-Petter; Jonsbu, Egil; Fadnes, Britt Lenes & Thuland, Silje Frich [Show all 7 contributors for this article] (2020). Learning oriented physiotherapy (LOP) in anxiety and depression: an 18 months multicentre randomised controlled trial (RCT). European Journal of Physiotherapy. ISSN 2167-9169. doi: 10.1080/21679169.2020.1739747. Full text in Research Archive Show summary

  Aim: Although many patients with anxiety and depression suffer from muscular pain and bodily dysfunctions, body is largely ignored in treatment. The aim of this study was to investigate the effectiveness of Learning Oriented Physiotherapy (LOP), based on recent knowledge about overlapping brain networks and the need of awakening body awareness in order to synchronise body and mind. Methods: Patients with moderate anxiety and/or depression referred to three outpatient psychiatric clinics in Norway during October 2014 to January 2016 were invited to participate. Of eligible patients, 42 were randomised to LOP and 39 to standard psychiatric treatment (controls). Self-reports of anxiety and depression (HADS), health-related quality of life (EQ-5D-5L) and global health (EQ-VAS) were recorded every 6 months from baseline (T1) to 18 months after (T4). Mixed linear model (MLM) analysis was used to estimate overall differences between groups. Results: After 1 year of follow-up, LOP participants reported higher quality of life and perceived global health than controls. At the end of the trial, there were no mean differences in health outcomes between groups, but LOP participants showed an overall faster rate of recovery than controls. Conclusions: LOP may be as effective as conventional therapies for patients with moderate anxiety and depression.

• Linnemørken, Lene Therese Bergerud; Granan, Lars-Petter & Reme, Silje Endresen (2020). Prevalence of posttraumatic stress symptoms and associated characteristics among patients with chronic pain conditions in a Norwegian university hospital outpatient pain clinic. Frontiers in Psychology. 11:749, p. 1–14. doi: 10.3389/fpsyg.2020.00749. Full text in Research Archive Show summary

  Introduction: Comorbid posttraumatic stress disorder (PTSD) in patients with chronic pain may have a negative effect on the course and outcome of both disorders. Nevertheless, the co-occurrence of the two conditions is often overlooked in clinical settings. Further, little is known about how PTSD is associated with biopsychosocial characteristics in this patient group. The first objective was to assess the prevalence of posttraumatic stress symptoms (PTSS) in patients with chronic pain in a Norwegian university hospital outpatient pain clinic. The second objective was to investigate possible associations between PTSS and adverse outcomes such as pain intensity, disability, and distress. The third objective was to compare the PTSS prevalence rates between primary versus secondary pain conditions. Materials and methods: Six hundred and ninety-two patients meeting for pain assessment completed self-report questionnaires about PTSS and possibly associated factors. The Life Events Checklist and the Stressful Life Events Screening Questionnaire were used to screen for potentially traumatic life events. The Impact of Events Scale – Revised and the PTSD Checklist for DSM-5 were used to assess PTSS. Differences between patients with and without severe PTSS on the possibly associated variables were analyzed by chi-squared-, and t-tests. Results: 20.7% of the participants reported a level of PTSS qualifying for a PTSD diagnosis. These patients reported higher levels of pain intensity, pain bothersomeness, disability, and psychological distress, as well as lower levels of self-efficacy. They also reported higher levels of pain catastrophizing, perceived injustice, fatigue, and sleep difficulties. Finally, there was not a significant difference in prevalence rates between primary and secondary pain conditions. Discussion: PTSS are frequent in patients with chronic pain, and a range of psychological characteristics is associated with a high level of such symptoms in this patient group. Patients with both conditions report a significantly higher symptom load, and the potential impact on the individual’s life is major. In terms of pain condition, there were no differences in PTSS between primary pain conditions and secondary pain conditions in this pain population. This study emphasizes the importance of increased attention on PTSS when seeing patients with chronic pain conditions in clinical practice.

• Granan, Lars-Petter (2019). Pain revised - Learning from anomalies. Scandinavian Journal of Pain. ISSN 1877-8860. p. 1–4. doi: 10.1515/sjpain-2019-0100. Full text in Research Archive
• Straume-Næsheim, Truls Martin; Randsborg, Per-Henrik; Mikaelsen, Jan Rune; Sivertsen, Einar; Devitt, Brian M. & Granan, Lars-Petter [Show all 7 contributors for this article] (2019). Recurrent lateral patella dislocation affects knee function as much as ACL deficiency – however patients wait five times longer for treatment. BMC Musculoskeletal Disorders. 20. doi: 10.1186/s12891-019-2689-7. Full text in Research Archive Show summary

  Background: Surgical treatment of young patients with recurrent lateral patella dislocation (RLDP) is often recommended because of loss of knee function that compromises their level of activity or even their daily life functioning. This situation is comparable to young patients with an anterior cruciate ligament (ACL) rupture. The purpose of this study was therefore to explore the time from injury to surgery and the pre-operative symptoms and knee function of young RLPD patients scheduled for stabilizing surgery and compare this group to age and sex-matched ACL-deficient patients. Method: Forty-seven patients with unilateral RLPD listed for isolated medial patellofemoral ligament reconstruction were included in the study (RLPD-group). This group was compared to an age, sex and BMI matched ACL patient group obtained from the Norwegian knee ligament registry (ACL-group) for the following outcome measures: the knee injury and osteoarthritis outcome score (KOOS) assessed on the day of surgery and time from injury to surgery. Results: The RLPD-group scored significantly lower than the ACL-group for the three KOOS subscales “Pain” (73.6 vs. 79.8, p < 0.05), “Symptoms” (71.7 vs. 79.3, p < 0.05) and “ADL” (84.7 vs 89.5, p < 0.05). The lowest KOOS values were found for Sports/Recreation (53.5 vs. 51.3, p = 0.65) and Quality of life (37.6 vs. 36.7, p = 0.81). The average time from primary injury to surgery was 6 months for the ACL group and 31 months for the RLPD group. Conclusion: RLPD affected knee function as much as ACL deficiency, and was associated with more pain. Still the RLDP patients waited on average 5 times longer for surgery.

• Granan, Lars-Petter; Reme, Silje Endresen; Jacobsen, Henrik Børsting; Stubhaug, Audun & Ljoså, Tone Marte (2019). The Oslo University Hospital Pain Registry: development of a digital chronic pain registry and baseline data from 1,712 patients. Scandinavian Journal of Pain. ISSN 1877-8860. 19(2), p. 365–373. doi: 10.1515/sjpain-2017-0160. Full text in Research Archive Show summary

  Background and aims Chronic pain is a leading cause to years lived with disability worldwide. However, few of the interventions used in pain medicine have proven efficacy, and evidence from the existing studies may not be valid for the general pain population. Therefore, it is of utmost need that we describe chronic pain conditions in their most relevant aspects, their various guises, as well as the real world outcomes of our clinical interventions. The most obvious and crude way to make these assessments are through large registries where patient characteristics, treatment characteristics (including but not limited to what, when, how often and by whom), treatment outcomes and patient outcomes are scrutinized and recorded. Methods and results This article describes in detail the design and baseline data of the comprehensive Oslo University Hospital Pain Registry (OPR). OPR is the local registry of the largest university and interdisciplinary outpatient pain clinic in Norway. Data registration started in October 2015, and approximately 1,000 patients are assessed and treated at the clinic each year. During the first 2 years of running the OPR (through September 2017), a total of 1,712 patient baseline reports were recorded from 2,001 patients. Clinicians enter data about relevant treatments and interventions, while patients provide self-reported data on aspects related to pain and pain management. The patients complete an electronic registration immediately before their first consultation at the outpatient pain clinic. The baseline questions of the OPR cover: Basic demographics; The Modified Oswestry Disability Index to assess general function; A pain drawing to assess pain location; Questions regarding the temporal aspects of pain; Six 0–10 Numeric Rating Scales to assess pain intensity and bothersomeness; The EQ-5D-5L to measure health-related quality of life; The Hopkins Symptom Check List-25 to assess psychological distress; A single question about self-rated health; The general self-efficacy scale to assess the patient’s perceived self-efficacy; The Bodily Distress Syndrome checklist to assess functional disorders; The Injustice Experience Questionnaire to assess whether the patients experience injustice; Chalder Fatigue Questionnaire to assess fatigue; The Insomnia Severity Index to assesses the levels of insomnia symptoms; The Pain Catastrophizing Scale to measure pain catastrophizing and exaggerated negative orientation toward pain stimuli and pain experience; And the SF36v2 to assess patients’ self-report of generic health and wellbeing. The baseline data show that chronic pain patients have a high degree of negative impact in all aspects of their lives. Conclusions and implications The OPR is the most comprehensive pain registry for multidisciplinary and interdisciplinary outpatient pain clinics in Norway. Detailed design of the registry and key baseline data are presented. Registries are of great value in that they enable real world effectiveness outcomes for patients with chronic pain conditions. The OPR can thus serve as a model for similar initiatives elsewhere. The OPR cohort may also serve as a historical control in future studies, both with experimental and observational design.

