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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: Different patterns of bone bruising are seen on magnetic resonance imaging in acute anterior cruciate ligament ruptures. These patterns may relate to the mechanism of injury.

Hypothesis: There is a correlation between the mechanism of anterior cruciate ligament injury and bone bruise patterns on magnetic resonance imaging.

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

Methods: Data regarding the mechanism of anterior cruciate ligament rupture were collected prospectively on patients who had anterior cruciate ligament reconstructions. Inclusion criteria included a clear history of mechanism, magnetic resonance imaging within 6 weeks of injury, and no previous knee injury. Patients were divided into noncontact and contact mechanism groups. Bone bruise frequency, location, depth, and intensity were analyzed using magnetic resonance imaging and correlated with the mechanism of injury.

Results: Two hundred fifty-six patients were identified; 100 met the inclusion criteria, 86 were in the noncontact mechanism group, and 14 were in the contact mechanism group. The proportion of bone bruises in the lateral compartment in both groups was higher (P < .001) than in the medial compartment. Bone bruising was more frequent, deeper, and more intense in the noncontact group, with frequency (P = .019) and intensity (P < .001) scores reaching significance at the lateral tibial plateau. Medial compartment bone bruising was seen more frequently than previously reported, particularly in the noncontact group.

Conclusion: The noncontact mechanism appears to cause more severe bone bruising in both the medial and lateral compartments.




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