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Anterior 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. We 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. Between 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. Surgical 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. The UK National Institute for Health Research Health Technology Assessment Programme.

According to Bergmann's and Allen's rules, climate change may drive morphological shifts in species, affecting body size and appendage length. These rules predict that species in colder climates tend to be larger and have shorter appendages to improve thermoregulation. Bats are thought to be sensitive to climate and are therefore expected to respond to climatic changes across space and time. We conducted a phylogenetic meta‐analysis on > 27 000 forearm length (FAL) and body mass (BM) measurements from 20 sedentary European bat species to examine body size patterns. We assessed the relationships between body size and environmental variables (winter and summer temperatures, and summer precipitation) across geographic locations, and also analysed temporal trends in body size. We found sex‐specific morphological shifts in the body size of European bats in response to temperature and precipitation patterns across space, but no clear temporal changes due to high interspecific variability. Across Europe, male FAL decreased with increasing summer and winter temperatures, and BM increased with greater precipitation. In contrast, both FAL and BM of female bats increased with summer precipitation and decreased with winter temperatures. Our data can confirm Bergmann's rule for both males and females, while females' BM variations are also related to summer precipitation, suggesting a potential link to resource availability. Allen's rule is confirmed only in males in relation to summer temperature, while in females FAL and BM decrease proportionally with increasing temperature, maintaining a constant allometric relationship incompatible with Allen's rule. This study provides new insights into sex and species‐dependent morphological changes in bat body size in response to temperature and precipitation patterns. It highlights how body size variation reflects adaptations to temperature and precipitation patterns, thus providing insights into potential species‐level morphological responses to climate change across Europe.

The reference dataset will be a useful tool for disease diagnosis and management, health surveillance and future outcome measure development for clinical trials of rehabilitative, surgical and pharmacological interventions. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative Keywords * Health Surveillance * Plantar Pressure * Reference Dataset * Measure Development * Ankle Instability Volume 7 Supplement 1 4th Congress of the International Foot and Ankle Biomechanics Community [RAW_REF_TEXT] Meeting abstract [/RAW_REF_TEXT] [RAW_REF_TEXT] Open Access [/RAW_REF_TEXT] [RAW_REF_TEXT] Published:08 April 2014 [/RAW_REF_TEXT] 1000 Norms Project: understanding foot and ankle health, disease and normality [RAW_REF_TEXT] Jennifer N Baldwin 1, [/RAW_REF_TEXT] [RAW_REF_TEXT] Marnee M McKay1, [/RAW_REF_TEXT] [RAW_REF_TEXT] Claire E Hiller1, [/RAW_REF_TEXT] [RAW_REF_TEXT] Jean E Nightingale1, [/RAW_REF_TEXT] [RAW_REF_TEXT] Niamh Moloney1, [/RAW_REF_TEXT] [RAW_REF_TEXT] Natalie Vanicek1, [/RAW_REF_TEXT] [RAW_REF_TEXT] Paulo Ferreira1, [/RAW_REF_TEXT] [RAW_REF_TEXT] Milena Simic1, [/RAW_REF_TEXT] [RAW_REF_TEXT] Kathryn Refshauge1, [/RAW_REF_TEXT] [RAW_REF_TEXT] Joshua Burns1,2 & [/RAW_REF_TEXT] [RAW_REF_TEXT] the 1000 Norms Project Consortium [/RAW_REF_TEXT] Journal of Foot and Ankle Research volume 7, Article number: The reference dataset will be a useful tool for disease diagnosis and management, health surveillance and future outcome measure development for clinical trials of rehabilitative, surgical and pharmacological interventions. Table 2 Inter-rater reliability of foot and ankle items assessed in the 1000 Norms Project Full size table Meeting abstract Open Access Published:08 April 2014 [/RAW_REF_TEXT] 1000 Norms Project: understanding foot and ankle health, disease and normality [RAW_REF_TEXT] Jennifer N Baldwin 1, Marnee M McKay1, Claire E Hiller1, Jean E Nightingale1, Niamh Moloney1, Natalie Vanicek1, Paulo Ferreira1, Milena Simic1, Kathryn Refshauge1, Joshua Burns1,2 & the 1000 Norms Project Consortium [/RAW_REF_TEXT] Journal of Foot and Ankle Research volume 7, Article number: