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 : 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 Few studies have assessed the results of autologous chondrocyte implantation in patients with high-impact activities . The purpose of this study was to evaluate the early functional outcome and activity level after 2-stage autologous chondrocyte implantation in professional soldiers and athletes . Nineteen patients with an average age of 32.2 years were treated with autologous chondrocyte implantation  and followed up for a minimum of 2 years . All patients except 2 had received previous arthroscopic treatment with debridement and /or microfracture .  The mean size of the postdebridement defect was 6.54 cm2 . Using Novocart technology ( B. Braun-Tetec , Reutlingen , Germany ) , periosteal patch and matrix-assisted autologous chondrocyte implantation was sequentially performed with no r and omization . The average subjective knee evaluation score and Lysholm score improved from 39.16 and 42.42 , respectively , preoperatively to 62.4 and 69.4 , respectively , at latest follow-up . Median Tegner activity score was 8.8 before injury , 3.8 preoperatively , and 6.15 at latest follow-up . Second-look arthroscopy was performed in 11 patients due to persistent pain , decreased range of movement , and mechanical symptoms . Six of 19 ( 31.5 % ) patients with professional or recreational athletic activities returned to preinjury levels of athletic performance . This study shows that mid-term results with autologous chondrocyte implantation in high-performance patients are not as good as have been reported with other similar technologies . Motivational issues during prolonged rehabilitation , multiple surgical interventions before autologous chondrocyte implantation , patient age , and large defects can potentially influence the outcome and overall performance in this selected group of patients PURPOSE Focal chondral or osteochondral defects can be painful and disabling , have a poor capacity for repair , and may predispose patients for osteoarthritis . New surgical procedures that aim to reestablish hyaline cartilage have been introduced and the results seem promising . The purpose of this study is to provide reliable data on chondral and osteochondral defects in patients with symptomatic knees requiring arthroscopy  and to calculate the prevalence of patients who might benefit from cartilage repair surgery . TYPE OF STUDY Prospect i ve study . METHODS One thous and consecutive knee arthroscopies were included in this study . Immediately after each arthroscopy , the surgeon completed a question naire providing detailed information about the findings . Chondral and osteochondral lesions were classified in accordance with the system recommended by the International Cartilage Repair Society ( ICRS ) . RESULTS Chondral or osteochondral lesions ( of any type ) were found in 61 % of the patients . Focal chondral or osteochondral defects were found in 19 % of the patients . In these patients , 61 % related their current knee problem to a previous trauma , and a concomitant meniscal or anterior cruciate ligament injury was found in 42 % ( n = 81 ) and 26 % ( n = 50 ) , respectively . The mean chondral or osteochondral total defect area was 2.1 cm(2 ) ( range , 0.5 to 12 ; st and ard deviation [ SD ] , 1.5 ) . The main focal chondral or osteochondral defect was found on the medial femoral condyle in 58 % , patella in 11 % , lateral tibia in 11 % , lateral femoral condyle in 9 % , trochlea in 6 % , and medial tibia in 5 % . It has been suggested that cartilage repair surgery may be most suitable in patients younger than 40 to 50 years old . A single , well-defined ICRS grade III or IV defect with an area of at least 1 cm(2 ) in a patient younger than 40 , 45 , or 50 years accounted for 5.3 % , 6.1 % , and 7.1 % of all arthroscopies , respectively . CONCLUSIONS Our study supports the contention that articular cartilage defects are common . It has the advantages of a prospect i ve design and use of a new classification system recommended by the ICRS . This modern system focuses on objective ly measurable parameters of the lesion 's extent and not its surface appearance BACKGROUND Despite introduction of autologous chondrocyte therapy for repair of hyaline articular cartilage injury in 1994 , microfracture remains a primary st and ard of care . NeoCart , an autologous cartilage tissue implant , was compared with microfracture in a multisite prospect i ve , r and omized trial of a tissue-engineered bioimplant for treating articular cartilage injuries in the knee . METHODS Thirty patients were r and omized at a ratio of two to one ( two were treated with an autologous cartilage tissue implant [ NeoCart ] for each patient treated with microfracture )  at the time of arthroscopic confirmation of an International Cartilage Repair Society ( ICRS ) grade -III lesion(s ) . Microfracture or cartilage biopsy was performed . NeoCart , produced by seeding a type-I collagen matrix scaffold with autogenous chondrocytes and bioreactor treatment , was implanted six weeks following arthroscopic cartilage biopsy . St and ard evaluations were performed with vali date d clinical outcomes measures . RESULTS Three , six , twelve , and twenty-four-month data are reported . The mean duration of follow-up ( and st and ard deviation ) was 26 ± 2 months . There were twenty-one patients in the NeoCart group and nine in the microfracture group . The mean age ( 40 ± 9 years ) , body mass index ( BMI ) ( 28 ± 4 kg/m2 ) , duration between the first symptoms and treatment ( 3 ± 5 years ) , and lesion size ( 287 ± 138 mm2 in the NeoCart group and 252 ± 135 mm2 in the microfracture group ) were similar between the groups . Adverse event rates per procedure did not differ between the treatment arms . The scores on the Short Form-36 ( SF-36 ) , Knee Injury and Osteoarthritis Outcome Score ( KOOS ) activities of daily living ( ADL ) scale , and International Knee Documentation Committee ( IKDC ) form improved from baseline ( p < 0.05 ) to two years postoperatively in both treatment groups . In the NeoCart group , improvement , compared with baseline , was significant ( p < 0.05 ) for all measures at six , twelve , and twenty-four months . Improvement in the NeoCart group was significantly greater ( p < 0.05 ) than that in the microfracture group for the KOOS pain score at six , twelve , and twenty-four months ; the KOOS symptom score at six months ; the IKDC , KOOS sports , and visual analog scale ( VAS ) pain scores at twelve and twenty-four months ; and the KOOS quality of life ( QOL ) score at twenty-four months . Analysis of covariance ( ANCOVA ) at one year indicated that the change in the KOOS pain ( p = 0.016 ) and IKDC ( p = 0.028 ) scores from pretreatment levels favored the NeoCart group . Significantly more NeoCart-treated patients ( p = 0.0125 ) had responded to therapy ( were therapeutic responders ) at six months ( 43 % versus 25 % in the microfracture group ) and twelve months ( 76 % versus 22 % in the microfracture group ) . This trend continued , as the proportion of NeoCart-treated patients ( fifteen of nineteen ) who were therapeutic responders at twenty-four months was greater than the proportion of microfracture-treated participants ( four of nine ) who were therapeutic responders at that time . CONCLUSIONS This r and omized study suggests that the safety of autologous cartilage tissue implantation , with use of the NeoCart technique , is similar to that of microfracture surgery and is associated with greater clinical efficacy at two years after treatment Autologous chondrocyte implantation is being used increasingly for the treatment of cartilage defects . In spite of this , there has been a paucity of objective , st and ardised assessment of the outcome and quality of repair tissue formed . We have investigated patients treated with autologous chondrocyte implantation ( ACI ) , some in conjunction with mosaicplasty  , and developed objective , semiquantitative scoring schemes to monitor the repair tissue using MRI and histology . Results indicate repair tissue to be on average 2.5 mm thick . It was of varying morphology ranging from predominantly hyaline in 22 % of biopsy specimens , mixed in 48 % , through to predominantly fibrocartilage , in 30 % , apparently improving with increasing time postgraft . Repair tissue was well integrated with the host tissue in all aspects viewed . MRI scans provide a useful assessment of properties of the whole graft area and adjacent tissue and is a noninvasive technique for long-term follow-up . It correlated with histology ( P = 0.02 ) in patients treated with ACI alone Purpose Chondromalacia patella is a distinct clinical entity of abnormal softening of the articular cartilage of the patella , which results in chronic retropatellar pain . Its aetiology is still unclear but the process is thought to be a due to trauma to superficial chondrocytes result ing in a proteolytic enzymic breakdown of the matrix . Our aim was to assess the effectiveness of autologous chondrocyte implantation on patients with a proven symptomatic retropatellar lesion who had at least one failed conventional marrow-stimulating therapy . Methods We performed chondrocyte implantation on 48 patients : 25 received  autologous chondrocyte implantation with a type I/III membrane ( ACI-C ) method ( Geistlich Bio material s , Wolhusen , Switzerl and ) , and 23 received the Matrix-assisted Chondrocyte Implantation ( MACI ) technique ( Genzyme , Kastrup , Denmark ) . Results Over a mean follow-up period of 40.3 months , there was a statistically significant improvement in subjective pain scoring using the visual analogue scale ( VAS ) and objective functional scores using the Modified Cincinnati Rating System ( MCS 
