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: Purpose Treatment of large cartilage lesions of the knee in weight-bearing areas is still a controversy and challenging topic . Autologous osteochondral mosaicplasty has proven to be a valid option for treatment but donor site morbidity with most frequently used autografts remains a source of concern . This study aims to assess clinical results and safety profile of autologous osteochondral graft from the upper tibio-fibular joint applied to reconstruct symptomatic osteochondral lesions of the knee . Methods Thirty-one patients ( 22 men and 9 women ) with grade 4 cartilage lesions in the knee were operated by mosaicplasty technique using autologous osteochondral graft from the upper tibio-fibular joint  , between 1998 and 2006 . Clinical assessment included visual analog scale ( VAS ) for pain and Lysholm score . All patients were evaluated by MRI pre- and post-operatively regarding joint congruency as good , fair ( inferior to 1 mm incongruence ) , and poor ( incongruence higher than 1 mm registered in any frame ) . Donor zone status was evaluated according to specific protocol considering upper tibio-fibular joint instability , pain , neurological complications , lateral collateral ligament insufficiency , or ankle complaints . Results Mean age at surgery was 30.1 years ( SD 12.2 ) . In respect to lesion sites , 22 were located in weight-bearing area of medial femoral condyle , 7 in lateral femoral condyle , 1 in trochlea , and 1 in patella . Mean follow-up was 110.1 months ( SD 23.2 ) . Mean area of lesion was 3.3 cm2 ( SD 1.7 ) , and a variable number of cylinders were used , mean 2.5 ( SD 1.3 ) . Mean VAS score improved from 47.1 ( SD 10.1 ) to 20.0 ( SD 11.5 ) ; p = 0.00 . Similarly , mean Lysholm score increased from 45.7 ( SD 4.5 ) to 85.3 ( SD 7.0 ) ; p = 0.00 . The level of patient satisfaction was evaluated , and 28 patients declared to be satisfied/very satisfied and would do surgery again , while 3 declared as unsatisfied with the procedure and would not su bmi t to surgery again . These three patients had lower clinical scores and kept complaints related to the original problem but unrelated to donor zone . MRI score significantly improved at 18–24 months comparing with pre-operative ( p = 0.004 ) . No radiographic or clinical complications related to donor zone with implication in activity were registered . Conclusions This work corroborates that mosaicplasty technique using autologous osteochondral graft from the upper tibio-fibular joint is effective to treat osteochondral defects in the knee joint . No relevant complications related to donor zone were registered . Level of evidence Case series , Level IV Abstract Purpose To compare long-term functional and radiological outcome following microfracture technique ( MF ) versus osteochondral autologous transplantation ( OAT ) mosaicplasty for treating focal chondral lesions of the knee . Methods Twenty-five patients ( mean age 32.3 years , SD 7.7 ) with a full-thickness ( International Cartilage Repair Society grade 3 or 4 ) chondral lesion of the articulating surface of the femur were r and omized to either MF  ( n = 11 ) or OAT mosaicplasty  ( n = 14 ) . At a median follow-up of 9.8 years ( range 4.9–11.4 ) , the patients were evaluated using Lysholm score ( n = 25 ) , Knee Injury and Osteoarthritis Outcome Score ( KOOS , n = 25 ) , isokinetic quadriceps measurement and hamstring strength measurement ( n = 22 ) and st and ing radiographs ( n = 23 ) . Results There were no significant differences in Lysholm score , KOOS , isokinetic muscle strength or radiographic osteoarthritis between MF-treated patients and OAT mosaicplasty-treated patients at follow-up . Mean Lysholm score at follow-up was 69.7 [ 95 % confidence interval ( CI ) , 55.1–84.4 ] for the MF group and 62.6 ( 95 % CI , 52.6–72.6 ) for the OAT mosaicplasty group . Conclusion At long-term follow-up , there were no significant differences between patients treated with MF  and patients treated with OAT mosaicplasty in patient-reported outcomes , muscle strength or radiological outcome .Level of evidence Therapeutic study , Level II Background : Autologous chondrocyte implantation ( ACI ) has been shown to be effective in the midterm for the treatment of symptomatic articular cartilage lesions of the knee , but few long-term series have been published . The multioperated chronic articular cartilage defect remains a difficult condition to treat . Purpose : To examine the long-term clinical results of ACI for large chronic articular cartilage defects , many treated as salvage . Study Design : Case series ; Level of evidence , 4 . Methods : This is a prospect i ve case series of 104 patients with a mean age of 30.2 years and a symptomatic lesion of the articular cartilage in the knee , who underwent ACI between 1998 and 2001 . The mean duration of symptoms before surgery was 7.8 