***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of this prospect i ve study was to compare two arthroscopic techniques for reconstructing the anterior cruciate ligament , the " outside-in " ( two incisions ) and the " all-inside " ( one incision ) techniques . The results obtained for 30 patients operated on using the " outside-in " technique ( group I ) were compared with those for 29 patients operated on using the " all-inside " technique ( group II ) . Before surgery , there were no significant differences between the groups in terms of Lysholm score , Tegner activity level , patellofemoral pain score , or knee laxity . Both groups displayed significant improvements in Lysholm score after 24 months , from 69 ( 16 ) to 91 ( 9 ) in group I and from 70 ( 17 ) to 90 ( 15 ) in group II ( means ( SD ) ) . There were also significant improvements in patellofemoral pain scores in both groups , from 13 ( 6 ) to 18 ( 5 ) in group I and from 14 ( 6 ) to 18 ( 4 ) in group II after 24 months . No difference was found between the groups in knee stability at the 24 month follow up . The IKDC score was identical in both groups at follow up . The operation took significantly longer for patients in group I ( mean 94 ( 15 ) ) than for those in group II ( mean 86 ( 20 ) ) ( p = 0.03 ) . The mean sick leave was 7.7 ( 6.2 ) weeks in group I and 12.3 ( 9.7 ) weeks in group II ( p = 0.026 ) , indicating that there may be a higher morbidity associated with the " all-inside " technique . It can be concluded that there were no significant differences between the two different techniques in terms of functional results , knee laxity , or postoperative complications . The results were satisfactory and the outcome was similar in both treatment groups PURPOSE To compare femoral graft bending angles and femoral tunnel geometries between the transportal ( TP ) and outside-in ( OI ) techniques after anatomic double-bundle ( DB ) anterior cruciate ligament ( ACL ) reconstruction . METHODS Thirty-nine patients underwent DB ACL reconstruction with the TP and OI techniques .  They were r and omized on the day of surgery to either the TP group ( group I , 21 cases ) or the OI group ( group II , 18 cases ) . Femoral graft bending angle , femoral tunnel geometry , posterior wall breakage , and tunnel communication were assessed by computed tomography imaging with OsiriX imaging software ( Pixmeo , Geneva , Switzerl and ) . RESULTS The mean anteromedial ( AM ) and posterolateral ( PL ) femoral graft bending angles of group II ( 97.3 ° ± 8.3 ° and 97.4 ° ± 8.6 ° , respectively ) were significantly more acute than those of group I ( 108.2 ° ± 8.4 ° and 109.9 ° ± 8.8 ° , respectively ) ( P < .001 ) . The mean AM femoral tunnel length of group II ( 34.3 ± 3.9 mm ) was significantly longer than that of group I ( 31.9 ± 2.7 mm ) ( P = .02 ) . However , the mean PL femoral tunnel lengths did not differ between groups . In 7 cases-4 cases ( 19.0 % ) in group I and 3 cases ( 16.6 % ) in group II-the femoral tunnel communication was found around the intra-articular aperture . Posterior wall breakage was observed in 5 cases ( 23.8 % ) , which were all in AM femoral tunnels of group I. CONCLUSIONS The OI technique result ed in more acute femoral graft bending angles ( difference of 10.9 ° and 12.5 ° for AM and PL , respectively ) and longer mean AM femoral tunnel lengths ( difference of 2.4 mm ) than the TP technique after anatomic DB ACL reconstruction , even though these small differences might be unlikely to be of clinical significance . Femoral tunnel communication was found in both groups , and posterior wall breakage was observed in AM femoral tunnels with the TP technique . LEVEL OF EVIDENCE Level I , prospect i ve r and omized trial Background Several studies have recently shown better restoration of normal knee kinematics and improvement of rotator knee stability after reconstruction with higher femoral tunnel obliquity . The aim of this study is to evaluate tunnel obliquity , length , and posterior wall blowout in single-bundle anterior cruciate ligament ( ACL ) reconstruction , comparing the transtibial ( TT ) technique and the out – in ( OI ) technique . Material s and methods Forty consecutive patients operated on for ACL reconstruction with hamstrings were r and omly divided into two groups : group A underwent a TT technique , while group B underwent an OI technique . At mean follow-up of 10 months , clinical results and obliquity , length , and posterior wall blowout of femoral tunnels in sagittal and coronal planes using computed