***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: PURPOSE OF THE STUDY The aim of this work was to assess the usefulness of specialized rehabilitation sessions after anterior cruciate ligament reconstruction in high-level athletes participating in regional- , national- , or international-level sports . MATERIAL AND METHODS We conducted a retrospective comparison between two population s : in the first ,  rehabilitation  was limited to the early postoperative period ( PO ) ; in the second , rehabilitation sessions were repeated , once in the early postoperative period and again 90 days later ( POR ) . The second rehabilitation period lasted two or three weeks and included an open and closed-chain muscle training program controlled by physical therapists using isokinetic devices . The sessions also included proprioceptive exercises and cardiovascular exercise reconditioning with a therapeutic project developed by the Physical Medicine and Rehabilitation physician in collaboration with other health professionals and taking into consideration the surgical recommendations and the patient 's clinical status . A question naire was addressed to all patients one year after the operation . The response rate was 55 % . Two groups were created at r and om : 74 patients were in the PO group and 75 in the POR group . The two population s were comparable in terms of gender ( 64 men , 10 women in PO versus 57 men and 18 women in POR ) , sports level ( regional , national , international ) , type of surgery ( 41 hamsting , 33 bone-patellar tendon-bone in PO and 43 hamstring and 32 bone-patellar tendon-bone in POR ) and sports ( generally rugby , soccer , h and ball or ski ) . RESULTS Our results were statistically in favor of the group POR in terms of resumption of sports activities : time to return to training ( 7.6 versus 8.7 months , p=0.03 ) and time to return to competition ( 9.06 versus 10.84 months , p=0.007 ) . They were also in favor of the group POR for resumption of sports activities at the former level ( 52.05 % versus 19.44 % , p=0.001 ) , pain ( numerical scale : 1.52 versus 2.03 , p=0.021 ) and subjective impression ( IKDC subjective score : 87.58 % versus 81.64 % , p=0.003 ) . There was no significant difference for resumption of training ( 90.50 % versus 81.69 % , p=0.2 ) or competition ( 71.80 % versus 56.76 % , p=0.1 ) at one year , but the results were close to the level of significance . DISCUSSION Adapted preparation before returning to sports activities using a scheme elaborated by specialists ( physicians , physical therapists , trainers ) provided a statistically significant improvement in time and quality of resumed activity ( return to prior level , pain , subjective IKDC score ) in this specific population of high-level competition athletes . A larger series would be interesting to check the statistical significance of return to training and competition at one year . Another follow-up beyond one year ( 1.5 or two years for example ) would also provide information on the percentage of definitive return to sports in these two population Introduction : Several established tools are available to assess study quality and reporting of r and omized controlled trials ; however , these tools were design ed with clinical intervention trials in mind . In exercise training intervention trials some of the traditional study quality criteria , such as participant or research er blinding , are extremely difficult to implement . Methods : We developed the Tool for the assEssment of Study qualiTy and reporting in EXercise ( TESTEX ) – a study quality and reporting assessment tool , design ed specifically for use in exercise training studies . Our tool is a 15-point scale ( 5 points for study quality and 10 points for reporting ) and addresses previously unmentioned quality assessment criteria specific to exercise training studies . Results : There were no systematic differences between the summated TESTEX scores of each observer [ H(2 ) = 0.392 , P = 0.822 ] . There was a significant association between the summated TESTEX scores of the three observers , with almost perfect agreement between observers 1 and 2 [ intra-class correlation coefficient ( ICC ) = 0.93 , 95 % confidence interval ( CI ) 0.82–0.97 , P < 0.001 ] , observers 1 and 3 ( ICC = 0.96 , 95 % CI 0.89–0.98 , P < 0.001 ) and observers 2 and 3 ( ICC = 0.91 , 95 % CI 0.75–0.96 , P < 0.001 ) . Conclusions : The TESTEX scale is a new , reliable tool , specific to exercise scientists , that facilitates a comprehensive review of exercise training trials A more sports-specific and detailed strength assessment has been advocated for patients after anterior cruciate ligament ( ACL ) injury and reconstruction . The purpose of this study was to develop a test battery of lower extremity strength tests with high ability to discriminate