human
***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: HYPOTHESIS Local application of autologous platelet rich plasma ( PRP ) improves tendon healing in patients undergoing arthroscopic rotator cuff repair . STUDY DESIGN Prospect i ve , r and omized , controlled , double blind study ; considering an alpha level of 5 % , a power of 80 % , 22 patients for group are needed . MATERIAL S AND METHODS Fifty-three patients who underwent shoulder arthroscopy for the repair of a complete rotator cuff tear were r and omly divided into 2 groups , using a block r and omization procedure . A treatment group ( N = 26 ) consisted of those who received an intraoperative application of PRP in combination with an autologous thrombin component . A control group ( N = 27 ) consisted of those who did not receive that treatment . Patients were evaluated with vali date d outcome scores . A magnetic resonance image ( MRI ) was performed in all cases at more than 1 year post-op . All patients had the same accelerated rehabilitation protocol . RESULTS The 2 groups were homogeneous . The pain score in the treatment group was lower than the control group at 3 , 7 , 14 , and 30 days after surgery ( P < .05 ) . On the Simple Shoulder Test ( SST ) , University of California ( UCLA ) , and Constant scores , strength in external rotation , as measured by a dynamometer , were significantly higher in the treatment group than the control group at 3 months after surgery ( strength in external rotation [ SER ] : 3 ± 1.6 vs 2.1 ± 1.3 kg ; SST : 8.9 ± 2.2 vs 7.1 ± 2.7 ; UCLA : 26.9 ± 3 vs 24.2 ± 4.9 ; Constant : 65 ± 9 vs 57.8 ± 11 ; P < .05 ) . There was no difference between the 2 groups after 6 , 12 , and 24 months . The follow-up MRI showed no significant difference in the healing rate of the rotator cuff tear . In the subgroup of grade 1 and 2 tears , with less retraction , SER in the PRP group was significant higher at 3 , 6 , 12 , and 24 months postoperative ( P < .05 ) . CONCLUSION The results of our study showed autologous PRP  reduced pain in the first postoperative months . The long-term results of subgroups of grade 1 and 2 tears suggest that PRP positively affected cuff rotator healing Background : The purpose of this study was threefold : ( 1 ) to determine the scientific quality of published r and omized trials in the American Volume of The Journal of Bone and Joint Surgery from 1988 through 2000 , ( 2 ) to identify predictors of study quality , and ( 3 ) to evaluate inter-rater agreement in the scoring of study quality with use of a simple scale . Methods : H and search es of The Journal of Bone and Joint Surgery were conducted in duplicate to identify r and omized clinical trials . Of 2468 studies identified , seventy-two ( 2.9 % ) met all eligibility criteria . Two investigators each assessed the quality of the study under blinded conditions and abstract ed relevant data . Results : The mean score ( and st and ard error ) for the quality of the seventy-two r and omized trials was 68.1 % ± 1.6 % ; 60 % ( forty-three ) scored < 75 % . Drug trials had a significantly higher mean quality score than did surgical trials ( 72.8 % compared with 63.9 % , p < 0.05 ) . Regression analysis revealed that cited affiliation with an epidemiology department and cited funding were associated with higher quality scores . Failure to conceal r and omization , to blind outcome assessors , and to describe why patients were excluded result ed in significantly lower quality scores ( p < 0.05 ) , more than the 5 % decrease expected by removal of each item . A priori calculations of sample size were rarely performed in the review ed studies , and only 2 % of the studies with negative results included a post hoc power analysis . The Detsky quality scale met accepted st and ards of interobserver reliability ( kappa , 0.87 ; 95 % confidence interval , 0.70 to 0.95 ) . Conclusions : Few studies published in The Journal of Bone and Joint Surgery were r and omized trials . More than half of the trials were limited by a lack of concealed r and omization , lack of blinding of outcome assessors , or failure to report reasons for excluding patients . Application of st and ardized guidelines for the reporting of clinical trials in orthopaedics should improve quality Background : Increased age , larger tear size , and more advanced fatty degeneration of the rotator cuff musculature have been correlated with poorer healing rates after rotator cuff