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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: Since 1963, the Orthopaedic In-Training Examination (OITE) has been administered to orthopaedic residents to assess resident knowledge and measure the quality of teaching within individual programs. The OITE has evolved dramatically over the years and now maintains a standardized format consisting of 275 questions divided among 12 sections.

Purpose: To provide a detailed analysis of the OITE sports medicine section to identify patterns in question content, recommended references, and resident performance.

Study Design: Cross-sectional study.

Methods: All OITE sports medicine questions from 2005 to 2009 were analyzed, and the following data were recorded: resident performance scores, tested topics, type of imaging modalities, tested treatment modalities, taxonomy classification, and recommended references.

Results: From 2005 to 2009, the sports medicine section composed 7.8% of the OITE. Mean resident performance on the entire OITE as well as on the sports medicine section improved during each year of training. Imaging modalities typically involved questions on radiographs and magnetic resonance imaging and constituted 27.4% of the OITE sports medicine section. Treatment modalities involved 36.8% of the OITE sports medicine section questions, including most treatment questions relating to ligament reconstruction or rehabilitation. The authors’ assessment of taxonomy classification showed that recall-type questions were most common; however, mean resident performance was minimally affected by type of taxonomy question. Finally, there were trends noted in recommended references; namely, the American Journal of Sports Medicine and Orthopaedic Knowledge Update Sports Medicine were the most commonly and consistently cited journal and review book, respectively.

Conclusion: The current study provides some unique information relating to content, recommended references, and resident performance on the OITE sports medicine section. It is hoped this information will provide orthopaedic trainees, orthopaedic residency programs, and the American Academy of Orthopaedic Surgeons Evaluation Committee valuable information relating to improving resident knowledge and performance and optimizing sports medicine educational curricula.




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