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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: Evaluating shoes during sport-related movements may provide a better assessment of plantar loads associated with repetitive injury and provide more specific data for comparing shoe cushioning characteristics.

Hypothesis: Accelerating, cutting, and jumping pressures will be higher than in straight running, differentiating regional shoe cushioning performance in sport-specific movements.

Study Design: Controlled laboratory study.

Materials and Methods: Peak pressures on seven anatomic regions of the foot were assessed in 10 male college athletes during running straight ahead, accelerating, cutting left, cutting right, jump take-off, and jump landing wearing Speed TD and Air Pro Turf Low shoes (Nike, Beaverton, Ore). Pedar insoles (Novel, Munich, Germany) were sampled at 99 Hz during the 6 movements.

Results: Cutting and jumping movements demonstrated more than double the pressure at the heel compared with running straight, regardless of shoe type. The Air Pro Turf showed overall lower pressure for all movement types (P<.0377). Cutting to the left, the Air Pro Turf shoe had lower heel pressures (36.6 ± 12.5 N/cm2) than the Speed TD (50.3 ± 11.2 N/cm2) (P<.0001), and the Air Pro Turf had lower great toe pressures than the Speed TD (44.8 ± 8.1 N/cm2 vs 54.4 ± 8.4 N/cm2; P= .0002). The Air Pro Turf also had significantly lower pressures than the Speed TD at the central forefoot during acceleration (38.2 ± 8.3 N/cm2 vs 50.8 ± 7.4 N/cm2; P<.0001).

Conclusion: Sport-related movements load the plantar surface of the foot more than running straight. Shoe cushioning characteristics were more robustly assessed during sport-related movements (4 significant results detected) compared with running straight (1 significant result detected).

Clinical Relevance: There is an interaction between shoe cushioning characteristics and sport-related movements that may influence plantar pressure and repetitive stress injuries.




May 2012
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