***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 . To investigate over a 1-year period in dogs that underwent extracapsular stabilization surgery ( ECS ) following anterior cruciate ligament ( ACL ) transection : whether reconstructive surgery could prevent osteoarthritis ( OA ) progression and whether treatment with the bisphosphonate tiludronic acid ( TA ) could improve the chronic evolution of OA structural changes . Methods . ACL transection was performed on dogs on Day 0 and ECS on Day 28 . Dogs were r and omly divided into 2 groups : 15 received placebo and 16 were treated with TA ( 2 mg/kg subcutaneous injection ) on Days 14 , 28 , 56 , and 84 . Magnetic resonance images were acquired on Days −10 , 26 , 91 , 210 , and 357 , and cartilage volume was quantified . At sacrifice ( Day 364 ) , cartilage from femoral condyles and tibial plateaus was macroscopically and histologically evaluated . Expression levels of MMP-1 , -3 , -13 , ADAMTS-4 , -5 , BMP-2 , FGF-2 , IGF-1 , TGF-ß1 , collagen type II , and aggrecan were determined using real-time RT-PCR . Results . The loss of cartilage volume observed after ACL transection stabilized following ECS . Thereafter , a gradual gain occurred , with the cartilage volume loss on the tibial plateaus reduced at Day 91 ( p < 0.02 ) and Day 210 ( p < 0.001 ) in the TA-treated dogs . At sacrifice , TA-treated dogs presented a reduction in the severity of macroscopic ( p = 0.03 for plateaus ) and histologic ( p = 0.07 for plateaus ) cartilage lesions , had a better preserved collagen network , and showed decreased MMP-13 ( p = 0.04 ) , MMP-1 and MMP-3 levels . Conclusion . Our findings indicate that in dogs with ACL transection , ECS greatly prevents development of cartilage volume loss . Treatment with TA provided an additional benefit of reducing the development of OA lesions OBJECTIVES To investigate changes in the knee during the first year after acute rupture of the anterior cruciate ligament ( ACL ) of volumes of joint fluid ( JF ) , bone marrow lesions ( BMLs ) , and cartilage volume ( VC ) , and cartilage thickness ( ThCcAB ) and cartilage surface area ( AC ) . To identify factors associated with these changes . METHODS Fifty-eight subjects ( mean age 26 years , 16 women ) with an ACL rupture to a previously un-injured knee were followed prospect ively using a 1.5 T MR imager at baseline ( within 5 weeks from injury ) , 3 months , 6 months , and 1 year . Thirty-four subjects were treated with ACL reconstruction followed by a structured rehabilitation program and 24 subjects were treated with structured rehabilitation only .  Morphometric data were acquired from computer-assisted segmentation of MR images . Morphometric cartilage change was reported as mean change divided by the st and ard deviation of change ( st and ard response mean , SRM ) . RESULTS JF and BML volumes gradually decreased over the first year , although BML persisted in 62 % of the knees after 1 year . One year after the ACL injury , a reduction of VC , AC and ThCcAB ( SRM -0.440 or greater ) was found in the trochlea femur ( TrF ) , while an increase of VC and ThCcAB was found in the central medial femur ( cMF ) ( SRM greater than 0.477 ) . ACL reconstruction was directly and significantly related to increased JF volume at 3 and 6 months ( P<0.001 ) , BML volume at 6 months ( P=0.031 ) , VC and ThCcAB in cMF ( P<0.002 ) and decreased cartilage area in TrF ( P=0.010 ) at 12 months . CONCLUSION Following an acute ACL tear , cMF and TrF showed the greatest consistent changes of cartilage morphometry . An ACL reconstruction performed within a mean of 6 weeks from injury was associated with increased ThCcAB and VC in cMF and decreased AC in TrF , compared to knees treated without reconstruction . This may suggest a delayed structural restitution in ACL reconstructed knees Background Bone marrow lesions ( BMLs ) , common osteoarthritis-related magnetic resonance imaging findings , are associated with osteoarthritis progression and pain . However , there are no articles describing the use of 3-dimensional quantitative assessment s to explore the longitudinal relationship between BMLs and hyaline cartilage loss . The purpose of this study was to assess the cross-sectional and longitudinal descriptive characteristics of BMLs with a simple measurement of approximate BML volume , and describe the cross-sectional and longitudinal relationships between BML