years . The mean number of previous surgical procedures on the cartilage defect , excluding arthroscopic debridement , was 1.3 . The defects were large , with a mean size of 477.1 mm2 ( range , 120 - 2500 mm2 ) . The modified Cincinnati , Stanmore/Bentley , and visual analog scale for pain scoring systems were used to assess pain and functional outcomes at a minimum 10 years ( mean , 10.4 years ; range , 10 - 12 years ) . Results : Twenty-seven patients ( 26 % ) experienced graft failure at a mean of 5.7 years after ACI . Of the 73 patients who did not fail , 46 patients ( 63 % of patients with a surviving graft ) had an excellent result , 18 ( 25 % ) were good , 6 ( 8 % ) were fair , and 3 ( 4 % ) had a poor result . Of a total of 100 patients successfully followed up , 98 were satisfied with the ACI technique for their chronic knee pain and would undergo the procedure again . Conclusion : Autologous chondrocyte implantation can provide a long-term solution in more than 70 % of young patients of a difficult-to-treat group with large chronic articular cartilage lesions , even in the salvage situation Objective : Fresh osteochondral allograft transplantation ( OCA ) is an increasingly available option for patients with damage to the bone-cartilage complex of the distal femur . This study prospect ively assesses osseous integration and early clinical results following fresh OCA with single or multiple cylindrical grafts to the femoral condyle . Design : Patients with grade 4 International Cartilage Repair Society ( ICRS ) defects of the distal femur were treated with OCA .  Outcome measures were collected preoperatively and postoperatively at 6 , 12 , and 24 months . Computed tomography ( CT ) scans obtained at 6 months were used to assess degree of osseous incorporation regionally . Results : Thirty-four patients , with a mean age of 34.5 years ( range , 15 - 61 ) , with a mean femoral osteochondral lesion of 5.7 cm2 ( range , 1.5 - 15.0 ) due to focal osteoarthritis , osteochondritis dissecans , and avascular necrosis , are reported . Statistically significant ( P < 0.05 ) mean improvement in outcome scores at 2 years included Knee Injury and Osteoarthritis Outcomes Score ( KOOS ) pain , sports and recreation , quality of life , and International Knee Documentation Committee ( IKDC ) . CT imaging indicated grafts implanted to direct weightbearing regions had > 75 % incorporation ( 20/26 grafts ) compared to < 50 % incorporation in the indirect weightbearing regions ( 8/14 grafts ) . A greater degree of incorporation and earlier outcome improvement were found after single ( n = 23 ) compared to multiple ( n = 11 ) grafts . Conclusion : CT scans were used to assess osseous incorporation of fresh osteochondral allografts in a cohort that showed significant improvements after 2 years . Single-graft implantation is associated with stable incorporation of a greater percentage of the graft . Lesser incorporation appears more frequently with grafts in posterior indirect weightbearing regions of the condyle and multiple contiguous grafts Background : There are currently several approaches being pursued to treat focal defects of articular cartilage , each having specific advantages or challenges . A single-stage procedure that uses autologous cartilage fragments , Cartilage Autograft Implantation System ( CAIS ) , is being evaluated in patients and may offer a clinical ly effective option . Purpose : To establish the safety of CAIS and to test whether CAIS improves quality of life by using st and ardized outcomes assessment tools . Study Design : R and omized controlled trial ; Level of evidence , 2 . Methods : Patients ( n = 29 ) were r and omized ( 1:2 ) with the intent to treat with either a  control ( microfracture [ MFX ] ) or an experimental ( CAIS ) procedure . Patients were followed at predetermined time points for 2 years using several st and ardized outcomes assessment tools ( SF-36 , International Knee Documentation Committee [ IKDC ] , Knee injury and Osteoarthritis Outcome Score [ KOOS ] ) . Magnetic resonance imaging was performed at baseline , 3 weeks , and 6 , 12 , and 24 months . Results : Lesion size and International Cartilage Repair Society ( ICRS ) grade were similar in both groups . General outcome measures ( eg , physical component score of the SF-36 ) indicated an overall improvement in both groups , and no differences in the number of adverse effects were noted in comparisons between the CAIS and MFX groups . The IKDC score of the CAIS group was significantly higher ( 73.9 ± 14.72 at 12 months and 82.95 ± 14.88 at 24 months ) compared with the MFX group ( 57.78 ± 18.31 at 12 months and 59.5 ± 13.44 at 24 months ) . Select subdomains ( 4/5 ) in the KOOS instrument were significantly different at 12 and 18 months , and all subdomains ( Symptoms and Stiffness , Pain , Activities of Daily Living , Sports and Recreation , Knee-related Quality of