Anterior cruciate ligament reconstruction with concomitant meniscal repair: Is graft choice predictive of meniscal repair success?

Background: When meniscal repair is performed during anterior cruciate ligament (ACL) reconstruction (ACLR), the effect of ACL graft type on meniscal repair outcomes is unclear. Hypothesis: The authors hypothesized that meniscal repairs would fail at the lowest rate when concomitant ACLR was performed with bone--patellar tendon--bone (BTB) autograft. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent meniscal repair at primary ACLR were identified from a longitudinal, prospective cohort. Meniscal repair failures, defined as any subsequent surgical procedure addressing the meniscus, were identified. A logistic regression model was built to assess the association of graft type, patient-specific factors, baseline Marx activity rating score, and meniscal repair location (medial or lateral) with repair failure at 6-year follow-up. Results: A total of 646 patients were included. Grafts used included BTB autograft (55.7%), soft tissue autograft (33.9%), and various allografts (10.4%). We identified 101 patients (15.6%) with a documented meniscal repair failure. Failure occurred in 74 of 420 (17.6%) isolated medial meniscal repairs, 15 of 187 (8%) isolated lateral meniscal repairs, and 12 of 39 (30.7%) of combined medial and lateral meniscal repairs. Meniscal repair failure occurred in 13.9% of patients with BTB autografts, 17.4% of patients with soft tissue autografts, and 19.4% of patients with allografts. The odds of failure within 6 years of index surgery were increased more than 2-fold with allograft versus BTB autograft (odds ratio = 2.34 [95% confidence interval, 1.12-4.92]; Conclusion: Meniscal repair location (medial vs lateral) and baseline activity level were the main drivers of meniscal repair outcomes. Graft type was ranked third, demonstrating that meniscal repairs performed with allograft were 2.3 times more likely to fail compared with BTB autograft. There was no significant difference in failure rates between BTB versus soft tissue autografts. Registration: NCT00463099 (ClinicalTrials.gov identifier)

Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort

BACKGROUND: While revision anterior cruciate ligament reconstruction (ACLR) can be performed to restore knee stability and improve patient activity levels, outcomes after this surgery are reported to be inferior to those after primary ACLR. Further reoperations after revision ACLR can have an even more profound effect on patient satisfaction and outcomes. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after revision ACLR. PURPOSE: To report the rate of reoperations, procedures performed, and risk factors for a reoperation 2 years after revision ACLR. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 1205 patients who underwent revision ACLR were enrolled in the Multicenter ACL Revision Study (MARS) between 2006 and 2011, composing the prospective cohort. Two-year questionnaire follow-up was obtained for 989 patients (82%), while telephone follow-up was obtained for 1112 patients (92%). If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for a reoperation. RESULTS: Of the 1112 patients included in the analysis, 122 patients (11%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperations, 27% were meniscal procedures (69% meniscectomy, 26% repair), 19% were subsequent revision ACLR, 17% were cartilage procedures (61% chondroplasty, 17% microfracture, 13% mosaicplasty), 11% were hardware removal, and 9% were procedures for arthrofibrosis. Multivariate analysis revealed that patients aged <20 years had twice the odds of patients aged 20 to 29 years to undergo a reoperation. The use of an allograft at the time of revision ACLR (odds ratio [OR], 1.79; P = .007) was a significant predictor for reoperations at 2 years, while staged revision (bone grafting of tunnels before revision ACLR) (OR, 1.93; P = .052) did not reach significance. Patients with grade 4 cartilage damage seen during revision ACLR were 78% less likely to undergo subsequent operations within 2 years. Sex, body mass index, smoking history, Marx activity score, technique for femoral tunnel placement, and meniscal tearing or meniscal treatment at the time of revision ACLR showed no significant effect on the reoperation rate. CONCLUSION: There was a significant reoperation rate after revision ACLR at 2 years (11%), with meniscal procedures most commonly involved. Independent risk factors for subsequent surgery on the ipsilateral knee included age <20 years and the use of allograft tissue at the time of revision ACLR

A Modern necessity : feminism, popular culture, and American womanhood, 1920-1948

Thesis (Ph. D.)--University of Rochester. Dept. of History, 2012.The metaphor of "waves" has dominated the academic discourse on the history of American feminism. Defining the feminist movement by the ebb and flow of coordinated appeals for women's rights and equality, historians initially identified a disconcerting lull in activity between the 1920s and the 1960s and concluded that feminism had largely subsided in this "inter-wave" period. This dissertation contributes to more recent scholarship, which has begun to challenge the wave metaphor by filling in this mid-century gap. Focusing on cultural implications of feminist ideas and efforts in the first half of the twentieth century, this study reexamines what happened to feminism in the decades that followed the political achievement of woman's suffrage. Rather than a trajectory of retreat or decline, it finds continuity across this chronological marker. Through an investigation of the performances, images, words and actions of four successful pop-cultural figures--Mae West, Bee Freeman, Nancy Drew, and Wonder Woman--this study shows that feminism was deeply embedded in postsuffrage Americans' understanding of what it meant to be a Modern Woman. Perpetuating the move away from the restrictive gender norms of the nineteenth century, these figures reinforced and promoted the early twentieth-century feminist effort to replace a traditional model of femininity with a modern alternative that was more independent, more self-assertive, freer, and more powerful. More than an interpretive search for liberating messages within cultural texts, this project uses personal papers, business correspondence, films, published and unpublished works, comic books, juvenile fiction, academic tracts, photographs, and newspaper and journal articles, advertisements, and reviews to examine the level of intentionality behind representations of strong and liberated women in the postsuffrage years. Contrary to the notion that popular culture merely appropriated and defused feminist ideas, West, Freeman, Nancy Drew, and Wonder Woman each reveals a purposeful attempt to shape and/or sustain a modern understanding of women's power, freedom, and identity. Although these pop-cultural figures, or the agents responsible for them, did not always acknowledge the feminism inherent in their work, their endorsement of modern womanhood indicates that feminism's cultural agenda was alive and well in the 1920s, 1930s, and 1940s

Polyhedral Specification and Code Generation of Sparse Tensor Contraction with Co-Iteration

This article presents a code generator for sparse tensor contraction computations. It leverages a mathematical representation of loop nest computations in the sparse polyhedral framework (SPF), which extends the polyhedral model to support non-affine computations, such as those that arise in sparse tensors. SPF is extended to perform layout specification, optimization, and code generation of sparse tensor code: (1) We develop a polyhedral layout specification that decouples iteration spaces for layout and computation; and (2) we develop efficient co-iteration of sparse tensors by combining polyhedra scanning over the layout of one sparse tensor with the synthesis of code to find corresponding elements in other tensors through an SMT solver. We compare the generated code with that produced by a state-of-the-art tensor compiler, TACO. We achieve on average 1.63× faster parallel performance than TACO on sparse-sparse co-iteration and describe how to improve that to 2.72× average speedup by switching the find algorithms. We also demonstrate that decoupling iteration spaces of layout and computation enables additional layout and computation combinations to be supported