size and the extent of hyaline cartilage damage . Methods 107 participants with baseline and 24-month follow-up magnetic resonance images from a clinical trial were included with symptomatic knee osteoarthritis . An ' index ' compartment was identified for each knee defined as the tibiofemoral compartment with greater disease severity . Subsequently , each knee was evaluated in four regions : index femur , index tibia , non-index femur , and non-index tibia . Approximate BML volume , the product of three linear measurements , was calculated for each BML within a region . Cartilage parameters in the index tibia and femur were measured based on manual segmentation . Results BML volume changes by region were : index femur ( median [ 95 % confidence interval of the median ] ) 0.1 cm3 ( -0.5 to 0.9 cm3 ) , index tibia 0.5 cm3 ( -0.3 to 1.7 cm3 ) , non-index femur 0.4 cm3 ( -0.2 to 1.6 cm3 ) , and non-index tibia 0.2 cm3 ( -0.1 to 1.2 cm3 ) . Among 44 knees with full thickness cartilage loss , baseline tibia BML volume correlated with baseline tibia full thickness cartilage lesion area ( r = 0.63 , p < 0.002 ) and baseline femur BML volume with longitudinal change in femoral full thickness cartilage lesion area ( r = 0.48 p < 0.002 ) . Conclusions Many regions had no or small longitudinal changes in approximate BML volume but some knees experienced large changes . Baseline BML size was associated to longitudinal changes in area of full thickness cartilage loss One of the primary goals of physiotherapy after anterior cruciate ligament ( ACL ) reconstruction  is to restore of the patient 's normal gait patterns . However , to date , only a limited number of studies have examined gait during physiotherapeutic procedures following ACL reconstruction . Thus , the objective of the present study was to evaluate gait kinematics and symmetry in male patients after ACL reconstruction during the first two stages of their physiotherapy programme . Ninety-seven males , including 53 patients after primary ACL reconstruction in one limb and 44 healthy controls , participated in the study . The patients were examined using a movement analysis system during their physiotherapeutic programme ( from the 2nd to the 12th week following reconstruction ) . Some selected parameters of gait kinematics , a dynamic range of movement in the knee joint and gait asymmetry coefficients were evaluated . During the 12th week of physiotherapy , a mean gait velocity increased by more than 0.97 m/s compared to that obtained during the 2nd week of physiotherapy . A statistically significant increase in the relative length of stance phase was observed in the involved extremity , from 36.1 % to 62.7 % ( P = 0.01 ) ; the range of movement significantly improved from 25.8 degrees during the 2nd week to 63.7 degrees during the 12th week of physiotherapy . At the same time , the stance time asymmetry coefficient decreased from 68.5 % to -0.4 % . We observed a significant improvement in most of the gait parameters from the 2nd to the 12th week of physiotherapy after reconstruction and also in comparison to the results obtained for the control group BACKGROUND The optimal management of a torn anterior cruciate ligament ( ACL ) of the knee is unknown . METHODS We conducted a r and omized , controlled trial involving 121 young , active adults with acute ACL injury in which we compared two strategies : structured rehabilitation plus early ACL reconstruction and structured rehabilitation with the option of later ACL reconstruction if needed . The primary outcome was the change from baseline to 2 years in the average score on four subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS)--pain , symptoms , function in sports and recreation , and knee-related quality of life ( KOOS(4 ) ; range of scores , 0 [ worst ] to 100 [ best ] ) . Secondary outcomes included results on all five KOOS subscales , the Medical Outcomes Study 36-Item Short-Form Health Survey , and the score on the Tegner Activity Scale . RESULTS Of 62 subjects assigned to rehabilitation plus early ACL reconstruction , 1 did not undergo surgery . Of 59 assigned to rehabilitation plus optional delayed ACL reconstruction , 23 underwent delayed ACL reconstruction ; the other 36 underwent rehabilitation alone . The absolute change in the mean KOOS(4 ) score from baseline to 2 years was 39.2 points for those assigned to rehabilitation plus early ACL reconstruction