***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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    Input: Although allograft use for primary anterior cruciate ligament reconstruction has continued to increase during the last 10 years , concerns remain regarding the long-term function of allografts ( primarily that they may stretch with time ) and clinical efficacy compared with autograft tendons . We attempted to address these issues by prospect ively comparing identical quadrupled hamstring autografts with allograft constructs for primary anterior cruciate ligament reconstruction in patients with a minimum followup of 3 years . Eighty-four patients ( 37 with autografts and 47 with allografts ) were enrolled ; the mean followup was 52 ± 11 months for the autograft group and 48 ± 8 months for the allograft group . Outcome measurements included objective and subjective International Knee Documentation Committee scores , Lysholm scores , Tegner activity scales , and KT-1000 arthrometer measurements . The two cohorts were similar in average age , acute or chronic nature of the anterior cruciate ligament rupture , and incidence of concomitant meniscal surgeries . At final followup , we found no difference in terms of Tegner , Lysholm , KT-1000 , or International Knee Documentation Committee scores . Five anterior cruciate ligament reconstructions failed : three in the autograft group and two in the allograft group . Our data suggest laxity is not increased in allograft tendons compared with autografts and clinical outcome scores 3 to 6 years after surgery are similar . Level of Evidence : Level II , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence PURPOSE To investigate the influence of harvesting semitendinosus and gracilis tendons on the rotational muscle strength of the limb after  anterior cruciate ligament ( ACL ) reconstruction .  TYPE OF STUDY Prospect i ve study . METHODS We performed a prospect i ve study of 62 consecutive ( 34 male , 28 female ) patients with ACL reconstructions using the semitendinosus and gracilis tendons .  The mean age at surgery was 20.8 years .  The semitendinosus tendon was harvested in 32 patients ( ST group ) , and semitendinosus and gracilis tendons in 30 patients ( STG group ) . The peak isokinetic torques for extension , flexion , internal rotation , and external rotation were measured before and 12 months after ACL reconstruction using the Cybex 6000B system ( Cybex Division of Lumex , Ronkonkoma , NY ) . The rotational torque was measured at 30 degrees/sec and 120 degrees/sec . RESULTS Before reconstruction , the mean isokinetic peak torque of the involved limb was decreased in extension and internal rotation . The mean isokinetic peak torque of the involved limb in extension recovered 12 months after ACL reconstruction ; however , the weakness in internal rotation persisted . The preoperative weakness of the involved limb in extension and internal rotation recovered in the male patients , but not in the female patients after postoperative rehabilitation . The peak torque of the involved limb in internal rotation was decreased in the STG group , but not in the ST group . CONCLUSIONS The internal rotational torque was influenced by harvesting the semitendinosus and gracilis tendons after ACL reconstruction , especially in female patients and patients from whom the gracilis tendon was harvested . Semitendinosus and gracilis tendons are important for the internal rotation of the limb and it was difficult to compensate for this function . Thus , we recommend harvesting the semitendinosus tendon only if tendon quality is sufficient to further minimize harvesting morbidity Purpose This study is to compare the clinical and radiographic results of  anterior cruciate ligament ( ACL ) reconstruction with four-str and ed autogenous hamstring tendon and two-str and ed free tendon Achilles allograft fixed with EndoButton in the femoral tunnel and Intrafix in the tibial tunnel . Material s and methods 106 patients diagnosed with ACL rupture underwent ACL reconstruction . Autogenous hamstring tendon was used in 33 patients ( group I ) and free tendon Achilles allografts were used in 32 patients ( group II ) . Median age was 23 years old ( 20–51 ) in group I and 22 years old ( 20–55 ) in group II .  