Now or maybe later for anterior cruciate reconstruction?

Early reconstruction isn’t always the best option for active young adults with a torn anterior cruciate ligament. Early reconstruction and standardised rehabilitation worked no better over two years than a “wait and see” policy of rehabilitation first with the option of surgery later in a small trial from Sweden. Patients treated with both strategies improved by around 39 points on a score measuring pain, symptoms, function, and quality of life (range 0 (worst) to 100).⇑ Of the 59 adults assigned to rehabilitation first, 23 eventually needed surgery, an average of one year later. All but one had symptomatic instability.

Many participants in both groups reported problems with their injured knee during follow-up. Instability and meniscal symptoms and signs were more common among those given rehabilitation first with the option of delayed surgery, and the difference was big enough to worry one editorialist (pp 386-7) This trial suggests that some young adults can tolerate an unreconstructed anterior cruciate ligament, or delayed surgery, without compromising function and quality of life over two years, he writes. But instability and arthritis are both possible in the longer term. Delayed reconstruction of a torn anterior cruciate has already been linked to further damage to the meniscus and articular cartilage in long term observational studies. Both can lead to premature osteoarthritis. In the end, a single strategy is unlikely to work for everyone.

One in 20 personal statements is plagiarised

Graduates applying to specialty residency programmes in the US must submit a personal statement with their application. A study of statements submitted to one large teaching centre found that around one in 20 included a substantial amount of copied text (5.2% (95% CI 4.6% to 5.9%)). The researchers used established software to look for matches between 4975 anonymised statements and a database of online and print resources and previously collated statements. Two …