McMurray Test Research Articles

Rare Source Of Knee Pain In A Basketball Player

HISTROTY: 15 year old male basketball player presented the sports medicine center for evaluation of bilateral knee pain for over 2 years. He was given a diagnosis of Osgood-Schlatters disease by his primary care physician but was sent for further evaluation with ongoing knee pain. The initital history and physical exam was consistent with a diagnosis of bilateral PFS and patellar tendonitis. The patient was sent to PT and asked to follow up in 4 weeks. At the subsequent visit the athlete noted near complete resolution of his left knee symptoms but continued to have pain and occasional swelling in his right knee. Closer questioning revealed an injury to his right knee 2 years prior. He could not recall the inciting event or specific details of the mechanism but he did see his school nurse and was diagnosed with a knee “sprain”. He noted swelling at the time but did not receive any treatment, x-rays, or further follow-up for this injury. The patient describes no locking or instability. PHYSICAL EXAM: General: Comfortable male. Inspection: Prominent tibial tuberosities bilaterally, no obvious effusion. Palpation: Minimal tenderness of the medial and lateral patellar facets. Medial joint line tenderness on the right. No tibial tubercle tenderness. Grade I effusion palpated. ROM: 0–140 degrees pain free ROM. Special Tests: Patellar grind test positive, Lachman's 1+ laxity on right but with firm end point, no laxity on left. Anterior/posterior drawer no laxity bilaterally. McMurray's Test positive with medial joint line pain on the right. DIFFERENTIAL DIAGNOSIS: Medial meniscal tear OCD Loose body Partial ACL tear TEST AND RESULTS: X-rays: A loose body was noted on right knee AP and lateral views near the intracondyler notch posteriorly. MRI: 2mm meniscal ossicle at the medial meniscal root. Attenuation of the root with mild medial meniscus subluxation was noted suggesting a chronic meniscal root tear. FINAL WORKING DIAGNOSIS Meniscal ossicle at the medial meniscal root. TREATMENT AND OUTCOMES Given the exam and MRI findings, the athlete was sent for arthroscopy. A separated loose body was not identified but a meniscal tear was noted as well as attenuation of the ACL consistent with partial tear. Partial medial menisectomy was performed. The athlete is asymptomatic and doing well at 4 week follow-up.

All-Inside Meniscal Repair Using a New Flexible, Tensionable Device

Background A new generation of flexible all-inside meniscal repair devices is available, but clinical studies with these devices are lacking. Hypothesis The RapidLoc has an intermediate-term meniscal healing rate that is equivalent to literature reports of inside-out suture technique in patients undergoing concurrent anterior cruciate ligament reconstruction. Study Design Case series; Level of evidence, 4. Methods Retrospective analysis was performed for 75 meniscal tears in 66 consecutive patients undergoing anterior cruciate ligament reconstruction who underwent meniscal repair with the RapidLoc. Patients with at least 2 years’ follow-up were evaluated for symptoms suggestive of a meniscal tear and were assessed with the International Knee Documentation Committee form and the Knee Disorders Subjective History visual analog scale. Subjects were asked to return for a clinical examination to include evaluation for an effusion and joint line tenderness as well as McMurray test and KT-1000 arthrometry readings. Patients with symptoms consistent with meniscal repair failure underwent magnetic resonance arthrography and repeat arthroscopy. Results Twenty patients with 21 meniscal tears were excluded, resulting in 54 meniscal tears in 46 patients. At a mean follow-up of 34.8 months, the clinical success rate for meniscal repair was 90.7% (49/54), with 5 failures requiring meniscectomy. Univariate analysis revealed predictive variables for failure: bucket-handle configuration, multiplanar tears, tear length greater than 2 cm, and chronicity longer than 3 months. Nonpredictive variables included compartment, zone, ligament graft choice, gender, age, follow-up, and visual analog scale score. Analysis of healed patients revealed a negative correlation between chronicity of tear and International Knee Documentation Committee score. Conclusions The RapidLoc has an acceptable intermediate-term clinical healing rate in patients undergoing concurrent anterior cruciate ligament reconstruction. Predictive variables for failure should be considered during operative decision making.