between leg power development on the injured and uninjured sides in patients after ACL injury and in patients who have undergone ACL reconstruction . Twenty-three patients were tested 6 months after ACL injury and 44 patients were tested 6 months after ACL reconstruction . Twenty-four of the 44 patients were operated on using a hamstrings graft and 20 patients were operated on using a patellar tendon graft . All the patients performed a test battery of three strength tests for each leg in a r and omised order . The three strength tests were chosen to reflect quadriceps and hamstring muscular power in a knee-extension and a knee-flexion test ( open kinetic chain ) and lower-extremity muscular power in a leg-press test ( closed kinetic chain ) . There was a higher sensitivity for the test battery to discriminate abnormal leg power compared with any of the three strength tests individually . Nine out of ten patients after ACL reconstruction and six out of ten of the patients after ACL injury exhibited abnormal leg power symmetry using the test battery . Thus , this test battery had high ability in terms of discriminating between the leg power performance on the injured and uninjured side , both in patients with an ACL injury and in patients who have undergone ACL reconstruction . It is concluded that a test battery consisting of a  knee-extension , knee-flexion  and  leg-press muscle power test had high ability to determine deficits in leg power 6 months after ACL injury and reconstruction . Only a minority of the patients had restored leg muscle power . The clinical relevance is that the test battery may contribute to the decision-making process when deciding whether and when patients can safely return to strenuous physical activities after an ACL injury or reconstruction [ Purpose ] To compare outcomes of anterior cruciate ligament ( ACL ) reconstruction after open kinetic chain ( OKC ) exercises and closed kinetic chain ( CKC ) exercises . [ Subjects and Methods ] The subjects comprised 11 female and 47 male patients who are r and omly divided into two groups : which performed a CKC exercise program Group I and Group II which performed an OKC exercise program .  Pain intensity was evaluated using visual analogue scale ( VAS ) . Knee flexion was evaluated using a universal goniometer , and thigh circumference measurements were taken with a tape measure at baseline and at 3 months and 6 months after the treatment . Lysholm scores were used to assess knee function . [ Results ] There were no significant differences between the two groups at baseline . Within each group , VAS values and knee flexion were improved after the surgery . These improvements were significantly higher in the CKC group than in the OKC group . There were increases in thigh circumference difference at the 3 and 6 month assessment s post-surgery . A greater improvement in the Lysholm score was observed in the CKC group at 6 months . [ Conclusion ] The CKC exercise program was more effective than OKC in improving the knee functions of patients with ACL reconstruction BACKGROUND AND PURPOSE Nondistally fixated ( ie , what is often referred to as " open kinetic chain " [ OKC ] ) knee extensor resistance training appears to have lost favor for some forms of rehabilitation due partly to concerns that this exercise will irritate the extensor mechanism . In this r and omized , single-blind clinical trial , nondistally fixated versus distally fixated ( ie , often called " closed kinetic chain " [ CKC ] ) leg extensor training were compared for their effects on knee pain . SUBJECTS Forty-three patients recovering from anterior cruciate ligament ( ACL ) reconstruction surgery ( 34 male , 9 female ; mean age=29 years , SD=7.9 , range=16 - 54 ) . METHODS Knee pain was measured at 2 and 6 weeks after ACL reconstruction surgery using visual analog scales in a self- assessment question naire and during maximal isometric contractions of the knee extensors . Between test sessions , subjects trained 3 times per week using either OKC or CKC resistance of their knee and hip extensors as part of their physical therapy . RESULTS No differences in knee pain were found between the treatment groups . DISCUSSION AND CONCLUSION Open kinetic chain and CKC leg extensor training in the early period after ACL reconstruction surgery do not differ in their immediate effects on anterior knee pain . Based on these findings , further studies are needed using different exercise dosages and patient groups BACKGROUND Subjective evaluation by patients has recently become an important adjunct to postoperative clinical assessment . Apart from st and ard physical examination , scales demonstrating patients ’ subjective outcome measures are used for assessing the efficacy of the treatment and rehabilitation of knee ligamentous injuries . The present work presents patients ’ subjective assessment of rehabilitation protocol s after ACL reconstruction . MATERIAL AND METHODS Forty individuals who had undergone ACL reconstruction were r and omised into two groups ( G1 , G2 ) and followed one of two rehabilitation protocol s ( A or B ) . The subjects assessed their knee function at baseline and after physical therapy using the  Lysholm score and the IKDC form .  