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Background: A treatment algorithm and screening examination have been developed to guide patient management and prospectively determine potential for highly active individuals to succeed with nonoperative care after anterior cruciate ligament rupture.

Objective: To prospectively characterize and classify the entire population of highly active individuals over a 10-year period and provide final outcomes for individuals who elected nonoperative care.

Methods: Inclusion criteria included presentation within 7 months of the index injury and an International Knee Documentation Committee level I or II activity level before injury. Concomitant injury, unresolved impairments, and a screening examination were used as criteria to guide management and classify individuals as noncopers (poor potential) or potential copers (good potential) for nonoperative care.

Results: A total of 832 highly active patients with subacute anterior cruciate ligament tears were seen over the 10-year period; 315 had concomitant injuries, 87 had unresolved impairments, and 85 did not participate in the classification algorithm. The remaining 345 patients (216 men, 129 women) participated in the screening examination a mean of 6 weeks after the index injury. There were 199 subjects classified as noncopers and 146 as potential copers. Sixty-three of 88 potential copers successfully returned to preinjury activities without surgery, with 25 of these patients not undergoing anterior cruciate ligament reconstruction at the time of follow-up.

Conclusion: The classification algorithm is an effective tool for prospectively identifying individuals early after anterior cruciate ligament injury who want to pursue nonoperative care or must delay surgical intervention and have good potential to do so.



NAVIGATION


         

 

Background

The posterior cruciate ligament heals to some extent after injury. However, results after conservative treatment may diminish with long-term follow-up. Bone morphogenetic protein-12 can induce formation of ligament tissues.


Hypothesis

Bone morphogenetic protein-12 gene transfer can improve the histologic and biomechanical properties of healing posterior cruciate ligaments.


Study Design

Controlled laboratory study.


Methods

Bilateral posterior cruciate ligaments of 32 rabbits were injured. The cut ends in 1 limb received an injection containing 3 x 107 pfu recombinant bone morphogenetic protein-12 adenovirus, and the posterior cruciate ligament in the contralateral limb served as an untreated control. Eight rabbits were sacrificed at each time point of 3, 6, 12, and 26 weeks after the operation. In addition, 6 rabbits receiving a sham operation were used to obtain normal control data. The posterior cruciate ligament specimens were evaluated biomechanically and histologically.


Results

The repair tissue of the treatment group at 26 weeks was similar to the normal posterior cruciate ligament in collagen arrangement, collagen formation, and mechanical properties. At weeks 6, 12, and 26, the ultimate load, stiffness, and energy absorbed at failure of the treatment group were significantly greater than those of the untreated group.


Conclusion

Adenovirus-mediated bone morphogenetic protein-12 gene transfer in a partial posterior cruciate ligament laceration rabbit model resulted in an obvious improvement of histologic properties, tensile strength, and stiffness of the repaired ligaments, indicating improved posterior cruciate ligament healing.


Clinical Relevance

Bone morphogenetic protein-12 gene transfer is a potential future strategy to improve the repair of injured posterior cruciate ligaments.




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