Arthroscopic meniscal repair: a comparative study between three different surgical techniques

The purpose of this prospective study was to evaluate and compare the results of arthroscopic meniscal repair using three different techniques. Between January 2002 and March 2004, 57 patients who met the inclusion criteria underwent an arthroscopic meniscal repair. The outside-in technique was used in 17 patients (group A), the inside-out in 20 patients (group B), while the rest of the 20 patients (group C) were managed by the all-inside technique using the Mitek RapidLoc soft tissue anchor (Mitek Surgical Products, Westwood, MA, USA). Anterior cruciate ligament (ACL) reconstruction was performed in 29 patients (51%). The criteria for clinical success included absence of joint line tenderness, locking, swelling, and a negative McMurray test. The minimum follow-up was one year for all groups. The mean follow-up was 23 months for group A, 22 months for group B, and 22 months for group C. All meniscal repairs were considered healed according to our criteria in group A, while 19 out of 20 repairs (95%) healed in group B. Finally 7 of 20 repairs (35%) were considered failures in group C and this difference was statistically significant in comparison with other groups. The time required for meniscal repair averaged 38.5 min for group A, 18.1 min for group B, and 13.6 min for group C. Operation time for meniscal repair in group A was statistically longer in comparison with other groups. There were no significant differences among the three groups concerning complications. According to our results, arhtroscopic meniscal repair with the inside-out technique seems to be superior in comparison with the other methods because it offers a high rate of meniscus healing without prolonged operation time.

Patellofemoral Pain Syndrome in Tibetan Buddhist Monks

Patellofemoral pain syndrome is a common diagnosis in athletes and especially runners. This article discusses 3 cases of patellofemoral pain caused by pronounced inactivity and prolonged knee hyperflexion at altitude in a unique population of Tibetan Buddhist monks. In this case, the monks responded well to a program of activity modification and exercises.

Anterior Horn Tears of the Lateral Meniscus in Soccer Players

The purpose of this retrospective study was to define the clinical and arthroscopic characteristics of anterior horn tears of the lateral meniscus. Case series. Fourteen patients with mean age of 20.2 years were enrolled in this institutional review board-approved study. All patients were soccer players with tears of the anterior horn of the lateral meniscus. All patients underwent physical examinations, magnetic resonance imaging (MRI), and arthroscopic treatment. Common symptoms were a catching sensation in 10 patients (71.4%), pain at squatting in 9 patients (64.3%), and sense of giving way and effusion, each in 7 patients (50%). Five patients (35.7%) had lateral joint-line tenderness. McMurray's test was positive in 6 (42.9%) and tears were diagnosed by MRI in 13 (92.8%) patients. Arthroscopic examination showed multiple longitudinal tears in the avascular white zone of the meniscus in 7 patients (50%). These data show that the McMurray test and joint-line tenderness had a low diagnostic value in diagnosing anterior horn tears of the lateral meniscus. MRI, however, had a high diagnostic value. Common arthroscopic findings included multiple longitudinal tears within the white zone of the anterior horn. Level IV.

Results of All-Inside Meniscal Repair With the FasT-Fix Meniscal Repair System

The goal of this prospective study was to evaluate the results of arthroscopic meniscal repair using the FasT-Fix repair system. Prospective case series. Sixty-one meniscal repairs with the FasT-Fix meniscal repair system in 58 patients with a mean age of 32.6 years were performed between 2001 and 2002. Concurrent anterior cruciate ligament reconstruction was performed in 36 patients (62%). All tears were longitudinal and located in the red/red or red/white zone. Criteria for clinical success included absence of joint-line tenderness, locking, swelling, and a negative McMurray test. Clinical evaluation also included the Tegner and Lysholm knee scores, and KT-1000 arthrometry. In addition, all patients were evaluated preoperatively with magnetic resonance imaging. The average follow-up was 18 months (range, 14 to 28 months). Six of 61 repaired menisci (9.8%) were considered failures according to our criteria. Therefore, the success rate was 90.2%. Time required for meniscal repair averaged 11 minutes. Postoperatively, the majority of the patients had no restrictions in sports activities. The mean Lysholm significantly improved from 43.6 preoperatively to 87.5 postoperatively (P < .001). Fifty-one patients (88%) had an excellent or good result according to the Lysholm knee score. Four patients had a restriction of knee joint motion postoperatively, and an arthroscopic arthrolysis was performed in 1 of them. Analysis showed that age, length of tear, simultaneous anterior cruciate ligament reconstruction, chronicity of injury, and location of tear did not affect the clinical outcome. Our results show that arthroscopic meniscal repair with the FasT-Fix repair system provided a high rate of meniscus healing and appeared to be safe and effective in this group of patients. Level IV, therapeutic study, case series (no control group).

