What was it possible for a woman to achieve at an early modern court? By analysing the experiences of a wide range of women at the court of Sweden, this book demonstrates the opportunities open to ...women who served at, and interacted with, the court; the complexities of women's agency in a court society; and, ultimately, the precariousness of power. In doing so, it provides an institutional context to women's lives at court, charting the full extent of the rewards that they might obtain, alongside the social and institutional constrictions that they faced. Its longue durée approach, moreover, clarifies how certain periods, such as that of the queens regnant, brought new possibilities. Based on an extensive array of Swedish and international primary sources, including correspondence, financial records and diplomatic reports, it also takes into account the materialities used to create hierarchies and ceremonies, such as physical structures and spaces within the court. Comprehensive in its scope, the book is divided into three parts, which focus respectively on outsiders at court, insiders, and members of the royal family.
What was it possible for a woman to achieve at an early modern court? By analysing the experiences of a wide range of women at the court of Sweden, this book demonstrates the opportunities open to ...women who served at, and interacted with, the court; the complexities of women's agency in a court society; and, ultimately, the precariousness of power. In doing so, it provides an institutional context to women's lives at court, charting the full extent of the rewards that they might obtain, alongside the social and institutional constrictions that they faced. Its longue durée approach, moreover, clarifies how certain periods, such as that of the queens regnant, brought new possibilities. Based on an extensive array of Swedish and international primary sources, including correspondence, financial records and diplomatic reports, it also takes into account the materialities used to create hierarchies and ceremonies, such as physical structures and spaces within the court. Comprehensive in its scope, the book is divided into three parts, which focus respectively on outsiders at court, insiders, and members of the royal family.
Background:
Simultaneous meniscal tears are often present with anterior cruciate ligament (ACL) injuries, and in the acute setting, the lateral meniscus (LM) is more commonly injured than the medial ...meniscus.
Purpose:
To investigate how a concomitant LM injury, repaired, resected, or left in situ during primary ACL reconstruction (ACLR), affects the ACL revision rate and cartilaginous and meniscal status at the time of revision within 2 years after the primary ACLR.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Data for 31,705 patients with primary ACLR, extracted from the Swedish National Knee Ligament Registry, were used. The odds of revision ACLR, and cartilaginous as well as meniscal injuries at the time of revision ACLR, were assessed between the unexposed comparison group (isolated ACLR) and the exposed groups of interest (ACLR + LM repair, ACLR + LM resection, ACLR + LM repair + LM resection, or ACLR + LM injury left in situ).
Results:
In total, 719 (2.5%) of the included 29,270 patients with 2 years follow-up data underwent revision ACLR within 2 years after the primary ACLR. No significant difference in revision rate was found between the groups. Patients with concomitant LM repair (OR, 3.56; 95% CI, 1.57-8.10; P = .0024) or LM resection (OR, 1.76; 95% CI, 1.18-2.62; P = .0055) had higher odds of concomitant meniscal injuries (medial or lateral) at the time of revision ACLR than patients undergoing isolated primary ACLR. Additionally, higher odds of concomitant cartilage injuries at the time of revision ACLR were found in patients with LM resection at index ACLR compared with patients undergoing isolated primary ACLR (OR, 1.73; 95% CI, 1.14-2.63; P = .010).
Conclusion:
The results of this study demonstrated higher odds of meniscal and cartilaginous injuries at the time of revision ACLR within 2 years after primary ACLR + LM resection and higher odds of meniscal injury at the time of revision ACLR within 2 years after primary ACLR + LM repair compared with isolated ACLR. Surgeons should be aware of the possibility of concomitant cartilaginous and meniscal injuries at the time of revision ACLR after index ACLR with concomitant LM injury, regardless of the index treatment type received.
Abstract
Background
Concomitant lateral meniscal (LM) injuries are common in acute anterior cruciate ligament (ACL) ruptures. However, the effect of addressing these injuries with various treatment ...methods during primary ACL reconstruction (ACLR) on patient-reported outcomes (PROs) is unknown. Therefore, the purpose of this study was to compare postoperative Knee injury and Osteoarthritis Outcome Score (KOOS) at 2-, 5-, and 10-years after isolated primary ACLR to primary ACLR with various treatment methods to address concomitant LM injury.
Methods
This study was based on data from the Swedish National Knee Ligament Registry. Patients ≥ 15 years with data on postoperative KOOS who underwent primary ACLR between the years 2005 and 2018 were included in this study. The study population was divided into five groups: 1) Isolated ACLR, 2) ACLR + LM repair, 3) ACLR + LM resection, 4) ACLR + LM injury left in situ, and 5) ACLR + LM repair + LM resection. Patients with concomitant medial meniscal or other surgically treated ligament injuries were excluded.
