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 —There is no disease specific , reliable , and valid clinical measure of Achilles tendinopathy . Objective —To develop and test a question naire based instrument that would serve as an index of severity of Achilles tendinopathy . Methods —Item generation , item reduction , item scaling , and pretesting were used to develop a question naire to assess the severity of Achilles tendinopathy . The final version consisted of eight questions that measured the domains of pain , function in daily living , and sporting activity . Results range from 0 to 100 , where 100 represents the perfect score . Its validity and reliability were then tested in a population of non-surgical patients with Achilles tendinopathy ( n = 45 ) , presurgical patients with Achilles tendinopathy ( n = 14 ) , and two normal control population s ( total n = 87 ) . Results —The VISA-A question naire had good test-retest ( r = 0.93 ) , intrarater ( three tests , r = 0.90 ) , and interrater ( r = 0.90 ) reliability as well as good stability when compared one week apart ( r = 0.81 ) . The mean ( 95 % confidence interval ) VISA-A score in the non-surgical patients was 64 ( 59–69 ) , in presurgical patients 44 ( 28–60 ) , and in control subjects it exceeded 96 ( 94–99 ) . Thus the VISA-A score was higher in non-surgical than presurgical patients ( p = 0.02 ) and higher in control subjects than in both patient population s ( p<0.001 ) . Conclusions —The VISA-A question naire is reliable and displayed construct validity when means were compared in patients with a range of severity of Achilles tendinopathy and control subjects . The continuous numerical result of the VISA-A question naire has the potential to provide utility in both the clinical setting and research . The test is not design ed to be diagnostic . Further studies are needed to determine whether the VISA-A score predicts prognosis PURPOSE To determine whether the use of platelet-rich plasma gel ( PRPG ) affects magnetic resonance imaging ( MRI ) findings in the anterior cruciate ligament ( ACL ) graft during the first year after reconstruction . METHODS A prospect i ve single-blinded study of 50 ACL reconstructions in 50 patients was performed . In group A ( study group ) PRPG was added to the graft with a st and ardized technique , and in group B ( control group ) no PRPG was added . An  MRI study  was performed postoperatively between 3 and 9 months in group A and between 3 and 12 months in group B. The imaging analysis was performed in a blind protocol by the same radiologist . RESULTS The mean heterogeneity score value at the time of MRI , assigned by the radiologist , was 1.14 in group A and 3.25 in group B. Both groups were comparable in terms of sex and age ( P < .05 ) . The mean time to obtain a completely homogeneous intra-articular segment in group A ( PRPG added ) was 177 days after surgery , and it was 369 days in group B. Using the quadratic predictive model , these findings show that group A ( PRPG added ) needed only 48 % of the time group B required to achieve the same MRI image ( P < .001 ) . CONCLUSIONS ACL reconstruction with the use of PRPG achieves complete homogeneous grafts assessed by MRI , in 179 days compared with 369 days for ACL reconstruction without PRPG . This represents a time shortening of 48 % with respect to ACL reconstruction without PRPG Background : Chronic lateral elbow epicondylitis is a tendinosis with angiofibrolastic degeneration of the wrist extensors ’ origin . Healing of this lesion is reported with the use of autologous blood as well as with platelet-rich plasma ( PRP ) . Purpose : A comparative study of these 2 treatments was conducted in an effort to investigate the possible advantages of PRP . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Twenty-eight patients were divided equally into 2 groups , after blocked r and omization . Group A was treated with a single injection of 3 mL of autologous blood and group B with 3 mL of PRP under ultrasound guidance . A st and ardized program of eccentric muscle strengthening was followed by all patients in both groups . Evaluation using a pain visual analog scale ( VAS ) and Liverpool elbow score was performed at 6 weeks , 3 months , and 6 months . Results : The VAS score improvement was larger in group B at every follow-up interval but the difference was statistically significant only at 6 weeks , when mean improvement was 3.8 points ( 95 % confidence interval [ CI ] , 3.1 - 4.5 ) in group B ( 61.47 % improvement ) and 2.5 points ( 95 % CI , 1.9 - 3.1 ) in group A ( 41.6 % improvement ) ( P < .05 ) . No statistically significant difference was noted between groups regarding Liverpool elbow score . Conclusion : Regarding pain reduction ,  PRP treatment seems to be an effective treatment for chronic lateral elbow epicondylitis and superior to autologous blood in the short term . Defining details of indications , best PRP concentration , number and time of injections , as well as rehabilitation protocol might increase the method ’s effectiveness . Additionally , the possibility of cost reduction of the method might justify the use of PRP over autologous whole blood for chronic or refractory