Clinical Findings of the CompleteRadial Rupture of the Meniscal Root Ligament of the Medial Meniscus Posterior Horn: Preliminary Report

Purpose : To evaluate the clinical findings of a complete radial rupture of the meniscal root ligament of the medial meniscus posterior horn. Materials and Methods : From April, 2004 to December, 2004, nineteen patients (mean age, 56.5 years old) who were diagnosed with a medial root ligament rupture of the medial meniscus posterior horn during an arthroscopic treatment were enrolled in this study. The clinical findings, physical examinations, and the radiological and arthroscopic findings were analyzed retrospectively. Results : Thirteen out of the nineteen cases had tenderness of the knee without specific trauma. The preoperative physical examination revealed posteromedial joint line tenderness in fifteen cases. A medial joint line protrusion with direct tenderness was observed in six cases (31.5%) and a positive McMurray test was observed in seventeen cases (89.5%). MRI was carried out in sixteen patients. All sixteen patients were diagnosed with a rupture of the meniscal root ligament using the author's diagnostic MRI criteria. Conclusion :,/b> Non-traumatic pain and posteromedial joint line tenderness in patients in their sixth decade are indications of a rupture of the meniscal root ligament of the medial meniscus posterior horn. Confirmation using MRI and arthroscopy is important for making a diagnosis.

Knee Pain and Swelling Due to Crohn Disease: A Case Report

A lthough peripheral arthritis is the most common extra-intestinal manifestation of inflammatory bowel disease, it is very rarely addressed in the orthopaedic literature. The overwhelming majority of patients with inflammatory bowel disease present with gastrointestinal symptoms and do not have any joint involvement until much later. We present the case of a patient who had joint pain and swelling but lacked any sign of gastrointestinal involvement. After five months of work-up, the patient was diagnosed with Crohn disease and the joint symptoms improved with appropriate medical treatment. We believe that inflammatory bowel disease should be considered in the differential diagnosis of joint pain and swelling. Our patient was informed that data concerning the case would be submitted for publication. A twenty-two-year-old male active-duty sailor in the United States Navy presented with a six-week history of right knee pain following a twisting injury that he had sustained while climbing a ladder on a ship; the knee twisted as the trunk rotated on the planted ipsilateral foot. At the time of the initial orthopaedic evaluation, the patient reported that pain and swelling in the right knee had failed to respond to a course of anti-inflammatory medication and activity modification. There was no history of clicking, catching, locking, or snapping. A review of systems was negative for fevers, chills, nausea, vomiting, recent sexual contact, recent weight loss, loose stools, abdominal pain, or a history of other joint pain or swelling. Physical examination of the knee revealed a moderate effusion, normal appearance of the skin, mild warmth to touch, and decreased range of motion from 0° to 100° secondary to pain and swelling. There was diffuse tenderness of the anterior fat pad but no tenderness at the joint line. Provocative testing of the knee in varus and valgus, the Lachman test, the McMurray test, …

Knee Pain - Martial Arts

HISTORY A 21-year-old man initially presented to an outside orthopedic clinic complaining of 5–6 weeks of left knee pain. At the time of onset he recalls slipping and twisting his knee while playing basketball. He did not hear or feel a pop and was able to continue playing. He was initially diagnosed with a lateral collateral ligament sprain, but did not respond to conservative treatment. After three months of symptoms, he underwent an arthroscopy which revealed diffuse synovitis, which was treated with a partial synovectomy. Post-operatively, he continued to have diffuse knee pain prompting further work-up. During this time he traveled to Guatemala where his symptoms worsened. Upon follow-up in the United States, serologic and knee aspirate evaluation suggested a rheumatologic etiology, possibly consistent with a seronegative arthropathy. He was treated with NSAIDs, sulfsalazine and eventually methotrexate over a four month period without significant improvement in his symptoms. With continued lateral knee pain and intermittent swelling, he presented for further evaluation. PHYSICAL EXAMINATION He was a well developed male in no acute distress. There was no obvious rash or atrophy, though he had a mild effusion. Left knee range of motion was 0/3/130 degrees. He was diffusely tender with palpation, though mainly along the lateral joint line. There was no instability with Lachman's testing, anterior and posterior drawer testing and varus/valgus stress at 0 and 30 degrees. McMurray's test was negative. DIFFERENTIAL DIAGNOSIS Pigmented Villonodulous Synovitis Tuberculous arthritis Mycotic arthritis Monoarthritis secondary to Lyme Disease Gout/Pseudogout arthiritis TEST AND RESULTS Plain radiographs (AP, lateral and sunrise views of the knee): normal. MRI knee: Moderate effusion and chronic proliferate synovitis. Laboratory: HLA-B27, negative; RF positive; ANA with low titer of 1:40; ESR 93, CRP 4.4. CBC, chemistry, and LFT's were normal. Lyme serologies were positive. FINAL WORKING DIAGNOSIS Monoarthritis of the knee secondary to Lyme disease. TREATMENT AND OUTCOMES Doxycycline 100mg BID for 21 days. Continued home exercise program for quadriceps and hamstring strengthening. Complete resolution of pain, but some residual mild crepitus. Return to full activity by a four weeks.

