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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.



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Background: The ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) neurocognitive testing battery is a popular assessment tool used for concussion management. The stability of the baseline neurocognitive assessment is important for accurate comparisons between postconcussion and baseline neurocognitive performance. Psychometric properties of the recently released online version of ImPACT have yet to be established; therefore, research evaluating the reliability of this measure is warranted.

Purpose: The authors investigated the 1-year test-retest reliability of the ImPACT online version in a sample of high school athletes.

Study Design: Case series; Level of evidence, 4

Methods: A total of 369 varsity high school athletes completed 2 mandatory preseason baseline cognitive assessments approximately 1 year apart as required by their respective athletics program. No diagnosed concussion occurred between assessments.

Results: Intraclass correlation coefficients (ICCs) for ImPACT online indicated that motor processing speed (.85) was the most stable composite score, followed by reaction time (.76), visual memory (.70), and verbal memory (.62). Unbiased estimates of reliability were consistent with ICCs: motor processing speed (.85), reaction time (.76), visual memory (.71), and verbal memory (.62).

Conclusion: The online ImPACT baseline is a stable measure of neurocognitive performance across a 1-year time period for high school athletes. These reliability data for online ImPACT are higher than the 2-year ICCs previously reported from the desktop version.

Clinical Relevance: It is recommended that the ImPACT baseline assessment (both desktop and online) continue to be updated every 2 years. The online version of ImPACT appears to be a stable measure of neurocognitive performance over a 1-year period, and systematic evaluation of its stability over a 2-year period is warranted.

 

Background: Computer-based tests are widely used for the purpose of documenting baseline neurocognitive function, and athletes are often tested in groups. At present, there is limited research on the effects of administering these tests in a group versus individual setting.

Hypothesis: Athletes assessed with neurocognitive tests in groups would show decreased performance compared with those assessed individually.

Study Design: Cohort study; Level of evidence, 3.

Methods: High school athletes completed preseason baseline neurocognitive tests either in groups in their school or individually in a private neuropsychological clinic (with no significant between-group differences in sex, history of concussion, and attention deficit disorder/learning disability). All athletes completed the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) test battery on 1 occasion, which yielded scores in the area of verbal memory, visual memory, motor processing speed, reaction time, and symptom scores.

Results: Athletes in the group setting scored significantly lower on verbal memory (mean 83.4 vs 86.5; P = .003), visual memory (mean 71.6 vs 76.7; P = .0001), motor processing speed (mean 35.6 vs 38.4; P = .0001), and reaction time (mean 0.61 vs 0.57; P = .001), but not symptom scores (mean 6.1 vs 4.4; P = .11), and exhibited a greater rate of invalid baselines. Similar results were obtained after excluding athletes with attention deficit disorder/learning disability and/or a history of concussion.

Conclusion: Administering baseline neurocognitive testing to athletes in a group setting may introduce extraneous error, negatively affecting test performance.




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