tomography ( CT ) scan were assessed . Results In sagittal plane , femoral tunnel obliquity was 38.6 ± 10.2 ° in group A and 36.6 ± 11.8 ° in group B ( p = 0.63 ) . In coronal plane , femoral tunnel obliquity was 57.8 ± 5.8 ° in group A and 35.8 ± 8.2 ° in group B ( p = 0.009 ) . Mean tunnel length was 40.3 ± 1.2 mm in group A and 32.9 ± 2.3 mm in group B ( p = 0.01 ) . No cases of posterior wall compromise were observed in any patient of either group . Clinical results were not significantly different between the two groups . Conclusions The OI technique provides greater obliquity of the femoral tunnel in coronal plane , along with satisfactory length of the tunnel and lack of posterior wall compromise . Level of evidence II , prospect i ve study Double-bundle  anterior cruciate ligament ( ACL ) reconstruction is intended to replicate the anatomy and the function of the anteromedial and posterolateral bundles of the native ACL to improve patients ' satisfaction and knee stability . We prospect ively assigned 75 consecutive patients with an isolated ACL lesion to one of three sequential groups of 25 patients each . Group I received a single-bundle , single-incision transtibial ACL reconstruction . Groups II and III received a double-bundle reconstruction with a single-incision transtibial technique or a double-bundle , twoincision outside-in technique , respectively . We obtained subjective International Knee Documentation Committee and Knee Injury and Osteoarthritis Outcome Score evaluations and objective International Knee Documentation Committee scores and KT-1000 measurements preoperatively and at followup . All patients reached a minimum followup of 2 years . KT side-to-side difference in Groups I , II , and III were 2.4 , 1.6 and 1.4 mm , respectively . Group III had fewer patients with a positive pivot shift than Group I. The double-bundle double-incision outside-in ACL reconstruction result ed in improved anteroposterior stability and less residual pivot shift than single-incision single-bundle technique . Level of Evidence : Level II , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence A linear analogue for rating  pain with 10 , 15 and 20 cm lines is significantly less variable than a 5 cm line ( mean error of 15 cm line is 0 - 19 % , 95 % confidence limits for the group + /- 2 % and an inood correlation between repeated ratins of a recalled pain distant in time . The variance of the rating is significantly less than the repeated rating of a r and om mark . The linear analogue rating of a constant pain stimulus is reproducible and changes in rating are likely to be real changes of opinion . Pethidine 150 mg intramuscularly had no significant effect , tested 30 minutes after the administration , on the accuracy or reproducibility of the analogue rating . A linear analogue seems a suitable method of recording the patient 's opion of a severe pain such as that of labour Objective To compare the transtibial and two-incision techniques for anterior cruciate ligament ( ACL ) reconstruction using a single b and . Methods A prospect i ve and r and omized study was conducted in blocks . Patients underwent ACL reconstruction by means of two techniques : transtibial ( group 1 : 20 patients ) or two incisions ( group 2 : 20 patients ) . The radiographic positioning of the tunnel , inclination of the graft , graft isometricity and functional results ( IKDC and Lysholm ) were evaluated . Results The positioning of the femoral tunnel on the anteroposterior radiograph , expressed as a mean percentage relative to the medial border of the tibial plateau , was 54.6 % in group 1 and 60.8 % in group 2 ( p < 0.05 ) . The positioning of the femoral tunnel on the lateral radiograph , expressed as a mean percentage relative to the anterior border of Blumensaat 's line , was 68.4 % in group 1 and 58 % in group 2 ( p < 0.05 ) . The mean inclination of the graft was 19 ° in group 1 and 27.2 ° in group 2 ( p < 0.05 ) . The mean graft isometricity was 0.96 mm in group 1 and 1.33 mm in group 2 ( p > 0.05 ) . Group 2 had better results from the pivot-shift maneuver ( p < 0.05 ) . Conclusion The technique of two incisions allowed positioning of the femoral tunnel that was more lateralized and anteriorized , such that the graft was more inclined and there was a clinical ly better result from the pivot-shift maneuver . There was no difference in isometricity and no final functional result over the short follow-up time evaluated Purpose To evaluate the accuracy of intraoperative femoral tunnel length measurement and to compare this between the transportal ( TP ) and outside-in ( OI ) techniques for double-bundle ( DB ) anterior cruciate ligament ( ACL ) reconstruction . Methods Eighty patients underwent a DB ACL reconstruction using either the TP or the OI technique .  