repair . Platelets are an endogenous source of growth factors present during rotator cuff healing . Hypothesis : Augmentation of rotator cuff repairs with platelet-rich fibrin matrix ( PRFM ) may improve the biology of rotator cuff healing and thus improve functional outcome scores and retear rates after repair . Study Design : Cohort study ; Level of evidence , 3 . Methods : Rotator cuff tears at risk for retear were prospect ively identified using an algorithm ; points were assigned for age ( 50 - 59 years = 1 ; 60 - 69 years = 2 ; > 70 years = 3 ) , anterior-to-posterior tear size ( 2 - 2.9 cm = 0 ; 3 - 3.9 cm = 1 ; > 4 cm = 2 ) , and fatty atrophy ( Goutallier score 0 - 2 = 0 ; Goutallier score 3 - 4 = 1 ) . Three points were required for enrollment . Arthroscopic rotator cuff repair was performed with the addition of PRFM . Preoperative and 1-year postoperative magnetic resonance imaging ( MRI ) and functional outcome scores were obtained . Imaging and functional outcomes were compared with historical controls meeting the same enrollment criteria . Results : Sixteen and 21 patients were enrolled in the PRFM and control groups , respectively . Mean age ( 65 ± 7 and 65 ± 9 years ; P = .89 ) ,  tear size ( 3.8 ± 1.1 and 3.9 ± 1.1 cm ; P = .79 ) , and median Goutallier scores ( 2 and 3 ; P = .18 ) were similar between the PRFM and control groups , respectively . Retear rates ( 56.2 % vs 38.1 % ) were statistically significantly higher ( P = .024 ) in the PRFM group compared with controls . Functional outcome scores postoperatively were not significantly improved compared with controls . Complications included 2 infections in the PRFM group . Conclusion : The augmentation of at-risk rotator cuff tears with PRFM did not result in improved retear rates or functional outcome scores compared with controls The purpose of this study was to examine the psychometric properties of the American Shoulder and Elbow Surgeons St and ardized Shoulder Assessment Form ( ASES ) , patient self-report section . Patients with shoulder dysfunction ( n = 63 ) completed the ASES , The University of Pennsylvania Shoulder Score , and the  Short Form-36  during the initial evaluation , 24 to 72 hours after the initial visit , and after 3 to 4 weeks of physical therapy . The test-retest reliability ( intraclass correlation coefficient[1-way r and om-effects ] , 0.84 ; 95 % CI lower limit , 0.75 ) and internal consistency ( Cronbach alpha , 0.86 ) values were acceptable . The st and ard error of the measure was 6.7 ASES points ( 90 % CI , 11.0 ) . Construct and discriminant validity was demonstrated . Responsiveness was demonstrated with a st and ardized response mean of 1.5 and an effect size of 1.4 . The minimal detectable change was 9.7 ASES points ( 90 % CI , 16 ) , and the minimal clinical ly important difference was 6.4 ASES points . The results indicate that the ASES is a reliable , valid , and responsive outcome tool A self-administered question naire was design ed to assess the severity of symptoms related to and the functional status of the shoulder . It includes domains of global assessment , pain , daily activities , recreational and athletic activities , work , satisfaction , and areas for improvement . Each domain is grade d separately and is weighted to arrive at the total score . The over-all scale and each domain were prospect ively tested for validity , reliability , and responsiveness to clinical change . One hundred patients who were seen for evaluation of the shoulder were enrolled in the study . The validity of the scale was demonstrated by moderate-to-high correlation of the domains and individual questions of the Shoulder Rating Question naire with those of the Arthritis Impact Measurement Scales 2 . Validity was supported further by significant correlation of the scores in each domain with the level of satisfaction in that domain and by significantly lower scores in domains that patients selected as areas important for improvement . The over-all scale and each domain were internally consistent ( Cronbach alpha , 0.71 to 0.90 ) . Reproducibility was evaluated by repeated administration of the question naire after a mean of three days to forty patients whose condition was clinical ly stable . Reproducibility of the over-all question naire and individual domains was excellent ( Spearman-Brown index , 0.94 to 0.98 ) . Individual questions were reproducible , with a weighted kappa value of more than 