Life ) were significantly increased at 24 months in CAIS with scores of 88.47 ± 11.68 , 90.64 ± 7.87 , 97.29 ± 3.8 , 78.16 ± 22.06 , and 69 ± 23.15 compared with 75 ± 9.31 , 78.94 ± 13.73 , 89.46 ± 8.13 , 51.67 ± 26.01 , and 37.15 ± 21.67 in the MFX group . These significant improvements were maintained at 24 months in both IKDC and KOOS . Qualitative analysis of the imaging data did not note differences between the 2 groups in fill of the graft bed , tissue integration , or presence of subchondral cysts . Patients treated with MFX had a significantly higher incidence of intralesional osteophyte formation ( 54 % and 70 % of total number of lesions treated ) at 6 and 12 months when compared with CAIS ( 8 % and 25 % of total number of lesions treated ) . Conclusion : The first clinical experience in using CAIS for treating patients with focal chondral defects indicates that it is a safe , feasible , and effective method that may improve long-term clinical outcomes Background There is no consensus about the optimal time for weightbearing activities after matrix-associated autologous chon-drocyte implantation ( MACI ) of the femoral condyle . Hypothesis A comprehensive protocol after MACI on the femoral condyle with accelerated weightbearing leads to a better functional and radiographic outcome compared with the same comprehensive protocol with delayed weightbearing . Study Design R and omized controlled trial ; Level of evidence , 1 . Methods Thirty-one patients ( 22 male , 9 female ) after MACI on the femoral condyle were r and omly assigned to the  accelerated weightbearing group ( group A ) or the  delayed weightbearing group ( group B ) . Aside from increase and time of full weightbearing , both groups adhered to the same rehabilitation protocol and exercises . Patients were assessed preoperatively and at 4 , 12 , 24 , 52 , and 104 weeks after surgery . Clinical evaluation was performed by determining the subjective form of the International Knee Documentation Committee ( IKDC ) , the Tegner activity scale , and the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) . Radiological outcome was evaluated by the MOCART score and the size and amount of bone marrow edema and effusion . Results In both groups , there were no differences with regard to the clinical outcome . For the radiological outcome , group A showed a higher prevalence of bone marrow edema after 6 months without correlation to the clinical outcome ( P 5 
    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: Purpose Treatment of large cartilage lesions of the knee in weight-bearing areas is still a controversy and challenging topic . Autologous osteochondral mosaicplasty has proven to be a valid option for treatment but donor site morbidity with most frequently used autografts remains a source of concern . This study aims to assess clinical results and safety profile of autologous osteochondral graft from the upper tibio-fibular joint applied to reconstruct symptomatic osteochondral lesions of the knee . Methods Thirty-one patients ( 22 men and 9 women ) with grade 4 cartilage lesions in the knee were operated by mosaicplasty technique using autologous osteochondral graft from the upper tibio-fibular joint  , between 1998 and 2006 . Clinical assessment included visual analog scale ( VAS ) for pain and Lysholm score . All patients were evaluated by MRI pre- and post-operatively regarding joint congruency as good , fair ( inferior to 1 mm incongruence ) , and poor ( incongruence higher than 1 mm registered in any frame ) . Donor zone status was evaluated according to specific protocol considering upper tibio-fibular joint instability , pain , neurological complications , lateral collateral ligament insufficiency , or ankle complaints . Results Mean age at surgery was 30.1 years ( SD 12.2 ) . In respect to lesion sites , 22 were located in weight-bearing area of medial femoral condyle , 7 in lateral femoral condyle , 1 in trochlea , and 1 in patella . Mean follow-up was 110.1 months ( SD 23.2 ) . Mean area of lesion was 3.3 cm2 ( SD 1.7 ) , and a variable number of cylinders were used , mean 2.5 ( SD 1.3 ) . Mean VAS score improved from 47.1 ( SD 10.1 ) to 20.0 ( SD 11.5 ) ; p = 0.00 . Similarly , mean Lysholm score increased from 45.7 ( SD 4.5 ) to 85.3 ( SD 7.0 ) ; p = 0.00 . The level of patient satisfaction was evaluated , and 28 patients declared to be satisfied/very satisfied and would do surgery again , while 3 declared as unsatisfied with the procedure and would not su bmi t to surgery again . These three patients had lower clinical scores and kept complaints related to the original problem but unrelated to donor zone . MRI score significantly improved at 18–24 months comparing with pre-operative ( p = 0.004 ) . No radiographic or clinical complications related to donor zone with implication in activity were registered . Conclusions This work corroborates that mosaicplasty technique