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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: It has been noted that some female anterior cruciate ligament–injured patients have complaints of both coxalgia and joint laxity.

Hypothesis: Female anterior cruciate ligament–injured patients tend to have both acetabular dysplasia and generalized joint laxity.

Study Design: Cohort study (prevalence); Level of evidence, 2.

Methods: Hip radiographs of 100 female anterior cruciate ligament–injured patients and 40 female athletes without any hip joint complaints or history of anterior cruciate ligament injury were evaluated by measuring their center-edge angle (CEA). In addition, generalized joint laxity tests using 8 items were performed for anterior cruciate ligament–injured patients. Anterior-posterior (A-P) tibiofemoral translation of the uninjured knee was measured using a KT-1000 knee arthrometer to evaluate joint laxity under anesthesia before anterior cruciate ligament reconstruction.

Results: The average (± standard deviation) CEA of female anterior cruciate ligament–injured patients was 25.5° ± 5.3° (uninjured side) and 25.8° ± 4.8° (injured side), and that of the control group was 28.2° ± 4.2° (right side) and 29.2° ± 5.7° (left side), both P < .05. Among the 100 patients with anterior cruciate ligament tears, both the generalized joint laxity score and A-P tibiofemoral translation of the group with acetabular dysplasia (CEA of <25°, n = 37) were significantly greater than that of the normal group (CEA of ≥25°, n = 63). There was a negative correlation between the CEA of female anterior cruciate ligament–injured patients and both the generalized joint laxity score and A-P tibiofemoral translation.

Conclusion: The CEA of female anterior cruciate ligament–injured patients was significantly smaller than that of the control group. Statstical analysis showed a moderate negative correlation between the CEA and generalized joint laxity score. Female athletes with an anterior cruciate ligament injury had an increased prevalence of acetabular dysplasia and generalized joint laxity.




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