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: Background : Arthrosis is particularly prevalent in the knee . Infiltration treatment for gonarthrosis is among the most widely used techniques in orthopaedic practice . Purpose : To compare the clinical response of hyaluronic acid ( HA ) and platelet-rich plasma ( PRP ) treatment in 2 groups of patients affected by gonarthrosis . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : A total of 120 patients affected by clinical ly and radiographically documented gonarthrosis were included in this study . The gonarthrosis was grade d using the Kellgren-Lawrence radiographic classification scale . The 120 patients were r and omized into 2 study groups in a 1:1 ratio : 60 patients received 4 intra-articular injections of PRP ( specifically , autologous conditioned plasma [ ACP ] , 5.5 mL ) , and 60 patients received 4 intra-articular injections of HA ( 20 mg/2 mL ) . An unblinded physician performed infiltration once a week for 4 weeks into the knee affected by clinical ly relevant gonarthrosis ( in both groups ) . All patients were evaluated with the Western Ontario and McMaster ( WOMAC ) score before the infiltration and at 4 , 12 , and 24 weeks after the first injection . Results : Treatment with a local injection of ACP had a significant effect shortly after the final infiltration and a continuously improving sustained effect up to 24 weeks ( WOMAC score , 65.1 and 36.5 in the HA and ACP groups , respectively ; P < .001 ) , where the clinical outcomes were better compared with the results with HA . In the HA group , the worst results were obtained for grade III gonarthrosis , whereas the clinical results obtained in the ACP group did not show any statistically significant difference in terms of the grade of gonarthrosis . The mean WOMAC scores for grade III gonarthrosis were 74.85 in the HA group and 41.20 in the ACP group ( P < .001 ) . Conclusion : Treatment with ACP showed a significantly better clinical outcome than did treatment with HA , with sustained lower WOMAC scores . Treatment with HA did not seem to be effective in the patients with grade III gonarthrosis PURPOSE The aim of our study is to compare the efficacy of platelet-rich plasma ( PRP ) and viscosupplementation ( hyaluronic acid [ HA ] ) intra-articular injections for the treatment of knee cartilage degenerative lesions and osteoarthritis ( OA ) . METHODS The study involved 150 patients affected by cartilage degenerative lesions and early and severe OA . Fifty symptomatic patients were treated with 3 autologous PRP intra-articular injections and were evaluated prospect ively at enrollment and at 2- and 6-month follow-up . The results obtained were compared with 2 homogeneous groups of patients treated with HA injections . One group was treated with injections of high-molecular weight HA ; the other group was treated with low-molecular weight ( LW ) HA .  International Knee Documentation Committee and EQ VAS scores were used for clinical evaluation ; adverse events and patient satisfaction were also recorded . RESULTS At 2 months ' follow-up , the PRP and LW HA groups showed a similar improvement , with higher results compared with the high-molecular weight HA group ( P < .005 ) . At 6 months ' follow-up , better results were observed in the PRP group ( P < .005 ) . PRP and LW HA treatments offered similar results in patients aged over 50 years and in the treatment of advanced OA . PRP showed a better performance compared with HA in younger patients affected by cartilage lesions or early OA . CONCLUSIONS Autologous PRP injections showed more and longer efficacy than HA injections in reducing pain and symptoms and recovering articular function . Better results were achieved in younger and more active patients with a low degree of cartilage degeneration , whereas a worse outcome was obtained in more degenerated joints and in older patients , in whom results similar to those of viscosupplementation have been observed . LEVEL OF EVIDENCE Level II , prospect i ve comparative study 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 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Purpose To compare the safety and efficacy of two different approaches of platelet-rich plasma ( PRP ) production methods as intra-articular injection treatment for knee cartilage degenerative lesions and osteoarthritis ( OA ) . Methods The study involved 144 symptomatic patients affected by cartilage degenerative lesions and OA . Seventy-two