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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: Age-related disability and lost independence currently plague one third of older Americans. Many causes of disability, lost muscle mass and bone mineral density, are modifiable with exercise. Most exemplary of successful aging are the Senior Olympians; this group of vital athletes exhibit persistently high levels of functional capacity.

Purpose: This study describes demographic data, injury characteristics and the effect of aging on physical performance in senior athletes to identify key time points for intervention to address declining performance.

Study Design: Cross-sectional study; Level of evidence, 4.

Methods: Senior Olympians (>50 years) participating in the 2001 National Senior Olympic Games were surveyed for demographic and health characteristics. Age-related changes in physical performance were determined from mean winning performance times in track and field events. These were plotted against age and task for men and women. Analysis of variance and intergroup significance were analyzed using the Tukey procedure. Percentage performance change across events was compared. The 2001 National Senior Olympic Games results were compared with American track and field record holders.

Results: Senior athletes’ performance declined (male and female) approximately 3.4% per year over 35 years of competition—slowly from age 50 to 75 years and dramatically after age 75 years. Men showed no difference in decline of sprint and endurance events, whereas the decline in the sprint was greater than in endurance for women, especially after the age of 75 years.

Conclusion: Even the healthiest examples of musculoskeletal aging experience significant performance declines around age 75 years. This may be a key time point for preventive intervention.




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