***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: Pre- clinical studies have shown that treatment by pulsed electromagnetic fields ( PEMFs ) can limit the catabolic effects of pro-inflammatory cytokines on articular cartilage and favour the anabolic activity of the chondrocytes . Anterior cruciate ligament ( ACL ) reconstruction is usually performed by arthroscopic procedure that , even if minimally invasive , may elicit an inflammatory joint reaction detrimental to articular cartilage . In this study the effect of I-ONE PEMFs treatment in patients undergoing ACL reconstruction was investigated . The study end-points were ( 1 ) evaluation of patients ’ functional recovery by International Knee Documentation Committee ( IKDC ) Form ; ( 2 ) use of non-steroidal anti-inflammatory drugs ( NSAIDs ) , necessary to control joint pain and inflammation . The study design was prospect i ve , r and omized and double blind . Sixty-nine patients were included in the study at baseline . Follow-up visits were scheduled at 30 , 60 and 180 days , followed by 2-year follow-up interview . Patients were evaluated by IKDC Form and were asked to report on the use of NSAIDs .  Patients were r and omized to active or placebo treatments ; active device generated a magnetic field of 1.5 mT at 75 Hz . Patients were instructed to use the stimulator ( I-ONE ) for 4 h per day for 60 days . All patients underwent ACL reconstruction with use of quadruple hamstrings semitendinosus and gracilis technique . At baseline there were no differences in the IKDC scores between the two groups . At follow-up visits the SF-36 Health Survey score showed a statistically significant faster recovery in the group of patients treated with I-ONE stimulator ( P < 0.05 ) . NSAIDs use was less frequent among active patients than controls ( P < 0.05 ) . Joint swelling resolution and return to normal range of motion occurred faster in the active treated group ( P < 0.05 ) too . The 2-year follow-up did not shown statistically significant difference between the two groups . Furthermore for longitudinal analysis the generalized linear mixed effects model was applied to calculate the group × time interaction coefficient ; this interaction showed a significant difference ( P < 0.0001 ) between the active and placebo groups for all investigated variables : SF-36 Health Survey , IKDC Subjective Knee Evaluation and VAS .  Twenty-nine patients ( 15 in the active group ; 14 in the placebo group ) underwent both ACL reconstruction and meniscectomy ; when they were analysed separately the differences in SF-36 Health Survey scores between the two groups were larger then what observed in the whole study group ( P < 0.05 ) . The results of this study show that patient ’s functional recovery occurs earlier in the active group . No side effects were observed and the treatment was well tolerated . The use of I-ONE should always be considered after ACL reconstruction , particularly in professional athletes , to shorten the recovery time , to limit joint inflammatory reaction and its catabolic effects on articular cartilage and ultimately for joint preservation Background / Purpose : This study sought to examine the effectiveness of a modeling video to reduce preoperative perceptions of anxiety and pain , as well as to increase postoperative self-efficacy and functional outcomes after anterior cruciate ligament reconstruction . Methods : Following baseline assessment of state anxiety , perceptions of expected pain , injury severity , and knee function ( International Knee Documentation Committee [ IKDC ] system ) , patients scheduled for surgical reconstruction of the anterior cruciate ligament were r and omly assigned to either a modeling intervention or a control group .  Psychological assessment s were repeated preoperatively for expected pain and anxiety . Actual pain was assessed preoperatively , prior to discharge , and at 2 weeks postoperatively . Rehabilitation self-efficacy was assessed prior to discharge and at 2 and 6 weeks postoperatively . IKDC functional assessment s were repeated at 6 weeks postoperatively , whereas range of motion was assessed at 2 and 6 weeks postsurgery . Results : Compared with the participants in the control condition , participants assigned to the modeling intervention reported significantly lower perceptions of expected pain preoperatively and significantly greater self-efficacy at predischarge to perform rehabilitation tasks . Those who received the modeling intervention also experienced significantly better IKDC objective functional outcome scores compared with their control counterparts . No psychological variables mediated relations between the intervention and functional outcomes . Conclusions : The data suggest that watching a modeling video may be an effective prophylactic treatment to decrease perceptions of expected pain , increase rehabilitation self-efficacy , and provide an early stimulus with respect to early function OBJECTIVE The aim of this study was to analyze the effect of running retraining on the recovery of the knee 's functional and muscular properties after anterior cruciate ligament ( ACL ) reconstruction . METHODS Eighty-five athletes who had undergone ACL reconstruction surgery were selected r and omly to receive , or not to receive , controlled running training based on interval training and speed exercises . The effect of retraining was measured by the evolution of the knee 's isokinetic strength deficit and progress ( at angular speeds of 60 and 180 degrees /s ) , the knee laxity parameters and the score on the Lysholm Knee Scale from the 4th to the 6th month after the surgery . Forty subjects were retrained and compared with 40 control-group subjects .  The effect of the retraining program was studied in terms of the type of ACL reconstruction and the effect of time . RESULTS After retraining , no difference was found for isokinetic knee strength deficit and progress , knee laxity and Lysholm Knee Score . The isokinetic strength deficit was influenced mainly by the type of ACL reconstruction . CONCLUSION It would seem that running retraining has an insufficient effect on the muscular and functional recovery after ACL reconstruction , despite the fact that this type of training is well-tolerated Background This study will attempt to evaluate the efficacy of knee immobilization on patient pain levels after an anterior cruciate ligament reconstruction . Hypothesis There is no difference in visual analog scale pain scores 2 days after anterior cruciate ligament reconstruction between patients who wear a knee immobilizer  and those who do not wear a knee immobilizer . Study Design R and omized clinical trial ; Level of evidence , 1 . Methods Patients aged 18 to 40 years who met study inclusion criteria were eligible . Patients meeting intraoperative inclusion critiera were r and omized  ( immobilizer or no immobilizer ) after wound closure . The immobilizer used was a soft , unhinged brace with Velcro ® straps . Preoperative , intraoperative , and postoperative protocol s were st and ardized . The primary outcome was patient self-assessed pain using a 0-to-100-mm visual analog scale at day 2 after surgery . Secondary outcomes included pain and analgesic use in the first 14 days after surgery , complications , and range of motion ( approximately 3 weeks postoperatively ) . A sample size estimate was calculated and result ed in the need for 44 patients per group . Results A total of 102 patients were enrolled ; 88 patients were r and omized , and 14 were excluded intraoperatively . There was no difference in mean visual analog scale pain scores at 2 days after surgery between immobilized and nonimmobilized patients ( 32.6 and 35.2 , respectively ; P = .59 ; difference , —2.6 ; 95 % confidence interval , —12.2 to 6.9 ) . There were no differences between groups in medication consumed , range of motion , or complications . Pain and analgesic use were the same for both groups at 7 and 14 days postoperatively . Conclusion No differences in pain or any of the secondary outcomes were detected between immobilized and nonimmobilized patients at any point during the first 14 days after anterior cruciate ligament reconstruction A prospect i ve , blinded , r and omised controlled trial investigated the effectiveness of quadriceps exercises  following anterior cruciate ligament reconstruction . A treatment group ( Quadriceps exercise group ) performed straight leg raises and isometric quadriceps contractions throughout the first two postoperative weeks , and a second group ( No quadriceps exercise group ) did not . A battery of outcome measures assessed subjects postoperatively at day one , two weeks , and one , three and six months . A total of 103 patients ( Quadriceps exercise n = 48 , No quadriceps exercise n = 55 ) commenced the study with 91 subjects available at final follow up ( Quadriceps exercise n = 47 , No quadriceps exercise n = 44 ) . Performance of quadriceps exercises significantly improved a number of knee flexion and extension range of motion measurements ( p = 0.01 to 0.04 ) . No significant differences were found between the two groups at any postoperative period for quadriceps lag ( p = 0.36 ) , functional hop testing ( p = 0.49 to 0.51 ) , isokinetic quadriceps strength ( p = 0.70 to 0.72 ) , the majority of numerical analogue scores ( p = 0.1 to 0.94 ) and Cincinnati scores ( p = 0.10 to 0.84 ) . Subjects performing quadriceps exercises reported significantly higher pain scores with exercise on the first postoperative day ( p = 0.02 ) . At six months postoperatively , the Quadriceps exercise subjects reported significantly more favourable Cincinnati scores for symptoms ( p = 0.005 ) and problems with sport ( p = 0.05 ) . While average knee laxity was not significantly different between treatment groups over time ( p = 0.27 to 0.94 ) , quadriceps exercise performance was associated with a significantly lower incidence of abnormal knee laxity .  