patients were treated with 3  injections of platelet concentrate prepared with a single-spinning procedure ( PRGF ) , the other 72 with 3 injections of PRP obtained with a double-spinning approach . The patients were evaluated prospect ively at the enrollment and at 2 , 6 , and 12 months ’ follow-up with IKDC , EQ-VAS and Tegner scores ; adverse events and patient satisfaction were also recorded . Results Both treatment groups presented a statistically significant improvement in all the scores evaluated at all the follow-up times . Better results were achieved in both groups in younger patients with a lower degree of cartilage degeneration . The comparative analysis showed similar improvements with the two procedures : in particular , IKDC subjective evaluation increased from 45.0 ± 10.1 to 59.0 ± 16.2 , 61.3 ± 16.3 , and 61.6 ± 16.2 at 2 , 6 , and 12 months in the PRGF group , and from 42.1 ± 13.5 to 60.8 ± 16.6 , 62.5 ± 19.9 , and 59.9 ± 20.0 at 2 , 6 , and 12 months in the PRP group , respectively . Concerning adverse events , more swelling ( P = 0.03 ) and pain reaction ( P = 0.0005 ) , were found after PRP injections . Conclusions Although PRP injections produced more pain and swelling reaction with respect to that produced by PRGF , similar results were found at the follow-up times , with a significant clinical improvement with respect to the basal level . Better results were achieved in younger patients with a low degree of cartilage degeneration . Level of evidence II Platelet-rich plasma ( PRP ) is a natural concentrate of autologous blood growth factors experimented in different fields of medicine in order to test its potential to enhance tissue regeneration . The aim of our study is to explore this novel approach to treat degenerative lesions of articular cartilage of the knee . One hundred consecutive patients , affected by chronic degenerative condition of the knee , were treated with PRP intra-articular injections ( 115 knees treated ) . The procedure consisted of 150-ml of venous blood collected and twice centrifugated : 3 PRP units of 5 ml each were used for the injections . Patients were clinical ly prospect ively evaluated before and at the end of the treatment , and at 6 and 12 months follow-up . IKDC , objective and subjective , and EQ VAS were used for clinical evaluation . Statistical analysis was performed to evaluate the significance of sex , age , grade of OA and BMI . A statistically significant improvement of all clinical scores was obtained from the basal evaluation to the end of the therapy and at 6–12 months follow-up ( P < 0.0005 ) . The results remained stable from the end of the therapy to 6 months follow up , whereas they became significantly worse at 12 months follow up ( P = 0.02 ) , even if still significantly higher respect to the basal level ( P < 0.0005 ) . The preliminary results indicate that the treatment with PRP injections is safe and has the potential to reduce pain and improve knee function and quality of live in younger patients with low degree of articular degeneration Objective This study aim ed to find a simple , cost-effective , and time-efficient method for the preparation of platelet-rich plasma ( PRP ) , so the acquired benefits will be readily available for multiple procedures in smaller outpatient clinics and to explore the safety and efficacy of the application of PRP in the treatment of degenerative lesions of articular cartilage of the knee . Design The study was design ed as a prospect i ve , cohort study with a control group . A total of 120 patients with Grade 1 , 2 , or 3 osteoarthritis according to the Kellgren and Lawrence grading scale were enrolled in the study . One group of patients was treated using three intra-articular applications of PRP , and the second group of patients was given three injections of hyaluronic acid . Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index and the 11-point pain intensity Numeric Rating Scale . Results On average , a 4.5-fold increase in platelet concentration was obtained in the PRP group . No severe adverse events were observed . Statistically significantly better results in the Western Ontario and McMaster Universities Osteoarthritis Index and Numeric Rating Scale scores were recorded in a group of patients who received PRP injections after a 3- and 6-mo follow-up . Conclusions Our preliminary findings support the application of autologous PRP as an effective and safe method in the treatment of the initial stages of knee osteoarthritis . Further studies are needed to confirm these results and to investigate the persistence of the beneficial effects observed Purpose Pro-inflammatory cytokines play a pivotal role in osteoarthritis , as well as in bone tunnel widening after ACL reconstructive surgery . A new treatment option is to administer autologous conditioned serum ( ACS ) containing endogenous anti-inflammatory cytokines including IL-1Ra and growth factors ( IGF-1 , PDGF , and TGF-β1 , among others ) in the liquid blood phase . The purpose of this trial was to establish whether the postoperative outcome could be affected by intraarticular application of ACS . Methods In a prospect i ve , r and omized , double-blinded , placebo-controlled trial with two parallel groups , 62 patients were treated .  Bone tunnel width was measured by CT scans , while clinical efficacy was assessed by patient-administered outcome instruments ( WOMAC , IKDC 2000 ) up to 1 year following the ACL reconstruction in patients receiving either ACS ( Group A ) or placebo ( Group B ) . We compared the levels and dynamics of IL-1β concentrations in the synovial liquid and examined the correlation between the levels of IL-1β at three different postoperative points . Results Bone tunnel enlargement was significantly less ( 6 months : 8 % , 12 months : 13 % ) in Group A than in Group B ( 6 months : 31 % , 12 months : 38 % ) . Clinical outcomes ( WOMAC , IKDC 2000 ) were consistently better in patients treated with ACS at all data points and for all outcome parameters , and there were statistically significant differences in the WOMAC stiffness subscale after 1 year . The decrease in IL-1β synovial fluid concentration was more pronounced in the ACS group , and values were lower , to a statistically significant degree , in the ACS group at day 10 . Conclusion The intraarticular administration/injection of ACS results in decreased bone tunnel widening after ACL reconstructive surgery . Level of evidence Therapeutic study , R and omized controlled trial ( significant differences and narrow confidence intervals ) , Level The aims of this study were to analyze the range of cartilage damage and patellofemoral joint ( PFJ ) degeneration in degenerative osteoarthritis ( OA ) and 
    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: Background : Arthrosis is particularly prevalent in the knee . Infiltration treatment for gonarthrosis is among the most widely used techniques in orthopaedic practice . Purpose : To compare the clinical response of hyaluronic acid ( HA ) and platelet-rich plasma ( PRP ) treatment in 2 groups of patients affected by gonarthrosis . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : A total of 120 patients affected by clinical ly and radiographically documented gonarthrosis were included in this study . The gonarthrosis was grade d using the Kellgren-Lawrence radiographic classification scale . The 120 patients were r and omized into 2 study groups in a 1:1 ratio : 60 patients received 4 intra-articular injections of PRP ( specifically , autologous conditioned plasma [ ACP ] , 5.5 mL ) , and 60 patients received 4 intra-articular injections of HA ( 20 mg/2 mL ) . An unblinded physician performed infiltration once a week for 4 weeks into the knee affected by clinical ly relevant gonarthrosis ( in both groups ) . All patients were evaluated with the Western Ontario and McMaster ( WOMAC ) score before the infiltration and at 4 , 12 , and 24 weeks after the first injection . Results : Treatment with a local injection of ACP had a significant effect shortly after the final infiltration and a continuously improving sustained effect up to 24 weeks ( WOMAC score , 65.1 and 36.5 in the HA and ACP groups , respectively ; P < .001 ) , where the clinical outcomes were better compared with the results with HA . In the HA group , the worst results were obtained for grade III gonarthrosis , whereas the clinical results obtained in the ACP group did not show any statistically significant difference in terms of the grade of gonarthrosis . The mean WOMAC scores for grade III gonarthrosis were 74.85 in the HA group and 41.20 in the ACP group ( P < .001 ) . Conclusion : Treatment with ACP showed a significantly better clinical outcome than did treatment with HA , with sustained lower WOMAC scores . Treatment with HA did not seem to be effective in the patients with grade III gonarthrosis PURPOSE The aim of our study is to compare the efficacy of platelet-rich plasma ( PRP ) and viscosupplementation ( hyaluronic acid [ HA ] ) intra-articular injections for the treatment of knee cartilage degenerative lesions and osteoarthritis ( OA ) . METHODS The study involved 150 patients affected by cartilage degenerative lesions and early and severe OA . Fifty symptomatic patients were treated with 3 autologous PRP intra-articular injections and were evaluated prospect ively at enrollment and at 2- and 6-month follow-up . The results obtained were compared with 2 homogeneous groups of patients treated with HA injections . One group was treated with injections of high-molecular weight HA ; the other group was treated with low-molecular weight ( LW ) HA .  