***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 Home and supervised exercise programmes consisting of stretching and eccentric exercises have been recommended for the management of lateral elbow tendinopathy ( LET ) . No studies have examined their comparative efficacy effectiveness . Objective In this study , whether a home exercise programme is more successful than a supervised exercise programme in treating patients with LET was investigated . Methods Patients with unilateral LET for at least 4 weeks were included in this trial . They were sequentially allocated to receive either a home exercise programme or a supervised exercise programme five times a week for 12 weeks . The exercise programme consisted of slow progressive eccentric exercises of wrist extensors and static stretching of the extensor carpi radialis brevis tendon . Outcome measures were pain , using a visual analogue scale , and function , using a visual analogue scale and the pain-free grip strength . Patients were evaluated at baseline , at the end of treatment ( week 12 ) , and 3 months ( week 24 ) after the end of treatment . Results 70 patients met the inclusion criteria . At the end of treatment , there was a decline in pain and a rise in function in both groups compared with baseline ( p<0.0005 , paired t test ) . There were significant differences in the reduction of pain and the improvement of function between the groups at the end of treatment and at the 3-month follow up ; the supervised exercise programme produced the largest effect ( p<0.0005 , independent t test ) . Conclusions Supervised exercise programme is superior to home exercise programme to reduce pain and improve function in patients with LET at the end of the treatment and at the follow-up . Further research is needed to confirm our results Tendons adapt in response to sports-specific loading , but sometimes develop tendinopathy . If the presence of ultrasound changes like hypoechoic areas and neovascularization in asymptomatic tendons precede ( and predict ) future tendon problems is unknown . The aim of this prospect i ve cohort study was to investigate the relationship between the development of ultrasound changes in the patellar and quadriceps tendons and symptoms of jumper 's knee , as well to examine the medium-term effects of intensive training on tendon thickness among adolescent athletes . Elite junior volleyball athletes were followed with semi-annual ultrasound and clinical examinations ( average follow-up : 1.7 years ) . Of the 141 asymptomatic athletes included , 22 athletes ( 35 patellar tendons ) developed jumper 's knee .  In a multivariate logistic regression analysis , a baseline finding of a hypoechoic tendon area ( odds ratio 3.3 , 95 % confidence interval 1.1 to 9.2 ) increased the risk of developing symptoms of jumper 's knee . Patellar tendon thickness among healthy athletes did not change ( Wilk 's lambda , P = 0.07 ) while quadriceps tendon thickness increased ( P = 0.001 ) . In conclusion ,  ultrasound changes  at baseline were risk factors for developing symptoms of jumper 's knee . Also , among healthy athletes , we observed a 7 - 11 % increase in quadriceps tendon thickness , while there was no increase in patellar tendon thickness Background : Jumper ’s knee is a common and troublesome condition among senior volleyball players , but its prevalence among elite junior players compared to matched non-sports active controls is not known . Objective : To clinical ly , and by sonography , examine the patellar tendons in elite junior volleyball players ( 15–19 years ) at the Swedish National Centre for volleyball and in matched controls . Methods : The patellar tendons in the 57 students at the Swedish National Centre for high school volleyball and in 55 age , height , and weight matched not regularly sports active controls were evaluated clinical ly and by grey scale ultrasonography ( US ) and power Doppler ( PD ) sonography . Results : There were no significant differences in mean age , height , and weight between the volleyball players and the controls . In the volleyball group , jumper ’s knee was diagnosed clinical ly and by US in 12 patellar tendons ( 10 male and two female ) . In 12/12 tendons , PD sonography demonstrated a neovascularisation in the area with structural tendon changes . In another 10 pain free tendons , there were structural tendon changes and neovessels . In the control group , no individual had a clinical diagnosis of jumper ’s knee . US demonstrated structural tendon changes in 11 tendons , but there was no neovascularisation on PD sonography . Conclusions : A clinical diagnosis of jumper ’s knee , together with structural tendon changes and neovascularisation visualised with sonography , was seen among Swedish elite junior volleyball players but not in matched not regularly sports active controls . Structural tendon change alone was seen in 10 % of the control tendons Background : Jumper ’s knee patellar tendinopathy is well known to be a common and