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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: An arthroscopic iliopsoas tendon release will alleviate painful snapping of the tendon. One question that remains is whether athletes can return to sports after this procedure. This study presents the results of 5 competitive and 10 recreational athletes who had an arthroscopic release of their iliopsoas tendon.

Hypothesis: Athletes can return to full participation in their sport after an arthroscopic iliopsoas tendon release.

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

Methods: Fifteen athletes (2 college, 3 high school, 10 recreational) with painful snapping hips and no pain relief after anesthetic magnetic resonance arthrography had an ultrasound evaluation of their iliopsoas tendon and an anesthetic injection into the psoas bursa. In all 15 patients, the injection relieved their hip pain, and in 10 patients, real-time imaging demonstrated snapping of the tendon. All hips were assessed with Byrd’s 100-point hip scoring system before the release and at 1.5, 3, 6, and 12 months after surgery.

Results: Preoperative hip scores averaged 41 and 44 points for the competitive and recreational athletes, respectively. After surgery, the 2 groups used crutches for 4 weeks, and had 6-week scores that averaged 87 and 63 points. At 6 months, their scores averaged 94 and 98 points, and at 12 months, 96 and 97 points, and none had recurrence of their snapping or pain. All 15 athletes returned to full participation in their sport at an average of 9 months after surgery.

Conclusion: A return to college, high school, and recreational sports can be expected after an arthroscopic release of the iliopsoas tendon.




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