***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: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results Background : The purpose of this study was threefold : ( 1 ) to determine the scientific quality of published r and omized trials in the American Volume of The Journal of Bone and Joint Surgery from 1988 through 2000 , ( 2 ) to identify predictors of study quality , and ( 3 ) to evaluate inter-rater agreement in the scoring of study quality with use of a simple scale . Methods : H and search es of The Journal of Bone and Joint Surgery were conducted in duplicate to identify r and omized clinical trials . Of 2468 studies identified , seventy-two ( 2.9 % ) met all eligibility criteria . Two investigators each assessed the quality of the study under blinded conditions and abstract ed relevant data . Results : The mean score ( and st and ard error ) for the quality of the seventy-two r and omized trials was 68.1 % ± 1.6 % ; 60 % ( forty-three ) scored < 75 % . Drug trials had a significantly higher mean quality score than did surgical trials ( 72.8 % compared with 63.9 % , p < 0.05 ) . Regression analysis revealed that cited affiliation with an epidemiology department and cited funding were associated with higher quality scores . Failure to conceal r and omization , to blind outcome assessors , and to describe why patients were excluded result ed in significantly lower quality scores ( p < 0.05 ) , more than the 5 % decrease expected by removal of each item . A priori calculations of sample size were rarely performed in the review ed studies , and only 2 % of the studies with negative results included a post hoc power analysis . The Detsky quality scale met accepted st and ards of interobserver reliability ( kappa , 0.87 ; 95 % confidence interval , 0.70 to 0.95 ) . Conclusions : Few studies published in The Journal of Bone and Joint Surgery were r and omized trials . More than half of the trials were limited by a lack of concealed r and omization , lack of blinding of outcome assessors , or failure to report reasons for excluding patients . Application of st and ardized guidelines for the reporting of clinical trials in orthopaedics should improve quality 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 Seventy-two patients with subacute or chronic rupture of the anterior cruciate ligament were r and omly assigned to autograft reconstruction with four-str and gracilis and semitendinosus tendon ( N = 37 ) or with patellar tendon-bone ( N = 35 ) from the ipsilateral side . The groups were similar in terms of age , sex , level of activity , degree of laxity , meniscal lesions found surgically , and rehabilitation program . The follow-up was performed at another hospital by independent observers after 6 , 12 , and 24 months . Sixty-one patients ( 32 with hamstring tendon grafts and 29 with patellar tendon grafts ) complied with the follow-up routine for the full 24 months . No differences were found between the groups with respect to Cincinnati functional score , KT-1000 arthrometer measurements , or stairs hopple test results . The subjective result and the single-legged hop test result were better for the hamstring tendon group after 6 and 12 months , but no differences were found after 24 months . The hamstring tendon group showed better isokinetic knee extension strength than did the patellar tendon group after 6 months , but not after 12 and 24 months . There was a significant weakness in isokinetic knee flexion strength among the hamstring tendon group . Anterior knee pain was not significantly different between the groups , but kneeling pain was significantly less common in the hamstring tendon group after 24 months We studied 79 patients with unilateral injury to the anterior cruciate ligament ( ACL ) . The patients were r and omly allocated to reconstruction with autologous patellar bone-tendon-bone ( BTB ) grafts ( 49 knees ) or hamstring tendon ( ST ) grafts ( 30 knees ) . We measured  anterior tibial translation ( ATT ) during isokinetic concentric contraction exercise  18–20 months after surgery using a computerized electrogoniometer . In both groups the highest ATT during exercise was observed at a knee flexion of about 20 ° and was 13.5±3.0 mm in the BTB group and 13.9±3.4 mm in the ST group . There was no difference in the ATT between the reconstructed and healthy knees . For a range of knee flexion between 30 and 50 ° the ATT in the ST group was significantly higher on the reconstructed side than on the healthy side . In the BTB group , the mean ATT in the reconstructed group was similar to that on the healthy side at a knee flexion angle between 0 and 90 ° .RésuméNous avons étudié 79 malades avec une rupture unilatérale du ligament croiseur antérieur ( ACL ) . Les malades étaient r and omisés pour avoir une reconstruction avec greffe autologue os-tendon-os rotulien ( BTB ; 49 genoux ) ou une greffe des tendons ischiojambiers ( ST ; 30 genoux ) . Nous avons mesuré la translation tibiale antérieure ( ATT ) pendant la contraction concentrique isocinétique , 18–20 mois après la chirurgie en utilisant un électrogoniomètre informatisé . Dans les deux groupes le plus haut ATT pendant l'exercice a été observé à une flexion du genou d'approximativement 20 ° et était de 13,5±3,0 mm dans le groupe BTB et 13,9±3,4 mm dans le groupe ST . Il n'y avait aucune différence dans la translation entre les genoux reconstruit et les genoux sains . Pour une flexion du genou entre 30 et 50 ° , l'ATT dans le groupe ST était significativement plus haut du côté reconstruit que du côté sain . Dans le groupe BTB , l'ATT dans le groupe reconstruit était semblable à celui sur le côté sain à un angle de la flexion du genou entre 0 et 90 ° 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 < 0.001 ( BPTB ) and p = 0.005 ( HS ) , uninjured side p = 0.008 and p = 0.042 , respectively ) . Forty-four patients ( BPTB 21 , ST 23 ) underwent a radiographic assessment at the 7-year follow-up , which revealed no significant differences between the study groups in terms of osteoarthritic findings classified according to the Fairbank and Ahlbäck rating systems . In overall terms , osteoarthritis was identified in 16 % ( BPTB 19 % ; ST 13 % ; n.s . ) according to the Ahlbäck rating system and 68 % ( BPTB 67 % ; ST 70 % ; n.s . ) according to the Fairbank rating system . There were no significant differences in knee laxity measurements between the two study groups pre-operatively or at 7 years . A decrease in knee laxity over time was seen in both groups . There were no significant differences between the BPTB and ST groups in terms of osteoarthritic findings at 7 years A five-year , prospect i ve , r and omized follow-up study was done to compare three methods for repair of a rupture of the anterior cruciate ligament of the knee :  acute primary repair ( Group 1 ) , acute repair with a synthetic ligament-augmentation device ( Group 2 ) , and acute repair augmented with an autologous bone-patellar ligament-bone graft ( Group 3 ) . One hundred and fifty patients who had an acute rupture of the anterior cruciate ligament were r and omized to one of the three repair groups , with fifty patients in each group . The patients were between sixteen and fifty years old ( mean , twenty-nine years old ) . All patients had the operation within ten days after the injury . The rehabilitation protocol was identical for each group . The patients were evaluated prospect ively at one , two , and five years with use of the Tegner scoring system for level of activity and the scoring system of Lysholm and Gillquist for function , and the stability of the knee was assessed with clinical examination and with use of the KT-1000 arthrometer . One hundred and thirty-one patients completed the study and ten other patients were known to have had a failure of the procedure , a 94 per cent rate of follow-up . All three groups had a lower level of activity at the five-year follow-up evaluation than they had had before the injury . The patients who had had augmentation with a patellar-ligament graft had a significantly higher mean level of activity at two years than those who had had non-augmented repair ( p = 0.002 ) and those who had had repair with a synthetic ligament-augmentation device ( p = 0.01 ) . They also had a significantly higher mean 
    Output:
    
Many trials were at high risk of bias reflecting inadequate methods of r and omization , lack of blinding and incomplete assessment of outcome .Pooled data for primary outcomes , reported in a minority of trials , showed no statistically significant differences between the two graft choices for functional assessment ( single leg hop test ) , return to activity , Tegner and Lysholm scores , and subjective measures of outcome .
There were also no differences found between the two interventions for re-rupture or International Knee Documentation Committee scores .
All tests ( instrumental , Lachman , pivot shift ) for static stability consistently showed that PT reconstruction result ed in a more statically stable knee compared with HT reconstruction .
Conversely , patients experienced more anterior knee problems , especially with kneeling , after PT reconstruction .
PT reconstructions result ed in a statistically significant loss of extension range of motion and a trend towards loss of knee extension strength .
HT reconstructions demonstrated a trend towards loss of flexion range of motion and a statistically significant loss of knee flexion strength .
There is insufficient evidence to draw conclusions on differences between the two grafts for long-term functional outcome .
While PT reconstructions are more likely to result in statically stable knees , they are also associated with more anterior knee problems