International Knee Documentation Committee and EQ VAS scores were used for clinical evaluation ; adverse events and patient satisfaction were also recorded . RESULTS At 2 months ' follow-up , the PRP and LW HA groups showed a similar improvement , with higher results compared with the high-molecular weight HA group ( P < .005 ) . At 6 months ' follow-up , better results were observed in the PRP group ( P < .005 ) . PRP and LW HA treatments offered similar results in patients aged over 50 years and in the treatment of advanced OA . PRP showed a better performance compared with HA in younger patients affected by cartilage lesions or early OA . CONCLUSIONS Autologous PRP injections showed more and longer efficacy than HA injections in reducing pain and symptoms and recovering articular function . Better results were achieved in younger and more active patients with a low degree of cartilage degeneration , whereas a worse outcome was obtained in more degenerated joints and in older patients , in whom results similar to those of viscosupplementation have been observed . LEVEL OF EVIDENCE Level II , prospect i ve comparative study 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 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Purpose To compare the safety and efficacy of two different approaches of platelet-rich plasma ( PRP ) production methods as intra-articular injection treatment for knee cartilage degenerative lesions and osteoarthritis ( OA ) . Methods The study involved 144 symptomatic patients affected by cartilage degenerative lesions and OA . Seventy-two patients were treated with 3  injections of platelet concentrate prepared with a single-spinning procedure ( PRGF ) , the other 72 with 3 injections of PRP obtained with a double-spinning approach . The patients were evaluated prospect ively at the enrollment and at 2 , 6 , and 12 months ’ follow-up with IKDC , EQ-VAS and Tegner scores ; adverse events and patient satisfaction were also recorded . Results Both treatment groups presented a statistically significant improvement in all the scores evaluated at all the follow-up times . Better results were achieved in both groups in younger patients with a lower degree of cartilage degeneration . The comparative analysis showed similar improvements with the two procedures : in particular , IKDC subjective evaluation increased from 45.0 ± 10.1 to 59.0 ± 16.2 , 61.3 ± 16.3 , and 61.6 ± 16.2 at 2 , 6 , and 12 months in the PRGF group , and from 42.1 ± 13.5 to 60.8 ± 16.6 , 62.5 ± 19.9 , and 59.9 ± 20.0 at 2 , 6 , and 12 months in the PRP group , respectively . Concerning adverse events , more swelling ( P = 0.03 ) and pain reaction ( P = 0.0005 ) , were found after PRP injections . Conclusions Although PRP injections produced more pain and swelling reaction with respect to that produced by PRGF , similar results were found at the follow-up times , with a significant clinical improvement with respect to the basal level . Better results were achieved in younger patients with a low degree of cartilage degeneration . Level of evidence II Platelet-rich plasma ( PRP ) is a natural concentrate of autologous blood growth factors experimented in different fields of medicine in order to test its potential to enhance tissue regeneration . The aim of our study is to explore this novel approach to treat degenerative lesions of articular cartilage of the knee . One hundred consecutive patients , affected by chronic degenerative condition of the knee , were treated with PRP intra-articular injections ( 115 knees treated ) . The procedure consisted of 150-ml of venous blood collected and twice centrifugated : 3 PRP units of 5 ml each were used for the injections . Patients were clinical ly prospect ively evaluated before and at the end of the treatment , and at 6 and 12 months follow-up . IKDC , objective