• Tschudi-Madsen, Hedda; Rødevand, Linn; Kaarbø, Mette Bøymo & Granan, Lars-Petter (2018). Chronic Widespread Pain in a tertiary pain clinic: Classification overlap and use of a patient generated quality of life instrument. Scandinavian Journal of Pain. ISSN 1877-8860. p. 1–11. doi: 10.1515/sjpain-2018-0097. Full text in Research Archive
• Ingelsrud, Lina H.; Terwee, Caroline B.; Terluin, Berend; Granan, Lars-Petter; Engebretsen, Lars & Mills, Kathryn A.G. [Show all 7 contributors for this article] (2018). Meaningful Change Scores in the Knee Injury and Osteoarthritis Outcome Score in Patients Undergoing Anterior Cruciate Ligament Reconstruction. American Journal of Sports Medicine. ISSN 0363-5465. 46(5), p. 1120–1128. doi: 10.1177/0363546518759543. Full text in Research Archive Show summary

  Background: Meaningful change scores in the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients undergoing anterior cruciate ligament (ACL) reconstruction have not yet been established. Purpose: To define the minimal important change (MIC) for the KOOS after ACL reconstruction. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: KOOS and anchor questions with 7-point scales ranging from “better, an important improvement” to “worse, an important worsening” were completed postoperatively by randomly chosen participants from the Norwegian Knee Ligament Registry. Presurgery KOOS scores were retrieved from the registry. The MIC for improvement was calculated with anchor-based approaches using the predictive modeling method adjusted for the proportion of improved patients, the mean change method, and the receiver operating characteristic (ROC) method. Results: Complete data for at least one of the KOOS subscales were obtained from 542 (45.3%) participants. Predictive modeling MIC values were 12.1 for the KOOS subscales of Sport and Recreational Function and 18.3 for Knee-Related Quality of Life. These values aid in interpreting within-group improvement over time and can be used as responder criteria when comparing groups. The corresponding and much lower values for the subscales of Pain (2.5), Symptoms (–1.2), and Activities of Daily Living (2.4) are the results from patients reporting, on average, only mild problems with these domains preoperatively. Although 4% to 10% of patients reported subscale-specific worsening, MIC deterioration calculations were not possible. The ROC MIC values were associated with high degrees of misclassification. Values obtained by the mean change method were considered less reliable because these estimates are derived from subgroups of patients. Average KOOS change scores were approximately similar for patients reporting acceptable symptoms postoperatively and patients reporting important improvements on the anchor items after surgery. Conclusion: KOOS users should apply subscale-specific cutoffs for meaningful improvement. Our results confirm using the subscales of Sport and Recreational Function and Knee-Related Quality of Life as primary patient-reported outcomes after ACL reconstruction. The predictive modeling approach gave the most robust estimates of MIC values. Our data suggest that reporting acceptable symptoms postoperatively corresponds to reporting an important improvement after ACL reconstruction.

• Owesen, Christian; Sandven-Thrane, Stine; Lind, Martin; Forssblad, Magnus; Granan, Lars-Petter & Årøen, Asbjørn (2017). Epidemiology of surgically treated posterior cruciate ligament injuries in Scandinavia. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 25(8), p. 2384–2391. doi: 10.1007/s00167-015-3786-2. Full text in Research Archive
• Aga, Cathrine; Kartus, Jüri-Tomas; Lind, Martin; Lygre, Stein Håkon Låstad; Granan, Lars-Petter & Engebretsen, Lars (2017). Risk of revision was not reduced by a double-bundle ACL reconstruction technique: results from the Scandinavian registers. Clinical Orthopaedics and Related Research. ISSN 0009-921X. 475(10), p. 2503–2512. doi: 10.1007/s11999-017-5409-3. Full text in Research Archive
• Rødevand, Linn Nilsen; Ljoså, Tone Marte; Granan, Lars-Petter; Knutzen, Thomas; Jacobsen, Henrik Børsting & Reme, Silje Endresen (2017). A pilot study of the individual placement and support model for patients with chronic pain. BMC Musculoskeletal Disorders. 18(1). doi: 10.1186/s12891-017-1908-3. Full text in Research Archive Show summary

  Background Individual Placement and Support (IPS) is an evidence-based work rehabilitation model with well-documented effects for people with mental illness. The model has, however, never been tested out for people with chronic pain. This pilot study aimed to investigate chronic pain patients’ experiences with the IPS job support model. Methods We recruited eight consecutive patients referred for various chronic pain conditions at a hospital outpatient pain clinic. They were offered IPS job support as an integrated part of their interdisciplinary pain rehabilitation. The patients’ experiences were investigated through semi-structured interviews 3 months after inclusion in the study. Results The participants reported mostly positive experiences with IPS. One participant dropped out of the study after deterioration of symptoms, while the remaining participants were satisfied with the intervention. Particular helpful aspects of the IPS intervention were the follow-up from the employment specialist, focus on competitive employment, focus on work despite pain complaints, reframing work into something positive, administrative support, and practice in writing applications. No participants reported adverse experiences from the IPS intervention. Within a 12-months time frame, 3 of the 8 participants gained competitive employment. Conclusions This is the first report of the IPS model of supported employment applied in an outpatient setting for chronic pain patients. The results suggest that IPS can be successfully integrated with interdisciplinary pain rehabilitation, and warrants large-scale testing in a randomized controlled trial.

• Skatteboe, Sigrid; Røe, Cecilie; Fagerland, Morten & Granan, Lars-Petter (2017). The influence of expectations on improvements in pain and function in patients with neck/back/shoulder complaints: a cohort study. European Journal of Physical and Rehabilitation Medicine. ISSN 1973-9087. 53(6), p. 936–943. doi: 10.23736/S1973-9087.17.04608-1. Full text in Research Archive
• Skatteboe, Sigrid; Røe, Cecilie; Fagerland, Morten & Granan, Lars-Petter (2017). Expectations of pain and functioning in patients with musculoskeletal disorders: A cross-sectional study. BMC Musculoskeletal Disorders. 18:48, p. 1–9. doi: 10.1186/s12891-016-1386-z. Full text in Research Archive Show summary

  Background Research has suggested that patient expectations are associated with treatment outcome and evolve along with patient communication within the musculoskeletal field. However, few studies have investigated if or how physical medicine and rehabilitation (PMR) consultations affect the attending patients’ expectations regarding pain and functional improvement. Hence, the aims of the present study were to compare patient expectations regarding pain and functional improvement before and after a PMR consultation and to assess patient characteristics, including diagnosis, that could perhaps predict changes in expectations. Methods The study design was cross-sectional. Eligible participants were first-time patients with neck/back or shoulder complaints who were referred to a PMR outpatient clinic between January and June 2013. Questionnaires (the Patient Shoulder Outcome Expectancies, or PSOE, questionnaire and a numeric rating scale, or NRS) focused on expectations regarding pain and functioning were completed immediately prior to and after a consultation with a PMR specialist. Results In total, 257 patients were included. In total, 24% of the subjects expected a more positive outcome after the PMR consultation compared with before the consultation, while 10% of the subjects exhibited a negative change in expectations. Few patient characteristics other than sick leave were associated with changes in expectations; however, patients with shoulder complaints seemed to be more optimistic than patients with neck/back complaints. Conclusion Expectations can be influenced by a single specialist consultation. Among clinical prognostic factors, only sick leave influenced the change expectations. However, patients with shoulder complaints seemed to be more optimistic than patients with neck/back complaints. Trial registration The study was approved by the Data Protection Office at Oslo University Hospital, 2012/2574. ISRCTN registration: 40963362  (registered retrospectively 12.12.2016)

• Søreide, Endre; Granan, Lars-Petter; Hjorthaug, Geir Aasmund; Espehaug, Birgitte; Dimmen, Sigbjørn & Nordsletten, Lars (2016). The effect of limited perioperative nonsteroidal anti-inflammatory drugs on patients undergoing anterior cruciate ligament reconstruction. American Journal of Sports Medicine. ISSN 0363-5465. 44(12), p. 3111–3118. doi: 10.1177/0363546516657539. Full text in Research Archive Show summary

  Background: The administration of nonsteroidal anti-inflammatory drugs (NSAIDs) to patients undergoing anterior cruciate ligament reconstruction (ACLR) is controversial because it may impair tissue healing and clinical outcomes. Purpose: To assess the effect of NSAID administration on patients undergoing ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Included patients were aged >15 years and were registered in the Norwegian Knee Ligament Registry from 2008 until 2013 after the primary ACLR. Patients with insufficient data regarding administration of NSAIDs and those with associated knee ligament injuries requiring surgical treatment were excluded from this study. Graft survival was estimated using Kaplan-Meier survival curves, and hazard ratios (HRs) for revision were evaluated using Cox regression analysis. Logistic regression analysis was used to calculate the odds ratio (OR) for a Knee Injury and Osteoarthritis Outcome Score (KOOS)–quality of life (QOL) subscale score <44 at 2-year follow-up. Results: A total of 7822 patients were included in the analysis for graft survival and assessment for risk of revision. Of these, 4144 patients were administered NSAIDs postoperatively. The mean duration of follow-up was 2.8 years (range, 0-5.9 years). Administration of NSAIDs did not influence graft survival (P = .568). Adjusted Cox regression analyses demonstrated the same finding regarding risk of revision (HR, 1.0; 95% CI, 0.8-1.3). ACLR using a bone–patellar tendon–bone autograft showed a reduced risk of revision (HR, 0.3; 95% CI, 0.1-0.8) among patients administered NSAIDs. In subgroup analyses of 3144 patients, administration of NSAIDs demonstrated a beneficial effect on the risk of a KOOS-QOL score <44 at 2-year follow-up (OR, 0.8; 95% CI, 0.6-0.9). Conclusion: Administration of NSAIDs to patients after ACLR does not have a negative effect on graft survival, risk of revision, or risk of a KOOS-QOL score <44 at 2-year follow-up. We emphasize using caution when administering NSAIDs by keeping the duration and dosage of NSAIDs as short and low as possible to ensure sufficient pain relief while limiting unwanted exposure to any known and unknown adverse effects of these drugs.

