***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: Purpose To evaluate granulocyte colony-stimulating factor ( G-CSF ) efficacy in accelerating bone regeneration following opening-wedge high tibial valgus osteotomy for genu varum . Methods A phase II trial was conducted for evaluating the preoperative administration of G-CSF given at 10 μg/kg/day for 3 consecutive days with an additional half-dose 4 h before the opening-wedge high tibial valgus osteotomy . Overall , 12 patients ( Group A ) received G-CSF treatment , and the subsequent 12 patients ( Group B ) underwent surgery without G-CSF . The osteotomy gap was filled by a bone graft substitute . Bone marrow cell ( BMC ) mobilization was monitored by CD34+ve cell and clonogenic progenitor cell analysis . All patients underwent a clinical ( Lysholm Knee Scale and SF-36 ) and radiographic evaluation preoperatively , as well as at given intervals postsurgery . Results All patients completed the treatment program without major side effects ; G-CSF was well tolerated . BMC mobilization occurred in all Group A patients , with median peak values of circulating CD34+ve cells of 110/μL ( range 29–256 ) . Circulating clonogenic progenitors paralleled CD34+ve cell levels . A significant improvement in Lysholm Knee Scale was recorded at follow-up in Group A compared to Group B. At the radiographic evaluation , there was a significant increase in osseointegration at the bone-graft junction in Group A at 1 , 2 , 3 and 6 months postsurgery compared to Group B. The computerized tomography scan of the grafted area at 2 months postsurgery showed no significant difference in the quality of the newly formed bone between the two Groups . Conclusions Although the limited number of patients does not allow firm conclusions , the study suggests that G-CSF can be safely administered preoperatively in subjects undergoing opening-wedge high tibial valgus osteotomy ; in addition , the clinical , radiographic and CT monitoring indicate that G-CSF and /or mobilized BMC s may hasten bone graft substitute osseointegration . Level of evidence Purpose Early knee OA is a significant problem that can be disabling . The purpose of this study was to underst and the symptomatic profile of patients with early knee OA when compared to those with end-stage knee OA . Methods A cross-sectional case control study design was used to compare those with early structural change to those with advanced structural change . In total , 100 consecutive patients with early radiographic knee OA presenting to the knee service outpatient clinic from December 2010 to August 2011 were prospect ively identified on the basis of their radiographic changes . All met the symptomatic and radiological diagnostic criteria of early knee OA as defined by Luyten et al. They were compared with  200 knees with full thickness anteromedial knee OA and 200 knees with full thickness tricompartmental knee OA  for their demographic , pain and functional profile . Results Patients with early knee OA were younger than those with full thickness disease . However , 78 % of individual patients with early radiographic OA had pain and function scores equal to individual patients presenting for UKA , whilst 74 % of individual patients with early radiographic OA had pain and function scores that are equal to or worse than individual patients presenting for TKA . Conclusions Patients with early radiographic knee OA demonstrate considerable overlap in the severity of their symptoms with those demonstrating end-stage structural changes within the knee . Patients with early structural changes of arthritis should not be assumed by clinicians to have mild disease . In many cases , their symptoms are as bad as those with end-stage structural changes . This work will help clinicians to identify and categorise those with early arthritis and thereby assist in guiding appropriate treatments In this prospect i ve r and omised study two treatments after non-traumatic medial meniscal tear diagnosed with radiological examination and magnetic resonance imaging were compared ; arthroscopic partial meniscectomy followed by supervised exercise or supervised exercise alone . The aim was to evaluate knee function and physical activity . Ninety patients ( mean age 56 years ) were evaluated using the  Knee Injury and Osteoarthritis Outcome Score , the Lysholm Knee Scoring Scale , the Tegner Activity Scale and a Visual Analogue Scale for knee pain prior to the intervention , after 8 weeks of exercise and after 6 months . According to the outcome scores arthroscopic partial medial meniscectomy combined with exercise did not lead to greater improvement than exercise alone . After the intervention both groups reported decreased knee pain , improved knee function and a high satisfaction ( P < 0.0001 ) . Forty-one per cent of the patients returned to their pre-injury activity level after 6 months . In conclusion , when evaluated with outcome scores , arthroscopic partial medial meniscectomy followed by supervised exercise was not superior to supervised exercise alone in terms of reduced knee pain , improved knee function and improved quality of life Purpose We compared the effectiveness of mechanical debridement ( MD ) and bipolar radiofrequency chondroplasty ( RF ) with regard to clinical outcome , rate of revision , and progression of knee osteoarthritis .  