***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 
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    ***EXAMPLES*** 
    Input: Background Concomitant injuries to secondary structures have been proposed as a major cause of failure of anterior cruciate ligament reconstruction . Purpose Our purpose was to determine the relationship between meniscal status at the time of anterior cruciate ligament reconstruction and ultimate long-term function and stability . Study Design Prospect i ve cohort study . Methods We prospect ively studied 63 patients for an average of 10.4 years after arthroscopically assisted bone-patellar tendon-bone anterior cruciate reconstruction . All surgeries were performed between 1988 and 1991 ; concomitant meniscal surgery was performed if necessary . Subjects were divided into subgroups relative to the integrity of their menisci at the end of the reconstruction procedure ( intact meniscus , partial meniscectomy , complete meniscectomy ) . Results Patients who had undergone any degree of meniscal resection reported significantly more subjective complaints and activity limitations than those with intact menisci . Subjective International Knee Documentation Committee and Lysholm scores were lower in the meniscectomy subgroups than in the meniscus-intact group . Objective testing revealed a significantly lower ability to perform the single-legged hop in the meniscectomy subgroups . Ligament stability based on instrumented laxity measurements was not significantly different between the subgroups . Radiographic abnormalities were also more common in the subgroups that had undergone meniscectomy . Conclusions The menisci should be repaired if at all possible , especially in the setting of anterior cruciate ligament reconstruction , for optimal functional outcome and patient satisfaction BACKGROUND There are no controlled , prospect i ve studies comparing the 10-year outcomes of anterior cruciate ligament ( ACL ) reconstruction using patellar tendon ( PT ) and 4-str and hamstring tendon ( HT ) autografts . HYPOTHESIS Comparable results are possible with HT and PT autografts . STUDY DESIGN Cohort study ; Level of evidence , 2 . METHODS One hundred eighty ACL-deficient knees that met inclusion criteria underwent ACL reconstruction ( 90 HT autograft , 90 PT autograft ) by one surgeon and were treated with an accelerated rehabilitation program . All knees were observed in a prospect i ve fashion with subjective , objective , and radiographic evaluation at 2 , 5 , 7 , and 10-year intervals . RESULTS At 10 years , there were no differences in graft rupture rates ( 7/90 PT vs. 12/90 HT , P = .24 ) . There were 20 contralateral ACL ruptures in the PT group , compared with 9 in the HT group ( P = .02 ) . In all patients , graft rupture was associated with instrumented laxity > 2 mm at 2 years ( P = .001 ) . Normal or near-normal function of the knee was reported in 97 % of patients in both groups . In the PT group , harvest-site symptoms ( P = .001 ) and kneeling pain ( P = .01 ) were more common than in the HT group . More patients reported pain with strenuous activities in PT knees than in HT knees ( P = .05 ) . Radiographic osteoarthritis was more common in PT knees than the HT-reconstructed knees ( P = .04 ) . The difference , however , was composed of patients with mild osteoarthritis . Other predictors of radiographic osteoarthritis were < 90 % single-legged hop test at 1 year and the need for further knee surgery . An " ideal " outcome , defined as an overall International Knee Documentation Committee grade of A or B and a radiographic grade of A at 10 years after ACL reconstruction , was associated with <3 mm of instrumented laxity at 2 years , the absence of additional surgery in the knee , and HT grafts . CONCLUSIONS It is possible to obtain excellent results with both HT and PT autografts . We recommend HT reconstructions to our patients because of decreased harvest-site symptoms and radiographic osteoarthritis We used single-photon emission computed tomography ( SPECT ) to determine the long-term risk of degenerative change after reconstruction of the anterior cruciate ligament ( ACL ) . Our study population was a prospect i ve series of 31 patients with a mean age at injury of 27.8 years ( 18 to 47 ) and a mean follow-up of ten years ( 9 to 13 ) after bone-patellar tendon-bone reconstruction of the ACL .  The contralateral normal knee was used as a control . All knees were clinical ly stable with high clinical scores ( mean Lysholm score , 93 ; mean Tegner activity score , 6 ) . Fifteen patients had undergone a partial meniscectomy and ACL reconstruction at or before reconstruction of their ACL .  