• Granan, Lars-Petter (2016). The ising model applied on chronification of pain. Pain medicine (Malden, Mass.). ISSN 1526-2375. 17(1), p. 5–9. doi: 10.1111/pme.12933. Full text in Research Archive
• Aga, Cathrine; Granan, Lars-Petter; Kartus, J; Lind, M; Maletis, G & Engebretsen, Lars (2016). No difference in revision rates or treatment failures between single bundle and doble bundle anterior cruciate ligament reconstruction, a register study. In Lorentzen, Karl-Ivar (Eds.), Høstmøteboken - Vitenskapelig program og abstrakter 2016. Norsk ortopedisk forening. p. 194–194. Full text in Research Archive
• Owesen, Christian; Sivertsen, Einar Andreas; Engebretsen, Lars; Granan, Lars-Petter & Årøen, Asbjørn (2015). Patients With Isolated PCL Injuries Improve From Surgery as Much as Patients With ACL Injuries After 2 Years. Orthopaedic Journal of Sports Medicine (OJSM). 3(8). doi: 10.1177/2325967115599539. Full text in Research Archive Show summary

  Background: Reports on outcome after posterior cruciate ligament (PCL) reconstruction often contain both isolated PCL and combined knee ligament injuries. This makes it difficult to conclude on the outcome after reconstruction of isolated PCL injuries. Purpose: To investigate the outcome after PCL reconstruction in patients with an isolated PCL injury and to compare this with the outcome of patients treated with reconstruction after isolated anterior cruciate ligament (ACL) injuries. Study Design: Cohort study; Level of evidence, 3. Methods: Seventy-one patients with an isolated PCL injury that was reconstructed surgically and who had registered in the Norwegian Knee Ligament Registry between 2004 and 2010 were included in this study. Patients with isolated ACL reconstructions (n ¼ 9661) who had registered in the same period were included for comparison. Knee Injury and Osteoarthritis Outcome Score (KOOS) was used as the patient-reported outcome measure. Preoperative and 2-year postoperative KOOS scores were compared. Changes in KOOS score reported by the PCL patients were compared with changes reported by the ACL patients. Results: At the 2-year postoperative follow-up of the PCL-reconstructed patients, the patient-reported outcome was improved, measured by KOOS as follows: pain, 15.1 (95% CI, 8.5-21.8; P < .001); symptoms, 0.9 (95% CI, –6.6 to 8.3; P ¼ .82); activities of daily living, 13.2 (95% CI, 6.6-13.9; P < .001); sports, 20.7 (95% CI, 11.8-29.4; P < .001); and quality of life, 26.6 (95% CI, 18.9-34.2; P < .001). According to the KOOS, the incremental improvements were similar for PCL and ACL patients. Time from injury to surgery was longer for the PCL patients compared with ACL patients (median, 21.5 vs 8.0 months; P < .001). Conclusion: Patients undergoing PCL reconstruction can expect the same improvements in KOOS score as patients undergoing ACL reconstruction. However, PCL patients start out with an inferior score on average and consequently end up at a lower score compared with ACL patients for all KOOS subscales.

• Grindem, Hege; Granan, Lars-Petter; Risberg, May Arna; Engebretsen, Lars; Snyder-Mackler, Lynn & Eitzen, Ingrid (2015). How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. British Journal of Sports Medicine. ISSN 0306-3674. 49(6), p. 385–389. doi: 10.1136/bjsports-2014-093891. Full text in Research Archive Show summary

  Background: Preoperative knee function is associated with successful postoperative outcome after anterior cruciate ligament reconstruction (ACLR). However, there are few longer term studies of patients who underwent progressive preoperative and postoperative rehabilitation compared to usual care. Objectives: To compare preoperative and 2 year postoperative patient-reported outcomes (PROs) in patients undergoing progressive preoperative and postoperative rehabilitation at a sports medicine clinic compared with usual care. Methods: We included patients aged 16–40 years undergoing primary unilateral ACLR. The preoperative and 2 year postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) of 84 patients undergoing progressive preoperative and postoperative rehabilitation at a sports medicine clinic (Norwegian Research Center for Active Rehabilitation (NAR) cohort) were compared with the scores of 2690 patients from the Norwegian National Knee Ligament Registry (NKLR). The analyses were adjusted for sex, age, months from injury to surgery and cartilage/meniscus injury at ACLR. Results: The NAR cohort had significantly better preoperative KOOS in all subscales, with clinically relevant differences (>10 points) observed in KOOS Pain, activities of daily living (ADL), Sports and Quality of Life. At 2 years, the NAR cohort still had significantly better KOOS with clinically relevant differences in KOOS Symptoms, Sports and Quality of Life. At 2 years, 85.7–94% of the patients in the NAR cohort scored within the normative range of the different KOOS subscales, compared to 51.4–75.8% of the patients in the NKLR. Conclusions: Patients in a prospective cohort who underwent progressive preoperative and postoperative rehabilitation at a sports medicine clinic showed superior patient-reported outcomes both preoperatively and 2 years postoperatively compared to patients in the NKLR who received usual care.

• Straume-Næsheim, Truls Martin; Mikaelsen, JR; Sivertsen, EA; Devitt, Brian M.; Brand, J & Granan, Lars-Petter [Show all 7 contributors for this article] (2015). Symptomer og funksjon hos pasienter med residiverende patellaluksasjon sammenlignet med pasienter med fremre korsbåndsskade. In Vagstad, Terje (Eds.), Høstmøteboken - Vitenskapelig program og abstrakter 2015. Norsk Ortopedisk Forening. p. 197–197. Full text in Research Archive
• Owesen, Christian; Sandven-Thrane, Stine; Lind, M; Granan, Lars-Petter & Årøen, Asbjørn (2015). Epidemiology of surgically treated posterior cruciate ligament injuries in scandinavia. In Vagstad, Terje (Eds.), Høstmøteboken - Vitenskapelig program og abstrakter 2015. Norsk Ortopedisk Forening. p. 204–204. doi: 10.1007/s00167-015-3786-2. Full text in Research Archive
• LaPrade, Christopher M.; Dornan, Grant; Granan, Lars-Petter; LaPrade, Robert F. & Engebretsen, Lars (2015). Outcomes After Anterior Cruciate Ligament Reconstruction Using the Norwegian Knee Ligament Registry of 4691 Patients : How Does Meniscal Repair or Resection Affect Short-term Outcomes? American Journal of Sports Medicine. ISSN 0363-5465. 43(7), p. 1591–1597. doi: 10.1177/0363546515577364. Full text in Research Archive Show summary

  Background: While the effects of concurrent meniscal resection and anterior cruciate ligament reconstruction (ACLR) are known to decrease patient outcomes and increase the rate of osteoarthritis over the long term, overall short-term patient functional outcomes in a large cohort of patients are not well known. Purpose/Hypothesis: The purpose of this study was to compare the preoperative and 2-year postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale scores after ACLR with and without meniscal injury. The hypothesis was that, in comparison with an isolated ACLR, patients with a medial meniscal (MM) or lateral meniscal (LM) resection with an ACLR would have significantly decreased 2-year postoperative KOOS outcomes, while those with an ACLR with an MM or LM repair would be indistinguishable from isolated ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: The Norwegian Knee Ligament Registry (NKLR) was used to evaluate outcomes for a total of 4691 patients with primary ACLR. The KOOS scoring system was used to evaluate patients on 5 subscales (Pain, Other Symptoms, Activities of Daily Life [ADL], Sport and Recreation Function, and Quality of Life [QoL]) at time of surgery and at 2-year postoperative follow-up. Patients with isolated ACLR and ACLR with LM repair, LM resection, MM repair, or MM resection were compared using multiple linear regression modeling. Results: Preoperatively, in comparison with isolated ACLR, patients who had an ACLR with either an MM repair or MM resection had significantly lower scores for all KOOS subscores, and LM repair had significantly decreased scores on the Other Symptoms, Pain, and ADL subscales. Postoperatively, in comparison with isolated ACLR, 2-year KOOS outcomes were not significantly different between patients with ACLR and LM repair, MM resection, or LM resection; however, those with MM repair had significantly lower scores on the Other Symptoms and QoL subscales. Conclusion: Patients with ACLR with meniscal resections do not exhibit decreased clinical outcomes at 2 years postoperatively. It is recommended that clinicians follow patients with ACLR and concurrent meniscal treatment for longer than 2 years postoperatively.

• Ingelsrud, Lina H.; Granan, Lars-Petter; Terwee, Caroline B.; Engebretsen, Lars & Roos, Ewa M. (2015). Proportion of Patients Reporting Acceptable Symptoms or Treatment Failure and Their Associated KOOS Values at 6 to 24 Months After Anterior Cruciate Ligament Reconstruction : A Study From the Norwegian Knee Ligament Registry. American Journal of Sports Medicine. ISSN 0363-5465. 43(8), p. 1902–1907. doi: 10.1177/0363546515584041. Full text in Research Archive Show summary

  Background: The proportion of patients perceiving their symptoms as either acceptable or as a failure of treatment after anterior cruciate ligament reconstruction (ACLR) is unknown. Commonly used outcome scores such as the Knee injury and Osteoarthritis Outcome Score (KOOS) suffer from poor interpretability, and little is known about which scores represent an acceptable or failed postoperative outcome. Purpose: To determine the proportion of patients reporting acceptable symptoms or treatment failure at 6 to 24 months after ACLR and to define KOOS values corresponding to the patients’ perceptions of treatment outcome. Study Design: Cross-sectional study; Level of evidence, 3. Methods: In 2012, a total of 1197 patients were randomly extracted from the Norwegian Knee Ligament Registry at 3 postoperative time points: 397 at 6 months, 400 at 12 months, and 400 at 24 months. The inclusion criterion was unilateral primary ACLR. Questions about acceptable symptoms and treatment failure and the KOOS questionnaire were sent to the patients, and those who answered “yes” to the acceptable symptoms question were considered to have acceptable symptoms. Patients who answered “no” to the same question and “yes” to the treatment failure question were considered to have treatment failure. Mean KOOS values and 95% CIs were calculated for each category. Results: A complete data set was obtained from 598 (50%) responders. Fifty-five percent of the patients perceived their symptoms as acceptable at 6-month follow-up versus 66% at 12- to 24-month follow-up. Similarly, 7% at 6-month follow-up perceived their treatment to have failed versus 12% at 12- to 24-month follow-up. Postoperative mean KOOS subscale values ranged from 72 (95% CI, 70-74) to 95 (95% CI, 94-96) for patients with acceptable symptoms and from 28 (95% CI, 22-34) to 71 (95% CI, 65-76) for patients with treatment failure. For both categories, the worst subscale values were seen in the sport and recreation and quality of life subscales and the best in the activities of daily living subscale. Conclusion: Only half of the patients at 6 months and about two-thirds at 1 to 2 years perceived their symptoms as acceptable after ACLR. For these patients, KOOS values reflected no problems to mild problems on average, while for patients reporting treatment failure, KOOS values reflected moderate to severe problems.

