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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: Several reconstruction procedures have been proposed to manage recurrent dislocation of the superior tibiofibular joint.

Hypothesis: Reconstruction of the superior tibiofibular joint using a gracilis tendon autograft is effective in recurrent dislocation of the superior tibiofibular joint.

Study Design: Case series; Level of evidence, 4.

Methods: Eight patients with recurrent dislocation of the superior tibiofibular joint without anatomical predisposing factors and who practiced sports were included in the study. Evaluation included the modified Cincinnati rating system and the Kujala score, anthropometry, plain radiography, and isokinetic dynamometry.

Results: The average follow-up was 44 ± 13 months. The mean modified Cincinnati score increased from 54 preoperatively to 92 (P = .01). The mean Kujala scores increased from 48 preoperatively to 85 (P = .05). The muscle volume of the thigh of the operated limb remained less well developed than the muscle volume of the nonoperated limb (P = .05). Significant isokinetic strength differences were found between the operated and the contralateral limb (P = .02) even at the latest follow-up.

Conclusion: Gracilis autograft for posttraumatic instability of the superior tibiofibular joint is a safe, reliable management option for recurrent dislocation of the superior tibiofibular joint in patients without any predisposing factors.




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