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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


         

 

Introduction: Posterior thigh muscle injuries in athletes are common, and prediction of recovery time would be of value.

Hypothesis: Knee active range of motion deficit 48 hours after a unilateral posterior thigh muscle injury correlates with time to full recovery.

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

Methods: One hundred sixty-five track and field athletes with acute, first-time, unilateral posterior thigh muscle injuries were prospectively evaluated regarding knee active range of motion deficit. This was compared with the uninjured side 48 hours after injury. A control group was also examined. Ultrasound was used to image the muscle lesion. All athletes were managed nonoperatively with the same rehabilitation protocol. The “full rehabilitation time” (interval from the injury to full athletic activities) was recorded.

Results: Range of motion of the affected leg was decreased in the 165 injured athletes compared with the uninjured side and the control group. Sonography identified abnormalities in 55% (90 of 165) of the injured athletes. The biceps femoris was the most commonly affected muscle (68 of 90 [75%]). The musculotendinous junction (proximal or distal) was involved in 93% (85 of 90) of lesions. Eighty-one percent (133 of 165) of athletes had active range of motion deficit of less than 20°, and had returned to full performance at 2 weeks. In 6 of 165 athletes (3.6%), with active range of motion deficit of more than 30°, recovery time exceeded 6 weeks, with a significant correlation between full rehabilitation time and active range of motion deficit (2 = 152.560; P = .0001).

Conclusion: Knee active range of motion deficit is an objective and accurate measurement, predicting recovery time in elite athletes.




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