***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: Background Osteochondral talar defects usually affect athletic patients . The primary surgical treatment consists of arthroscopic debridement and microfracturing . Although this is mostly successful , early sport resumption is difficult to achieve , and it can take up to one year to obtain clinical improvement . Pulsed electromagnetic fields ( PEMFs ) may be effective for talar defects after arthroscopic treatment by promoting tissue healing , suppressing inflammation , and relieving pain . We hypothesize that PEMF-treatment compared to sham-treatment after arthroscopy will lead to earlier resumption of sports , and aim at 25 % increase in patients that resume sports . Methods / Design A prospect i ve , double-blind , r and omized , placebo-controlled trial ( RCT ) will be conducted in five centers throughout the Netherl and s and Belgium . 68 patients will be r and omized to either active PEMF-treatment or sham-treatment for 60 days , four hours daily . They will be followed-up for one year . The combined primary outcome measures are ( a ) the percentage of patients that resume and maintain sports , and ( b ) the time to resumption of sports , defined by the Ankle Activity Score . Secondary outcome measures include resumption of work , subjective and objective scoring systems ( American Orthopaedic Foot and Ankle Society – Ankle-Hindfoot Scale , Foot Ankle Outcome Score , Numeric Rating Scales of pain and satisfaction , EuroQol-5D ) , and computed tomography . Time to resumption of sports will be analyzed using Kaplan-Meier curves and log-rank tests . Discussion This trial will provide level-1 evidence on the effectiveness of PEMFs in the management of osteochondral ankle lesions after arthroscopy . Trial registration Netherl and s Trial Register ( NTR1636 Background R and omized trials are essential in assessing the effects of healthcare interventions and are a key component in systematic review s of effectiveness . Search ing for reports of r and omized trials in data bases is problematic due to the absence of appropriate indexing terms until the 1990s and inconsistent application of these indexing terms thereafter . Objectives The objectives of this study are to devise a search strategy for identifying reports of r and omized trials in EMBASE which are not already indexed as trials in MEDLINE and to make these reports easily accessible by including them in the Cochrane Central Register of Controlled Trials ( CENTRAL ) in The Cochrane Library , with the permission of Elsevier , the publishers of EMBASE . Methods A highly sensitive search strategy was design ed for EMBASE based on free-text and thesaurus terms which occurred frequently in the titles , abstract s , EMTREE terms ( or some combination of these ) of reports of trials indexed in EMBASE . This search strategy was run against EMBASE from 1980 to 2005 ( 1974 to 2005 for four of the terms ) and records retrieved by the search , which were not already indexed as r and omized trials in MEDLINE , were downloaded from EMBASE , printed and read . An analysis of the language of publication was conducted for the reports of trials published in 2005 ( the most recent year completed at the time of this study ) . Results Twenty-two search terms were used ( including nine which were later rejected due to poor cumulative precision ) . More than a third of a million records were downloaded and scanned and approximately 80,000 reports of trials were identified which were not already indexed as r and omized trials in MEDLINE . These are now easily identifiable in CENTRAL , in The Cochrane Library . Cumulative sensitivity ranged from 0.1 % to 60 % and cumulative precision ranged from 8 % to 61 % . The truncated term ' r and om$ ' identified 60 % of the total number of reports of trials but only 35 % of the more than 130,000 records retrieved by this term were reports of trials . The language analysis for the sample year 2005 indicated that of the 18,427 reports indexed as r and omized trials in MEDLINE , 959 ( 5 % ) were in language s other than English . The EMBASE search identified an additional 658 reports in language s other than English , of which the highest number were in Chinese ( 320 ) . Conclusion The results of the search to date have greatly increased access to reports of trials in EMBASE , especially in some language s other than English . The search strategy used was subjectively derived from a small ' gold st and ard ' set of test records and was not vali date d in an independent test set . We intend to design an objective ly-derived vali date d search strategy using logistic regression based on the frequency of occurrence of terms in the approximately 80,000 reports of r and omized trials identified compared with the frequency of these terms across the entire EMBASE data base 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 Background Arthroscopic examination has shown that the regenerative cartilage that appears after arthroscopic drilling for thetreatment of osteochondral lesions of the talar dome does not always cover the cartilage defect sufficiently . Hypothesis The remaining degenerative cartilage at the lesions may obstruct the healing of the articular cartilage . Study Design Prospect i ve cohort study . Methods Thirty-nine patients underwent arthroscopic drilling that kept the remaining cartilage at the lesion ( group A ) , and 30 patients underwent arthroscopic drilling that  removed the remaining cartilage at the lesion ( group B ) . At 1 year after theoperation , we performed ankle arthroscopy to evaluate the cartilage condition . Results The arthroscopic findings revealed that in group A , 11 cases ( 28.2 % ) were improved , 12 cases ( 30.8 % ) wereunchanged , and 16 cases ( 41.0 % ) had deteriorated ; in group B , 27 cases ( 93.1 % ) were improved and 2 cases were unchanged . There were significant differences between group A and group B in the rate of cases whose cartilage condition was seen toimprove under arthroscopic examination ( P < 0.0001 ) . Conclusions The study shows that in the treatment of osteochondral lesions of the talar dome , the removing of the remainingdegenerative cartilage may be of some benefit in the treatment of these lesions PURPOSE The purpose of this study was to compare outcomes of chondroplasty versus microfracture versus osteochondral autologous transplantation ( OAT ) in patients with osteochondral lesions of the talus ( OLT ) . METHODS After prospect i ve sample size analysis , patients with symptomatic , recalcitrant Ferkel class 2b , 3 , and 4 OLT were r and omized to chondroplasty , microfracture , or OAT treatment groups . Outcomes were measured with use of the American Orthopaedic Foot and Ankle Society ( AOFAS ) Ankle-Hindfoot Scale ( AHS ) , the Subjective Assessment Numeric Evaluation ( SANE ) rating , Numeric Pain Intensity ( NPI ) , and magnetic resonance imaging ( MRI ) . RESULTS Eleven patients had chondroplasty , 10 ankles ( 9 patients ) had microfracture , and 12 patients had OAT .  Mean time to follow-up was 53 months ( range , 24 to 119 months ) . AHS scores showed no differences at 12 and 24 months , and SANE ratings showed no differences at final follow-up . NPI was significantly lower ( P < .001 ) in chondroplasty and microfracture cases as compared with OAT at 24 hours postoperatively . Pearson 's correlation analysis demonstrated an inverse relation between microfracture and OAT groups in that better outcome was associated with smaller lesions , compared with the chondroplasty group , which revealed mixed results with no particular trend . MRI revealed incomplete fill and edema after chondroplasty or microfracture and chondral gaps after OAT . CONCLUSION Our results demonstrate no difference between chondroplasty , microfracture , and OAT with regard to AHS and SANE ratings in patients with OLT . However , NPI at 24 hours postoperatively was significantly lower in patients who had chondroplasty and microfracture . LEVEL OF EVIDENCE Level I , Therapeutic study , high- quality r and omized controlled trial with no statistically significant differences but narrow confidence interval 
    Output:
    
There is insufficient evidence from r and omised trials to determine which interventions are best for osteochondral defects of the talus in adults .