0.7 for each . Responsiveness was evaluated by comparison of the preoperative and postoperative scores of thirty patients who had a satisfactory result one year after an operation on the shoulder . The over-all Shoulder Rating Question naire and each domain were responsive to clinical change as demonstrated by favorable st and ardized response means ( range , 1.1 to 1.9 ) and indices of responsiveness ( range , 1.1 to 2.0 ) . Similar analysis performed for individual diagnostic groups supported the validity , reliability , and responsiveness of the question naire in each group . The self-administered shoulder question naire was found to be valid , reliable , and responsive to clinical change . These qualities should make it a useful instrument for the prospect i ve assessment of the outcome of treatment of disorders related to the shoulder PURPOSE Arthroscopic rotator cuff repair produces equally good clinical results compared with open or mini-open repair . However , there are concerns about whether the same repair integrity can be achieved . The purpose of our study was to compare clinical and structural results of arthroscopic and mini-open rotator cuff repair . METHODS Nineteen patients who had arthroscopic rotator cuff repair ( mean follow-up , 25.0 months ) were matched for age , gender , and duration of symptoms with nineteen patients who had mini-open repair ( mean follow-up , 17.6 months ) . We compared preoperative and follow-up Constant scores , as well as early range of motion after 6 weeks and 3 months . All patients were examined with the same magnetic resonance imaging system at follow-up to evaluate cuff integrity . RESULTS There was no difference in clinical and structural outcome . The overall Constant score improved from 53.8 to 83.9 in the arthroscopic group and from 53.5 to 83.7 in the mini-open group . Early range of motion did not differ significantly at 6 weeks or 3 months postoperatively . The number of retears was 6 ( 31.6 % ) in the arthroscopic group and 7 ( 36.8 % ) in the mini-open group . This difference was not statistically significant ( P = .7358 ) . Although smaller retears had no influence on the clinical result , more retracted retears correlated with lower abduction strength regardless of the repair method . CONCLUSIONS In isolated supraspinatus tears  arthroscopic rotator cuff repair produces excellent clinical results and equivalent tendon integrity compared with mini-open repair . LEVEL OF EVIDENCE Level III , retrospective therapeutic comparative study Tendon injuries are notorious for their slow and functionally inferior healing . Intratendinous application of platelet-rich plasma ( PRP ) has been reported to stimulate the repair process of tendon injuries , but there is little conclusive evidence for its effectiveness . A placebo-controlled experimental trial was performed to test the hypothesis that a single intratendinous PRP treatment enhances the quality of tendon repair , as evidence d by improved biochemical , biomechanical , and histological tissue properties . In six horses , tendon lesions were created surgically in the Superficial Digital Flexor Tendons ( SDFT ) of both front limbs , one of which was treated with PRP and the other with saline . After 24 weeks , the tendons were harvested for biochemical , biomechanical , and histological evaluations . Collagen , glycosaminoglycan , and DNA content ( cellularity ) was higher in PRP-treated tendons ( p = 0.039 , 0.038 , and 0.034 , respectively ) . The repair tissue in the PRP group showed a higher strength at failure ( p = 0.021 ) and Elastic Modulus ( p = 0.019 ) . Histologically , PRP-treated tendons featured better organization of the collagen network ( p = 0.031 ) and signs of increased metabolic activity ( p = 0.031 ) . It was concluded that PRP increases metabolic activity and seems to advance maturation of repair tissue over nontreated experimentally induced tendon lesions , which suggests that PRP might be beneficial in the treatment of clinical tendon injuries PURPOSE To assess the effect of platelet-rich plasma fibrin matrix ( PRPFM ) construct augmentation on postoperative tendon healing as determined by magnetic resonance imaging ( MRI ) and clinical outcome of arthroscopic rotator cuff repair . METHODS A comparative series of patients undergoing arthroscopic rotator cuff repair was studied . Two matched groups of patients ( 20 each ) were included : rotator cuff 
    Output:
    