using autologous osteochondral graft from the upper tibio-fibular joint is effective to treat osteochondral defects in the knee joint . No relevant complications related to donor zone were registered . Level of evidence Case series , Level IV Abstract Purpose To compare long-term functional and radiological outcome following microfracture technique ( MF ) versus osteochondral autologous transplantation ( OAT ) mosaicplasty for treating focal chondral lesions of the knee . Methods Twenty-five patients ( mean age 32.3 years , SD 7.7 ) with a full-thickness ( International Cartilage Repair Society grade 3 or 4 ) chondral lesion of the articulating surface of the femur were r and omized to either MF  ( n = 11 ) or OAT mosaicplasty  ( n = 14 ) . At a median follow-up of 9.8 years ( range 4.9–11.4 ) , the patients were evaluated using Lysholm score ( n = 25 ) , Knee Injury and Osteoarthritis Outcome Score ( KOOS , n = 25 ) , isokinetic quadriceps measurement and hamstring strength measurement ( n = 22 ) and st and ing radiographs ( n = 23 ) . Results There were no significant differences in Lysholm score , KOOS , isokinetic muscle strength or radiographic osteoarthritis between MF-treated patients and OAT mosaicplasty-treated patients at follow-up . Mean Lysholm score at follow-up was 69.7 [ 95 % confidence interval ( CI ) , 55.1–84.4 ] for the MF group and 62.6 ( 95 % CI , 52.6–72.6 ) for the OAT mosaicplasty group . Conclusion At long-term follow-up , there were no significant differences between patients treated with MF  and patients treated with OAT mosaicplasty in patient-reported outcomes , muscle strength or radiological outcome .Level of evidence Therapeutic study , Level II Background : Autologous chondrocyte implantation ( ACI ) has been shown to be effective in the midterm for the treatment of symptomatic articular cartilage lesions of the knee , but few long-term series have been published . The multioperated chronic articular cartilage defect remains a difficult condition to treat . Purpose : To examine the long-term clinical results of ACI for large chronic articular cartilage defects , many treated as salvage . Study Design : Case series ; Level of evidence , 4 . Methods : This is a prospect i ve case series of 104 patients with a mean age of 30.2 years and a symptomatic lesion of the articular cartilage in the knee , who underwent ACI between 1998 and 2001 . The mean duration of symptoms before surgery was 7.8 years . The mean number of previous surgical procedures on the cartilage defect , excluding arthroscopic debridement , was 1.3 . The defects were large , with a mean size of 477.1 mm2 ( range , 120 - 2500 mm2 ) . The modified Cincinnati , Stanmore/Bentley , and visual analog scale for pain scoring systems were used to assess pain and functional outcomes at a minimum 10 years ( mean , 10.4 years ; range , 10 - 12 years ) . Results : Twenty-seven patients ( 26 % ) experienced graft failure at a mean of 5.7 years after ACI . Of the 73 patients who did not fail , 46 patients ( 63 % of patients with a surviving graft ) had an excellent result , 18 ( 25 % ) were good , 6 ( 8 % ) were fair , and 3 ( 4 % ) had a poor result . Of a total of 100 patients successfully followed up , 98 were satisfied with the ACI technique for their chronic knee pain and would undergo the procedure again . Conclusion : Autologous chondrocyte implantation can provide a long-term solution in more than 70 % of young patients of a difficult-to-treat group with large chronic articular cartilage lesions , even in the salvage situation Objective : Fresh osteochondral allograft transplantation ( OCA ) is an increasingly available option for patients with damage to the bone-cartilage complex of the distal femur . This study prospect ively assesses osseous integration and early clinical results following fresh OCA with single or multiple cylindrical grafts to the femoral condyle . Design : Patients with grade 4 International Cartilage Repair Society ( ICRS ) defects of the distal femur were treated with OCA .  Outcome measures were collected preoperatively and postoperatively at 6 , 12 , and 24 months . Computed tomography ( CT ) scans obtained at 6 months were used to assess degree of osseous incorporation regionally . Results : Thirty-four patients , with a mean age of 34.5 years ( range , 15 - 61 ) , with a mean femoral osteochondral lesion of 5.7 cm2 ( range , 1.5 - 15.0 ) due to focal osteoarthritis , osteochondritis dissecans , and avascular necrosis , are reported . Statistically significant ( P < 0.05 ) mean improvement in outcome scores at 2 years included Knee Injury and Osteoarthritis Outcomes Score ( KOOS ) pain , sports and recreation , quality of life , and International Knee Documentation Committee ( IKDC ) . CT imaging indicated grafts implanted to direct weightbearing regions had > 75 % incorporation ( 20/26 grafts ) compared to < 50 % incorporation in the