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15 years of the Scandinavian knee ligament registries: lessons, limitations and likely prospects
  1. Eric Hamrin Senorski1,
  2. Eleonor Svantesson2,
  3. Lars Engebretsen3,4,
  4. Martin Lind5,
  5. Magnus Forssblad6,
  6. Jon Karlsson2,7,
  7. Kristian Samuelsson2,7
  1. 1 Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
  2. 2 Department of Orthopaedics, Institue of Clinical Sciences, Goteborgs Universitet, Gothenburg, Sweden
  3. 3 Orthopedic Clinic, Oslo University Hospital and University of Oslo, Oslo, Norway
  4. 4 OSTRC, The Norwegian School of Sports Sciences, Oslo, Norway
  5. 5 Sportstrauma Division, Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
  6. 6 Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden, Stockholm, Sweden
  7. 7 Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
  1. Correspondence to Dr Kristian Samuelsson,Department of Orthopaedics, Institute of Clinical Sciences, Gothenburg, Sweden; kristian{at}

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High-quality national health registries provide the opportunities to: (1) improve patient outcomes by giving medical units and clinicians relevant feedback about their work; (2) detect inferior treatments and (3) identify prognostic factors associated with both good and bad outcomes. The Scandinavian knee ligament registries were established in 2004 and 2005, include data from 70 000 patients,1 and have led to more than 70 studies publications already (2019). This editorial reflects on lessons learnt, limitations identified and what the future may hold.

Lessons learnt

Two systematic reviews including all studies from the registries focused on factors associated with (1) additional anterior cruciate ligament (ACL) reconstruction and (2) patient-reported outcomes after ACL injury and reconstruction are summarised in table 1.2 3

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Table 1

Primary findings of the systematic reviews on the Scandinavian knee ligament registries

There is a balance in health registry studies between the large number of patients that decrease the type-II error (false negative) risk, and the multiple analyses and similar questions that are addressed which increase the type-I error (false positive) risk. Registry data are also susceptible to confounding interactions, some of which are unknown. Nevertheless, the registries produce results that reflect day-to-day practice owing to two key factors, a high rate of coverage (proportion of medical units who participate in relation to all eligible medical units) and completeness (proportion of target population in the registry). However, it must be remembered that the response rates from patient-reported follow-ups are a persistent challenge for health registries, where at …

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  • Contributors EHS, ES and KS have substantially contributed and are primarily responsible of drafting the work and revising the manuscript. LE, ML, MF and JK have supported the drafting of the work and revising it critically for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.