tennis elbow CONTEXT Tendon disorders comprise 30 % to 50 % of all activity-related injuries ; chronic degenerative tendon disorders ( tendinopathy ) occur frequently and are difficult to treat . Tendon regeneration might be improved by injecting platelet-rich plasma ( PRP ) , an increasingly used treatment for releasing growth factors into the degenerative tendon . OBJECTIVE To examine whether a PRP injection would improve outcome in chronic midportion Achilles tendinopathy . DESIGN , SETTING , AND PATIENTS A stratified , block-r and omized , double-blind , placebo-controlled trial at a single center ( The Hague Medical Center , Leidschendam , The Netherl and s ) of 54 r and omized patients aged 18 to 70 years with chronic tendinopathy 2 to 7 cm above the Achilles tendon insertion . The trial was conducted between August 28 , 2008 , and January 29 , 2009 , with follow-up until July 16 , 2009 . INTERVENTION Eccentric exercises ( usual care ) with either a PRP injection ( PRP group ) or saline injection ( placebo group ) . R and omization was stratified by activity level . MAIN OUTCOME MEASURES The vali date d Victorian Institute of Sports Assessment -Achilles ( VISA-A ) question naire , which evaluated pain score and activity level , was completed at baseline and 6 , 12 , and 24 weeks . The VISA-A score ranged from 0 to 100 , with higher scores corresponding with less pain and increased activity . Treatment group effects were evaluated using general linear models on the basis of intention-to-treat . RESULTS After r and omization into the PRP group ( n = 27 ) or placebo group ( n = 27 ) , there was complete follow-up of all patients . The mean VISA-A score improved significantly after 24 weeks in the PRP group by 21.7 points ( 95 % confidence interval [ CI ] , 13.0 - 30.5 ) and in the placebo group by 20.5 points ( 95 % CI , 11.6 - 29.4 ) . The increase was not significantly different between both groups ( adjusted between-group difference from baseline to 24 weeks , -0.9 ; 95 % CI , -12.4 to 10.6 ) . This CI did not include the predefined relevant difference of 12 points in favor of PRP treatment . CONCLUSION Among patients with chronic Achilles tendinopathy who were treated with eccentric exercises , a PRP injection compared with a saline injection did not result in greater improvement in pain and activity . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00761423 Background : The patellar tendon has limited ability to heal after harvesting its central third . Platelet-rich plasma ( PRP ) could improve patellar tendon healing . Hypothesis : Adding PRP to the patellar tendon harvest site would improve donor site healing and improve clinical outcome at 6 months after anterior cruciate ligament ( ACL ) reconstruction with a patellar tendon graft . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Twenty-seven patients were r and omly divided to receive ( n = 12 ) or not receive ( n = 15 ) PRP in the patellar tendon harvest site during ACL reconstruction . The primary outcome was magnetic resonance imaging ( MRI ) assessment of patellar tendon healing ( gap area ) after 6 months . Secondary outcomes were question naires and isokinetic testing of ACL reconstruction with a patellar tendon graft comparing both groups . Results : Patellar tendon gap area was significantly smaller in the PRP group ( 4.9 ± 5.3 mm2 ; 95 % confidence interval [ CI ] , 1.1 - 8.8 ) than in the control group ( 9.4 ± 4.4 mm2 ; 95 % CI , 6.6 - 12.2 ; P = .046 ) . Visual analog scale score for pain was lower in the PRP group immediately postoperatively ( 3.8 ± 1.0 ; 95 % CI , 3.18 - 4.49 ) than in the control group ( 5.1 ± 1.4 ; 95 % CI , 4.24 - 5.90 ; P = .02 ) . There were no differences after 6 months in question naire and isokinetic testing results comparing both groups . Conclusion : We showed that PRP had a positive effect on patellar tendon harvest site healing on MRI after 6 months and also reduced pain in the immediate postoperative period . Question naire and isokinetic testing results were not different between the groups at 6 months PURPOSE The purpose of this study was to determine if the use of platelet concentrate ( PC ) and bone plug ( BP ) does accelerate the healing process in anterior cruciate ligament ( ACL ) reconstruction . METHODS One hundred and eight patients requiring ACL reconstruction were prospect ively r and omized into 4 groups :  control  ( 27 patients ) , PC ( 26 patients ) , BP ( 28 patients ) , and a combination of PC and BP ( 27 patients ) . Magnetic resonance imaging ( MRI ) studies were carried out at both 3 and 6 months postsurgery . Maturation of the graft was evaluated at the femoral tunnel using MRI maturation criteria defined by a low-intensity signal , absence of osteoligamentous interface , and no widening of the femoral tunnel . RESULTS Three months after surgery , no differences were found among the groups regarding MRI maturation criteria . Six months postsurgery , 78 % of the patients in the control group had a low-intensity signal , while in the PC group the low-intensity signal was present in 100 % of the patients ( P = .036 ) . No statistical differences were observed regarding the osteoligamentous interface between 
