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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: Shoe manufacturers market motion control, stability, and cushioned shoes for plantar shapes defined as low, normal, and high, respectively. This assignment procedure is presumed to reduce injuries by compensating for differences in running mechanics.

Hypothesis: Assigning running shoes based on plantar shape will not reduce injury risk in Marine Corps basic training.

Study Design: Randomized controlled clinical trial; Level of evidence, 1.

Methods: After foot examinations, Marine Corps recruits in an experimental group (E: 408 men, 314 women) were provided motion control, stability, or cushioned shoes for plantar shapes indicative of low, medium, or high arches, respectively. A control group (C: 432 men, 257 women) received a stability shoe regardless of plantar shape. Injuries during the 12 weeks of training were determined from outpatient visits obtained from the Defense Medical Surveillance System. Other known injury risk factors (eg, fitness, smoking, prior physical activity) were obtained from a questionnaire, existing databases, or the training units.

Results: Cox regression indicated little difference in injury risk between the E and C groups among men (hazard ratio [E/C] = 1.01; 95% confidence interval, 0.82-1.24) or women (hazard ratio [E/C] = 0.88; 95% confidence interval, 0.70-1.10).

Conclusion: This prospective study demonstrated that assigning shoes based on the shape of the plantar foot surface had little influence on injuries even after considering other injury risk factors.




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