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Open LRC provides significant pain relief and improvement in functional knee outcome scores in patients with persistent pain and tenderness at the site of a previous lateral release and a positive medial patellar apprehension test. Lateral release procedures should be considered with caution. For patients with anterolateral knee pain and symptoms of medial patellar instability after lateral release, LRC may provide symptomatic relief and functional improvement.

BackgroundMeniscal tears often accompany knee osteoarthritis, a disabling condition affecting 14 million individuals in the United States. While several randomized controlled trials have compared physical therapy to surgery for individuals with knee pain, meniscal tear, and osteoarthritic changes (determined via radiographs or magnetic resonance imaging), no trial has evaluated the efficacy of physical therapy alone in these subjects.MethodsThe Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial is a four-arm multi-center randomized controlled clinical trial designed to establish the comparative efficacy of two in-clinic physical therapy interventions (one focused on strengthening and one containing placebo) and two protocolized home exercise programs.DiscussionThe goal of this paper is to present the rationale behind TeMPO and describe the study design and implementation strategies, focusing on methodologic and clinical challenges.Trial registrationThe TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004. on February 14, 2017.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2327-9) contains supplementary material, which is available to authorized users.

No correlation was found between the Lachman and pivot shift test in both the intact and ACL-deficient knee. This suggests that the Lachman cannot be used as a surrogate for the pivot shift as the magnitude of the Lachman did not predict the magnitude of the pivot shift.

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Proximal lacerations of the extensor tendon apparatus can pose a surgical challenge, especially when located at the musculotendinous junction or in patients presenting late. We describe a technique to augment the suture repair of these injuries utilizing local harvested strips of dorsal forearm fascia.

Objectives:Effective treatment of Biceps-Labral (B-L) Complex lesions is predicated upon accurate diagnosis. Diagnostic algorithms include both physical examination and MRI. We sought to evaluate the contribution of MRI and physical examination to the accurate diagnosis of B-L Complex lesions.Methods:A retrospective review of 273 surgical cases of lesions of the B-L Complex was performed comparing the preoperative documented clinical "Three Pack" examination to the preoperative Radiologist's MRI reading in accurately predicting lesions of the B-L Complex seen at the time of surgery, and as documented by intraoperative photos and videos. After the completion of this retrospective review, an additional 145 patients(116 symptomatic, 29 matched controls) were enrolled in a prospective validation study of the "Three Pack" examination. All patients were examined independently and separately by three examiners without contamination: the senior surgeon, the sports medicine fellow, and the senior surgeon' s PA. Results were adjusted for order of examination.All B-L Complex Lesions were documented at surgery by digital photos and or video.Results:In the retrospective review, the MRI accurately described the labral tears found at surgery in only 45% of the cases. Of the documented biceps lesions, only 28% of the time was the biceps read on MRI as abnormal. When the preop ACT was positive, a positive"arthroscopic"ACT (where the biceps incarcerates between the humeral head and glenoid) or labral tear was noted in 88% of the cases. There were no cases where the preop ACT was negative and the "arthroscopic" ACT was positive. However, when the "arthroscopic"ACT was positive, 46% of the time there was no tear of the labrum. The average age of the patients with a positive "arthroscopic" ACT was 34 yo. In the subsequent prospective validation of the "Three Pack", The interobserver reliability for the "three pack" evaluation was quite strong with Kappa values between.700 to.850 for all tests, indicating substantial (.61-.80) to almost perfect (.81-1.00) agreement categories. This was in contrast to other "traditional" tests performed (Speed's, Yergason's, full and empty can tests), where only moderate agreement at best (.41-.60) was noted. Tenderness to BGP had a high sensitivity and specificity of.978 and.703 respectively for groove lesions; a positive throwing test had a moderate sensitivity of.694 and higher specificity of.745; the ACT (O'Brien Sign) had a very high sensitivity for labral tears and biceps incarceration,.897 and.914 respectively, with moderate specificities of.562 and.602 respectively. Seventy percent of patients had more than 1 site of pain and pathology confirmed at surgery. 88% of patients had a positive ACT in the symptomatic shoulder vs 11% in the unaffected shouder (and 18% of controls) for a p value<.001; 87% of patients had a positive BGP testversus 18% in the unaffected shoulder ( and 11% of controls) for a p value of <.001 as well.Seventy six percent of unaffected shoulders had all three tests negative.C...