The TeMPO trial (treatment of meniscal tears in osteoarthritis): rationale and design features for a four arm randomized controlled clinical trial.

BACKGROUND: Meniscal 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. METHODS: The 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. DISCUSSION: The 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 REGISTRATION: The TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004 . on February 14, 2017.

Variability in knee laxity in anterior cruciate ligament deficiency using a mechanized model.

PURPOSE: To establish normative values for the magnitude of anterior tibial translation (ATT) in the Lachman and pivot shift tests in the intact and anterior cruciate ligament (ACL)-deficient states, and to explore whether a correlation in ATT magnitude exists between the Lachman and pivot shift tests. METHODS: Twenty-six fresh frozen cadaveric hip-to-toe specimens were used. Mechanized testing was performed to simulate both a Lachman and pivot shift test with the ACL intact. Tests were repeated after sectioning the ACL. ATT was recorded using a computer navigation system. Difference in ATT after sectioning was calculated for each specimen. RESULTS: For the Lachman, mean lateral compartment ATT in the intact knee was 5.3 mm (SD = 2.8 mm). After sectioning the ACL, translation increased to 11.4 mm (SD = 3.9 mm; P < 0.05). For the mechanized pivot shift, mean lateral compartment ATT in the intact knee was -0.2 mm (SD = 2.6 mm). After sectioning the ACL, translation increased to 8.2 mm (SD = 3.1 mm; P < 0.05). No correlation in the magnitude of ATT was found between the intact and ACL-deficient knees for either the Lachman or pivot shift tests, or between both tests (Cronbach's α < 0.7). CONCLUSIONS: 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.

Fascial augmentation tenorrhaphy for extensor tendon lacerations in the forearm.

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.

Open lateral retinacular closure surgery for treatment of anterolateral knee pain and disability after arthroscopic lateral retinacular release.

BACKGROUND: Although lateral retinacular release (LR) surgery has historically been one of the most commonly used arthroscopic procedures for the treatment of patellar instability and anterior knee pain, it may be associated with complications and poor functional outcome measures. PURPOSE: To examine the clinical efficacy of open lateral retinacular closure (LRC), a novel but technically simple procedure in the treatment of disabling anterolateral knee pain, tenderness, and positive medial patellar apprehension testing in patients who have undergone prior arthroscopic LR surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The records of 22 patients who had previously undergone an arthroscopic LR and underwent a diagnostic arthroscopy and LRC were reviewed. Physical examination findings and symptoms after prior LR surgery, duration between LR and LRC surgeries, and arthroscopic findings immediately before LRC were analyzed. Preoperative and postoperative Lysholm knee scores and activity levels were compared, and subjective satisfaction ratings assessed. RESULTS: Average follow-up after LRC was 3.2 years. Mean preoperative Lysholm knee score was 46.5 (range, 25-90), which improved postoperatively to a mean score of 86 (range, 48-100). Fourteen percent of patients subjectively rated their preoperative function as fair and 86% as poor. Postoperatively, 82% rated themselves as good or excellent and 18% as fair, with all patients improving from the LRC procedure. All patients stated that they would have the procedure again for the same problem. CONCLUSION: 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.