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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: Hyperconcavity of the lumbar spine has been found in a disproportionate percentage of college football lineman evaluated at the National Football League (NFL) Combine compared with age-matched controls.

Hypothesis: College football linemen with hyperconcavity of the lumbar spine are more likely to play in the NFL and to have a longer career in professional football.

Study Design: Cohort study; Level of evidence, 3.

Methods: Ninety three linemen from the 1992 and 1993 NFL Combines with hyperconcavity of the lumbar spine were compared with 191 linemen from the same combines without these changes in the lumbar spine. The percentage of athletes who played at least 1 game for an NFL team and the average length of career was calculated for both groups. In addition, the length of career for players with these changes was compared with those of matched controls based on other injuries and surgeries, year drafted, and round drafted.

Results: There was no difference in the likelihood of playing professional football between linemen with lumbar spine changes (54 of 93 [58%]) and those without (101 of 191 [53%]) (P = .41). There was no significant difference between the 2 groups in length of career in terms of years played, games played, or games started.

Conclusion: Hyperconcavity of the lumbar spine does not appear to have any effect on the potential professional American football careers of college football linemen entering the NFL. Endplate changes on radiographs are not a significant screening tool for elite American football linemen. Further study of larger populations is needed to definitively answer whether these adaptive changes in the lumbar spine have any clinical relevance to these athletes.




May 2012
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