In the group with an intact meniscus , clinical symptoms of osteoarthritis ( OA ) were found in only one patient ( 7 % ) , who was also the only patient with marked isotope uptake on the SPECT scan compatible with OA . In the group which underwent a partial meniscectomy , clinical symptoms of OA were found in two patients ( 13 % ) , who were among five ( 31 % ) with isotope uptake compatible with OA . Only one patient ( 7 % ) in this group had evidence of advanced OA on plain radiographs . The risk of developing OA after ACL reconstruction in this series is very low and lower than published figures for untreated ACL-deficient knees . There is a significant increase ( p < 0.05 ) in degenerative change in patients who had a reconstruction of their ACL and a partial meniscectomy  compared with those who had a reconstruction of their ACL alone Objective To compare , in young active adults with an acute anterior cruciate ligament ( ACL ) tear , the mid-term ( five year ) patient reported and radiographic outcomes between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL reconstruction . Design Extended follow-up of prospect i ve r and omised controlled trial . Setting Orthopaedic departments at two hospitals in Sweden . Participants 121 young , active adults ( mean age 26 years ) with acute ACL injury to a previously uninjured knee . One patient was lost to five year follow-up . Intervention All patients received similar structured rehabilitation . In addition to rehabilitation , 62 patients were assigned to early ACL reconstruction and 59 were assigned to the option of having a delayed ACL reconstruction if needed . Main outcome measure The main outcome was the change from baseline to five years in the mean value of four of the five subscales of the knee injury and osteoarthritis outcome score ( KOOS4 ) . Other outcomes included the absolute KOOS4 score , all five KOOS subscale scores , SF-36 , Tegner activity scale , meniscal surgery , and radiographic osteoarthritis at five years . Results Thirty ( 51 % ) patients assigned to optional delayed ACL reconstruction had delayed ACL reconstruction  ( seven between two and five years ) . The mean change in KOOS4 score from baseline to five years was 42.9 points for those assigned to rehabilitation plus early ACL reconstruction and 44.9 for those assigned to rehabilitation plus optional delayed reconstruction ( between group difference 2.0 points , 95 % confidence interval −8.5 to 4.5 ; P=0.54 after adjustment for baseline score ) . At five years , no significant between group differences were seen in KOOS4 ( P=0.45 ) , any of the KOOS subscales ( P≥0.12 ) , SF-36 ( P≥0.34 ) , Tegner activity scale ( P=0.74 ) , or incident radiographic osteoarthritis of the index knee ( P=0.17 ) . No between group differences were seen in the number of knees having meniscus surgery ( P=0.48 ) or in a time to event analysis of the proportion of meniscuses operated on ( P=0.77 ) . The results were similar when analysed by treatment actually received . Conclusion In this first high quality r and omised controlled trial with minimal loss to follow-up , a strategy of rehabilitation plus early ACL reconstruction did not provide better results at five years than a strategy of initial rehabilitation with the option of having a later ACL reconstruction . Results did not differ between knees surgically reconstructed early or late and those treated with rehabilitation alone . These results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear . Trial registration Current Controlled Trials IS RCT N84752559 Background The choice of different graft types and surgical techniques used when reconstructing a torn anterior cruciate ligament may influence the long-term prevalence of osteoarthritis and functional outcomes . Hypothesis There are no differences in the prevalence of knee osteoarthritis or  knee function in patients undergoing reconstruction of a torn anterior cruciate ligament with 4-str and hamstring autograft versus patellar tendon — bone autograft .  