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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 authors previously identified a significant association between lumbar disc degeneration (LDDG) and cartilage intermediate layer protein (CILP) single nucleotide polymorphism (SNP) in collegiate male judokas.

Hypothesis: A significant association between LDDG and the CILP SNP is observed in Japanese collegiate athletes.

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

Methods: The participants were 601 trained collegiate athletes (male, 403; female, 198) from 7 different sports. Lumbar disc degeneration was evaluated using T2-weighted magnetic resonance imaging. Genotyping of the CILP gene (1184T/C) was performed by using DNA sequencing.

Results: Among the 601 collegiate athletes, the odds ratio (OR) for the occurrence of LDDG with the CILP C allele was 1.4 (95% confidence interval [CI], 1.05-1.86). By using logistic regression analysis concomitant with the interaction term and the Wald test, the authors found that weight (OR, 1.04; 95% CI, 1.02-1.06), CILP genotype (CT: OR, 2.0; 95% CI, 1.24-3.15; CC: OR, 2.9; 95% CI, 1.09-7.74), and gender (OR, 2.1; 95% CI, 1.21-3.67) were significant risk factors for LDDG. These analyses also indicated that there was no effect of the CILP genotype on LDDG in female athletes.

Conclusion: The CILP SNP 1184T/C is a risk factor for male collegiate athletes. Information regarding the CILP gene polymorphism may be important for preventing and managing lumbar disc diseases, especially in male athletes.




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