***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: OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review Background Techniques for repairing the meniscus include both open and arthroscopic techniques using sutures and bioabsorbable implants . The purpose of this study was to compare the effectiveness of inside-out suturing and bioabsorbable arrows for repair of vertical meniscal lesions . Study Design R and omized controlled clinical trial ; Level of evidence , 1 . Methods One hundred consecutive patients were r and omly assigned to arrows ( n = 51 ) or sutures ( n = 49 ) . Sixty-five percent of patients ( 31 sutures , 34 arrows ) underwent a  concomitant anterior cruciate ligament reconstruction .  A blinded research associate conducted assessment s at 6 weeks and 3 , 6 , 12 , and 24 months postoperatively . The primary outcome was retear rate . Secondary outcomes included the Western Ontario Meniscal Evaluation Tool , Anterior Cruciate Ligament Quality of Life Outcome Measure , and side-to-side comparisons of flexion and extension . Results At baseline , groups were similar in age , gender , time from injury to surgery , and length and location of tear . Mean follow-up was 28.0 ± 8.4 months . There were 22 failed meniscal repairs  ( 11 in each group ) , which did not represent a significant difference in the rate of failure between groups ( P = .92 ) . The mean quality of life scores and side-to-side differences in extension and flexion measurements were not significantly different between groups . Two patients from the arrow group crossed over into the suture group at the time of surgery because of technical difficulties with the device , and in 3 instances , a single suture was needed to keep the tear reduced while arrows were introduced . Two patients required reoperation for removal of a prominent , subcutaneous arrow , and 1 patient in the suture group suffered a transient peroneal nerve palsy during revision suturing . Conclusion At intermediate follow-up , there were no statistically significant differences in measured outcomes between meniscal suturing and arrows . Longer term follow-up is necessary to identify differences between these 2 treatments , particularly to estimate the incidence of articular surface damage in patients whose meniscal tear was repaired using arrows Abstract This study examined the effect of four different methods for treating intrasubstance meniscal lesions . Forty patients ( 21 men , ¶19 women ; age 30.4 years , range 16–50 ) with an isolated and symptomatic painful horizontal grade 2 meniscal lesion on the medial side ( documented with MRI ) were included . Patients were r and omly assigned by the birth date to one of four treatment groups : group A , conservative therapy ( n = 12 ) ; group B , arthroscopic suture repair with access channels ( n = 10 ) ; group C , arthroscopic minimal central resection , intrameniscal fibrin clot and suture repair ( n = 7 ) ; and group D , arthroscopic partial meniscectomy ¶(n = 11 ) . The average length of follow-up was 26.5 months ( range 12–38 months ) . Follow-up evaluation consisted of clinical examination with the findings recorded according to the IKDC protocol , radiographs , and control MRI . Group A had 75 % normal or nearly normal final evaluation at follow-up , group B 90 % , group C 43 % , and group D 100 % normal or nearly normal at follow-up . These short-term results indicate that intrasubstance meniscal lesions can be treated best by performing partial meniscectomy . To preserve the important function of the meniscus , arthroscopic suture repair with access channels might give even better medium- to long-term results . Conservative treatment is often not satisfactory . Additionally , our findings show that MRI examinations are not superior to accurate clinical examinations Background : It is still debated whether a degenerative horizontal tear of the medial meniscus should be treated with surgery . Hypothesis : The clinical outcomes of arthroscopic meniscectomy will be better than those of nonoperative treatment for a degenerative horizontal tear of the medial meniscus . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : A total of 102 patients with knee pain and a degenerative horizontal tear of the posterior horn of the medial meniscus on magnetic resonance imaging were included in this study between January 2007 and July 2009 . The study included 81 female and 21 male patients with an average age of 53.8 years ( range , 43 - 62 years ) . Fifty patients underwent arthroscopic meniscectomy ( meniscectomy group ) , and 52 patients underwent nonoperative treatment with strengthening exercises  ( nonoperative group ) . Functional outcomes were compared using a visual analog scale ( VAS ) for pain , Lysholm knee score , Tegner activity scale , and patient subjective knee pain and satisfaction . Radiological evaluations were performed using the Kellgren-Lawrence classification to evaluate osteoarthritic changes . Results : In terms of clinical outcomes , meniscectomy did not provide better functional improvement than nonoperative treatment . At the final follow-up , the average VAS scores were 1.8 ( range , 1 - 5 ) in the meniscectomy group and 1.7 ( range , 1 - 4 ) in the nonoperative group ( P = .675 ) . The average Lysholm knee scores at 2-year follow-up were 83.2 ( range , 52 - 100 ) and 84.3 ( range , 58 - 100 ) in the meniscectomy and nonoperative groups , respectively ( P = .237 ) . In addition , the average Tegner activity scale and subjective satisfaction scores were not significantly different between the 2 groups . Although most patients initially had intense knee pain with mechanical symptoms , both groups reported a relief in knee pain , improved knee function , and a high level of satisfaction with treatment ( P < .05 for all values ) . Two patients in the meniscectomy group and 3 in the