Results
Of 31,819 included patients, 24% had LM injury. After post hoc comparisons, significantly lower scores were found for the KOOS Symptoms subscale in ACLR + LM repair group compared to isolated ACLR (76.0 vs 78.3,
p
= 0.0097) and ACLR + LM injury left in situ groups (76.0 vs 78.3,
p
= 0.041) at 2-year follow-up. However, at 10-year follow-up, no differences were found between ACLR + LM repair and isolated ACLR, but ACLR + LM resection resulted in significantly lower KOOS Symptoms scores compared to isolated ACLR (80.4 vs 82.3,
p
= 0.041).
Conclusion
The results of this study suggest that LM injury during ACLR is associated with lower KOOS scores, particularly in the Symptoms subscale, at short- and long-term follow-up. However, this finding falls below minimal clinical important difference and therefore may not be clinically relevant.
Level of Evidence
III.
In state formation research, princely houses have been a blind spot. The development of states has been discussed from many perspectives, like interstate competition, internal social conflicts, ...fiscal-military developments, etc., but at the centre of most European states, there was a princely house. These ruling houses have been overlooked in studies about state formation. What’s more, when discussing such dynasties, the vertical chronological perspective (grandfather-father-son) is all dominating, for instance in the focus on dynastic continuity, dynastic culture and representation, and the like. This collection of essays highlights the horizontal perspective (ruler, all children, siblings, cousins), in asking how the members of a princely family acted as a power network. The quest is to develop an understanding how this family network interplayed with other factors in the state formation process. This volume brings together existing knowledge of the topic with the aim of exchanging insights and furthering knowledge.
Several surgical techniques have been described to restore the anatomy of the medial collateral ligament, involving suture repair and reconstruction, with the latter having been associated with ...superior postoperative outcomes. Recently, a growing interest in anatomic isometric medial collateral ligament reconstruction (MCLR) has been developed, involving careful evaluation and finding the most appropriate location for the femoral placement of the allograft. Therefore, the purpose of this article is to describe anatomic MCLR aiming to restore medial knee stability by focusing on isometric positions within the native anatomy of the MCL.
Video 1
Anatomic technique for medial collateral ligament (MCL) reconstruction performed using flattened double-bundle allograft such as peroneus longus or semitendinosus graft. Intraoperative physical examination includes valgus stress testing at 0° and 20°. The surgical procedure begins with the patient positioned supine on the operating room table. A skin incision is made extending from the medial femoral condyle to the pes anserinus. The fascia overlying the pes anserinus is thereafter opened in such a manner that it can be closed afterward. The anterior and posterior borders of the distal MCL are visualized, and a K-wire is placed at the center of the distal tibial insertion of the superficial MCL (sMCL), approximately 6 cm below the joint line. The femoral MCL insertion is visualized and palpated, and a K-wire is placed in the anatomic center of the MCL origin. Graft isometry is checked throughout joint range of motion by wrapping a suture around both K-wires. The ends of the suture are then clamped at the proximal femoral K-wire. Suture displacement should not exceed 1 to 2 mm as the knee is ranged from flexion to extension, starting from 30°. Once graft isometry has been confirmed, one 5.5-mm Healix Advance PEEK anchor and one 5.5-mm Healix Advance BR anchor with 4 nonabsorbable sutures and needles are placed: one at the distal tibial insertion of the sMCL and the other about 10 mm below the joint line, central to the course of the native MCL, at the proximal insertion of the sMCL. The femoral guidewire is removed and changed to a Beath pin to pass the sutures. The looped MCL allograft is thereafter placed and tied firmly to the distal tibial sMCL suture anchor. Each graft arm is additionally tied to the proximal tibial suture anchor to provide a second tibial attachment closer to the joint line. Both proximal graft ends are now whipstitched together at a length of at least 25 mm using a No. 2 nonabsorbable suture. Any excess graft should be removed at this point. The femoral guidewire is then over-reamed using a drill based on the diameter of the whipstitched graft. The lead sutures are shuttled through the bone tunnel and lateral soft tissue using the Beath pin, allowing the insertion of the graft into the bone tunnel. With the knee in 30° of knee flexion and neutral rotation, a fully threaded cannulated Bioresorbable Matryx Interference Screw is inserted over a nitinol guidewire. The sutures of the proximal and distal tibial suture anchors are now used to tie the MCL graft with whipstitches to the native MCL, followed by cutting of the remaining sutures, to obtain the final flat double-bundle MCL reconstruction.
Royal courts could profoundly influence other parts of government. While government bureaucracy has usually been seen as leading the charge towards new, more efficient and stronger centralised ...authority, this article demonstrates how the Swedish court acted as an engine in the transformation of the dysfunctional Swedish state of 1600 into something much more formidable. At the encouragement of monarchs, noble courtiers became more attentive in their service to the state, more educated, more diverse in their origins, and more skilled in the arts of war. But such change was not everlasting, and the article compares characteristics of the court at the beginning of the seventeenth century with those of the later decades - the Caroline period. In these years the court turned inward on itself, declining from a position of innovation and leadership to one of reaction and decay, more rearguard than vanguard.