Range of motion , Lachman test , Pivot shift test , IKDC score , Lysholm score and side-to-side difference ( SSD ) were evaluated preoperatively and at the last follow-up . Tegner activity scale was evaluated before injury and at the last follow-up . Results The mean follow-up periods were 28.1 months in group I and 31.6 months in group II . Range of motion of the knee was not different from that of the unaffected side in most cases except one flexion deficit in group I and three in group II ( n.s . ) . One in group I and three in group II showed grade two or three laxity on Lachman test at the last follow-up . One in group I and three in group II showed clear positive results on Pivot shift test at the last follow-up . Thirty in group I and 26 in group II were classified to IKDC A or B at the last follow-up ( n.s . ) . Median Lysholm scores were 98 ( 85–100 ) in group I and 99 ( 85–100 ) in group II at the last follow-up ( n.s . ) . Median Tegner activity scales were 6 ( 5–9 ) in group I and 6 ( 4–9 ) in group II at the last follow-up ( n.s . ) . The mean SSD at the last follow-up were 1.4 ± 2.0 mm in group I and 1.9 ± 2.4 mm in group II ( n.s . ) . Conclusion Clinical and radiological outcomes of ACL reconstruction with two-str and ed free tendon Achilles allograft were comparable to those of four-str and ed autogenous hamstring tendon . This technique is reasonable to accomplish good results without some weaknesses when using allograft with bone block . Level of evidence Therapeutic r and omized controlled prospect i ve study , Level Background : Most studies of allograft versus autograft for anterior cruciate ligament reconstruction have been of bone – patellar tendon – bone ; outcome reports evaluating anterior cruciate ligament reconstruction with hamstring tendon autograft versus allograft are rare . Purpose : This study was undertaken to compare the clinical outcome of arthroscopic anterior cruciate ligament reconstruction with hamstring tendon autograft versus allograft . Study Design : R and omized controlled trial ; Level of evidence , 2 . Methods : Between 2000 and 2004 , 208 patients who met the inclusion and exclusion criteria of the study were prospect ively r and omized into autograft ( n = 104 ) or allograft ( n = 104 ) groups . All hamstring tendon allografts were fresh-frozen and obtained from a single certified tissue bank . All the operations were done by the same surgeon with the same surgical technique . Femoral and tibial fixation was by means of an EndoButton and a bioabsorbable interference screw augmented with a staple , respectively . Patients were evaluated preoperatively and postoperatively . Evaluations included detailed history , physical examination , functional knee ligament testing , KT-2000 arthrometer testing , Harner vertical jump and Daniel 1-legged hop tests , Lysholm score , Tegner score , the International Knee Documentation Committee ( IKDC ) st and ard evaluation form , Cincinnati knee score , and radiographs . Results : Of these patients , 186 ( autograft , n = 91 ; allograft , n = 95 ) were available for full evaluation . Demographic data were comparable between groups . The mean follow-up was 7.8 years for both groups . There were no statistically significant differences according to the evaluations of the outcome aforementioned between the 2 groups except that patients in the allograft group had a shorter operation time than the autograft group . Seven patients ( 7.7 % ) in the autograft group and 8 ( 8.4 % ) in the allograft group had a side-to-side difference > 5 mm . Eighty-five patients ( 93.4 % ) in the autograft group and 86 ( 90.5 % ) in the allograft group were normal or nearly normal according to the overall IKDC . According to the subjective IKDC , the average scores were 89 and 90 points , respectively , for the autograft and allograft groups . The mean Lysholm and Tegner scores were 89 points and 7.7 points , respectively , for the autograft group and 90 points and 7.6 points , respectively , for the allograft group . For the Cincinnati knee score , the average scores were 90 and 91 points , respectively , for the autograft and allograft groups . Conclusion : Both groups of patients achieved almost the same satisfactory outcome at an average of 7.8 years of follow-up . Fresh-frozen hamstring tendon allograft is a reasonable alternative choice to autograft for anterior cruciate ligament reconstruction Background : Tearing an anterior cruciate ligament ( ACL ) graft is a devastating occurrence after ACL reconstruction ( ACLR ) . Identifying and underst and ing the independent predictors of ACLR graft failure is important for surgical planning , patient counseling , and efforts to decrease