nonoperative group with Kellgren-Lawrence grade 1 progressed to grade 2 at the 2-year follow-up . Conclusion : There were no significant differences between arthroscopic meniscectomy and nonoperative management with strengthening exercises in terms of relief in knee pain , improved knee function , or increased satisfaction in patients after 2 years of follow-up BACKGROUND Arthroscopic partial meniscectomy is one of the most common orthopedic procedures , yet rigorous evidence of its efficacy is lacking . METHODS We conducted a multicenter , r and omized , double-blind , sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis . Patients were r and omly assigned to arthroscopic partial meniscectomy or sham surgery . The primary outcomes were changes in the Lysholm and Western Ontario Meniscal Evaluation Tool ( WOMET ) scores ( each ranging from 0 to 100 , with lower scores indicating more severe symptoms ) and in knee pain after exercise ( rated on a scale from 0 to 10 , with 0 denoting no pain ) at 12 months after the procedure . RESULTS In the intention-to-treat analysis , there were no significant between-group differences in the change from baseline to 12 months in any primary outcome . The mean changes ( improvements ) in the primary outcome measures were as follows : Lysholm score , 21.7 points in the partial-meniscectomy group as compared with 23.3 points in the sham-surgery group ( between-group difference , -1.6 points ; 95 % confidence interval [ CI ] , -7.2 to 4.0 ) ; WOMET score , 24.6 and 27.1 points , respectively ( between-group difference , -2.5 points ; 95 % CI , -9.2 to 4.1 ) ; and score for knee pain after exercise , 3.1 and 3.3 points , respectively ( between-group difference , -0.1 ; 95 % CI , -0.9 to 0.7 ) . There were no significant differences between groups in the number of patients who required subsequent knee surgery ( two in the partial-meniscectomy group and five in the sham-surgery group ) or serious adverse events ( one and zero , respectively ) . CONCLUSIONS In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear , the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure . ( Funded by the Sigrid Juselius Foundation and others ; Clinical Trials.gov number , NCT00549172 . ) Purpose The aim of this prospect i ve r and omized intervention study was to evaluate the outcome at a 2 and 5 year follow-up whether combined arthroscopic surgery followed by exercise therapy was superior to the same exercise therapy alone when treating non-traumatic , degenerative medial meniscal tears . Methods Ninety-six middle-aged patients with MRI-verified degenerative medial meniscus tear and radiographic osteoarthritis grade ≤1 ( Ahlbäck ) participated in the study . Radiographic examination was done before r and omization and after 5 years . The patients were r and omly assigned to either arthroscopic treatment followed by exercise therapy for 2 months or to the same exercise therapy alone . At the start of the study and at the follow-ups at 24 and 60 months the patients answered three question naires KOOS , Lysholm Knee Scoring Scale and Tegner Activity Scale and made pain ratings on the Visual Analogue Scale ( VAS ) . Results Both groups showed highly significant clinical improvements from baseline to the follow-ups at 24 and 60 months on all subscales of KOOS , Lysholm Knee Scoring Scale and VAS ( p < 0.0001 ) . No group differences were found at any of the testing occasions . One third of the patients that were treated with exercise therapy alone did not feel better after the treatment but were improved after arthroscopic surgery . According to radiographic findings two patients from each group had a slight progression of their osteoarthritis after 5 years . Conclusion The findings indicate that arthroscopic surgery followed by exercise therapy was not superior to the same exercise therapy alone for this type of patients . Consequently , exercise therapy can be recommended as initial treatment . However , one third of the patients from the exercise group still had disabling knee symptoms  after exercise therapy but improved to the same level as the rest of the patients after arthroscopic surgery with partial meniscectomy . Level of evidence Abstract In a prospect ively r and omized study including 68 patients , the results of inside-out horizontal meniscus suturing were compared to meniscus repair using the meniscus arrow . 96 % of the patients underwent re-arthroscopy after 3–4 months . Only lesions in the red/red or red/white areas were included . Patients were treated with a hinged brace for 9 weeks . 30 patients had an isolated bucket-h and le lesion . In 19 cases the repair was done in conjunction with an  ACL reconstruction  and in 19 cases the repair was performed in an ACL-insufficient knee . The two groups were comparable . Operating time in the arrow group was one half that of the suture group . Of 65 re-arthroscopies , 91 % of the patients had healed or partially healed in the arrow group compared to 75 % in the suture group ( P = 0.11 ) . In only 50 % of the non-healed cases was this clinical ly suspected prior to control arthroscopy . The difference between healing in ACL-reconstructed and ACL-insufficient knees was not significant . Two patients in the suture group had a deep infection . There were no serious neurovascular injuries . Five patients in the suture group and two patients in the arrow group had symptoms in the saphenous nerve area . All patients had some synovial irrit 
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Some evidence was found to indicate that patients with resistant mechanical symptoms who initially fail nonoperative management may benefit from meniscal debridement No studies compared meniscal repair with meniscectomy or nonoperative management .
Initial evidence suggested that meniscal transplant might be favorable in certain patient groups .