The results were analysed with the Mann-Whitney U test . The subjects also completed a question naire at discharge . RESULTS Analysis of Lysholm and IKDC scores revealed significant differences between the mean pre- and postrehabilitation results in the groups ( p<0.05 ) . The greatest improvement was seen in G2 patients rehabilitated with protocol B , with significant mean improvements of 56.3 % and 46.7 % for the Lysholm and IKDC scores , respectively . Group G1 registered only half of this magnitude of change . Protocol B was also highly rated in the question naires . CONCLUSION According the patients opinion a rehabilitation protocol involving a larger number of open kinetic chain exercises may prove more effective in the rehabilitation of patients after ACL reconstruction compared to a programme basing mainly on closed kinetic chains The goal of this prospect i ve study was to determine the outcome -predictive role of various parameters in the nonoperative treatment of chronic anterior knee pain patients . Thirty patients followed a five-week treatment program  , which consisted out of only closed kinetic chain exercises . Prior to this treatment all subjects were evaluated on muscular characteristics , subjective symptoms , weight , sex , duration of symptoms and functional performance . A multiple stepwise regression analysis revealed that the reflex response time of m. vastus medialis obliquus ( VMO ) ( P=0.041 ; 0.026 ) , and the duration of symptoms ( P=0.019 ; 0.045 ) were the only two parameters which were significantly associated with the outcome ( evaluated by the Kujala score ) at five weeks , and at three months . The shorter the duration of symptoms , or the faster the reflex response time of VMO prior to the treatment , the better the outcome after a closed kinetic chain exercise program . The statistical significance of these parameters in this study may be seen as an indication of the importance of these variables as predictors of the outcome of a closed kinetic chain strengthening program . Using this information , it seems clinical ly important to begin the treatment program before the  anterior knee pain becomes more chronic and treatment results become less good We compared the diagnostic and predictive value of magnetic resonance imaging ( MRI ) and clinical findings with  arthroscopy in 61 knees in a prospect i ve study . In meniscal tears , the accuracy and positive predictive value of MRI was found to be nearly twice that of clinical examination . The sensitivity , specificity , and negative predictive value of MRI were comparable to the figures found in other studies . We recommend MRI as a clarifying diagnostic tool when a clinical examination indicates a lesion of the meniscus . In our study , the clinical relevance of MRI in anterior cruciate ligament lesions and especially in cartilage lesions was more doubtful . The combination of clinical and MRI findings would reduce the number of blank arthroscopies to 5 % . MRI is a valuable diagnostic tool in planning the type of anesthesia and treatment , and could significantly reduce the need for a second arthroscopy Open kinetic chain ( OKC ) knee extensor resistance training has lost favour in ACLR rehabilitation due to concerns that this exercise is harmful to the graft and will be less effective in improving function . In this r and omized , single-blind clinical trial OKC and closed kinetic chain ( CKC ) knee extensor training were compared for their effects on knee laxity and function in the middle period of ACLR rehabilitation . The study subjects were 49 patients recovering from ACLR surgery ( 37 M , 12 F ; mean age=33 years ) . Tests were carried out at 8 and 14 weeks after ACLR with knee laxity measured using a ligament arthrometer and function with the Hughston Clinic knee self- assessment question naire and single leg , maximal effort jump testing ( post-test only ) . Between tests , subjects trained using either OKC or CKC resistance of their knee and hip extensors as part of formal physical therapy sessions three times per week . No statistically significant ( one-way ANOVA , p>0.05 ) differences were found between the treatment groups in knee laxity or leg function .  OKC and CKC knee extensor training in the middle period of 
    Output:
    
Conclusions While OKC and CKC may be beneficial during ACL surgical rehabilitation , there is insufficient evidence to suggest that either one is superior to the other