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 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 Platelet Rich Plasma ( PRP ) , a blood-derived product rich in growth factors , is a promising treatment for cartilage defects but there is still a lack of clinical evidence . The aim of this study is to show , through a r and omized double blind prospect i ve trial , the efficacy of this procedure , by comparing PRP to Hyaluronic Acid ( HA ) injections for the treatment of knee chondropathy or osteoarthritis ( OA ) . Methods 109 patients ( 55 treated with HA and 54 with PRP )  were treated and evaluated at 12 months of follow-up . The patients were enrolled according to the following inclusion criteria : age > 18 years , history of chronic ( at least 4 months ) pain or swelling of the knee and imaging findings of degenerative changes of the joint ( Kellgren-Lawrence Score up to 3 ) . A cycle of 3 weekly injections was administered blindly . All patients were prospect ively evaluated before and at 2 , 6 , and 12 months after the treatment by : IKDC , EQ-VAS , TEGNER , and KOOS scores . Range of motion and knee circumference changes were measured over time . Adverse events and patient satisfaction were also recorded . Results Only minor adverse events were detected in some patients , such as mild pain and effusion after the injections , in particular in the PRP group , where a significantly higher post-injective pain reaction was observed ( p=0.039 ) . At the follow-up evaluations , both groups presented a clinical improvement but the comparison between the two groups showed a not statistically significant difference in all scores evaluated . A trend favorable for the PRP group was only found in patients with low grade articular degeneration ( Kellgren-Lawrence score up to 2 ) . Conclusions Results suggest that PRP injections offer a significant clinical improvement up to one year of follow-up . However , conversely to what was shown by the current literature , for middle-aged patients with moderate signs of OA , PRP results were not better than those obtained with HA injections , and thus it should not be considered as first line treatment . More promising results are shown for its use in low grade degeneration , but they still have to be confirmed 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 Background : Platelet-rich plasma ( PRP ) has been shown to be a general stimulation for repair and 1-year results showed promising success percentages . Purpose : This trial was undertaken to determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis with a 2-year follow-up . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : The trial was conducted in 2 Dutch teaching hospitals . One hundred patients with chronic lateral epicondylitis were r and omly assigned to a leukocyte-enriched PRP group ( n = 51 ) or the corticosteroid group ( n = 49 ) . R and omization and allocation to the trial group were carried out by a central computer system . Patients received either a corticosteroid injection or an autologous platelet concentrate injection through a peppering needling technique . The primary analysis included visual analog scale ( VAS ) pain scores and Disabilities of the Arm , Shoulder and H and ( DASH ) outcome scores . Results : The PRP group was more often successfully treated than the corticosteroid group ( P < .0001 ) . Success was defined as a reduction of 25 % on VAS or DASH scores without a reintervention after 2 years . When baseline VAS and DASH scores were compared with the scores at 2-year follow-up , both groups significantly improved across time ( intention-to-treat principle ) . However , the DASH scores of the corticosteroid group returned to baseline levels , while those of the PRP group significantly improved ( as-treated principle ) . There were no complications related to the use of PRP . Conclusion : Treatment of patients with chronic lateral epicondylitis with PRP  reduces pain and increases function significantly , exceeding the effect of corticosteroid injection even after a follow-up of 2 years . Future decisions for application of PRP for lateral epicondylitis should be confirmed by further follow-up from this trial and should take into account possible costs and harms as well as benefits AIM Professional athletes require faster recovery after trauma . The aim of our study was to evaluate the efficacy of ultrasound guided platelets rich plasma ( PRP ) treatment for acute muscle injury comparing with traditional conservative therapy . MATERIAL S AND METHODS Thirty consecutive men ( mean age 24 years old ) professional athletes with acute local muscle injury were enrolled . All patients underwent US and sonoelastography examination . Patients were r and omly assigned to 2 groups : group A received targeted PRP injection under US guidance and additionally conservative treatment and group B received conventional conservative treatment only . The pain was assessed according to visual analogue scale ( 0 to 10 ) , muscle function according to pain on resisted ﬂexion or strength , and range of motion . Both groups were further evaluated in the days 1 , 7 , 14 , 21 , and 28 after treatment starting . US criteria for regeneration were considered to be the disappearance of hypoechoic areas of muscle damage , fibrous tissue more stiff on sonoelastography , and neovascularity appearances . RESULTS The pain relief was more important in group A compared to group B starting from day 1 and continuing in the next 3 evaluation sessions ( p<0.05 ) . At the end of observation ( 28 day ) , 93 % of pain regression was declared by patients in group A vs 80 % of regression of pain in group B ( p>0.05 ) . Assessing the physical evolution in the 7th and 14th days significant changes in strength ( p<0.05 ) and range of motion ( p<0.05 ) for PRP treatment group was observed . After 28 days no significant differences between groups were observed concerning the pain on resisted ﬂexion and strength ( p>0.05 ) but the range of movement improved better in group A compared with group B ( p < 0.05 ) . Subjective global function scores improved significantly in group A compared with group B on the 28th day ( p<0.05 ) . The mean time for the physical recovery movement volume and the ability to practice sport was 10+/-1.2 days in group A and 22+/-1.5 days in group B. CONCLUSIONS Injections of PRP under ultrasound guidance had asignificantly higher level of pain relief , physical recovery , and faster regeneration compared with conventional conservative treatment in acute muscle trauma in professional athletes Background : Tendinopathies represent a serious challenge for orthopaedic surgeons involved in treatment of athletes . Purpose : To compare the effectiveness and safety of platelet-rich plasma ( PRP ) injections and focused extracorporeal shock wave therapy ( ESWT ) in athletes with jumper ’s knee . 
