A 10-year prospective trial of a patient management algorithm and screening examination for highly active individuals with anterior cruciate ligament injury
A 10-year prospective trial of a patient management algorithm and screening examination for highly active individuals with anterior cruciate ligament injury
复制标题
DOI：
10.1177/0363546507308190
复制
发表时间：
2008-01-01
影响因子：
4.8
通讯作者：
Snyder-Mackler, Lynn
中科院分区：
文献类型：
--
作者：
Hurd, Wendy J.;Axe, Michael J.;Snyder-Mackler, Lynn
背景：已经开发了一种治疗算法和筛查检查来指导患者管理，并前瞻性地确定前十字韧带断裂后高度活跃的个体成功接受非手术治疗的可能性。目的：前瞻性地描述和分类10年期间所有高度活跃的个体的特征和分类，并为选择非手术治疗的个体提供最终结果。方法：纳入标准包括指数损伤后7个月内的表现和受伤前国际膝关节文献委员会I级或11级活动水平。以合并损伤、未解决的损伤和筛查检查为标准来指导治疗，并将个人分为非手术护理的非患者(潜力差)或潜在的患者(良好的潜力)。结果：在10年的时间里，共有832例高度活跃的亚急性前交叉韧带撕裂患者；315例合并损伤，87例未解决的损伤，85例没有参与分类算法。其余345例患者(男性216例，女性129例)参加了指数损伤后平均6周的筛查。199名受试者被归类为非复制者，146名受试者被归类为潜在复制者。在88名潜在患者中，63名患者在没有手术的情况下成功地恢复了损伤前的活动，其中25名患者在随访时没有接受前交叉韧带重建。结论：分类算法是一种前瞻性地识别前交叉韧带损伤后早期希望进行非手术治疗或必须推迟手术干预的患者的有效工具，并且具有很好的潜力。
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 11 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.