agent
***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: HYPOTHESIS Local application of autologous platelet rich plasma ( PRP ) improves tendon healing in patients undergoing arthroscopic rotator cuff repair . STUDY DESIGN Prospect i ve , r and omized , controlled , double blind study ; considering an alpha level of 5 % , a power of 80 % , 22 patients for group are needed . MATERIAL S AND METHODS Fifty-three patients who underwent shoulder arthroscopy for the repair of a complete rotator cuff tear were r and omly divided into 2 groups , using a block r and omization procedure . A treatment group ( N = 26 ) consisted of those who received an intraoperative application of PRP in combination with an autologous thrombin component . A control group ( N = 27 ) consisted of those who did not receive that treatment . Patients were evaluated with vali date d outcome scores . A magnetic resonance image ( MRI ) was performed in all cases at more than 1 year post-op . All patients had the same accelerated rehabilitation protocol . RESULTS The 2 groups were homogeneous . The pain score in the treatment group was lower than the control group at 3 , 7 , 14 , and 30 days after surgery ( P < .05 ) . On the Simple Shoulder Test ( SST ) , University of California ( UCLA ) , and Constant scores , strength in external rotation , as measured by a dynamometer , were significantly higher in the treatment group than the control group at 3 months after surgery ( strength in external rotation [ SER ] : 3 ± 1.6 vs 2.1 ± 1.3 kg ; SST : 8.9 ± 2.2 vs 7.1 ± 2.7 ; UCLA : 26.9 ± 3 vs 24.2 ± 4.9 ; Constant : 65 ± 9 vs 57.8 ± 11 ; P < .05 ) . There was no difference between the 2 groups after 6 , 12 , and 24 months . The follow-up MRI showed no significant difference in the healing rate of the rotator cuff tear . In the subgroup of grade 1 and 2 tears , with less retraction , SER in the PRP group was significant higher at 3 , 6 , 12 , and 24 months postoperative ( P < .05 ) . CONCLUSION The results of our study showed autologous PRP  reduced pain in the first postoperative months . The long-term results of subgroups of grade 1 and 2 tears suggest that PRP positively affected cuff rotator healing Background : The purpose of this study was threefold : ( 1 ) to determine the scientific quality of published r and omized trials in the American Volume of The Journal of Bone and Joint Surgery from 1988 through 2000 , ( 2 ) to identify predictors of study quality , and ( 3 ) to evaluate inter-rater agreement in the scoring of study quality with use of a simple scale . Methods : H and search es of The Journal of Bone and Joint Surgery were conducted in duplicate to identify r and omized clinical trials . Of 2468 studies identified , seventy-two ( 2.9 % ) met all eligibility criteria . Two investigators each assessed the quality of the study under blinded conditions and abstract ed relevant data . Results : The mean score ( and st and ard error ) for the quality of the seventy-two r and omized trials was 68.1 % ± 1.6 % ; 60 % ( forty-three ) scored < 75 % . Drug trials had a significantly higher mean quality score than did surgical trials ( 72.8 % compared with 63.9 % , p < 0.05 ) . Regression analysis revealed that cited affiliation with an epidemiology department and cited funding were associated with higher quality scores . Failure to conceal r and omization , to blind outcome assessors , and to describe why patients were excluded result ed in significantly lower quality scores ( p < 0.05 ) , more than the 5 % decrease expected by removal of each item . A priori calculations of sample size were rarely performed in the review ed studies , and only 2 % of the studies with negative results included a post hoc power analysis . The Detsky quality scale met accepted st and ards of interobserver reliability ( kappa , 0.87 ; 95 % confidence interval , 0.70 to 0.95 ) . Conclusions : Few studies published in The Journal of Bone and Joint Surgery were r and omized trials . More than half of the trials were limited by a lack of concealed r and omization , lack of blinding of outcome assessors , or failure to report reasons for excluding patients . Application of st and ardized guidelines for the reporting of clinical trials in orthopaedics should improve quality Background : Increased age , larger tear size , and more advanced fatty degeneration of the rotator cuff musculature have been correlated with poorer healing rates after rotator