• Kristiansen, Annette; Brandt, Linn; Agoritsas, Thomas; Akl, Elie A.; Berge, Eivind & Bondi, Johan Fridtjof [Show all 19 contributors for this article] (2014). Adaptation of trustworthy guidelines developed using the GRADE methodology: a novel five-step process. Chest. ISSN 0012-3692. 146(3), p. 727–734. doi: 10.1378/chest.13-2828. Full text in Research Archive Show summary

  BACKGROUND: Adaptation of guidelines for use at the national or local level can facilitate their implementation. We developed and evaluated an adaptation process in adherence with standards for trustworthy guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, aiming for efficiency and transparency. This article is the first in a series describing our adaptation of Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines for a Norwegian setting. METHODS: Informed by the ADAPTE framework, we developed a five-step adaptation process customized to guidelines developed using GRADE: (1) planning, (2) initial assessment of the recommendations, (3) modification, (4) publication, and (5) evaluation. We developed a taxonomy for describing how and why recommendations from the parent guideline were modified and applied a mixed-methods case study design for evaluation of the process. RESULTS: We published the adapted guideline in November 2013 in a novel multilayered format. The taxonomy for adaptation facilitated transparency of the modification process for both the guideline developers and the end users. We excluded 30 and modified 131 of the 333 original recommendations according to the taxonomy and developed eight new recommendations. Unforeseen obstacles related to acquiring a licensing agreement and procuring a publisher resulted in a 9-month delay. We propose modifications of the adaptation process to overcome these obstacles in the future. CONCLUSIONS: This case study demonstrates the feasibility of a novel guideline adaptation process. Replication is needed to further validate the usefulness of the process in increasing the organizational and methodologic efficiency of guideline adaptation.

• Inacio, Maria C S; Chen, Yuexin; Maletis, Gregory B.; Ake, Christopher F.; Fithian, Donald C. & Granan, Lars-Petter (2014). Injury Pathology at the Time of Anterior Cruciate Ligament Reconstruction Associations With Self-assessment of Knee Function. Clinical Journal of Sports Medicine. ISSN 1050-642X. 24(6), p. 461–467. doi: 10.1097/JSM.0000000000000077. Full text in Research Archive Show summary

  Objective: To evaluate the association of preoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) and structural injuries reported at the time of anterior cruciate ligament reconstruction (ACLR). Design: Cross-sectional study. Setting: Three medical centers in California. Participants: Primary ACLRs (N = 636) performed between January 2009 and June 2010. Independent Variables: The 5 KOOS subscales: pain, other symptoms, activities of daily living (ADL), function in sport and recreation (Sport/Rec), and quality of life (QoL). Main Outcome Measures: Associated injuries (cartilage, medial meniscus, lateral meniscus, other ligaments), identified at the time of ACLR. Results: Sixty-eight percent of the cohort was male and the median age was 26 years. No gender differences in KOOS were observed. No KOOS differences were observed by race, except in Sport/Rec. Younger patients reported higher KOOS. Pain and ADL scores were not associated with any concurrent injury. A 10-point increase in KOOS symptoms subscale was associated with 22% higher likelihood of isolated ACL, 13% lower likelihood of medial meniscus injury, and 10% lower likelihood of lateral meniscus. A 10-point increase in the KOOS Sport/Rec subscale score was associated with 8% higher likelihood of isolated ACL and 9% lower likelihood of medial meniscus injury. A 10-point increase in the KOOS QoL subscale was associated with 15% lower likelihood of medial meniscus injury. Conclusions: Weak associations between the symptoms, Sports/Rec, and QoL subscales and structural injuries at ACLR were observed. The KOOS and its subscales are not useful as indicators of the pattern or severity of preoperative injury of patients presenting for ACLR.

• Skatteboe, Sigrid; Røe, Cecilie; Fagerland, Morten & Granan, Lars-Petter (2014). Expectations for treatment outcomes in neck/back patients regarding improvements in pain and function: A cross-sectional pilot study. European Journal of Physical and Rehabilitation Medicine. ISSN 1973-9087. 50(6), p. 649–656. Full text in Research Archive
• Magnussen, Robert A.; Trojani, Christophe; Granan, Lars-Petter; Neyret, Philippe; Colombet, Philippe & Engebretsen, Lars [Show all 8 contributors for this article] (2014). Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 23(8), p. 2339–2348. doi: 10.1007/s00167-014-3060-z. Full text in Research Archive
• Grindem, Hege; Granan, Lars-Petter; Risberg, May Arna; Engebretsen, Lars; Snyder-Mackler, L & Eitzen, Ingrid (2014). Store forskjeller i knefunksjon 2 år etter korsbåndsrekonstruksjon - progressiv rehabilitering versus standard behandling i Norge. In Drogset, Jon Olav (Eds.), Høstmøteboken : vitenskapelig program og abstrakter 2014. Norsk ortopedisk forening. p. 214–214. Full text in Research Archive
• Sivertsen, Einar; Wagner, LR; Lind, M; Granan, Lars-Petter; Skråmm, Inge & Årøen, Asbjørn (2014). Infeksjon etter ACL rekonstruksjon. Data fra de norske og danske korsbåndregistrene. In Drogset, Jon Olav (Eds.), Høstmøteboken : vitenskapelig program og abstrakter 2014. Norsk ortopedisk forening. p. 2012–2012. Full text in Research Archive
• Granan, Lars-Petter; Baste, Valborg; Engebretsen, Lars & Inacio, Maria C S (2014). Associations between inadequate knee function detected by KOOS and prospective graft failure in an anterior cruciate ligament-reconstructed knee. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 23(4), p. 1135–1140. doi: 10.1007/s00167-014-2925-5. Full text in Research Archive Show summary

  Purpose: First, to evaluate whether the 2 year post-operative Knee injury and Osteoarthritis Outcome Score (KOOS) in primary anterior cruciate ligament reconstructions (ACLRs) was significantly different between patients that did not go on to have a subsequent revision after the 2 year post-operative control and the ones that did. Second, to test whether the “clinically failure” value of KOOS quality of life (QoL) < 44 was indicative of a clinically relevant difference in the risk of subsequent revision ACLR. Methods: ACLRs reported to the Norwegian Knee Ligament Registry between June 2004 and December 2009. 5,517 primary ACLRs with at least 2-year follow-up with KOOS QoL before revision surgery. Results: There were clinically significant differences, adjusted and unadjusted, in both the KOOS Sport and Recreation and QoL subscales in patients with a later revision surgery compared to those that did not have a revision surgery. In adjusted models, the risk of later ACLR revision was 3.7 (95 % CI 2.2–6.0) higher in patients with a 2-year KOOS QoL < 44 compared to patients with a KOOS QoL ≥ 44. For every 10-point reduction in the KOOS QoL, a 33.6 % (95 % CI 21.2–47.5 %) higher risk for later ACLR revision was observed. Conclusions: This study reveals an association between inadequate knee function, as measured by KOOS, and a prospective ACL-reconstructed graft failure. Level of evidence: Prognostic study (prospective cohort study), Level II.

• Kristiansen, Annette; Brandt, Linn; Agoritsas, Thomas; Akl, Elie A; Berge, Eivind & Jacobsen, Anne Flem [Show all 10 contributors for this article] (2014). Applying new strategies for the national adaptation, updating and dissemination of trustworthy guidelines: Results from the Norwegian adaptation of the American College of chest physicans evidence-based guidelines on antithrombotic therapy and the prevention of thrombosis, 9th edidion. Chest. ISSN 0012-3692. 146(3), p. 735–761. doi: 10.1378/chest.13-2993. Full text in Research Archive Show summary

  BACKGROUND: The Antithrombotic Therapy and the Prevention of Thrombosis, 9th Edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) represent trustworthy international guidelines for antithrombotic treatment and thromboprophylaxis. We describe major changes to the format and content resulting from applying new strategies for guideline adaptation and dissemination. METHODS: A Norwegian guideline panel of 46 experts completed a structured and systematic adaptation process, updated the recommendations based on new evidence, and rewrote the recommendations in an electronic multilayered presentation format. We published the adapted guideline using the web-based Making GRADE the Irresistible Choice Guideline Authoring and Publication Platform. RESULTS: We applied a novel presentation format to 333 recommendations from 11 of the 15 management chapters in AT9 and condensed and restructured them into 249 recommendations in a multilayered format. We added additional relevant information, such as 29 best-practice statements about new oral anticoagulants and practical information sections for 121 recommendations. Common reasons for modifications included feasibility of the recommendations in a national context, disagreement with applied baseline risk estimates, and reevaluation of the balance between the benefits and harms of interventions in relation to assumed typical patient preferences and values. The adapted guideline was published and disseminated online in November 2013. CONCLUSIONS: New strategies for adapting, updating, and disseminating trustworthy guidelines proved feasible and will provide Norwegian health-care professionals and patients with up-to-date guidance tailored to national circumstances.

• Årøen, Asbjørn; Sivertsen, Einar; Owesen, Christian; Engebretsen, Lars & Granan, Lars-Petter (2013). An isolated rupture of the posterior cruciate ligament results in reduced preoperative knee function in comparison with an anterior cruciate ligament injury. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 21(5), p. 1017–1022. doi: 10.1007/s00167-012-2132-1. Full text in Research Archive
• Granan, Lars-Petter; Inacio, Maria C.S.; Maletis, Gregory B.; Funahashi, Tadashi T. & Engebretsen, Lars (2013). Sport-Specific Injury Pattern Recorded During Anterior Cruciate Ligament Reconstruction. American Journal of Sports Medicine. ISSN 0363-5465. 41(12), p. 2814–2818. doi: 10.1177/0363546513501791. Full text in Research Archive Show summary

  Background: Anterior cruciate ligament (ACL) injuries are more commonly seen with certain cutting and pivoting sports. However, injury patterns associated with these sports have not been well described. Purpose: (1) To describe the patient demographics and injury pattern at the time of ACL reconstruction (ACLR) by activities that lead to ACL injuries and (2) to estimate the association of activities at the time of injury with the odds of isolated ACL injuries as well as with meniscus, cartilage, and multiligament injuries diagnosed at the time of ACLR. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study combined 2 ACLR registry cohorts, from Norway and the United States, from 2004 to 2011. A cohort of 10,958 primary ACLRs was included. The most prevalent sports activities at the time of injury were the following: soccer, skiing, American football, basketball, and team handball. The end points were the concurrent injury patterns at the time of ACLR: isolated ACL, meniscus, cartilage, and multiligament injuries. Results: All sports were compared with the most prevalent injury mechanism: soccer. Skiing injuries were 1.13 (95% confidence interval [CI], 1.01-1.27) times more likely to result in isolated ACL tears, 2.05 (95% CI, 1.01-4.16) times more likely to result in posterior cruciate ligament tears, 1.94 (95% CI, 1.51-2.49) times more likely to result in medial collateral ligament (MCL) tears, and 1.73 (95% CI, 1.38-2.17) times more likely to result in multiligament injuries. Athletes playing American football were 2.72 (95% CI, 1.32-5.62) times more likely to have MCL tears. Those injured playing basketball were 1.28 (95% CI, 1.06-1.54) times more likely to have lateral meniscus tears, 1.23 (95% CI, 1.01-1.51) times more likely to have cartilage damage, and 1.38 (95% CI, 1.11-1.72) times more likely to have meniscus and cartilage injuries. Athletes injured playing team handball were less likely to have MCL tears (odds ratio [OR], 0.68; 95% CI, 0.46-0.99) and more likely to have lateral meniscus injuries (OR, 1.27; 95% CI, 1.10-1.48). Conclusion: Injury patterns were associated with certain sports. Compared with soccer, American football has a higher likelihood of resulting in multiligament injuries, whereas basketball has a higher likelihood of resulting in cartilage and lateral meniscus injuries. Injury patterns seen at the time of surgery may reflect the forces applied to the knee by the specific sports performed.

• Årøen, Asbjørn; Øiestad, Britt Elin; Sivertsen, Einar; Løken, Sverre Bertrand & Granan, Lars-Petter (2012). Study design and research methodology in sports medicine. In Menetrey, Jacques; Zaffagnini, Stefano; Fritschy, Daniel & Djik, Niek van (Ed.), ESSKA instructional course lecture book. Springer. ISSN 9783642294457. p. 163–171. doi: 10.1007/978-3-642-29446-4_11. Full text in Research Archive
• Ytterstad, Karianne; Granan, Lars-Petter; Ytterstad, Børge; Steindal, Kjersti; Fjeldsgaard, Knut & Furnes, Ove [Show all 7 contributors for this article] (2012). Registration rate in the Norwegian Cruciate Ligament Register Large-volume hospitals perform better. Acta Orthopaedica. ISSN 1745-3674. 83(2), p. 174–178. doi: 10.3109/17453674.2012.678800. Full text in Research Archive Show summary

  Background and purpose: The Norwegian Cruciate Ligament Register (NCLR) was founded in 2004. The purpose of the NCLR is to provide representative and reliable data for future research. In this study we evaluated the development of the registration rate in the NCLR. Methods: The Norwegian Patient Register (NPR) and the electronic patient charts (EPCs) were used as reference data for public and private hospitals, respectively. Data were retrieved for all primary and revision anterior cruciate ligament (ACL) surgery during 2008–2009 in public hospitals and during 2008 in private hospitals. The NOMESCO classification of surgical procedures was used for identification of ACL surgeries. Public hospitals were divided into subgroups according to the annual number of operations in the NPR: small hospitals (< 30 operations) and large hospitals (≥ 30 operations). Results: For the 2-year data extracted from public hospitals, 2,781 and 2,393 operations met the inclusion criteria according to the NPR and the NCLR, respectively, giving an average registration rate of 86% (95% CI: 0.85–0.87). The registration rate for small public hospitals was 69% (CI: 0.65–0.73), which was significantly less than for large public hospitals (89%, CI: 0.88–0.90; p < 0.001). In 2008, private hospitals reported 548 operations to the NCLR while 637 were found in the EPCs, giving a registration rate of 86% (CI: 0.83–0.89). In that year, the registration rate for public hospitals was 86%, which was similar to that for private hospitals. Interpretation: The NCLR registration rate for the period 2008–09 was similar in both 2008 and 2009, and is satisfactory for research. There is room for improvement of registration rates, particularly in hospitals with a small volume of ACL operations.

• Inacio, Maria C.S.; Paxton, Elizabeth W.; Maletis, Gregory B.; Csintalan, Rick P.; Granan, Lars-Petter & Fithian, Donald C. [Show all 7 contributors for this article] (2012). Patient and Surgeon Characteristics Associated With Primary Anterior Cruciate Ligament Reconstruction Graft Selection. American Journal of Sports Medicine. ISSN 0363-5465. 40(2), p. 339–345. doi: 10.1177/0363546511424130. Full text in Research Archive Show summary

  Background: It has been suggested that a surgeon’s experience and training are the most important factors associated with graft selection, but no studies have qualified this association. Graft usage prevalence has not been described for large anterior cruciate ligament reconstruction (ACLR) populations in the United States. Purpose: To describe the prevalence of graft usage in a large community-based practice and evaluate the association of patient, surgeon, and site characteristics with choice of primary ACLR graft. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Primary ACLRs performed between February 2005 and June 2010 were selected for the study. A community-based ligament registry was used to identify cases and variables used for analysis. Graft choice (any allograft, hamstring autograft, and bone–patellar tendon–bone [BPTB] autograft) was compared by patient characteristics and surgeon and site characteristics. Associations between independent variables and graft choice were evaluated using a polychotomous regression model. Results: Of the 9849 patients included in the study, 64% were male, and overall median age was 28 years. Of these, 2796 (28.4%) received BPTB autografts, 3013 (30.6%) received hamstring autografts, and 4040 (41.0%) received allografts. The prevalence of graft source by patients’ gender, race, age, body mass index (BMI), as well as surgeons’ fellowship training status, average volume, and site volume were significantly different (all P < .001). Adjusted models showed that patients’ gender (P < .001), race (P = .018), age (P < .001), BMI (P < .001), as well as surgeons’ fellowship training status (P < .001), average volume (P < .001), and site volume (P < .001) are associated with graft selection. Older and female patients with lower BMI were more likely to receive allografts and hamstring autografts than BPTB autografts. Cases performed by non–fellowship-trained surgeons, lower volume sites, and/or lower volume surgeons were also more likely to be performed with allografts or hamstring autografts than BPTB autografts. Conclusion: Gender, age, race, as well as facility and surgeon characteristics such as volume and location are associated with ACL graft choices.

• Granan, Lars-Petter; Inacio, Maria C S; Maletis, Gregory B.; Funahashi, Tadashi T. & Engebretsen, Lars (2012). Intraoperative findings and procedures in culturally and geographically different patient and surgeon populations : An anterior cruciate ligament reconstruction registry comparison between Norway and the USA. Acta Orthopaedica. ISSN 1745-3674. 83(6), p. 577–582. doi: 10.3109/17453674.2012.741451. Full text in Research Archive Show summary

  Background and purpose: Patient and implant registries are important clinical tools in monitoring and benchmarking quality of care. For comparisons amongst registries to be valid, a common data set with comparable definitions is necessary. In this study we compared the patients in the Norwegian Knee Ligament Registry (NKLR) and the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry (KP ACLRR) with regard to intraarticular findings, procedures, and graft fixation characteristics reported by the operating surgeon for both primary and revision anterior cruciate ligament reconstructions (ACLRs). Methods: We performed a cross-sectional comparison of the NKLR and KP ACLRR cohorts registered between 2005 and 2010. Aggregate-level data including patient characteristics (age, sex, and laterality), meniscal and cartilage injury patterns and corresponding treatment procedures, choice of graft, and fixation characteristics (type and component material) were shared between registries. Descriptive analyses were then conducted. Results: During the study period, 11,217 ACLRs were registered in the NKLR and 11,050 were registered in the KP ACLRR. In the NKLR, hamstring autograft was used more (68% vs. 30%) for primary ACLRs and allograft was used less (0.2% vs. 41%) than in the KP ACLRR. The KP ACLRR reports more meniscal tears among both primary and revision ACLRs (63% and 50% vs. 49% and 36%). The NKLR reports less use of biodegradable fixation devices. Conclusions: Baseline findings between the NKLR and the KP ACLRR were congruent regarding patient characteristics and most injury patterns, adding to the evidence that comparisons and collaborations between these registries will provide generalizable information to the international orthopedic community. The variation in the treatment, including graft and implant selection and meniscus procedures, between the 2 registries provides opportunities to explore the impact of treatment choices on the outcomes of ACLRs.