    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 —There is no disease specific , reliable , and valid clinical measure of Achilles tendinopathy . Objective —To develop and test a question naire based instrument that would serve as an index of severity of Achilles tendinopathy . Methods —Item generation , item reduction , item scaling , and pretesting were used to develop a question naire to assess the severity of Achilles tendinopathy . The final version consisted of eight questions that measured the domains of pain , function in daily living , and sporting activity . Results range from 0 to 100 , where 100 represents the perfect score . Its validity and reliability were then tested in a population of non-surgical patients with Achilles tendinopathy ( n = 45 ) , presurgical patients with Achilles tendinopathy ( n = 14 ) , and two normal control population s ( total n = 87 ) . Results —The VISA-A question naire had good test-retest ( r = 0.93 ) , intrarater ( three tests , r = 0.90 ) , and interrater ( r = 0.90 ) reliability as well as good stability when compared one week apart ( r = 0.81 ) . The mean ( 95 % confidence interval ) VISA-A score in the non-surgical patients was 64 ( 59–69 ) , in presurgical patients 44 ( 28–60 ) , and in control subjects it exceeded 96 ( 94–99 ) . Thus the VISA-A score was higher in non-surgical than presurgical patients ( p = 0.02 ) and higher in control subjects than in both patient population s ( p<0.001 ) . Conclusions —The VISA-A question naire is reliable and displayed construct validity when means were compared in patients with a range of severity of Achilles tendinopathy and control subjects . The continuous numerical result of the VISA-A question naire has the potential to provide utility in both the clinical setting and research . The test is not design ed to be diagnostic . Further studies are needed to determine whether the VISA-A score predicts prognosis PURPOSE To determine whether the use of platelet-rich plasma gel ( PRPG ) affects magnetic resonance imaging ( MRI ) findings in the anterior cruciate ligament ( ACL ) graft during the first year after reconstruction . METHODS A prospect i ve single-blinded study of 50 ACL reconstructions in 50 patients was performed . In group A ( study group ) PRPG was added to the graft with a st and ardized technique , and in group B ( control group ) no PRPG was added . An  MRI study  was performed postoperatively between 3 and 9 months in group A and between 3 and 12 months in group B. The imaging analysis was performed in a blind protocol by the same radiologist . RESULTS The mean heterogeneity score value at the time of MRI , assigned by the radiologist , was 1.14 in group A and 3.25 in group B. Both groups were comparable in terms of sex and age ( P < .05 ) . The mean time to obtain a completely homogeneous intra-articular segment in group A ( PRPG added ) was 177 days after surgery , and it was 369 days in group B. Using the quadratic predictive model , these findings show that group A ( PRPG added ) needed only 48 % of the time group B required to achieve the same MRI image ( P < .001 ) . CONCLUSIONS ACL reconstruction with the use of PRPG achieves complete homogeneous grafts assessed by MRI , in 179 days compared with 369 days for ACL reconstruction without PRPG . This represents a time shortening of 48 % with respect to ACL reconstruction without PRPG Background : Chronic lateral elbow epicondylitis is a tendinosis with angiofibrolastic degeneration of the wrist extensors ’ origin . Healing of this lesion is reported with the use of autologous blood as well as with platelet-rich plasma ( PRP ) . Purpose : A comparative study of these 2 treatments was conducted in an effort to investigate the possible advantages of PRP . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Twenty-eight patients were divided equally into 2 groups , after blocked r and omization . Group A was treated with a single injection of 3 mL of autologous blood and group B with 3 mL of PRP under ultrasound guidance . A st and ardized program of eccentric muscle strengthening was followed by all patients in both groups . Evaluation using a pain visual analog scale ( VAS ) and Liverpool elbow score was performed at 6 weeks , 3 months , and 6 months . Results : The VAS score improvement was larger in group B at every follow-up interval but the difference was statistically significant only at 6 weeks , when mean improvement was 3.8 points ( 95 % confidence interval [ CI ] , 3.1 - 4.5 ) in group B ( 61.47 % improvement ) and 2.5 points ( 95 % CI , 1.9 - 3.1 ) in group A ( 41.6 % improvement ) ( P < .05 ) . No statistically significant difference was noted between groups regarding Liverpool elbow score . Conclusion : Regarding pain reduction ,  PRP treatment seems to be an effective treatment for chronic lateral elbow epicondylitis and superior to autologous blood in the short term . Defining details of indications , best PRP concentration , number and time of injections , as well as rehabilitation protocol might increase the method ’s effectiveness . Additionally , the possibility of cost reduction of the method might justify the use of PRP over autologous whole blood for chronic or refractory tennis