Diagnostic Accuracy of a New Clinical Test (the Thessaly Test) for Early Detection of Meniscal Tears

Clinical tests used for the detection of meniscal tears in the knee do not present acceptable diagnostic sensitivity and specificity values. Diagnostic accuracy is improved by arthroscopic evaluation or magnetic resonance imaging studies. The objective of this study was to evaluate the diagnostic accuracy of a new dynamic clinical examination test for the detection of meniscal tears. Two hundred and thirteen symptomatic patients with knee injuries who were examined clinically, had magnetic resonance imaging studies performed, and underwent arthroscopic surgery and 197 asymptomatic volunteers who were examined clinically and had magnetic resonance imaging studies done of their normal knees were included in this study. For clinical examination, the medial and lateral joint-line tenderness test, the McMurray test, the Apley compression and distraction test, the Thessaly test at 5 degrees of knee flexion, and the Thessaly test at 20 degrees of knee flexion were used. For all clinical tests, the sensitivity, specificity, false-positive, false-negative, and diagnostic accuracy rates were calculated and compared with the arthroscopic and magnetic resonance imaging data for the test subjects and the magnetic resonance imaging data for the control population. The Thessaly test at 20 degrees of knee flexion had a high diagnostic accuracy rate of 94% in the detection of tears of the medial meniscus and 96% in the detection of tears of the lateral meniscus, and it had a low rate of false-positive and false-negative recordings. Other traditional clinical examination tests, with the exception of joint-line tenderness, which presented a diagnostic accuracy rate of 89% in the detection of lateral meniscal tears, showed inferior rates. The Thessaly test at 20 degrees of knee flexion can be used effectively as a first-line clinical screening test for meniscal tears, reducing the need for and the cost of modern magnetic resonance imaging methods.

A new weight-bearing meniscal test and a comparison with McMurray’s test and joint line tenderness

The purpose of this study was to describe a new weight-bearing McMurray's test (Ege's test) and to compare its diagnostic value with McMurray's test and joint line tenderness (JLT). We also aimed to determine if associated lesions had any effect on the diagnostic values of the 3 tests. Prospective controlled trial, clinical study. The study group consisted of 150 consecutive patients who had had symptoms related to intra-articular knee pathology, and arthroscopic diagnoses were used as the gold standard. There were a total of 211 diagnoses on arthroscopy. A meniscus tear was found in 127 of the 150 patients; 90 had medial, 28 had lateral, and 9 had tears of both menisci. There were no statistically significant differences between the 3 tests in detecting a meniscal tear ( P > .05). However, better accuracy, sensitivity, and specificity rates were obtained with Ege's test for medial meniscal lesions (71%, 67%, and 81%, respectively). JLT also gave superior accuracy rates (71%), but the specificity of Ege's test was apparently higher than JLT (81% v 44%). The highest positive predictive value was also obtained with Ege's test (86%), whereas a superior negative predictive value was obtained with JLT (67%) in medial meniscal tears. Lateral meniscal tears were diagnosed more accurately than medial meniscal tears, and Ege's test gave results superior to the others (84%, 64%, 90% for accuracy, sensitivity, and specificity, respectively). Higher positive predictive values were obtained with McMurray's and Ege's tests than with JLT, but similar negative predictive values were achieved in all. A torn anterior cruciate ligament did not decrease the diagnostic values of the 3 tests, whereas the number of associated lesions in the knee negatively affected the diagnostic capabilities of the tests. Accuracies of traditional clinical meniscus tests may be improved by including Ege's test in the clinical examination. Level II, diagnostic.

Arthroscopic all-inside suture repair of medial meniscus lesion in anterior cruciate ligament—deficient knees: Results of second-look arthroscopies in 39 cases