• Ytterstad, Karianne; Granan, Lars-Petter & Engebretsen, Lars (2011). God rapportering til korsbåndsregisteret. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 131(3), p. 248–250. doi: 10.4045/tidsskr.10.0536. Full text in Research Archive Show summary

  Bakgrunn. Nasjonalt korsbåndsregister fikk i 2010 status som nasjonalt medisinsk kvalitetsregister. Det er viktig at rapporteringsgraden til registeret er høy, slik at man trygt kan bruke registerets data til fremtidig forskning. Formålet med studien var å sammenlikne rapporteringsgraden av operasjoner for rekonstruksjon av fremre korsbånd i Nasjonalt korsbåndsregister (NK) med registrerte data i operasjonsprotokoll-elektronisk pasientjournal (OP-EPJ) og Norsk pasientregister (NPR). Materiale og metode. Vi innhentet data fra Nasjonalt korsbåndsregister, operasjonsprotokoll-elektronisk pasientjournal og Norsk pasientregister elektronisk, per telefon og ved manuell opptelling for 14 tilfeldig valgte sykehus i Norge. Det ble innhentet data fra perioden 1.10. 2005 - 28.2. 2006. Operasjonsprotokoll-elektronisk pasientjournal på sykehusene ble brukt som gullstandard. Resultat. Det totale antall operasjoner ifølge gullstandarden (OP-EPJ) var 202. I Nasjonalt korsbåndsregister manglet sju operasjoner. I Norsk pasientregister manglet 21 operasjoner. Ett privat sykehus rapporterte bare til korsbåndsregisteret og ikke til pasientregisteret i studieperioden, og utførte ifølge elektronisk pasientjournal 19 av de 21 operasjoner som manglet i pasientregisteret. Ser man bort fra dette sykehuset, er det høy registreringsgrad i både korsbåndsregisteret (97 %) og pasientregisteret (99 %) sammenliknet med gullstandarden. Fortolkning. Resultatet bekrefter at Nasjonalt korsbåndsregister har høy rapporteringsgrad to år etter etablering, og at registerets data kan brukes til fremtidig forskning.

• Maletis, Gregory B.; Granan, Lars-Petter; Inacio, Maria C S; Funahashi, Tadashi T. & Engebretsen, Lars (2011). Comparison of Community-Based ACL Reconstruction Registries in the U.S. and Norway. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 93, p. 31–36. doi: 10.2106/JBJS.K.00905. Full text in Research Archive
• Magnussen, Robert; Granan, Lars-Petter; Dunn, WR; Amendola, A; Andrish, Jack T. & Brophy, Robert [Show all 21 contributors for this article] (2010). Cross-cultural comparison of patients undergoing ACL reconstruction in the United States and Norway. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 18(1), p. 98–105. doi: 10.1007/s00167-009-0919-5. Full text in Research Archive Show summary

  Data from large prospectively collected anterior cruciate ligament (ACL) cohorts are being utilized to address clinical questions regarding ACL injury demographics and outcomes of ACL reconstruction. These data are affected by patient and injury factors as well as surgical factors associated with the site of data collection. The aim of this article is to compare primary ACL reconstruction data from patient cohorts in the United States and Norway, demonstrating the similarities and differences between two large cohorts. Primary ACL reconstruction data from the Multicenter Orthopaedic Outcomes Network (MOON) in the United States and the Norwegian National Knee Ligament Registry (NKLR) were compared to identify similarities and differences in patient demographics, activity at injury, preoperative Knee injury and Osteoarthritis Outcome Score (KOOS), time to reconstruction, intraarticular pathology, and graft choice. Seven hundred and thirteen patients from the MOON cohort were compared with 4,928 patients from the NKLR. A higher percentage of males (NKLR 57%, MOON 52%; P < 0.01) and increased patient age (NKLR 27 years, MOON 23 years; P < 0.001) were noted in the NKLR population. The most common sports associated with injury in the MOON cohort were basketball (20%), soccer (17%), and American football (14%); while soccer (42%), handball (26%), and downhill skiing (10%) were most common in the NKLR. Median time to reconstruction was 2.4 (Interquartile range [IQR] 1.2-7.2) months in the MOON cohort and 7.9 (IQR 4.2-17.8) months in the NKLR cohort (P < 0.001). Both meniscal tears (MOON 65%, NKLR 48%; P < 0.001) and articular cartilage defects (MOON 46%, NKLR 26%; P < 0.001) were more common in the MOON cohort. Hamstring autografts (MOON 44%, NKLR 63%) and patellar tendon autografts (MOON 42%, NKLR 37%) were commonly utilized in both cohorts. Allografts were much more frequently utilized in the MOON cohort (MOON 13%, NKLR 0.04%; P < 0.001). Significant diversity in patient, injury, and surgical factors exist among large prospective cohorts collected in different locations. Surgeons should investigate and consider the characteristics of these cohorts when applying knowledge gleaned from these groups to their own patient populations.

• Granan, Lars-Petter; Bahr, Roald; Lie, S.A. & Engebretsen, Lars (2009). Timing of Anterior Cruciate Ligament Reconstructive Surgery and Risk of Cartilage Lesions and Meniscal Tears A Cohort Study Based on the Norwegian National Knee Ligament Registry. American Journal of Sports Medicine. ISSN 0363-5465. 37(5), p. 955–961. doi: 10.1177/0363546508330136. Full text in Research Archive
• Granan, Lars-Petter; Forssblad, M.; Lind, Martin & Engebretsen, Lars (2009). The Scandinavian ACL registries 2004-2007 : baseline epidemiology. Acta Orthopaedica. ISSN 1745-3674. 80(5), p. 563–567. Full text in Research Archive Show summary

  Background and purpose: No prospective surveillance systems have been available for monitoring the outcome of cruciate ligament surgery in Scandinavia (Denmark, Norway, and Sweden). In the present paper we describe the Scandinavian ACL registries including their main function, similarities, and preliminary baseline results. Methods: The Scandinavian registries were established in 2004 (Norway) and 2005 (Denmark and Sweden). The Danish and Swedish registries were originally based on the Norwegian registry, and there is no overriding difference between the three. In Denmark, all hospitals and clinics are legally bound to report to an approved national database. In Norway and Sweden, the registries are based on voluntarily reporting by surgeons. Results: The annual incidence of primary ACL reconstructions is higher in Denmark than in Norway, except in females younger than 20 years. Among Scandinavian surgeons, there is a similar approach to the patients. Differences do, however, exist regarding choice of grafts, choice of implants, and choice of treatment of simultaneous meniscal and cartilage injuries; the proportion of ACL reconstructions performed as outpatient surgery; and the use of prophylactic anticoagulation. Clinically, the preoperative KOOS scores are not significantly different between the Scandinavian registries, except that Denmark reports more symptoms both pre- and postoperatively. Interpretation: The Scandinavian national ACL registries will generate new data about ACL reconstructions. They will contribute important knowledge regarding ACL epidemiology. They will be the only source of data on the performance of a wide range of different implants and techniques. In addition, they will hopefully have an impact on the selection of methods for ACL reconstructions in Scandinavia and elsewhere.

• Bahr, Roald; Granan, Lars-Petter; Lie, Stein Atle & Engebretsen, Lars (2009). Timing of Anterior Cruciate Ligament Reconstructive Surgery and Risk of Cartilage Lesions and Meniscal Tears A Cohort Study Based on the Norwegian National Knee Ligament Registry. American Journal of Sports Medicine. ISSN 0363-5465. 37(5), p. 955–961. Full text in Research Archive Show summary

  Conclusion: The odds of a cartilage lesion in the adult knee increased by nearly 1% for each month that elapsed from the injury date until the surgery date and that of cartilage lesions were nearly twice as frequent if there was a meniscal tear, and vice versa.

• Granan, Lars-Petter; Steindal, K; Furnes, O.N.; Bahr, Roald & Engebretsen, Lars (2008). Development of a national cruciate ligament surgery registry - The Norwegian National Knee Ligament Registry. American Journal of Sports Medicine. ISSN 0363-5465. 36(2), p. 308–315. Full text in Research Archive Show summary

  Conclusions: A national population-based cruciate ligament registry has been developed, implemented, and maintained in Norway. The registry will each year enroll approximately 1500 primary cruciate ligament reconstruction cases. It is expected that inadequate procedures and devices can be identified, as well as prognostic factors associated with good and poor outcomes, at least for the most frequent categories.

• Granan, Lars-Petter; Bahr, Roald; Steindal, Kjersti; Furnes, Ove Nord & Engebretsen, Lars (2008). Development of a national cruciate ligament surgery registry. American Journal of Sports Medicine. ISSN 0363-5465. 36(2), p. 308–315. doi: 10.1177/0363546507308939. Full text in Research Archive
• Solumshengslet, K.; Granan, Lars-Petter; Steindal, K.; Furnes, O.N. & Engebretsen, Lars (2007). Registreringsgrad av Nasjonalt Korsbåndregister. Norsk idrettsmedisin. ISSN 0806-9328. 2, p. 7–11. Full text in Research Archive

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• Ekholdt, Christopher; Granan, Lars-Petter Ness; Stubhaug, Audun; Toennis, Maren; Salthe, Stine & LUNDELAND, BÅRD (2024). Ryggmargsstimulering har en plass i behandling av langvarige smertetilstander. 144(7). doi: 10.4045/tidsskr.24.0120. Full text in Research Archive
• vambheim, Sara Magelssen; Hjellvik, Vidar; Odsbu, Ingvild; Skurtveit, Svetlana Ondrasova; Ekholdt, Christopher & Granan, Lars-Petter Ness [Show all 8 contributors for this article] (2023). Postoperative Opioid Use in Norway - Patterns of Prolonged Use. Full text in Research Archive
• Holmen, Heidi; Holm, Are Martin; Kilvær, Thomas Karsten; Ljoså, Tone Marte; Granan, Lars-Petter Ness & Ekholdt, Christopher [Show all 8 contributors for this article] (2023). Digital Outpatient Services for Adults: Development of an Intervention and Protocol for a Multicenter Non-Randomized Controlled Trial. JMIR Research Protocols. 12. doi: 10.2196/46649. Full text in Research Archive Show summary