the risk of graft failure . Hypothesis : Patient and surgical variables will predict graft failure after ACLR . Study Design : Prospect i ve cohort study . Methods : A multicenter group initiated a cohort study in 2002 to identify predictors of ACLR outcomes , including graft failure . First , to control for confounders , a single surgeon ’s data ( n = 281 ACLRs ) were used to develop a multivariable regression model for ACLR graft failure . Evaluated variables were graft type ( autograft vs allograft ) , sex , age , body mass index , activity at index injury , presence of a meniscus tear , and primary versus revision reconstruction . Second , the model was vali date d with the rest of the multicenter study ’s data ( n = 645 ACLRs ) to evaluate the generalizability of the model . Results : Patient age and ACL graft type were significant predictors of graft failure for all study surgeons . Patients in the age group of 10 to 19 years had the highest percentage of graft failures . The odds of graft rupture with an allograft reconstruction are 4 times higher than those of autograft reconstructions . For each 10-year decrease in age , the odds of graft rupture increase 2.3 times . Conclusion : There is an increased risk of ACL graft rupture in patients who have undergone allograft reconstruction . Younger patients also have an increased risk of ACL graft failure . Clinical Relevance : Given these risks for ACL graft rupture , allograft ACLRs should be performed with caution in the younger patient population BACKGROUND The Oxford Levels of Evidence are now routinely assigned at many orthopaedic journals . One disadvantage of this approach is that study design s with a higher level of evidence may be given greater weight than the overall quality of the study merits . In other words , there is no guarantee that research is scientifically valid simply because a more sophisticated study design was employed . The aim of this study was to review Level-I and II therapeutic studies on lateral epicondylitis to measure variation in quality among the highest-level study design s. METHODS Fifty-four prospect i ve r and omized therapeutic trials involving patients with lateral epicondylitis were evaluated by two independent  review ers according to the Oxford Levels of Evidence , a modification of the Coleman Methodology Score ( a 0 to 100-point scale ) , and the revised CONSORT ( Consoli  date d St and ards of Reporting Trials ) score . RESULTS The two review ers were consistent in their use of the Oxford Levels of Evidence ( kappa = 0.73 , p < 0.01 ) , the modified Coleman Methodology Score ( kappa = 0.73 ; p < 0.01 ) , and the CONSORT score ( kappa = 0.53 ; p < 0.01 ) . Both review ers rated the majority of studies as Level II ( 91 % and 94 % ) and as unsatisfactory according to the Coleman Methodology Score ( 87 % and 89 % ) and the CONSORT score ( 62 % and 63 % ) . Areas of deficiency included poor descriptions of recruitment ( > 90 % of the trials ) , power-level calculations ( 73 % ) , r and omization ( 58 % ) , blinding ( 90 % ) , and participant flow ( 50 % ) as well as inadequate follow-up , sample size , and blinding . CONCLUSIONS The use of the gold-st and ard trial design , the prospect i ve r and omized therapeutic study ( Level-I or II evidence ) , does not ensure quality research or reporting . Critical analysis of scientific work is important regardless of the study design . Clinical scientists should be familiar with the CONSORT criteria and adhere to them when reporting clinical trials PURPOSE To compare the clinical outcomes of arthroscopic  anterior cruciate ligament ( ACL ) reconstruction  with hamstring tendon autograft versus irradiated allograft . METHODS All irradiated hamstring tendon allografts ( gracilis and semitendinosus ) , which were sterilized with 2.5 Mrad of irradiation before distribution , were obtained from a single certified tissue bank . A total of 78 patients undergoing arthroscopic ACL reconstruction  were prospect ively r and omized consecutively into 1 of 2 groups : autograft and irradiated allograft . The same surgical technique was used in all operations , which were performed by the same senior surgeon . 
    Output:
    
On the basis of this systematic review and meta- analysis of 5 r and omized controlled trials , there is no statistically significant difference in outcome between patients undergoing ACL reconstruction with hamstring autograft and those undergoing ACL reconstruction with soft-tissue allograft .