The incidence of noncontact anterior cruciate ligament injuries in young to middle-aged athletes remains high. Despite early diagnosis and appropriate operative and nonoperative treatments, posttraumatic degenerative arthritis may develop. In a meeting in Atlanta, Georgia (January 2005), sponsored by the American Orthopaedic Society for Sports Medicine, a group of physicians, physical therapists, athletic trainers, biomechanists, epidemiologists, and other scientists interested in this area of research met to review current knowledge on risk factors associated with noncontact anterior cruciate ligament injuries, anterior cruciate ligament injury biomechanics, and existing anterior cruciate ligament prevention programs. This article reports on the presentations, discussions, and recommendations of this group.

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The prevalence, characterization, and classification of acute, post-traumatic, occult subcortical fractures of the knee, identified at magnetic resonance (MR) imaging, were evaluated prospectively in 120 consecutive patients first seen with acute posttraumatic hemarthrosis of the knee. Occult subcortical femoral and tibial fractures were identified in 72% of patients. A modified MR imaging classification is suggested based on a combination of the appearances of such lesions at MR imaging and their short-term osteochondral sequelae. Among 67% of a cohort of 21 patients first seen with what have been described as occult geographic subcortical fractures, osteochondral sequelae were seen at follow-up MR imaging 6-12 months later. The evidence from this study indicates that specific subcategories of occult subcortical knee fractures are associated with an inordinately high prevalence of osteochondral sequelae, especially significant cartilage damage.

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