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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

Anterior cruciate ligament (ACL) injury prevention programs show promising results with changing movement; however, little information exists regarding whether a program designed for an individual’s movements may be effective or how baseline movements may affect outcomes.


Hypothesis

A program designed to change specific movements would be more effective than a “one-size-fits-all” program. Greatest improvement would be observed among individuals with the most baseline error. Subjects of different ages and sexes respond similarly.


Study Design

Randomized controlled trial; Level of evidence, 1.


Methods

One hundred seventy-three youth soccer players from 27 teams were randomly assigned to a generalized or stratified program. Subjects were videotaped during jump-landing trials before and after the program and were assessed using the Landing Error Scoring System (LESS), which is a valid clinical movement analysis tool. A high LESS score indicates more errors. Generalized players performed the same exercises, while the stratified players performed exercises to correct their initial movement errors. Change scores were compared between groups of varying baseline errors, ages, sexes, and programs.


Results

Subjects with the highest baseline LESS score improved the most (95% CI, –3.4 to –2.0). High school subjects (95% CI, –1.7 to –0.98) improved their technique more than pre–high school subjects (95% CI, –1.0 to –0.4). There was no difference between the programs or sexes.


Conclusions

Players with the greatest amount of movement errors experienced the most improvement. A program’s effectiveness may be enhanced if this population is targeted.




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