  Background: Health care services are being challenged by an increasing number of patients and limited resources. Hence, research investigating options to reduce costs and increase effectiveness is warranted. Digital outpatient services can provide flexible and tailored follow-up, improve patients’ health literacy, and facilitate the identification of adverse courses of disease. However, previous research largely focused on disease-specific contexts and outcomes. Therefore, research on digital services investigating generic outcomes such as health literacy is warranted.<p> <p>Objective: This article aims to describe the “digital outpatient service” intervention and present the protocol for an ongoing multicenter, nonrandomized trial evaluating this intervention.<p> <p>Methods: Based on previous experiences and evidence-based knowledge, we developed this intervention through patient-journey maps in collaboration with each clinical specialty. The patients gain access to a mobile app for self-monitoring and patient-reported outcomes and a chat for contact between the patients and health care workers. The health care workers’ dashboard includes a traffic light system to draw attention to the most urgent patient reports. In this multicenter, non–randomized controlled trial, patients are allocated to the control group receiving standard care or the 6-month intervention. Eligible patients are aged 18 years or older who receive outpatient care at the neurology, lung, pain, or cancer departments at 2 university hospitals in Norway. Our evaluation will include patient-reported outcomes, qualitative interviews, and clinical measures. The primary outcome will be health literacy using the Health Literacy Questionnaire. A sample size of 165 participants is split into a 1:2 ratio in favor of the intervention. We will analyze quantitative data in SPSS (IBM Corp) using descriptive statistics and logistic regression, and qualitative data using thematic analysis.<p> <p>Results: This trial started in September 2021, and the intervention started in January 2022. Recruitment has ended, with 55 patients in the control group and 107 patients in the intervention group. Follow-up is expected to end in July 2023, with results expected to be obtained in December 2023.<p> <p>Conclusions: This study will evaluate an intervention facilitated by an already certified digital multicomponent solution, with intervention content based on patient-reported outcomes, health literacy, and self-monitoring. The intervention is specifically tailored to each participating center and the needs of their patients using patient journey maps. The comprehensive and generic evaluation of this digital outpatient service intervention is a strength as it targets a heterogeneous sample of patients. Thus, this study will provide important knowledge about the applicability and effects of digital health care services. As a result, patients and health care workers will gain a new, evidence-based understanding of whether and how digital tools may be used in clinical care.Background: Health care services are being challenged by an increasing number of patients and limited resources. Hence, research investigating options to reduce costs and increase effectiveness is warranted. Digital outpatient services can provide flexible and tailored follow-up, improve patients’ health literacy, and facilitate the identification of adverse courses of disease. However, previous research largely focused on disease-specific contexts and outcomes. Therefore, research on digital services investigating generic outcomes such as health literacy is warranted.<p>

• Vambheim, Sara Magelssen; Stubhaug, Audun; Ljoså, Tone Marte & Granan, Lars-Petter Ness (2021). S. Vambheim og medarbeidere svarer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(18). doi: 10.4045/tidsskr.21.0819. Full text in Research Archive
• Stubhaug, Audun; Ljoså, Tone Marte; Granan, Lars-Petter & Vambheim, Sara Magelssen (2021). Opioidkrisen kan avblåses. doi: 10.4045/tidsskr.21.0621. Full text in Research Archive
• Østlie, Kristin & Granan, Lars-Petter (2017). Retningslinje for rehablilitering etter ervervet overekstremitetsamputasjon. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(1), p. 15–15. doi: 10.4045/tidsskr.16.1025. Full text in Research Archive
• Aga, Cathrine; Lygre, Stein Håkon Låstad; Granan, Lars-Petter; Kartus, Jüri; Lind, Martin & Engebretsen, Lars (2017). Revisjon av double bundle korsbåndopererte knær i Skandinavia - en registerstudie med over 60 000 pasienter. Full text in Research Archive
• Granan, Lars-Petter (2017). We do not need a third mechanistic descriptor for chronic pain states! Not yet. Pain. ISSN 0304-3959. 158(1), p. 179–179. doi: 10.1097/j.pain.0000000000000735. Full text in Research Archive
• Aga, Cathrine; Kartus, Jüri-Tomas; Lind, Martin; Granan, Lars-Petter & Engebretsen, Lars (2017). No difference in revision rates or treatment failures between single bundle and double bundle anterior cruciate ligament reconstruction, a register study of 66,000 Patients. Full text in Research Archive
• Granan, Lars-Petter (2016). When researchers stumble, clinicians fall and patients suffer. European Journal for Person Centered Healthcare. ISSN 2052-5648. 4(3), p. 431–432. Full text in Research Archive
• Aga, Cathrine; Granan, Lars-Petter; Kartus, J; Lind, M; Maletis, G & Engebretsen, Lars (2016). No difference in revision rates or treatment failures between single bundle and doble bundle anterior cruciate ligament reconstruction, a register study. Full text in Research Archive
• Reme, Silje; Jacobsen, Henrik Børsting; Hafstad, Endre; Granan, Lars-Petter & Ljoså, Tone Marte (2015). Seks grunner til at psykologer bør kunne noe om smerte. Full text in Research Archive
• Granan, Lars-Petter; Jacobsen, Henrik Børsting; Reme, Silje; Stubhaug, Audun; Hansson, Per & Breivik, Harald [Show all 7 contributors for this article] (2015). Tverrfaglig utdanning for bedre smertebehandling. doi: 10.4045/tidsskr.15.0498. Full text in Research Archive
• Magnussen, Robert A.; Trojani, Christophe; Granan, Lars-Petter; Neyret, Philippe; Colombet, Philippe & Engebretsen, Lars [Show all 8 contributors for this article] (2015). Erratum to: Patient demographics and surgical characteristics in ACL revision: a comparison of French, Norwegian, and North American cohorts. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. Published ahead of print. doi: 10.1007/s00167-015-3835-x. Full text in Research Archive
• LaPrade, Christopher M; Dornan, Grant; Granan, Lars-Petter; LaPrade, R.F. & Engebretsen, Lars (2015). Outcomes after anterior cruciate ligament reconstruction using the norwegian knee ligament registry of 14,142 patients: How does meniscal repair or resection affect short-term outcomes. Full text in Research Archive
• Owesen, Christian; Sivertsen, Einar; Engebretsen, Lars; Granan, Lars-Petter & Årøen, Asbjørn (2015). Patients with an isolated PCL injury improve as much as the ACL patioens from surgery measured by KOOS after 2 years. Full text in Research Archive
• Granan, Lars-Petter; Jacobsen, Henrik Børsting; Reme, Silje; Stubhaug, Audun; Hansson, Per & Breivik, Harald [Show all 7 contributors for this article] (2015). Tverrfaglig utdanning for bedre smertebehandling. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(12/13), p. 1114–1115. doi: 10.4045/tidsskr.15.0498. Full text in Research Archive
• Straume-Næsheim, Truls Martin; Mikaelsen, JR; Sivertsen, EA; Devitt, Brian M.; Brand, J & Granan, Lars-Petter [Show all 7 contributors for this article] (2015). Symptomer og funksjon hos pasienter med residiverende patellaluksasjon sammenlignet med pasienter med fremre korsbåndskade. Full text in Research Archive Show summary

  Innledning: Patellaluksasjon er en betydelig kneskade med høyest forekomst i alderen 10-17 år. Opp mot 40 % av disse får vedvarende plager med re-dislokasjoner og vedvarende frykt for nye hendelser. Dette gjør at de ikke stoler på kneet og det er en følelse de deler med pasienter som har røket fremre korsbånd. Den siste gruppen har tradisjonelt fått mer fokus i og denne studien ønsket derfor å sammenligne symptomene hos de med residiverende patellaluksasjon med korsbåndpasienter som er satt opp til korsbåndrekonstruksjon. Materialer og metoder: Patellaluksasjonsgruppen bestod av pasienter med to eller flere unilaterale patellaluksasjoner som var søkt inn til rekonstruksjon av mediale patellofemorale ligament (MPFL) fra mai 2010 til mai 2014. Hver av disse ble matchet etter alder, kjønn, og BMI med to pasienter fra Korsbåndregisteret (ACL). Preoperativ Knee injury and Osteoarthritis Outcome Score (KOOS) ble brukt for å vurdere og funksjon for begge grupper. Gruppene ble også sammenlignet i forhold til forekomst av bruskskader og tid fra skade til operasjon. Resultater: I alt 33 pasienter (10 menn og 23 kvinner, snittalder 18,9 (SD=5,0)) ble inkludert i MPFL gruppen. Disse ble matchet med 66 ACL pasienter. MPFL-gruppen hadde signifikant lavere resultat enn ACL gruppen for de tre første underkategoriene av KOOS (MPFL/ACL); smerte; 72,1/80,7 (p=0,021), symptomer; 68,3/79,2 (p<0,01) og daglige aktiviteter; 83,3/90,3 (p<0,01). De laveste resultatene for KOOS var for underkategoriene sport; 51,4/54,5 og livskvalitet; 37,5/38,4, men her var det ingen forskjell mellom MPFL og ACL gruppen. I MPFL-gruppen hadde 36,4 % bruskskade ved operasjonstidspunktet mens tilsvarende tall for ACL-gruppen var kun 7,6 % (p<0,001). Samtidig var gjennomsnittstiden fra første skade til operasjon 32,5 måneder for MPFL-gruppa mot 6,5 måneder for ACL-gruppen. Diskusjon og klinisk relevans: Pasienter med residiverende patellaluksajsoner er like plaget funksjonelt og oppgir mer smerter enn pasienter med sviktende knefunksjon som følge av fremre korsbåndsskade. Patelaluksasjonsgruppen har også 5 ganger så hyppig bruskskade ved operasjonstidspunktet og man venter i snitt 5 ganger så lenge med operasjon fra første skadetidspunkt sammenlignet med de med korsbåndskade

• Owesen, Christian; Sandven-Thrane, Stine; Lind, M; Forssblad, M; Granan, Lars-Petter & Årøen, Asbjørn (2015). Epidemiology surgically treated posterior cruciate ligament injuries in Scandinavia. Full text in Research Archive Show summary