and 39.4 for those assigned to rehabilitation plus optional delayed reconstruction ( absolute between-group difference , 0.2 points ; 95 % confidence interval , -6.5 to 6.8 ; P=0.96 after adjustment for the baseline score ) . There were no significant differences between the two treatment groups with respect to secondary outcomes . Adverse events were common in both groups . The results were similar when the data were analyzed according to the treatment actually received . CONCLUSIONS In young , active adults with acute ACL tears , a strategy of rehabilitation plus early ACL reconstruction was not superior to a strategy of rehabilitation plus optional delayed ACL reconstruction . The latter strategy substantially reduced the frequency of surgical reconstructions . ( Funded by the Swedish Research Council and the Medical Faculty of Lund University and others ; Current Controlled Trials number , IS RCT N84752559 . OBJECTIVE Prevalence and clinical relevance of patellofemoral ( PF ) osteoarthritis ( OA ) after anterior cruciate ligament ( ACL ) injury . METHOD Prospect ively we studied 94 out of 100 consecutive patients 15 years after acute ACL injury .  ACL reconstructions were only performed late if recurrent " give way " persisted or a secondary meniscal injury suitable for repair occurred . The subjects , mean age 42 years , had knee radiographs including skyline PF view taken  , which were grade d according to the atlas of the Osteoarthritis Research Society International . Knee-related symptoms and function were assessed by question naires . RESULTS PF OA  was present in 12/75 knees ( 16 % ) . Of 94 patients 22 ( 23 % ) have had their ACL reconstructed during follow-up . Meniscal injury and ACL reconstruction had occurred more often in knees with PF OA than in knees without PF OA ( P=0.004 and P=0.002 , respectively ) . Seven of 15 ACL reconstructed knees showed radiographic PF OA at follow-up . Knees with PF OA had more extension and flexion deficit than knees without PF OA . Subjects with PF OA maintained a higher activity level from injury to follow-up , but did not differ significantly from those without PF OA regarding patient-relevant symptoms and knee function . However , there was a trend for worse outcome in subjects with PF OA . CONCLUSION We found a relatively low prevalence of mild PF OA after ACL injury treated non-operatively , and it had limited impact on knee symptoms and patient-relevant knee function . At follow-up PF OA was associated with higher activity level , meniscal injury , extension and flexion deficit , and ACL reconstruction OBJECTIVE To evaluate the effects of a modified shoe that incorporates both lateral wedging and a variable-stiffness sole on knee joint loading in 3 population s : individuals with symptomatic and radiographic knee osteoarthritis ( OA ) , asymptomatic overweight individuals , and asymptomatic healthy weight individuals . METHODS Ninety participants ( 30 per group ) underwent a 3-dimensional gait analysis  across 3 test conditions : modified shoes , st and ard control shoes , and barefoot . For each condition , the first peak knee adduction moment ( KAM ) and knee flexion moment ( KFM ) ( both expressed as Nm/[body weight × height]% ) as well as the KAM impulse ( expressed as Nm.s/[body weight × height]% ) were determined . RESULTS The modified shoes significantly reduced the peak KAM as compared to the control shoes in both the OA ( P = 0.002 ) and the overweight ( P = 0.03 ) groups . In the OA group , there was no significant difference in peak KAM when walking in the modified shoe as compared to walking barefoot . In the overweight and the healthy weight groups , the peak KAM when walking in the modified shoe was significantly higher than that when walking barefoot ( P < 0.001 ) . Irrespective of group , the KAM impulse was significantly reduced when walking in the modified shoe as compared to the control shoe ( P < 0.001 ) and was significantly higher during both shoe conditions as compared to walking barefoot ( P < 0.001 ) . There was no change 
    Output:
    
Moderate-to-strong evidence was presented for meniscal lesion or meniscectomy , presence of bone marrow lesions ( BMLs ) , time from injury , and persisting altered biomechanics , possibly affecting cartilage change after ACL reconstruction .
First-year morphological change was more aggravated in ACL reconstruction compared to non-surgical treatment .