Methods Sixty patients with MRI-detected grade III cartilage lesions on the medial femoral condyle were considered for the study . For MD ( group 1 ; n = 30 ) , each lesion was debrided using a mechanical shaver . For RF ( group 2 ; n = 30 ) , each lesion was smoothed using a temperature-controlled RF probe set at 50 ° C . Results The 10-year follow-up was available for 47 patients ( 78.3 % ) . Sixty per cent of group 1 ( n = 18 ) underwent revision during the follow-up period . In contrast , the revision rate in group 2 was 23.3 % ( n = 7 ; p = 0.061 ) . The mean survival was 94.1 months ( 95 % CI 77.1–111.3 ) and 62.5 months ( 95 % CI 45.9–79.2 ) for group 2 and group 1 , respectively . Patients who did not require revision ( group 1 , n = 9 ; group 2 , n = 13 ) were assessed before surgery and 1 , 4 , and 10 years after surgery using the knee injury and osteoarthritis outcome score ( KOOS ) . At follow-up , the KOOS was higher for group 2 than group 1 . At the time of surgery , no patient showed any radiological signs of osteoarthritis . The width of the medial joint was 5.4 mm ( 95 % CI 4.3–6.5 ) and 5.6 mm ( 95 % CI 4.9–6.3 ) in the MD and RF groups , respectively ( n.s . ) . During the follow-up period , the joint space width narrowed continuously in both groups ( p < 0.001 ) , but more rapidly in the group 1 ( n.s ) . Conclusion Compared to conventional MD , 50 ° RF treatment appears to be a superior method based on short- and medium-term clinical outcomes and the progression of knee osteoarthritis . Clear predictors for the indications of different cartilage treatments and more r and omized clinical trials are needed . Level of evidence Objective Compare arthroscopic partial meniscectomy to a true sham intervention . Methods Sham-controlled superiority trial performed in three county hospitals in Denmark comparing  arthroscopic partial meniscectomy to skin incisions only  in patients aged 35–55 years with persistent knee pain and an MRI-confirmed medial meniscus lesion . A computer-generated table of r and om numbers generated two comparison groups . Participants and outcome assessors were blinded to group allocation . Exclusions were locking knees , high-energy trauma or severe osteoarthritis . Outcomes were collected at baseline , 3 and 24 months . We hypothesised no difference between groups . The primary outcome was the between-group difference in change from baseline to 2 years in the mean score across all five normalised Knee injury and Osteoarthritis Outcome Score ( KOOS ) subscales ( KOOS5 ) . Results Forty-four patients ( of the estimated 72 ) underwent r and omisation ; 22 in each group . Sixteen participants ( 36 % ) were non-blinded and eight participants ( 36 % ) from the sham group crossed over to the surgery group prior to the 2-year follow-up . At 2 years , both groups reported clinical ly relevant improvements ( surgery 21.8 , skin incisions only 13.6 ) , the mean difference between groups was 8.2 in favour of surgery , which is slightly less than the cut-off of 10 prespecified to represent a clinical ly relevant difference ; judged by the 95 % CI ( −3.4 to 19.8 ) , a possibility of clinical ly relevant difference could not be excluded . In total , nine participants experienced 11 adverse events ; six in the surgery group and three in the skin-incisions-only group . Conclusion We found greater improvement from arthroscopic partial meniscectomy compared with skin incisions only at 2 years , with the statistical uncertainty of the between-group difference including what could be considered clinical ly relevant . Because of the study being underpowered , nearly half in the sham group being non-blinded and one-third crossing over to surgery , the results can not be generalised to the greater patient population . Trial registration number NCT01264991 Background : The optimal treatment for middle-aged patients with knee pain and meniscal lesions has been extensively debated . Most previous studies have revealed only short-term beneficial results of knee arthroscopic surgery . The authors have previously shown a positive benefit of knee arthroscopic surgery and an exercise program after 1 year when compared with an exercise program alone . Purpose : To evaluate if knee arthroscopic surgery combined with an exercise program provided an additional long-term benefit after 3 years compared with an exercise program alone in middle-aged patients with meniscal symptoms . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Of 179 eligible patients , aged 45 to 64 years , 150 were r and omized to ( 1 ) a 3-month exercise program ( nonsurgery group ) or ( 2 ) the same as group 1 plus knee arthroscopic surgery within 4 weeks ( surgery group ) . The primary outcome was the change in the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) subscore of pain between baseline and the 3-year follow-up . Results from the 1-year follow-up have been published previously . Results : Both treatment groups improved significantly in the KOOS pain subscore at 3 years ’ follow-up in the intention-to-treat and as-treated analyses ( P < .001 ) . The between-group difference for the change in the KOOS pain subscore between baseline and the 3-year follow-up was no longer statistically significant , neither in the intention-to-treat analysis ( 7.6 points ; 95 % CI , –0.6 to 15.9 ; P = .068 ) nor in the as-treated analysis ( 5.3 points ; 95 % CI , –3.1 to 13.8 ; P = .216 ) . The factorial analysis of the effect of the intervention and age , onset of pain , and mechanical symptoms indicated that older patients improved more , regardless of treatment , and surgery may be more beneficial for patients without mechanical symptoms ( as-treated analysis ) . The effect of the predictive factors on the KOOS pain subscore was uncertain because of the small sample size in the subgroup analyses . Conclusion : The benefit of knee arthroscopic surgery , seen at 1 year in middle-aged patients with meniscal symptoms , was diminished at 3 years and was no longer statistically significant . Clinical Relevance : Knee arthroscopic surgery may be beneficial for middle-aged patients with meniscal symptoms in addition to an exercise program . Older age and absence of mechanical symptoms should not be contraindications to surgery . Registration : NCT01288768 ( Clinical Trials.gov identifier BACKGROUND Few studies have examined whether chondral lesions encountered in patients undergoing meniscectomy should be surgically treated . The primary aim of the ChAMP ( Chondral Lesions And Meniscus Procedures ) Trial is to determine whether there is a difference in knee pain between patients undergoing debridement versus observation of chondral lesions encountered during arthroscopic meniscectomy .  This paper describes the rationale and study design for the ChAMP Trial . METHODS / DESIGN The ChAMP Trial is a r and omized controlled trial of patients aged 30 and older undergoing partial meniscectomy and r and omly allocated to debridement ( CL-Deb , N=98 ) or observation ( CL-Obs , N=92 ) of chondral lesions identified during surgery and deemed to be significant ( Outerbridge Grade II-IV ) . Patients and data collectors were unaware of treatment allocation until completion of the study . Patients with surgically insignificant ( Outerbridge Grade I ) chondral lesions or no chondral lesions were included as a third non-r and omized comparison group ( NoCL , N=76 ) . The primary outcome is the difference in knee pain assessed by WOMAC ( Western Ontario and McMaster Universities Arthritis Index ) between the CL-Deb and CL-Obs groups at 1-year after surgery . Secondary outcomes include 1-year differences in additional measures of knee pain , function , symptoms , activity , and quality of life assessed by the WOMAC , KOOS ( Knee Injury and Osteoarthritis Outcome Score ) , visual analog pain scale , and physical exam ; as well as general health assessed with the SF-36 ( Short-form Health Survey ) . Increased intraoperative costs associated 
    Output:
    
Low- quality evidence suggests there may be little difference in pain and function at 12 months follow-up in people who have arthroscopic partial meniscectomy and those who have physical therapy .
Due to very low quality evidence , we are uncertain if surgery is associated with an increased risk of serious adverse events , incidence of total knee replacement or withdrawal rates .
Similarly , low- quality evidence from a few small trials indicates there may not be any benefit of arthroscopic surgery over other non-surgical treatments including saline irrigation and hyaluronic acid injection , or one type of surgery over another .
We are uncertain of the risk of adverse events or of progressing to total knee replacement due to very small event rates .