cuff repair . Platelets are an endogenous source of growth factors present during rotator cuff healing . Hypothesis : Augmentation of rotator cuff repairs with platelet-rich fibrin matrix ( PRFM ) may improve the biology of rotator cuff healing and thus improve functional outcome scores and retear rates after repair . Study Design : Cohort study ; Level of evidence , 3 . Methods : Rotator cuff tears at risk for retear were prospect ively identified using an algorithm ; points were assigned for age ( 50 - 59 years = 1 ; 60 - 69 years = 2 ; > 70 years = 3 ) , anterior-to-posterior tear size ( 2 - 2.9 cm = 0 ; 3 - 3.9 cm = 1 ; > 4 cm = 2 ) , and fatty atrophy ( Goutallier score 0 - 2 = 0 ; Goutallier score 3 - 4 = 1 ) . Three points were required for enrollment . Arthroscopic rotator cuff repair was performed with the addition of PRFM . Preoperative and 1-year postoperative magnetic resonance imaging ( MRI ) and functional outcome scores were obtained . Imaging and functional outcomes were compared with historical controls meeting the same enrollment criteria . Results : Sixteen and 21 patients were enrolled in the PRFM and control groups , respectively . Mean age ( 65 ± 7 and 65 ± 9 years ; P = .89 ) ,  tear size ( 3.8 ± 1.1 and 3.9 ± 1.1 cm ; P = .79 ) , and median Goutallier scores ( 2 and 3 ; P = .18 ) were similar between the PRFM and control groups , respectively . Retear rates ( 56.2 % vs 38.1 % ) were statistically significantly higher ( P = .024 ) in the PRFM group compared with controls . Functional outcome scores postoperatively were not significantly improved compared with controls . Complications included 2 infections in the PRFM group . Conclusion : The augmentation of at-risk rotator cuff tears with PRFM did not result in improved retear rates or functional outcome scores compared with controls The purpose of this study was to examine the psychometric properties of the American Shoulder and Elbow Surgeons St and ardized Shoulder Assessment Form ( ASES ) , patient self-report section . Patients with shoulder dysfunction ( n = 63 ) completed the ASES , The University of Pennsylvania Shoulder Score , and the  Short Form-36  during the initial evaluation , 24 to 72 hours after the initial visit , and after 3 to 4 weeks of physical therapy . The test-retest reliability ( intraclass correlation coefficient[1-way r and om-effects ] , 0.84 ; 95 % CI lower limit , 0.75 ) and internal consistency ( Cronbach alpha , 0.86 ) values were acceptable . The st and ard error of the measure was 6.7 ASES points ( 90 % CI , 11.0 ) . Construct and discriminant validity was demonstrated . Responsiveness was demonstrated with a st and ardized response mean of 1.5 and an effect size of 1.4 . The minimal detectable change was 9.7 ASES points ( 90 % CI , 16 ) , and the minimal clinical ly important difference was 6.4 ASES points . The results indicate that the ASES is a reliable , valid , and responsive outcome tool A self-administered question naire was design ed to assess the severity of symptoms related to and the functional status of the shoulder . It includes domains of global assessment , pain , daily activities , recreational and athletic activities , work , satisfaction , and areas for improvement . Each domain is grade d separately and is weighted to arrive at the total score . The over-all scale and each domain were prospect ively tested for validity , reliability , and responsiveness to clinical change . One hundred patients who were seen for evaluation of the shoulder were enrolled in the study . The validity of the scale was demonstrated by moderate-to-high correlation of the domains and individual questions of the Shoulder Rating Question naire with those of the Arthritis Impact Measurement Scales 2 . Validity was supported further by significant correlation of the scores in each domain with the level of satisfaction in that domain and by significantly lower scores in domains that patients selected as areas important for improvement . The over-all scale and each domain were internally consistent ( Cronbach alpha , 0.71 to 0.90 ) . Reproducibility was evaluated by repeated administration of the question naire after a mean of three days to forty patients whose condition was clinical ly stable . Reproducibility of the over-all question naire and individual domains was excellent ( Spearman-Brown index , 0.94 to 0.98 ) . Individual questions were reproducible , with a weighted kappa value of more than 