To evaluate by second-look arthroscopy the clinical results of arthroscopic all-inside sutures with hook using 2 posteromedial portals for medial meniscus posterior horn (MMPH) tears in patients who underwent concurrent anterior cruciate ligament (ACL) reconstruction. Case series. From May 1997 to June 2001, 78 knees underwent surgery for MMPH tears with arthroscopic all-inside sutures with hook and concurrent ACL reconstruction. Among them, 39 patients were evaluated with follow-up second-look arthroscopy. All MMPH tears were repaired by arthroscopic all-inside suture technique using 2 posteromedial portals. The second-look arthroscopy was performed, on average, 19 months (range, 6 to 40 months) after the ACL reconstruction and meniscal repair. They were divided into complete healing, incomplete healing, and failure groups. Tear size, type, and location were analyzed. We determined clinical criteria for success in meniscal status as (1) not positive for 4 clinical objective parameters--joint line pain and tenderness, locking or catching, recurrent effusions, and McMurray test; and (2) complete healing of all-inside sutured meniscus during second-look arthroscopy. Among 39 knees assessed by second-look arthroscopy, 32 (82.1%) knees showed complete healing and 6 (15.4%) showed incomplete healing without any positive findings of the clinical symptoms. Furthermore, all cases in the incompletely healed group had complete healing of the posterior horn, which was sutured by an all-inside suture; the incomplete healing was observed between the junction areas of all-inside to inside-out sutures, which was mainly at the posteromedial corner. The success rate was 97.4% (38 of 39 patients) overall for all-inside suture healing. The 1 patient (2.6%) with clinical failure had a retear of the repaired site. The average knee scores improved and all showed less than 2-mm side-to-side difference on KT-2000 testing. Arthroscopic all-inside vertical suture using a suture hook resulted in a high rate of healing even in large and complex vertical tears. This suturing can be one of the optimal treatments for MMPH tears greater than 1 cm during concurrent ACL reconstruction. Level IV, Therapeutic Study, Cases Series (no, or historical, control group).

Arthroscopic meniscal repair with an absorbable screw: results and surgical technique.

The results of a new method for arthroscopic all-inside meniscus repair using a biodegradable cannulated screw (Clearfix meniscal screw) were assessed in a medium-term follow-up prospective study. The Clearfix meniscal screw system consists of delivery cannulae, screw driver, and screw implants. After tear debridement, a screw is located on the driver and passed through the cannula to the insertion site, holding the two sides of the tear together under linear compression. Forty-eight patients (48 repairs) with a mean age of 32.7 years were included in the study. Ligament stabilizing procedures were done in 39 patients (81%) who had anterior cruciate ligament deficient knees. Only longitudinal lesions in the red/red or red/white zone were repaired. Follow-up averaged 19 months, with a range from 12 to 48 months. Patients were evaluated using clinical examination, the "Orthopaedische Arbeitsgemeinschaft Knie (OAK)" knee evaluation scheme and magnetic resonance imaging (MRI). Criteria for clinical success included absence of joint-line tenderness, absence of swelling and a negative McMurray test. Postoperatively, there were no complications directly associated with the device. Twelve of 48 repaired menisci (25%) were considered failures according to the above-mentioned criteria. According to the OAK knee evaluation scheme, 38 patients (79%) had an excellent or good result. MRI, however, showed persisting grade III or IV lesions in 35 patients (73%). Analysis showed that age, length of tear, and simultaneous anterior cruciate ligament reconstruction did not affect the clinical outcome. In contrast, risk factors for failure of meniscus repair are chronicity of injury, location of tear more than 3 mm from the meniscosynovial junction and meniscus side (medial).

Musculoskeletal-Chronic Left Knee Pain in a High School Athlete Competing in Football and Basketball

0109 HISTORY: A 15 year-old high school basketball and football player presents with complaint of intermittent left knee pain for 3 months. One week prior to presentation, the athlete notes that while running and cutting in football practice he “felt something pop in his left knee during contact drills.” After this episode, the patient describes acute swelling over his left knee, occasional “locking” of the knee, and has had to reduce his activities to non-contact drills due to the increased pain with his left knee. The pain presently is located over “the front, inside part of my knee.” Denies any 'giving out' of the knee when ambulating, and has no difficulty ascending or descending stairs. PHYSICAL EXAM: On examination, atrophy of the left thigh over vastus medialis (left thigh girth 2 cm smaller in diameter). Tenderness over medial femoral condyle and anteromedial aspect of knee. Small joint effusion was noted over the left knee. Normal range of motion, no other areas of point tenderness over patella, patellar tendon, or tibial tubercle, and normal patellar tracking with negative apprehension test. No point tenderness over medial or lateral joint lines. Negative Lachman's, posterior drawer, valgus and varus stress testing. Negative McMurray's test. Wilson's test negative. Tanner stage 4. DIFFERENTIAL DIAGNOSIS: Osteochondritis Dissecans of the Knee Stress Fracture of the Knee Medial Meniscal injury Medial Collateral Ligament Sprain Patellar subluxation Tibial Plateau fracture Idiopathic Anterior Knee pain (patellofemoral knee syndrome) TESTS AND RESULTS: Left Knee plain radiographs – Partial loose body defect of lateral part of medial femoral. FINAL/WORKING DIAGNOSIS: Osteochondritis Dissecans of the Left Knee TREATMENT AND OUTCOMES: Restriction of all athletic competition and placed on non-weight bearing status via crutches. Two fragments were fixed into position using Acutrak screws followed by chondroplasty. Athlete was placed into immobilizing brace and advised to follow up on a monthly basis to determine weight bearing status via physical examination and follow up radiographs. Follow up radiographs from his first visit showed good approximation of osteochondral body in situ by Acutrak screws. Due to the osteochondral body in situ, patient will likely be non-weight bearing for 8–12 weeks with avoidance of pivoting. For the first 4 weeks, the patient was advised to start range-of-motion exercises with extension and flexion only. Following this, he will start quadriceps strengthening and rehabilitation of left knee. The athlete will likely return to sports in 3–4 months from surgery with graded progression of activity.

