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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: Pelvis and trunk motions during baseball pitching are associated with ball velocity. Thus, limits in hip flexibility may adversely affect pitching biomechanics and the ability to generate ball velocity.

Hypotheses: Professional baseball pitchers will have less passive range of motion in the nondominant hip and the measured ranges of motion of both the nondominant and dominant hips will correlate with biomechanical parameters of the lower extremity among professional pitchers.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Nineteen healthy professional baseball pitchers volunteered for testing. Fluid goniometry was used to measure passive range of motion of adduction (ADD), abduction (ABD), internal rotation, external rotation, total arc of rotation, and total arc of ADD + ABD. Pitching biomechanical data were collected using an automated 3-dimensional motion analysis system while participants threw fastballs.

Results: Pitchers possessed significantly less passive range of motion in the nondominant hip when compared with the dominant hip for all ranges. Total arc of rotation of the nondominant hip correlated with ball velocity (r = .50). Total arc of ADD + ABD in the nondominant hip and ABD in the nondominant hip were correlated with stride length (r = –.72 and .70, respectively). Dominant hip ABD (r = .63), total arc of rotation in the nondominant hip (r = –.45), and total arc of ADD + ABD of the dominant hip (r = .44) were correlated with trunk separation. Total arc of ADD + ABD of the nondominant hip (r = –.52) and total arc of rotation of the dominant hip (r = –.44) were correlated with pelvic orientation.

Conclusion: Passive range of motion is smaller in the nondominant hip than the dominant hip among professional pitchers. The measured disparity between the hips is significantly correlated with various pitching biomechanical parameters of the trunk and pelvis. Future research is required to investigate a causal relationship between less hip passive range of motion and both ball velocity and pitching biomechanics.




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