elbow CONTEXT Tendon disorders comprise 30 % to 50 % of all activity-related injuries ; chronic degenerative tendon disorders ( tendinopathy ) occur frequently and are difficult to treat . Tendon regeneration might be improved by injecting platelet-rich plasma ( PRP ) , an increasingly used treatment for releasing growth factors into the degenerative tendon . OBJECTIVE To examine whether a PRP injection would improve outcome in chronic midportion Achilles tendinopathy . DESIGN , SETTING , AND PATIENTS A stratified , block-r and omized , double-blind , placebo-controlled trial at a single center ( The Hague Medical Center , Leidschendam , The Netherl and s ) of 54 r and omized patients aged 18 to 70 years with chronic tendinopathy 2 to 7 cm above the Achilles tendon insertion . The trial was conducted between August 28 , 2008 , and January 29 , 2009 , with follow-up until July 16 , 2009 . INTERVENTION Eccentric exercises ( usual care ) with either a PRP injection ( PRP group ) or saline injection ( placebo group ) . R and omization was stratified by activity level . MAIN OUTCOME MEASURES The vali date d Victorian Institute of Sports Assessment -Achilles ( VISA-A ) question naire , which evaluated pain score and activity level , was completed at baseline and 6 , 12 , and 24 weeks . The VISA-A score ranged from 0 to 100 , with higher scores corresponding with less pain and increased activity . Treatment group effects were evaluated using general linear models on the basis of intention-to-treat . RESULTS After r and omization into the PRP group ( n = 27 ) or placebo group ( n = 27 ) , there was complete follow-up of all patients . The mean VISA-A score improved significantly after 24 weeks in the PRP group by 21.7 points ( 95 % confidence interval [ CI ] , 13.0 - 30.5 ) and in the placebo group by 20.5 points ( 95 % CI , 11.6 - 29.4 ) . The increase was not significantly different between both groups ( adjusted between-group difference from baseline to 24 weeks , -0.9 ; 95 % CI , -12.4 to 10.6 ) . This CI did not include the predefined relevant difference of 12 points in favor of PRP treatment . CONCLUSION Among patients with chronic Achilles tendinopathy who were treated with eccentric exercises , a PRP injection compared with a saline injection did not result in greater improvement in pain and activity . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00761423 Background : The patellar tendon has limited ability to heal after harvesting its central third . Platelet-rich plasma ( PRP ) could improve patellar tendon healing . Hypothesis : Adding PRP to the patellar tendon harvest site would improve donor site healing and improve clinical outcome at 6 months after anterior cruciate ligament ( ACL ) reconstruction with a patellar tendon graft . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Twenty-seven patients were r and omly divided to receive ( n = 12 ) or not receive ( n = 15 ) PRP in the patellar tendon harvest site during ACL reconstruction . The primary outcome was magnetic resonance imaging ( MRI ) assessment of patellar tendon healing ( gap area ) after 6 months . Secondary outcomes were question naires and isokinetic testing of ACL reconstruction with a patellar tendon graft comparing both groups . Results : Patellar tendon gap area was significantly smaller in the PRP group ( 4.9 ± 5.3 mm2 ; 95 % confidence interval [ CI ] , 1.1 - 8.8 ) than in the control group ( 9.4 ± 4.4 mm2 ; 95 % CI , 6.6 - 12.2 ; P = .046 ) . Visual analog scale score for pain was lower in the PRP group immediately postoperatively ( 3.8 ± 1.0 ; 95 % CI , 3.18 - 4.49 ) than in the control group ( 5.1 ± 1.4 ; 95 % CI , 4.24 - 5.90 ; P = .02 ) . There were no differences after 6 months in question naire and isokinetic testing results comparing both groups . Conclusion : We showed that PRP had a positive effect on patellar tendon harvest site healing on MRI after 6 months and also reduced pain in the immediate postoperative period . Question naire and isokinetic testing results were not different between the groups at 6 months PURPOSE The purpose of this study was to determine if the use of platelet concentrate ( PC ) and bone plug ( BP ) does accelerate the healing process in anterior cruciate ligament ( ACL ) reconstruction . METHODS One hundred and eight patients requiring ACL reconstruction were prospect ively r and omized into 4 groups :  control  ( 27 patients ) , PC ( 26 patients ) , BP ( 28 patients ) , and a combination of PC and BP ( 27 patients ) . Magnetic resonance imaging ( MRI ) studies were carried out at both 3 and 6 months postsurgery . Maturation of the graft was evaluated at the femoral tunnel using MRI maturation criteria defined by a low-intensity signal , absence of osteoligamentous interface , and no widening of the femoral tunnel . RESULTS Three months after surgery , no differences were found among the groups regarding MRI maturation criteria . Six months postsurgery , 78 % of the patients in the control group had a low-intensity signal , while in the PC group the low-intensity signal was present in 100 % of the patients ( P = .036 ) . No statistical differences were observed regarding the osteoligamentous interface between 
    Output:
    