Musculoskeletal-Chronic Left Knee Pain in a High School Athlete Competing in Football and Basketball

0109 HISTORY: A 15 year-old high school basketball and football player presents with complaint of intermittent left knee pain for 3 months. One week prior to presentation, the athlete notes that while running and cutting in football practice he “felt something pop in his left knee during contact drills.” After this episode, the patient describes acute swelling over his left knee, occasional “locking” of the knee, and has had to reduce his activities to non-contact drills due to the increased pain with his left knee. The pain presently is located over “the front, inside part of my knee.” Denies any 'giving out' of the knee when ambulating, and has no difficulty ascending or descending stairs. PHYSICAL EXAM: On examination, atrophy of the left thigh over vastus medialis (left thigh girth 2 cm smaller in diameter). Tenderness over medial femoral condyle and anteromedial aspect of knee. Small joint effusion was noted over the left knee. Normal range of motion, no other areas of point tenderness over patella, patellar tendon, or tibial tubercle, and normal patellar tracking with negative apprehension test. No point tenderness over medial or lateral joint lines. Negative Lachman's, posterior drawer, valgus and varus stress testing. Negative McMurray's test. Wilson's test negative. Tanner stage 4. DIFFERENTIAL DIAGNOSIS: Osteochondritis Dissecans of the Knee Stress Fracture of the Knee Medial Meniscal injury Medial Collateral Ligament Sprain Patellar subluxation Tibial Plateau fracture Idiopathic Anterior Knee pain (patellofemoral knee syndrome) TESTS AND RESULTS: Left Knee plain radiographs – Partial loose body defect of lateral part of medial femoral. FINAL/WORKING DIAGNOSIS: Osteochondritis Dissecans of the Left Knee TREATMENT AND OUTCOMES: Restriction of all athletic competition and placed on non-weight bearing status via crutches. Two fragments were fixed into position using Acutrak screws followed by chondroplasty. Athlete was placed into immobilizing brace and advised to follow up on a monthly basis to determine weight bearing status via physical examination and follow up radiographs. Follow up radiographs from his first visit showed good approximation of osteochondral body in situ by Acutrak screws. Due to the osteochondral body in situ, patient will likely be non-weight bearing for 8–12 weeks with avoidance of pivoting. For the first 4 weeks, the patient was advised to start range-of-motion exercises with extension and flexion only. Following this, he will start quadriceps strengthening and rehabilitation of left knee. The athlete will likely return to sports in 3–4 months from surgery with graded progression of activity.

Knee Pain-Recreational Athlete

1267 HISTORY: A 24-year old male presented to the office with progressive wax/waning severe knee pain associated with effusions for 4 weeks. He denied any acute injury or increase of his usual activities of jogging and weight training. He had a past medical history significant for a torn medial meniscus in the same knee 2 years ago confirmed by MRI, which subsided without invasive intervention. He felt that his symptoms at present were reminiscent of those associated with his prior injury. He denied locking or buckling, but admitted to difficulty pivoting in certain directions, and also admitted to pain with full weight-bearing. He denied systemic symptoms. PHYSICAL EXAMINATION: Patient walked in with a noticeable limp, but was able to fully bear weight. Patient's knee was warm and swollen, with a significant joint effusion. The skin is slightly wam, without erythema. range of motion severely limited in both flexion and extension, with knee held at 45 degrees. There was no obvious deformity. The knee was globally tender without definitive joint line tenderness. There was no patellar apprehension or associated tenderness upon gentle manipulation. Lachman, McMurray's, anterior and posterior drawer tests were limited secondary to patient discomfort, with no positive findings. Likewise, there was no appreciable laxity with valgus and varus stress (also limited). Under sterile conditions the knee joint was aspirated, yielding 37 cc. of cloudy serous fluid, with partial resolution of the patient's symptoms. DIFFERENTIAL DIAGNOSIS: Reexacerbation of medial meniscus tear Other internal derangement Septic arthritis TEST AND RESULTS: Joint aspiration-cloudy serous synovial fluid. CBC- Largely WNL Comprehensive metabolic panel, including uric acid- WNL Synovial Fluid Cell Count: WBC 13900 cells/mm-3 RBC 2200 cells/mm-3 Polys 50% Lymph 14% No crystals Glucose 51 mg/dl Protein 4.2 g/dl Fluid culture- No aerobic or anaerobic growth Lyme Western Blot of Fluid: Positive for IgM and IgG FINAL WORKING DIAGNOSIS: Lyme disease TREATMENT AND OUTCOMES: Patient was placed on Doxycycline 100 mg BID for a thirty day course, along with Ibuprofen 800 mg TID, and sent to orthopaedics for further evaluation. Patient was initially with assisted weight bearing, progress as tolerated. The patient subsequently had complete resolution of his symptoms after his course of antibiotics. Complete follow-up pending.