and subjective , and EQ VAS were used for clinical evaluation . Statistical analysis was performed to evaluate the significance of sex , age , grade of OA and BMI . A statistically significant improvement of all clinical scores was obtained from the basal evaluation to the end of the therapy and at 6–12 months follow-up ( P < 0.0005 ) . The results remained stable from the end of the therapy to 6 months follow up , whereas they became significantly worse at 12 months follow up ( P = 0.02 ) , even if still significantly higher respect to the basal level ( P < 0.0005 ) . The preliminary results indicate that the treatment with PRP injections is safe and has the potential to reduce pain and improve knee function and quality of live in younger patients with low degree of articular degeneration Objective This study aim ed to find a simple , cost-effective , and time-efficient method for the preparation of platelet-rich plasma ( PRP ) , so the acquired benefits will be readily available for multiple procedures in smaller outpatient clinics and to explore the safety and efficacy of the application of PRP in the treatment of degenerative lesions of articular cartilage of the knee . Design The study was design ed as a prospect i ve , cohort study with a control group . A total of 120 patients with Grade 1 , 2 , or 3 osteoarthritis according to the Kellgren and Lawrence grading scale were enrolled in the study . One group of patients was treated using three intra-articular applications of PRP , and the second group of patients was given three injections of hyaluronic acid . Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index and the 11-point pain intensity Numeric Rating Scale . Results On average , a 4.5-fold increase in platelet concentration was obtained in the PRP group . No severe adverse events were observed . Statistically significantly better results in the Western Ontario and McMaster Universities Osteoarthritis Index and Numeric Rating Scale scores were recorded in a group of patients who received PRP injections after a 3- and 6-mo follow-up . Conclusions Our preliminary findings support the application of autologous PRP as an effective and safe method in the treatment of the initial stages of knee osteoarthritis . Further studies are needed to confirm these results and to investigate the persistence of the beneficial effects observed Purpose Pro-inflammatory cytokines play a pivotal role in osteoarthritis , as well as in bone tunnel widening after ACL reconstructive surgery . A new treatment option is to administer autologous conditioned serum ( ACS ) containing endogenous anti-inflammatory cytokines including IL-1Ra and growth factors ( IGF-1 , PDGF , and TGF-β1 , among others ) in the liquid blood phase . The purpose of this trial was to establish whether the postoperative outcome could be affected by intraarticular application of ACS . Methods In a prospect i ve , r and omized , double-blinded , placebo-controlled trial with two parallel groups , 62 patients were treated .  Bone tunnel width was measured by CT scans , while clinical efficacy was assessed by patient-administered outcome instruments ( WOMAC , IKDC 2000 ) up to 1 year following the ACL reconstruction in patients receiving either ACS ( Group A ) or placebo ( Group B ) . We compared the levels and dynamics of IL-1β concentrations in the synovial liquid and examined the correlation between the levels of IL-1β at three different postoperative points . Results Bone tunnel enlargement was significantly less ( 6 months : 8 % , 12 months : 13 % ) in Group A than in Group B ( 6 months : 31 % , 12 months : 38 % ) . Clinical outcomes ( WOMAC , IKDC 2000 ) were consistently better in patients treated with ACS at all data points and for all outcome parameters , and there were statistically significant differences in the WOMAC stiffness subscale after 1 year . The decrease in IL-1β synovial fluid concentration was more pronounced in the ACS group , and values were lower , to a statistically significant degree , in the ACS group at day 10 . Conclusion The intraarticular administration/injection of ACS results in decreased bone tunnel widening after ACL reconstructive surgery . Level of evidence Therapeutic study , R and omized controlled trial ( significant differences and narrow confidence intervals ) , Level The aims of this study were to analyze the range of cartilage damage and patellofemoral joint ( PFJ ) degeneration in degenerative osteoarthritis ( OA ) and 
    Output:
    