difficult injury in volleyball . Knowledge about its aetiology and pathogenesis is sparse . Objective : To prospect ively follow clinical status , tendon structure and vascularity in elite junior volleyball players . Methods : 22 volleyball players ( 44 patellar tendons ) beginning their first grade at the Swedish National Centre for high school volleyball were continuously evaluated clinical ly and by ultrasonography ( US ) and power Doppler ( PD ) over the 3 school years . Results : At inclusion , there were 44 tendons being assessed . Jumper ’s knee was diagnosed clinical ly in eight patellar tendons ( seven of eight had structural changes and vascularity on US+PD ) . There were 27 normal ( clinical and US+PD ) tendons . At 3 years , there were 36 tendons still being assessed . Four individuals ( eight tendons ) had been excluded . Jumper ’s knee had developed in 2 of 25 ( 2 were excluded ) tendons that were normal ( clinical and US+PD ) at inclusion . Jumper ’s knee ( clinical and US+PD ) was also present in six tendons . Conclusions : Normal clinical tests and ultrasound findings at the start indicated a low risk for these elite junior volleyball players to sustain jumper ’s knee during three school years with intensive training and playing Training volume and body composition have been suggested as risk factors for jumper 's knee among athletic youth , but research is lacking . The aim of this 4-year prospect i ve cohort study was to examine the relationship between training and competition load , body composition , and risk for developing jumper 's knee .  Participants are elite volleyball players , aged 16 - 18 years .  Training and competition load was recorded continuously and body composition semiannually . Jumper 's knee was diagnosed on a st and ardized clinical examination . We recruited 141 healthy students ( 69 males and 72 females ) , and 28 developed jumper 's knee ( 22 boys and six girls ) . In a multivariate analyses , boys had three to four times higher risk compared with girls . Volleyball training had an odds ratio ( OR ) 1.72 ( 1.18 - 2.53 ) for every extra hour trained , and match exposure was the strongest sports-related predictor for developing jumper 's knee with an OR of 3.88 ( 1.80 - 8.40 ) for every extra set played per week . We did not detect any significant differences between the groups in body composition at the time of inclusion or in the change of body composition during the study period . Conclusion , male gender , a high volume of volleyball training and match exposure were risk factors for developing jumper 's knee OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Background : Patellar tendinopathy ( PT ) is one of the most common reasons for sport-induced pain of the knee . Low ankle dorsiflexion range might predispose for PT because of load-bearing compensation in the patellar tendon . Purpose : The purpose of this 1-year prospect i ve study was to analyze if a low ankle dorsiflexion range increases the risk of developing PT for basketball players . Study Design : Cohort study ( prognosis ) ; Level of evidence , 2 . Methods : Ninety junior elite basketball players were examined for different characteristics and potential risk factors for PT , including  ankle dorsiflexion range in the dominant and nondominant leg .  Data were collected over a 1-year period and follow-up , including reexamination , was made at the end of the year . Results : Seventy-five players met the inclusion criteria . At the follow-up , 12 players ( 16.0 % ) had developed unilateral PT . These players were found to have had a significantly lower mean ankle dorsiflexion range at baseline than the healthy players , with a mean difference of −4.7 ° ( P = .038 ) for the dominant limb and −5.1 ° ( P = .024 ) for the nondominant limb . Complementary statistical analysis showed that players with dorsiflexion range less than 36.5 ° had a risk of 18.5 % to 29.4 % of developing PT within a year , as compared with 1.8 % to 2.1 % for players with dorsiflexion range greater than 36.5 ° . Limbs with a history of 2 or more ankle sprains had a slightly less mean ankle dorsiflexion range compared to those with 0 or 1 sprain ( mean difference , −1.5 ° to −2.5 ° ) , although this was only statistically significant for nondominant legs . Conclusion : This study clearly shows that low ankle dorsiflexion range is a risk factor for developing PT in basketball players . In the studied material , an ankle dorsiflexion range of 36.5 ° was found to be the most appropriate cutoff point for prognostic screening . This might be useful information in identifying at-risk individuals in basketball teams and enabling preventive actions . A history of ankle sprains might contribute to reduced ankle dorsiflexion range 
    Output:
    
This systematic review found that tendinopathy is present in children and adolescents , and increases in prevalence with age up to 18 years .
Male sex is significantly associated with tendinopathy in studies that report tendinopathy by tendon