Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

BackgroundAnterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability.MethodsWe did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367.FindingsBetween Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications.InterpretationSurgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management

L' Etourdie, Ou Histoire De Mis Betsy Tatless : Traduite De L'Anglois

[Eliza Haywood

Fantomina: or, Love in a Maze, Being a Secret History of an Amour Between Two Persons of Condition

172

The Injur\u27d Husband and Lasselia

Eliza Haywood (1693?-1756) was one of the first women in England to earn a living writing fiction. Her early tales of amorous intrigue, sometimes based on real people, were exceedingly popular though controversial. Haywood, along with her contemporary Daniel Defoe, did more than any other writer to create a market for fiction in the period just prior to the emergence of Samuel Richardson, Henry Fielding, and Tobias Smollett, the dominant novelists of the mid-eighteenth century. The scheming, sexually predatory anti-heroine of The Injur\u27d Husband is a memorable villain who defies all expectations of a woman\u27s conduct in marriage. The heroine of Lasselia is initially a model of virtue who bravely resists the advances of a king, only to be driven by her passion and desire into an illicit affair with a married man and ultimately into ruin. These two provocative narratives strikingly represent Haywood\u27s extraordinary contribution to the development of the novel. Jerry C. Beasley, professor of English at the University of Delaware, is the author of Novels of the 1740s and Tobias Smollett: Novelist. Reveals considerable inventiveness in technique and preceptiveness in analysis of character and motive. —Choice Will please anyone interested in the early novel and delight students of Haywood. —East-Central Intelligencer Deserves to be studied and taught. —Eighteenth-Century Fiction Provides a modern edition of two Haywood texts which ‘have never before been edited.’ —Eighteenth-Century Studies The Injur’d Husband and Lasselia impart more than critical insights into the novel’s history and women’s role in that history. They’re plain fun to read—something Haywood’s contemporaries understood, and a pleasure we can now enjoy for ourselves. —Jane Austen Society of North America News Haywood’s two novellas are a sample document of the range of women’s sexual and literary possibilities in the early century. —Notes and Queries The juxtaposition of two of Haywood’s novels in one volume is very welcome as it gives the reader a broader sense of Haywood’s style and purpose. —Review of English Studieshttps://uknowledge.uky.edu/upk_english_language_and_literature_british_isles/1070/thumbnail.jp

Anti-Pamela: or, Feign'd Innocence Detected

London: Printed for J. Huggonson, 174

The British Recluse: or, The Secret History of Cleomira, Suppos'd Dead

London: D. Browne and S. Chapman, 182

Idalia, or, The Unfortunate Mistress: A Novel

third edition; London: Dan Browne, 172