Globalepolicy.org is a free to access global medical news service for the consumer, professional and researcher.


             
 

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: Although successful at restoring near normal laxity to the knee in the short term, anterior cruciate ligament reconstructions have not been shown to prevent the development of posttraumatic arthritis.

Hypothesis: Bone bruises and articular cartilage injuries sustained at the time of initial injury (1991) would not resolve. Our secondary hypothesis was that the presence of a bone bruise or articular cartilage injury originally identified on magnetic resonance imaging would not be associated with long-term outcomes after anterior cruciate ligament reconstruction evaluated by the International Knee Documentation Committee questionnaire.

Study Design: Cohort study (prognosis); Level of evidence, 1.

Methods: We attempted to contact all patients from an original cohort (N = 54) for follow-up evaluation, which included repeat radiographs, magnetic resonance images, physical examination, and International Knee Documentation Committee questionnaire more than a decade postoperatively.

Results: Forty-four patients (82% of the original cohort) returned for on-site follow-up. No patient with a bone bruise identified on original magnetic resonance imaging had one identified at 12-year follow-up. The mean ( ± SD) International Knee Documentation Committee score at follow-up with no bone bruise originally present was 70.6 ( ± 12.7) versus 70.0 ( ± 8.1) when a bone bruise was observed (P > .05). No consistent association was observed between the presence of an initial articular cartilage lesion with a lesion on follow-up magnetic resonance images. The mean ( ± SD) International Knee Documentation Committee score at follow-up with no articular cartilage injury was 69.0 ( ± 11.9) versus 72.8 ( ± 12.0) with articular cartilage lesion (P > .05).

Conclusion: All bone bruises identified in our study with magnetic resonance imaging at the time of initial injury had resolved at 12-year follow-up. The presence of a bone bruise at the time of initial injury did not significantly alter the patient-oriented outcome by International Knee Documentation Committee after anterior cruciate ligament reconstruction. Additionally, articular cartilage abnormality on magnetic resonance imaging did not influence the International Knee Documentation Committee score.




August 2008
Mon Tue Wed Thu Fri Sat Sun
« Jul    
 123
45678910
11121314151617
18192021222324
25262728293031