Knee Pain-Recreational Athlete

1267 HISTORY: A 24-year old male presented to the office with progressive wax/waning severe knee pain associated with effusions for 4 weeks. He denied any acute injury or increase of his usual activities of jogging and weight training. He had a past medical history significant for a torn medial meniscus in the same knee 2 years ago confirmed by MRI, which subsided without invasive intervention. He felt that his symptoms at present were reminiscent of those associated with his prior injury. He denied locking or buckling, but admitted to difficulty pivoting in certain directions, and also admitted to pain with full weight-bearing. He denied systemic symptoms. PHYSICAL EXAMINATION: Patient walked in with a noticeable limp, but was able to fully bear weight. Patient's knee was warm and swollen, with a significant joint effusion. The skin is slightly wam, without erythema. range of motion severely limited in both flexion and extension, with knee held at 45 degrees. There was no obvious deformity. The knee was globally tender without definitive joint line tenderness. There was no patellar apprehension or associated tenderness upon gentle manipulation. Lachman, McMurray's, anterior and posterior drawer tests were limited secondary to patient discomfort, with no positive findings. Likewise, there was no appreciable laxity with valgus and varus stress (also limited). Under sterile conditions the knee joint was aspirated, yielding 37 cc. of cloudy serous fluid, with partial resolution of the patient's symptoms. DIFFERENTIAL DIAGNOSIS: Reexacerbation of medial meniscus tear Other internal derangement Septic arthritis TEST AND RESULTS: Joint aspiration-cloudy serous synovial fluid. CBC- Largely WNL Comprehensive metabolic panel, including uric acid- WNL Synovial Fluid Cell Count: WBC 13900 cells/mm-3 RBC 2200 cells/mm-3 Polys 50% Lymph 14% No crystals Glucose 51 mg/dl Protein 4.2 g/dl Fluid culture- No aerobic or anaerobic growth Lyme Western Blot of Fluid: Positive for IgM and IgG FINAL WORKING DIAGNOSIS: Lyme disease TREATMENT AND OUTCOMES: Patient was placed on Doxycycline 100 mg BID for a thirty day course, along with Ibuprofen 800 mg TID, and sent to orthopaedics for further evaluation. Patient was initially with assisted weight bearing, progress as tolerated. The patient subsequently had complete resolution of his symptoms after his course of antibiotics. Complete follow-up pending.

Knee Injury - Tae Kwon Do

2221 HISTORY: An 11 year old female presented to the outpatient clinic for follow up of a right knee injury, from Tae Kwon Do, seen at the ER 2 weeks prior. She described a progressive discomfort in her right knee over the couple of days preceeding the ER visit, localizing it to the region of a 'lump' on her right knee near the patellar tendon. She described having to 'crawl on the. oor on her knees' at Tae Kwon Do. At this time, she described being able to finish the exercise with no pain or discomfort. She had no pain with jumping, twisting, and kicking. Pain was increased while climbing stairs. She then visited the ER where they took X-rays, placed her in an immobilizer, and directed her to follow up with the primary care physician. She was advised to rest, take NSAIDS, and avoid physical activity until the pain subsided at which time the immobilizer could be removed. She presented to the clinic with the immobilizer, which had been worn continuously since the ER. There was a pain rating of 5-6/10 and concern about her future activities. PHYSICAL EXAM: Examination in the clinic revealed patient in an immobilizer. Once removed, patient was able to walk to the exam table with a slight limb and step onto the table. Right knee had full range of motion, negative Lachman test, negative Valgus/Vargus test, and negative McMurray test. There was localized swelling and tenderness on palpation of the right tibial tuberosity. There was no effusion. Left knee examination normal. Hip and ankle exam normal. DIFFERENTIAL DIAGNOSIS: Osgood-Schlatter disease Osteomyelitis Bursitis-prepatellar/retropatellar Patellar tendonitis Sinding-Larsen-Johansson syndrome Malignant tumor- osteosarcoma or Ewing's Proximal tibial physeal fracture Avulsion Fracture off the Anterior Tibial Tubercle TEST AND RESULTS: X-ray of Right knee Soft tissue swelling over the proximal anterior tibia with some thickening of the patellar tendon. Avulsion fracture off the anterior tibial tubercle. FINAL/WORKING DIAGNOSIS: Osgood Schlatter disease with possible avulsion fracture off the anterior tibial tubercle. TREATMENT AND OUTCOMES: Relative rest NSAID, Ice Allow ROM, walking, and tolerated activity Follow up appointment

