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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: Elbow injury is common in boxing, but it has not been reported in the literature. The onset is often a hyperextension trauma caused by a missed hit. Clinically the boxers complain of pain, stiffness, and an extension deficit.

Purpose: To evaluate the pathogenesis, diagnostic approach, and arthroscopic treatment of elbow injury in boxers, and to compare these with other sports-related elbow injuries.

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

Methods: Between 2003 and 2005, a group of 5 professional boxers received a diagnosis of posterior elbow impingement. An arthroscopic debridement was performed. All patients were evaluated preoperatively and 1 year postoperatively with the Hospital for Special Surgery Elbow Assessment Scale.

Results: An arthroscopic partial resection of the posterior olecranon tip was performed, and osteophytes and fibrous tissue were removed in this area. Loose bodies were removed from the elbow in 3 patients. They were present in the posterior compartment in 2 patients and the anterior compartment in 1. The Hospital for Special Surgery score showed satisfactory to good improvement after 1 year in all 5 cases. They all showed a normal function at follow-up and had a full return to their sports activities. In contrast with the valgus extension overload syndrome, our patients did not show any signs of concomitant ulnar collateral ligament injury.

Conclusion: Posterolateral elbow impingement in boxers is caused by hyperextension trauma. Concomitant medial elbow instability was not present. Standard arthroscopic debridement showed good results.




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