indirect weightbearing regions ( 8/14 grafts ) . A greater degree of incorporation and earlier outcome improvement were found after single ( n = 23 ) compared to multiple ( n = 11 ) grafts . Conclusion : CT scans were used to assess osseous incorporation of fresh osteochondral allografts in a cohort that showed significant improvements after 2 years . Single-graft implantation is associated with stable incorporation of a greater percentage of the graft . Lesser incorporation appears more frequently with grafts in posterior indirect weightbearing regions of the condyle and multiple contiguous grafts Background : There are currently several approaches being pursued to treat focal defects of articular cartilage , each having specific advantages or challenges . A single-stage procedure that uses autologous cartilage fragments , Cartilage Autograft Implantation System ( CAIS ) , is being evaluated in patients and may offer a clinical ly effective option . Purpose : To establish the safety of CAIS and to test whether CAIS improves quality of life by using st and ardized outcomes assessment tools . Study Design : R and omized controlled trial ; Level of evidence , 2 . Methods : Patients ( n = 29 ) were r and omized ( 1:2 ) with the intent to treat with either a  control ( microfracture [ MFX ] ) or an experimental ( CAIS ) procedure . Patients were followed at predetermined time points for 2 years using several st and ardized outcomes assessment tools ( SF-36 , International Knee Documentation Committee [ IKDC ] , Knee injury and Osteoarthritis Outcome Score [ KOOS ] ) . Magnetic resonance imaging was performed at baseline , 3 weeks , and 6 , 12 , and 24 months . Results : Lesion size and International Cartilage Repair Society ( ICRS ) grade were similar in both groups . General outcome measures ( eg , physical component score of the SF-36 ) indicated an overall improvement in both groups , and no differences in the number of adverse effects were noted in comparisons between the CAIS and MFX groups . The IKDC score of the CAIS group was significantly higher ( 73.9 ± 14.72 at 12 months and 82.95 ± 14.88 at 24 months ) compared with the MFX group ( 57.78 ± 18.31 at 12 months and 59.5 ± 13.44 at 24 months ) . Select subdomains ( 4/5 ) in the KOOS instrument were significantly different at 12 and 18 months , and all subdomains ( Symptoms and Stiffness , Pain , Activities of Daily Living , Sports and Recreation , Knee-related Quality of Life ) were significantly increased at 24 months in CAIS with scores of 88.47 ± 11.68 , 90.64 ± 7.87 , 97.29 ± 3.8 , 78.16 ± 22.06 , and 69 ± 23.15 compared with 75 ± 9.31 , 78.94 ± 13.73 , 89.46 ± 8.13 , 51.67 ± 26.01 , and 37.15 ± 21.67 in the MFX group . These significant improvements were maintained at 24 months in both IKDC and KOOS . Qualitative analysis of the imaging data did not note differences between the 2 groups in fill of the graft bed , tissue integration , or presence of subchondral cysts . Patients treated with MFX had a significantly higher incidence of intralesional osteophyte formation ( 54 % and 70 % of total number of lesions treated ) at 6 and 12 months when compared with CAIS ( 8 % and 25 % of total number of lesions treated ) . Conclusion : The first clinical experience in using CAIS for treating patients with focal chondral defects indicates that it is a safe , feasible , and effective method that may improve long-term clinical outcomes Background There is no consensus about the optimal time for weightbearing activities after matrix-associated autologous chon-drocyte implantation ( MACI ) of the femoral condyle . Hypothesis A comprehensive protocol after MACI on the femoral condyle with accelerated weightbearing leads to a better functional and radiographic outcome compared with the same comprehensive protocol with delayed weightbearing . Study Design R and omized controlled trial ; Level of evidence , 1 . Methods Thirty-one patients ( 22 male , 9 female ) after MACI on the femoral condyle were r and omly assigned to the  accelerated weightbearing group ( group A ) or the  delayed weightbearing group ( group B ) . Aside from increase and time of full weightbearing , both groups adhered to the same rehabilitation protocol and exercises . Patients were assessed preoperatively and at 4 , 12 , 24 , 52 , and 104 weeks after surgery . Clinical evaluation was performed by determining the subjective form of the International Knee Documentation Committee ( IKDC ) , the Tegner activity scale , and the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) . Radiological outcome was evaluated by the MOCART score and the size and amount of bone marrow edema and effusion . Results In both groups , there were no differences with regard to the clinical outcome . For the radiological outcome , group A showed a higher prevalence of bone marrow edema after 6 months without correlation to the clinical outcome ( P 5 
    Output:
    