Knee Injury - Tae Kwon Do

2221 HISTORY: An 11 year old female presented to the outpatient clinic for follow up of a right knee injury, from Tae Kwon Do, seen at the ER 2 weeks prior. She described a progressive discomfort in her right knee over the couple of days preceeding the ER visit, localizing it to the region of a 'lump' on her right knee near the patellar tendon. She described having to 'crawl on the. oor on her knees' at Tae Kwon Do. At this time, she described being able to finish the exercise with no pain or discomfort. She had no pain with jumping, twisting, and kicking. Pain was increased while climbing stairs. She then visited the ER where they took X-rays, placed her in an immobilizer, and directed her to follow up with the primary care physician. She was advised to rest, take NSAIDS, and avoid physical activity until the pain subsided at which time the immobilizer could be removed. She presented to the clinic with the immobilizer, which had been worn continuously since the ER. There was a pain rating of 5-6/10 and concern about her future activities. PHYSICAL EXAM: Examination in the clinic revealed patient in an immobilizer. Once removed, patient was able to walk to the exam table with a slight limb and step onto the table. Right knee had full range of motion, negative Lachman test, negative Valgus/Vargus test, and negative McMurray test. There was localized swelling and tenderness on palpation of the right tibial tuberosity. There was no effusion. Left knee examination normal. Hip and ankle exam normal. DIFFERENTIAL DIAGNOSIS: Osgood-Schlatter disease Osteomyelitis Bursitis-prepatellar/retropatellar Patellar tendonitis Sinding-Larsen-Johansson syndrome Malignant tumor- osteosarcoma or Ewing's Proximal tibial physeal fracture Avulsion Fracture off the Anterior Tibial Tubercle TEST AND RESULTS: X-ray of Right knee Soft tissue swelling over the proximal anterior tibia with some thickening of the patellar tendon. Avulsion fracture off the anterior tibial tubercle. FINAL/WORKING DIAGNOSIS: Osgood Schlatter disease with possible avulsion fracture off the anterior tibial tubercle. TREATMENT AND OUTCOMES: Relative rest NSAID, Ice Allow ROM, walking, and tolerated activity Follow up appointment

Patient outcomes following T-Fix meniscal repair and a modifiable, progressive rehabilitation program, a retrospective study.

This retrospective study presents clinical patient outcomes following meniscal repair using T-Fix devices and a modifiable, progressive rehabilitation program. Fifty-two patients (35 males and 17 females) with a mean age of 26.7 years (range 13-50 years) representing all of the patients who underwent arthroscopic meniscal repair (43 medial meniscus, 12 lateral meniscus) over a 3-year period by the same surgeon (D.C.) (55 menisci) participated in this study. Thirty-two of the patients (62%) had an associated ACL tear. All patients with an ACL tear underwent reconstruction (tibialis anterior allograft) at the time of meniscal repair. All meniscal tears were located in either the red-red zone (29) or the red-white zone (26). All patients who underwent meniscal repair participated in a modifiable (based on meniscal tear size, type, and location) progressive rehabilitation program. Operative notes and photographs were reviewed to identify the meniscal tear location, tear type, tear length, and the number of T-Fix devices used. Orthopedic clinic and physical therapy reports were also reviewed for postoperative range of motion, knee joint effusion, knee joint pain, McMurray test findings, and single-leg broad-jump test performance (90% bilateral equivalence goal). The average postoperative clinical follow-up period was 10.3 months (range 4-24 months). Most (22/23, 96%) patients who underwent meniscal repair alone displayed excellent results. All patients (32/32, 100%) who underwent combined ACL reconstruction-meniscal repair displayed excellent results. During an acute event such as a sudden directional change while running or contact with another player, 5 of these patients re-injured their meniscus at the repair site in conjunction with tearing the reconstructed ACL at 12+/-3 months following the index surgical procedure. Each of these 1-2 cm meniscal tears had been previously repaired with two T-Fix devices. The T-Fix device used in combination with a modifiable progressive rehabilitation program produced excellent clinical patient outcomes among this patient group.