The participants were r and omized to either a TP group ( I , 40 cases ) or a OI group ( II , 40 cases ) . The intraoperatively measured femoral tunnel length was recorded , and the postoperative femoral tunnel length was measured using computed tomography with OsiriX ® imaging software . Results The mean femoral tunnel lengths measured intraoperatively in Group II ( 38.9 ± 3.0 mm for anteromedial [ AM ] , 39.3 ± 3.4 mm for posterolateral [ PL ] ) were significantly longer than those of Group I ( 34.8 ± 2.7 mm for AM , 36.0 ± 3.2 mm for PL ) ( P < 0.001 ) . The mean AM femoral tunnel length measured postoperatively in Group II ( 33.3 ± 3.8 mm ) was significantly longer than that in Group I ( 31.1 ± 2.9 mm ) ( P = 0.006 ) . The mean intraoperatively measured femoral tunnel length was significantly longer than that measured postoperatively in Groups I and II ( P < 0.001 ) . Conclusion After anatomic DB ACL reconstruction , the femoral tunnel length  of the OI technique measured intraoperatively ( AM/PL ) and postoperatively ( AM ) was longer than those of the TP technique . The femoral tunnel length measured intraoperatively was longer than that measured postoperatively in both TP and OI technique . This study may help surgeons to measure femoral tunnel length accurately in anatomic DB ACL reconstruction with suspensory fixation device . Level of evidence Prospect i ve r and omized controlled trial , Level The purpose of this study was to find out whether the single-incision technique for anterior cruciate ligament repair  has advantages over the two-incision technique in terms of muscular function up to 1 year postoperatively . Twenty patients who underwent unilateral anterior cruciate ligament reconstruction with bone-patellar tendon-bone autografts  were r and omly assigned to one of the two procedures . Both groups ( 10 patients in each ) were followed up at 1 year . Lysholm and International Knee Documentation scores and thigh circumferences were markedly reduced after surgery in both groups but improved up until the last follow-up examination at 12 months postoperatively . Clinical examination , functional scores , stabilometry measurements , and thigh circumferences did not differ between the two groups . Isokinetic evaluation revealed a significant reduction of extensor peak torques in both groups that was most pronounced at 3 months , then improved continuously but was still present 12 months postoperatively . A significant reduction of peak torques , up to 35 % , was seen in the flexor muscles of the involved legs compared with the contralateral legs , but this deficit vanished completely after 12 months in both groups . At 3 and 6 months , for the flexor as well as the extensor muscles , the deficits in peak torque on the injured sides were found to have improved faster in the single-incision group . These results indicate improved dynamic muscle function with use of the single-incision technique because the dissection of the vastus lateralis muscle that occurs in the two-incision technique is avoided Abstract  Anterior cruciate ligament ( ACL ) reconstruction with patellar tendon graft has become a st and ard procedure . The graft can be inserted either using two tunnels and a lateral femoral incision or with a femoral half-tunnel drilled from the joint , thus avoiding the lateral incision . Advantages have been cl aim ed for the single-incision technique in the early rehabilitation period . Forty patients with ACL deficiency were included in a prospect i ve r and omized trial comparing the single- and two-incision technique with a follow-up period of 12 months . Preoperative data did not show any significant difference between the two groups . At early follow-up no differences were observed with respect to complications or the progress of re 
    Output:
    
The very low- quality and often absent evidence means that we are uncertain whether one-incision arthroscopically assisted ACL reconstruction techniques yield better , worse , or equivalent results compared with two-incision techniques in terms of short- , intermediate- , or long-term subjective function , quality of life , adverse outcomes , activity levels , and objective ly rated knee function .
The evidence was available only for single-bundle ACL reconstruction using patella tendon grafts .