Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Sports Health. 2009 Jan;1(1):39-46. doi: 10.1177/1941738108326977.
Identification of highly active individuals early after acute anterior cruciate ligament deficiency who are good candidates for nonoperative management is a clinical challenge. The University of Delaware has developed and validated a treatment algorithm and screening examination to distinguish between nonoperative and surgical candidates.
Review.
A description of the decision-making rules and rehabilitation protocol for highly active individuals with anterior cruciate ligament deficiency is provided. Results from clinical trials, outcome studies, and biomechanical investigations conducted using the treatment algorithm and screening examination are also reviewed.
Patients identified as nonoperative rehabilitation candidates using these clinical guidelines have a far greater success rate than what has been reported when patients self-select nonoperative management. Furthermore, nonoperative outcomes are improved when patients participate in a perturbation-enhanced rehabilitation protocol. Divergent lower extremity movement patterns are consistent with the different functional abilities of the dichotomous patient groups identified with the screening examination.
Given the differential patient response to anterior cruciate ligament injury, implementation of the decision-making guidelines discussed in this review offers clinicians the opportunity to provide individualized patient care rather than continuing with a blanket surgical treatment strategy.
在急性前交叉韧带缺失后早期识别出非常活跃的个体，这些个体是适合非手术治疗的候选者，这是一个临床挑战。特拉华大学已经开发并验证了一种治疗算法和筛选检查，以区分非手术和手术候选者。
回顾。
提供了一种针对前交叉韧带缺失的高度活跃个体的决策规则和康复方案的描述。还回顾了使用治疗算法和筛选检查进行的临床试验、结果研究和生物力学研究的结果。
使用这些临床指南确定为非手术康复候选者的患者的成功率远远高于患者自行选择非手术治疗时的报告成功率。此外，当患者参加基于扰动的康复方案时，非手术结果会得到改善。下肢运动模式的差异与筛查检查确定的二分患者组的不同功能能力一致。
鉴于前交叉韧带损伤的患者反应不同，实施本综述中讨论的决策指南为临床医生提供了提供个体化患者护理的机会，而不是继续采用一刀切的手术治疗策略。