0.7 for each . Responsiveness was evaluated by comparison of the preoperative and postoperative scores of thirty patients who had a satisfactory result one year after an operation on the shoulder . The over-all Shoulder Rating Question naire and each domain were responsive to clinical change as demonstrated by favorable st and ardized response means ( range , 1.1 to 1.9 ) and indices of responsiveness ( range , 1.1 to 2.0 ) . Similar analysis performed for individual diagnostic groups supported the validity , reliability , and responsiveness of the question naire in each group . The self-administered shoulder question naire was found to be valid , reliable , and responsive to clinical change . These qualities should make it a useful instrument for the prospect i ve assessment of the outcome of treatment of disorders related to the shoulder PURPOSE Arthroscopic rotator cuff repair produces equally good clinical results compared with open or mini-open repair . However , there are concerns about whether the same repair integrity can be achieved . The purpose of our study was to compare clinical and structural results of arthroscopic and mini-open rotator cuff repair . METHODS Nineteen patients who had arthroscopic rotator cuff repair ( mean follow-up , 25.0 months ) were matched for age , gender , and duration of symptoms with nineteen patients who had mini-open repair ( mean follow-up , 17.6 months ) . We compared preoperative and follow-up Constant scores , as well as early range of motion after 6 weeks and 3 months . All patients were examined with the same magnetic resonance imaging system at follow-up to evaluate cuff integrity . RESULTS There was no difference in clinical and structural outcome . The overall Constant score improved from 53.8 to 83.9 in the arthroscopic group and from 53.5 to 83.7 in the mini-open group . Early range of motion did not differ significantly at 6 weeks or 3 months postoperatively . The number of retears was 6 ( 31.6 % ) in the arthroscopic group and 7 ( 36.8 % ) in the mini-open group . This difference was not statistically significant ( P = .7358 ) . Although smaller retears had no influence on the clinical result , more retracted retears correlated with lower abduction strength regardless of the repair method . CONCLUSIONS In isolated supraspinatus tears  arthroscopic rotator cuff repair produces excellent clinical results and equivalent tendon integrity compared with mini-open repair . LEVEL OF EVIDENCE Level III , retrospective therapeutic comparative study Tendon injuries are notorious for their slow and functionally inferior healing . Intratendinous application of platelet-rich plasma ( PRP ) has been reported to stimulate the repair process of tendon injuries , but there is little conclusive evidence for its effectiveness . A placebo-controlled experimental trial was performed to test the hypothesis that a single intratendinous PRP treatment enhances the quality of tendon repair , as evidence d by improved biochemical , biomechanical , and histological tissue properties . In six horses , tendon lesions were created surgically in the Superficial Digital Flexor Tendons ( SDFT ) of both front limbs , one of which was treated with PRP and the other with saline . After 24 weeks , the tendons were harvested for biochemical , biomechanical , and histological evaluations . Collagen , glycosaminoglycan , and DNA content ( cellularity ) was higher in PRP-treated tendons ( p = 0.039 , 0.038 , and 0.034 , respectively ) . The repair tissue in the PRP group showed a higher strength at failure ( p = 0.021 ) and Elastic Modulus ( p = 0.019 ) . Histologically , PRP-treated tendons featured better organization of the collagen network ( p = 0.031 ) and signs of increased metabolic activity ( p = 0.031 ) . It was concluded that PRP increases metabolic activity and seems to advance maturation of repair tissue over nontreated experimentally induced tendon lesions , which suggests that PRP might be beneficial in the treatment of clinical tendon injuries PURPOSE To assess the effect of platelet-rich plasma fibrin matrix ( PRPFM ) construct augmentation on postoperative tendon healing as determined by magnetic resonance imaging ( MRI ) and clinical outcome of arthroscopic rotator cuff repair . METHODS A comparative series of patients undergoing arthroscopic rotator cuff repair was studied . Two matched groups of patients ( 20 each ) were included : rotator cuff 
    Output:
    