Isometric quadriceps exercises and straight leg raises can be safely prescribed during the first two postoperative weeks and confer advantages for faster recovery of knee range of motion and stability . It remains to be proven whether the magnitude of differences between groups is clinical ly significant If permission of full active and passive extension immediately after an anterior cruciate ligament ( ACL ) reconstruction will increase the post-operative laxity of the knee has been a subject of discussion . We investigated whether a post-operative rehabilitation protocol including active and passive extension without any restrictions in extension immediately after an ACL reconstruction would increase the post-operative anterior – posterior knee laxity ( A – P laxity ) . Our hypothesis was that full active and passive extension immediately after an ACL reconstruction would have no effect on the A – P laxity and clinical results up to 2 years after the operation . Twenty-two consecutive patients ( 14 men , 8 women , median age 21 years , range 17–41 ) were included . All the patients had a unilateral ACL rupture and no other ligament injuries or any other history of previous knee injuries . The surgical procedure was identical in all patients and one experienced surgeon operated on all the patients , using the bone-patellar tendon-bone autograft . The post-operative rehabilitation programme was identical in both groups , except for extension training during the first 4 weeks post-operatively . The patients were r and omly allocated to post-operative rehabilitation programmes either allowing ( Group A , n=11 ) or not allowing [ Group B ( 30 to −10 ° ) , n=11 ] full active and passive extension immediately after the operation . They were evaluated pre-operatively and at 6 months and 2 years after the reconstruction . To evaluate the A – P knee laxity , radiostereometric analysis ( RSA ) and KT-1000 arthrometer ( KT-1000 ) measurements were used , range of motion , Lysholm score , Tegner activity level , the International Knee Documentation Committee ( IKDC ) evaluation system and one-leg-hop test quotient were used . Pre-operatively , the RSA measurements revealed side-to-side differences in Group A of 8.6 mm ( 2.3–15.4 ) , median ( range ) and in Group B of 7.2 mm ( 2.2–17.4 ) ( n.s . ) . The corresponding KT-1000 values were for Group A , 2.0 mm ( 0–8.0 ) and Group B , 4.0 mm ( 0–10.0 ) ( n.s . ) . At 2 years , the differences between the two groups were minimal , regardless of the method that had been used . The RSA measurements in Group A were 2.7 mm ( 0–10.7 ) and in Group B 2.8 ( −1.8 to 9.5 ) . The KT-1000 values were for Group A , 1.0 mm ( −1.5 to 3.5 ) , and for Group B , 0.5 mm ( −1.0 to 4.0 ) , without any significant differences between the groups . Nor did the Lysholm score , Tegner activity level , IKDC or one-leg-hop test differ . Early active and passive extension training , without any restrictions in extension , immediately after an ACL reconstruction using bone-patellar tendon-bone graft  did not increase post-operative knee laxity up to 2 years after the ACL reconstruction Background and Purpose The purpose of this study was to determine the effect of a 6-month neuromuscular training ( NT ) program versus a traditional strength training ( ST ) program following anterior cruciate ligament ( ACL ) reconstruction . Subjects Seventy-four subjects with ACL reconstruction participated in the study . Methods The study was a r and omized , single-blinded , controlled trial . The NT and ST groups were tested preoperatively and at 3 and 6 months . The main outcome measure was the Cincinnati Knee Score . Secondary outcome measures were visual analog scales ( VASs ) for pain and function , the 36-Item Short-Form Health Survey ( SF-36 ) , hop tests , isokinetic muscle strength , proprioception , and static and dynamic balance tests . Results The NT group demonstrated significantly improved Cincinnati Knee Scores and VAS scores for global knee function compared with the ST group at the 
    Output:
    
RESULTS Bracing following ACL reconstruction remains neither necessary nor beneficial and adds to the cost of the procedure .
Home-based  rehabilitation can be successful .
Although neuromuscular interventions are not likely to be harmful to patients , they are also not likely to yield large improvements in outcomes or help patients return to sports faster .
Vibration training may lead to faster and more complete proprioceptive recovery but further evidence is needed .
Several new modalities for rehabilitation after ACL reconstruction may be helpful but should not be performed to the exclusion of range-of-motion , strengthening , and functional exercises .