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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: Participation in snowboarding as a winter sport is comparable to alpine skiing concerning the demographics of the participants, risk of injury, and variation in types of injuries sustained.

Purpose: To examine the types of snowboarding injuries and changes in injury patterns over time. We also sought to highlight important differences in injury patterns between snowboarders and alpine skiers as affected by age, experience, and sex.

Study Design: Case control; Level of evidence, 3.

Methods: Data were collected on injured snowboarders and skiers in a base-lodge clinic of a ski resort in Vermont over 18 seasons (1988-2006) and included extensive information about injury patterns, demographics, and experience. Control data were also obtained during this time period to provide information about the population at risk.

Results: The injury rates were assessed as mean days between injuries (MDBI). The average MDBI for all injuries among snowboarders was 345 as compared with 400 for skiers (the lower the number, the higher the injury rate). The most common type of injury for snowboarders was a wrist injury (MDBI, 1258), while for skiers, it was an anterior cruciate ligament (ACL) sprain (MDBI, 2332). Wrist injuries accounted for 27.6% of all snowboard injuries and 2.8% of skiing injuries, and ACL injuries composed 1.7% of all snowboard injuries and 17.2% of skiing injuries. Among snowboarders, more wrist injuries, shoulder soft tissue injuries, ankle injuries, concussions, and clavicle fractures were seen, while skiers had more ACL sprains, medial collateral ligament (MCL) sprains of the knee, lateral collateral ligament (LCL) sprains of the knee, lower extremity contusions, and tibia fractures. The trend analysis revealed an increased incidence of clavicle fractures (P < .01) and a decrease in MCL injuries (P < .01) and ankle injuries (P < .025) among snowboarders over time. Skiers had a decrease in thumb metacarpophalangeal-ulnar collateral ligament (MCP-UCL) injuries (P < .001) and MCL injuries of the knee (P < .001) over time. We found the highest rate of injury among young, inexperienced, female snowboarders. When examining the location of injury, 21.8% of snowboard injuries occurred in the terrain park compared with 6.5% of ski injuries.

Conclusion: Injury rates in snowboarders have fluctuated over time but currently remain higher than in skiers. Wrist, shoulder, and ankle injuries are more common among snowboarders, while knee ligament injuries are more common in skiers. Injured snowboarders were significantly younger, less experienced, and more likely to be female than injured skiers or snowboard control participants. We did not find any evidence that those who spend time in terrain parks are overrepresented in the injury population.

 

Background: Snowkiting is becoming an increasingly popular extreme sport; however, its injury rates and patterns are unknown to date.

Purpose: The authors surveyed the injuries in a group of snowkiters over 1 season.

Study Design: Descriptive epidemiology study.

Methods: The study was conducted over the course of 1 winter season ranging from November 2009 until March 2010; 80 snowkiters were surveyed prospectively. All participants were recruited through contacts with snowkite schools, snowkiting-related web portals, or Internet-based social networks.

Results: During 3929 hours of snowkiting recorded, 33 injuries occurred, of which 60.6% were mild; 21.2%, moderate; and 18.2%, severe. The calculated injury rate was 8.4 injuries per 1000 hours of exposure. Most frequently injured body sites were the back (30.3%), knee (24.2%), shoulder (21.2%), and head (21.2%). Upper extremity injuries included 2 shoulder dislocations, a clavicle fracture, and a dislocation fracture of the radial head. Injuries to the lower extremity included 3 knee sprains and 1 anterior cruciate ligament rupture. The most common injury causes were riding errors (75.8%), wind gusts (36.4%), and poor snow conditions (27.3%). When compared with experts (5.1 injuries per 1000 hours of exposure), beginners (20.8 injuries per 1000 hours of exposure) had a significantly increased risk of getting injured (odds ratio [OR] 4.11; 95% confidence interval [CI], 1.34-12.64; P = .008). Athletes who used snowboards for snowkiting purposes were injured almost 3 times more frequently than their colleagues using skis (11.7 vs 4.1 injuries per 1000 hours of exposure; OR 2.85; 95% CI, 1.23-6.57; P = .010). The quick-release system (97.5%), helmet (92.5%), kite leash (83.8%), spine protector (51.3%), and shoulder protectors (20.0%) were the most commonly used protective/safety equipment.

Conclusion: Snowkiting can be considered a sport carrying a high risk of injury. More caution in assessing local snow conditions and wind gust occurrences is recommended as well as considering using the help and advice of a professional instructor when beginning this action-packed sport. Injury prevention strategies should also include the further improvement of currently available safety equipment.




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