  Innledning: Bakre korsbånd (PCL) er kneets sterkeste ligament og hindrer i hovedsak posterior translasjon av tibia i forhold til femur, men PCL har også en sekundær stabiliserende funksjon. Det er stor variasjon i rapportert insidens av og årsak til PCL-skader. Det er også uoverensstemmelse i litteraturen når det gjelder forekomst av ledsagende skader. Hensikten med denne studien var å gi en oversikt over skademekanismer, ledsagende skader og andre epidemiologiske data for PCL-skader i de skandinaviske kneligamentregistrene. Materialer og Metoder: Totalt 1287 pasienter som gikk gjennom PCL-rekonstruksjon fra 2004-2013 i de Skandinaviske landene ble inkludert fra de nasjonale ligamentregistrene. Variablene alder, kjønn, aktivitet og graft benyttet ved rekonstruksjon ble samlet inn. Deretter ble skadene sortert basert på ledsagende skader. Til slutt ble data fra de forskjellige landene sammenliknet. Resultater: Pasientenes gjennomsnittsalder var 32.7 år. Kjønnsfordelingsratio var mann kvinne 66.7 %:33.3 %. Avhengig av definisjon var 26-37 % av de behandlede skadene isolerte skader. PCLskader var oftest forekommende i idrett med 35.4 % av det totale antallet PCL-skader. Fotball var den idretten med høyest antall skader (13.1 %). Minimum ett annet ligament var skadet hos 62.2 %. 26.1 % av PCL-skadene hadde en ledsagende bruskskade, 21.0 % hadde meniskskade. Hamstring autograft var det graftet som ble benyttet hyppigst ved rekonstruksjon. Diskusjon: Om lag 1/3 av PCL-skadene er isolerte skader, og er derfor klinisk viktig. Dette er ny informasjon når det gjelder kneligamentskader. Det er høy prevalens av ledsagende brusk- og meniskskader assosiert med PCL-skader, spesielt der minst ett annet ligament også er skadet. Dette kan muligvis forklares ut fra skademekanisme, men dette er fremdeles usikkert. Idrett er den aktivitet som oftest forårsaker PCL-skader som behandles kirurgisk. Dette er i kontrast til den tradisjonelle oppfatningen at PCL-skader forårsakes av dashboard-traume i bilulykker. Det er noen forskjeller i aktiviteter som fører til PCL-skade i de forskjellige landene, og forskjellene kan for en stor del tilskrives antallet utøvere av de forskjellige idrettene. Betydning/Relevans: Grunnleggende kunnskap mangler når det gjelder etiologien til PCL-skader og ledsagende skader. Dette gjør det vanskelig å vurdere hvor representativt materialet som publiseres i ulike ortopediske journaler i virkeligheten er. Epidemiologiske data er en nødvendig del av skadeforebygging i fremtiden. Prevalensen av ledsagende skader er avgjørende for valg av kirurgisk prosedyre og for de forventede resultatene etter kirurgi. De senere år er stadig flere PCL-skader behandlet kirurgisk. Denne studien sikter på å dekke huller i den eksisterende litteraturen ettersom de skandinaviske registrene inneholder et relativt stort antall PCL-skader. Det store antallet gjør det mulig å analysere skademekanismer og ledsagende skader.

• Owesen, Christian; Sandven-Thrane, Stine; Lind, Martin; Forssblad, Magnus; Granan, Lars-Petter & Årøen, Asbjørn (2015). Epidemiology of surgically treated posterior cruciate ligament injuries in scandinavia. Full text in Research Archive
• Owesen, Christian; Sandven-Thrane, Stine; Lind, Martin; Forssblad, Magnus; Granan, Lars-Petter & Årøen, Asbjørn (2015). Epidemiology of surgically treated posterior cruciate ligament injuries in scandinavia. Norsk idrettsmedisin. ISSN 0806-9328. 30(3), p. 43–43. doi: 10.1007/s00167-015-3786-2. Full text in Research Archive
• Owesen, Christian; Sivertsen, Einar; Engebretsen, Lars; Granan, Lars-Petter & Årøen, Asbjørn (2015). Patients With An Isolated PCL Injury Improve As Much As The ACL Patients From Surgery Measured By KOOS After 2 Years. Orthopaedic Journal of Sports Medicine (OJSM). 3(7). doi: 10.1177/2325967115S00072. Full text in Research Archive
• Granan, Lars-Petter (2014). The Norwegian National Knee Ligament Registry. Full text in Research Archive
• Vandvik, PO; Granan, Lars-Petter; Holme, PA & Bondi, J (2014). Antitrombotisk behandling ved kirurgi. 134(9), p. 925–925. Full text in Research Archive
• Granan, Lars-Petter (2014). Siste nytt om bakre korsbåndskader - Registerrapport. Full text in Research Archive
• Grindem, Hege; Granan, Lars-Petter; Risberg, May Arna; Engebretsen, Lars; Snyder-Mackler, L & Eitzen, Ingrid (2014). Store forskjeller i knefunksjon 2 år etter korsbåndsrekonstruksjon - progressiv rehabilitering versus standard behandling i Norge. Full text in Research Archive
• Sivertsen, Einar; Wagner, LR; Lind, M; Granan, Lars-Petter; Skråmm, Inge & Årøen, Asbjørn (2014). Infeksjon etter ACL rekonstruksjon. Data fra de norske og danske korsbåndregistrene. Full text in Research Archive
• Grindem, Hege; Granan, Lars-Petter; Risberg, May Arna; Engebretsen, Lars; Snyder-Mackler, L & Eitzen, Ingrid (2014). Store forskjeller i knefunksjon 2 år etter korsbåndsrekonstruksjon - progressiv rehabilitering versus standard behandling i Norge. Norsk idrettsmedisin. ISSN 0806-9328. p. 19–19. Full text in Research Archive
• Grindem, Hege; Granan, Lars-Petter; Risberg, May Arna; Engebretsen, Lars; Snyder-Mackler, L & Eitzen, Ingrid (2014). Store forskjeller i knefunksjon 2 år etter korsbåndsrekonstruksjon - progressiv rehabilitering versus standard behandling i Norge. Full text in Research Archive
• Granan, Lars-Petter (2012). Scandinavian ACL register - what lessons have been learnet? Full text in Research Archive
• Granan, Lars-Petter (2012). Pitfalls and strengths in registry studies. Full text in Research Archive
• Granan, Lars-Petter (2012). The Norwegian scene from the ACL registry. Full text in Research Archive
• Granan, Lars-Petter (2011). Update and future direction of the Norwegian ACL registry. Full text in Research Archive
• Granan, Lars-Petter (2011). Translating research into clinical practice. Full text in Research Archive
• Granan, Lars-Petter (2010). Effects of cartilage and meniscus injuries on ACL reconstruction outcome. Full text in Research Archive
• Granan, Lars-Petter; Bahr, Roald; Lie, Stein Atle & Engebretsen, Lars (2009). Timing of ACL reconstructive surgery, and risk of cartilage lesions and meniscal tears. Full text in Research Archive
• Granan, Lars-Petter (2008). Nasjonalt Korsbåndsregister. Full text in Research Archive
• Granan, Lars-Petter; Bahr, Roald; Lie, SA & Engebretsen, Lars (2008). Timing av korsbåndskirurgi. Full text in Research Archive
• Granan, Lars-Petter (2008). Regional Symposium: The potential impact of the Scandinavian Knee Ligament Registries Scandinavia. The results from the Norwegian Registry. Full text in Research Archive
• Lind, Martin; Forssblad, M.; Granan, Lars-Petter & Jacobsen, Bent Wulff (2007). The effect og ACL registries on the practice of ACL surgery. Full text in Research Archive
• Solumshengslet, Kristoffer; Granan, Lars-Petter; Steindal, K; Furnes, O.N. & Engebretsen, Lars (2007). Registreringsgrad i Nasjonalt korsbåndsregister. Norsk idrettsmedisin. ISSN 0806-9328. 22(2), p. 79–11. Full text in Research Archive Show summary

  Bakgrunn: 7. juni 2004 ble Nasjonalt korsbåndsregister etablert. Registerets validitet avhenger av kavaliteten på registrerte data og registreringsgrad av korsbåndskirurgisk aktivitet i Norge. Studiens formål var å undersøke registreringsgrad i Nasjonalt korsbåndsregister i forhold til Norsk pasientregister og operasjonsprotokoller ved sykehusene. i første driftsår. Materiale og metode: Antallet registreringer av primære fremre korsbåndsoperasjoner i Nasjonalt korsbåndsregister, Norsk pasientregister og operasjonsprotokoller ble sammenlignet for perioden 01.10.2004 - 28.02.2005. Ti sykehus ble valgt ut til å delta basert på kriteriene helseregioner, private og offentlige, operasjonsvolum og tilknytningsgrad i etableringen av registeret. Resultater: Registreringsgrad i studieperioden var 84,1% (95% KI 79,1% - 89,1%) sammenlignet med Norsk pasientregister. I samme periode var det 85,8% (95% KI 80.8% - 90,8%) registreringsgrad sammenlignet med operasjonsprotokollene. Fortolkning: Tallene viser en høy registreringsgrad allerede første driftsår. Dette tyder på at Nasjonalt korsbåndsregister allerede i en tidlig fase kan medvirke til kvalitetssikring og kvalitetsutvikling i behandlingen av pasienter med korsbåndsskader.

• Granan, Lars-Petter; Engebretsen, Lars; Bahr, Roald; Steindal, K & Furnes, O.N. (2007). The national knee ligament registry in Norway. Full text in Research Archive
• Granan, Lars-Petter (2007). The effect of ACL registres on the practiceof ACL surgery. Full text in Research Archive
• Granan, Lars-Petter (2007). The national knee-ligament registry in Norway. Full text in Research Archive
• Granan, Lars-Petter (2007). Nasjonalt korsbåndregister. Full text in Research Archive
• Granan, Lars-Petter (2007). Nasjonalt korsbåndregister. Full text in Research Archive
• Granan, Lars-Petter (2007). The National knee Ligament Registery. Full text in Research Archive
• Bahr, Roald; Granan, Lars-Petter; Engebretsen, Lars; Steindal, K & Furunes, ON (2006). Nasjonalt korsbåndregister. Full text in Research Archive
• Forssblad, M.; Granan, Lars-Petter & Lind, M. (2006). The Scandinavian ACL Registry - why it will change ACL surgery in the future? Full text in Research Archive
• Granan, Lars-Petter (2009). Development of a national knee ligament registry. Unipub forlag. ISSN 9788280723512. Full text in Research Archive

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