    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 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 Platelet Rich Plasma ( PRP ) , a blood-derived product rich in growth factors , is a promising treatment for cartilage defects but there is still a lack of clinical evidence . The aim of this study is to show , through a r and omized double blind prospect i ve trial , the efficacy of this procedure , by comparing PRP to Hyaluronic Acid ( HA ) injections for the treatment of knee chondropathy or osteoarthritis ( OA ) . Methods 109 patients ( 55 treated with HA and 54 with PRP )  were treated and evaluated at 12 months of follow-up . The patients were enrolled according to the following inclusion criteria : age > 18 years , history of chronic ( at least 4 months ) pain or swelling of the knee and imaging findings of degenerative changes of the joint ( Kellgren-Lawrence Score up to 3 ) . A cycle of 3 weekly injections was administered blindly . All patients were prospect ively evaluated before and at 2 , 6 , and 12 months after the treatment by : IKDC , EQ-VAS , TEGNER , and KOOS scores . Range of motion and knee circumference changes were measured over time . Adverse events and patient satisfaction were also recorded . Results Only minor adverse events were detected in some patients , such as mild pain and effusion after the injections , in particular in the PRP group , where a significantly higher post-injective pain reaction was observed ( p=0.039 ) . At the follow-up evaluations , both groups presented a clinical improvement but the comparison between the two groups showed a not statistically significant difference in all scores evaluated . A trend favorable for the PRP group was only found in patients with low grade articular degeneration ( Kellgren-Lawrence score up to 2 ) . Conclusions Results suggest that PRP injections offer a significant clinical improvement up to one year of follow-up . However , conversely to what was shown by the current literature , for middle-aged patients with moderate signs of OA , PRP results were not better than those obtained with HA injections , and thus it should not be considered as first line treatment . More promising results are shown for its use in low grade degeneration , but they still have to be confirmed 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 Background : Platelet-rich plasma ( PRP ) has been shown to be a general stimulation for repair and 1-year results showed promising success percentages . Purpose : This trial was undertaken to determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis with a 2-year follow-up . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : The trial was conducted in 2 Dutch teaching hospitals . One hundred patients with chronic lateral epicondylitis were r and omly assigned to a leukocyte-enriched PRP group ( n = 51 ) or the corticosteroid group ( n = 49 ) . R and omization and allocation to the trial group were carried out by a central computer system . Patients received either a corticosteroid injection or an autologous platelet concentrate injection through a peppering needling technique . The primary analysis included visual analog scale ( VAS ) pain scores and Disabilities of the Arm , Shoulder and H and ( DASH ) outcome scores . Results : The PRP group was more often successfully treated than the corticosteroid group ( P < .0001 ) . Success was defined as a reduction of 25 % on VAS or DASH scores without a reintervention after 2 years . When baseline VAS and DASH scores were compared with the scores at 2-year follow-up , both groups significantly improved across time ( intention-to-treat principle ) . However , the DASH scores of the corticosteroid group returned to baseline levels , while those of the PRP group significantly improved ( as-treated principle ) . There were no complications related to the use of PRP . Conclusion : Treatment of patients with chronic lateral epicondylitis with PRP  reduces pain and increases function significantly , exceeding the effect of corticosteroid injection even after a follow-up of 2 years . Future decisions for application of PRP for lateral epicondylitis should be confirmed by further follow-up from this trial and should take into account possible costs and harms as well as benefits AIM Professional athletes require faster recovery after trauma . The aim of our study was to evaluate the efficacy of ultrasound guided platelets rich plasma ( PRP ) treatment for acute muscle injury comparing with traditional conservative therapy . MATERIAL S AND METHODS Thirty consecutive men ( mean age 24 years old ) professional athletes with acute local muscle injury were enrolled . All patients underwent US and sonoelastography examination . Patients were r and omly assigned to 2 groups : group A received targeted PRP injection under US guidance and additionally conservative treatment and group B received conventional conservative treatment only . The pain was assessed according to visual analogue scale ( 0 to 10 ) , muscle function according to pain on resisted ﬂexion or strength , and range of motion . Both groups were further evaluated in the days 1 , 7 , 14 , 21 , and 28 after treatment starting . US criteria for regeneration were considered to be the disappearance of hypoechoic areas of muscle damage , fibrous tissue more stiff on sonoelastography , and neovascularity appearances . RESULTS The pain relief was more important in group A compared to group B starting from day 1 and continuing in the next 3 evaluation sessions ( p<0.05 ) . At the end of observation ( 28 day ) , 93 % of pain regression was declared by patients in group A vs 80 % of regression of pain in group B ( p>0.05 ) . Assessing the physical evolution in the 7th and 14th days significant changes in strength ( p<0.05 ) and range of motion ( p<0.05 ) for PRP treatment group was observed . After 28 days no significant differences between groups were observed concerning the pain on resisted ﬂexion and strength ( p>0.05 ) but the range of movement improved better in group A compared with group B ( p < 0.05 ) . Subjective global function scores improved significantly in group A compared with group B on the 28th day ( p<0.05 ) . The mean time for the physical recovery movement volume and the ability to practice sport was 10+/-1.2 days in group A and 22+/-1.5 days in group B. CONCLUSIONS Injections of PRP under ultrasound guidance had asignificantly higher level of pain relief , physical recovery , and faster regeneration compared with conventional conservative treatment in acute muscle trauma in professional athletes Background : Tendinopathies represent a serious challenge for orthopaedic surgeons involved in treatment of athletes . Purpose : To compare the effectiveness and safety of platelet-rich plasma ( PRP ) injections and focused extracorporeal shock wave therapy ( ESWT ) in athletes with jumper ’s knee . 
    Output:
    