Study design characteristics should also be taken into account whenever a study on MRI assessing its diagnostic performance is designed or reviewed.

5In a prospective single-center longitudinal randomized controlled trial 116 patients were 6 allocated to the sub-vastus approach, and 115 to the medial parapatellar approach. At one 7 week follow-up, compared to baseline, range of motion, Knee Society (KS) global, KS 8 knee, and KS pain scores were significantly better in the sub-vastus group. At the one year 9 follow-up WOMAC global and pain scores, SF36 physical function and role-physical 10 scores, and EuroQol utility and pain score were significantly better in the sub-vastus 11 group. The ease of exposure in the sub-vastus approach was significantly worse. There 12 was no significant difference in length of stay or analgesia intake. The sub-vastus approach 13 to total knee arthroplasty was more effective than a medial parapatellar approach at both 14 one week and fifty-two weeks post-operatively, but surgeons reported a less easy exposure 15 in the sub-vastus group. 16[ISRCTN44544446] 17 18

ESE in athletic patients provide comparable clinical outcome compared to our previous results in non-athletic patients. ESE are a viable option for the management of AT in athletes, but, in our hands, only around 60% of our athletic patients benefited from an intensive, heavy load eccentric heel drop exercise regimen alone. If ESE fail to improve the symptoms, aprotinin and local anaesthetic injections should be considered. Surgery is indicated in recalcitrant cases after 3 to 6 months of non operative management.

In our setting, percutaneous repair and conservative management are viable alternatives to open surgery, which carries higher complications rates and was the most costly of the three. Individual patients will have different needs due to their age, occupation, or level of sporting activity.