Study Design R and omized controlled trial ; Level of evidence , 1 . Methods Seventy-two patients with subacute or chronic rupture of the anterior cruciate ligament were r and omly assigned to autograft reconstruction with 4-str and gracilis and semitendinosus tendon ( HAM ) ( N = 37 ) or with patellar tendon — bone ( PTB ) ( N = 35 ) from the ipsilateral side . Outcome measurements were the Cincinnati knee score , single-legged hop tests , isokinetic muscle strength tests , pain , knee joint laxity test ( KT-1000 arthrometer ) , and a radiologic evaluation ( Kellgren and Lawrence ) at 10-year follow-up . Results At 10 years , 57 patients ( 79 % ) were eligible for evaluation—29 in the HAM group and 28 in the PTB group . No differences were found between the 2 graft groups with respect to the Cincinnati knee score , the single-legged hop tests , pain , muscle strength measurements , or knee joint laxity . Fifty-five percent and 64 % of the patients had osteoarthritis corresponding to Kellgren and Lawrence grade 2 or more in the HAM and the PTB groups , respectively ( P = .27 ) . For the uninvolved knee , the corresponding numbers were 28 % and 22 % ( P = .62 ) . Conclusion At 10 years postoperatively , no statistically significant differences in clinical outcome between the 2 graft types were found . The prevalence of osteoarthritis was significantly higher in the operated leg than in the contralateral leg , but there were no significant differences between the 2 groups . The results indicate that the choice of graft type after an anterior cruciate ligament injury has minimal influence on the prevalence of osteoarthritis 10 years after surgery There is little evidence examining the relationship between anatomical l and marks , radiological placement of the tunnels and long-term clinical outcomes following  anterior cruciate ligament ( ACL ) reconstruction .  The aim of this study was to investigate the reproducibility of intra-operative l and marks for placement of the tunnels in  single-bundle reconstruction of the ACL using four-str and hamstring tendon autografts . Isolated reconstruction of the ACL was performed in 200 patients , who were followed prospect ively for seven years with use of the International Knee Documentation Committee forms and radiographs . Taking 0 % as the anterior and 100 % as the posterior extent , the femoral tunnel was a mean of 86 % ( sd 5 ) along Blumensaat 's line and the tibial tunnel was 48 % ( sd 5 ) along the tibial plateau . Taking 0 % as the medial and 100 % as the lateral extent , the tibial tunnel was 46 % ( sd 3 ) across the tibial plateau and the mean inclination of the graft in the coronal plane was 19 degrees ( sd 5.5 ) . The use of intra-operative l and marks result ed in reproducible placement of the tunnels and an excellent clinical outcome seven years after operation . Vertical inclination was associated with increased rotational instability and degenerative radiological changes , while rupture of the graft was associated with posterior placement of the tibial tunnel . If the osseous tunnels are correctly placed , single-bundle reconstruction of the ACL adequately controls both anteroposterior and rotational instability The aims of the study were to analyse the change in knee laxity over time after  anterior cruciate ligament ( ACL ) reconstruction  , using either bone – patellar – tendon – bone ( BPTB ) or hamstring ( HS ) tendon autografts , and to compare the knee laxity measurements between the study groups both pre-operatively and on multiple follow-up occasions . Another aim was to compare the radiographic findings in terms of degenerative changes between the study groups . A r and omised series of 71 patients , who underwent ACL reconstruction using BPTB or HS tendon autografts and interference screw fixation , were included in the study . Of these patients , 47/71 ( 66 % ) attended a clinical examination , including laxity measurements using the  KT-1000 arthrometer  , pre-operatively and on four post-operative occasions ; 6 months , 1 year , 2 years and 7 years after the reconstruction . The BPTB group consisted of 22 patients , while there were 25 patients in the HS group . There were no significant differences in the mean side-to-side knee laxity between the BPTB and the HS group pre-operatively or at the follow-up examinations . There was a tendency towards a reduction in side-to-side knee laxity over time in both groups , measured with the KT-1000 arthrometer . The decrease was significant when analysing the injured and uninjured knee separately ( injured side p < 0. 
    Output:
    
Medial meniscal injury/meniscectomy showed moderate evidence for influencing OA development ( tibiofemoral OA and compartment unspecified ) .
Lateral meniscal injury/meniscectomy showed moderate evidence for no relationship ( compartment unspecified ) , as did time between injury and reconstruction ( tibiofemoral and patellofemoral OA ) .
CONCLUSIONS Medial meniscal injury/meniscectomy after ACL rupture increased the risk of OA development .
In contrast , it seems that lateral meniscal injury/meniscectomy has no relationship with OA development .
Our results suggest that time between injury and reconstruction does not influence patellofemoral and tibiofemoral OA development .
Many determinants showed conflicting and limited evidence and no determinant showed strong evidence