    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 : 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 Few studies have assessed the results of autologous chondrocyte implantation in patients with high-impact activities . The purpose of this study was to evaluate the early functional outcome and activity level after 2-stage autologous chondrocyte implantation in professional soldiers and athletes . Nineteen patients with an average age of 32.2 years were treated with autologous chondrocyte implantation  and followed up for a minimum of 2 years . All patients except 2 had received previous arthroscopic treatment with debridement and /or microfracture .  The mean size of the postdebridement defect was 6.54 cm2 . Using Novocart technology ( B. Braun-Tetec , Reutlingen , Germany ) , periosteal patch and matrix-assisted autologous chondrocyte implantation was sequentially performed with no r and omization . The average subjective knee evaluation score and Lysholm score improved from 39.16 and 42.42 , respectively , preoperatively to 62.4 and 69.4 , respectively , at latest follow-up . Median Tegner activity score was 8.8 before injury , 3.8 preoperatively , and 6.15 at latest follow-up . Second-look arthroscopy was performed in 11 patients due to persistent pain , decreased range of movement , and mechanical symptoms . Six of 19 ( 31.5 % ) patients with professional or recreational athletic activities returned to preinjury levels of athletic performance . This study shows that mid-term results with autologous chondrocyte implantation in high-performance patients are not as good as have been reported with other similar technologies . Motivational issues during prolonged rehabilitation , multiple surgical interventions before autologous chondrocyte implantation , patient age , and large defects can potentially influence the outcome and overall performance in this selected group of patients PURPOSE Focal chondral or osteochondral defects can be painful and disabling , have a poor capacity for repair , and may predispose patients for osteoarthritis . New surgical procedures that aim to reestablish hyaline cartilage have been introduced and the results seem promising . The purpose of this study is to provide reliable data on chondral and osteochondral defects in patients with symptomatic knees requiring arthroscopy  and to calculate the prevalence of patients who might benefit from cartilage repair surgery . TYPE OF STUDY Prospect i ve study . METHODS One thous and consecutive knee arthroscopies were included in this study . Immediately after each arthroscopy , the surgeon completed a question naire providing detailed information about the findings . Chondral and osteochondral lesions were classified in accordance with the system recommended by the International Cartilage Repair Society ( ICRS ) . RESULTS Chondral or osteochondral lesions ( of any type ) were found in 61 % of the patients . Focal chondral or osteochondral defects were found in 19 % of the patients . In these patients , 61 % related their current knee problem to a previous trauma , and a concomitant meniscal or anterior cruciate ligament injury was found in 42 % ( n = 81 ) and 26 % ( n = 50 ) , respectively . The mean chondral or osteochondral total defect area was 2.1 cm(2 ) ( range , 0.5 to 12 ; st and ard deviation [ SD ] , 1.5 ) . The main focal chondral or osteochondral defect was found on the medial femoral condyle in 58 % , patella in 11 % , lateral tibia in 11 % , lateral femoral condyle in 9 % , trochlea in 6 % , and medial tibia in 5 % . It has been suggested that cartilage repair surgery may be most suitable in patients younger than 40 to 50 years old . A single , well-defined ICRS grade III or IV defect with an area of at least 1 cm(2 ) in a patient younger than 40 , 45 , or 50 years accounted for 5.3 % , 6.1 % , and 7.1 % of all arthroscopies , respectively . CONCLUSIONS Our study supports the contention that articular cartilage defects are common . It has the advantages of a prospect i ve design and use of a new classification system recommended by the ICRS . This modern system focuses on objective ly measurable parameters of the lesion 's extent and not its surface appearance BACKGROUND Despite introduction of autologous chondrocyte therapy for repair of hyaline articular cartilage injury in 1994 , microfracture remains a primary st and ard of care . NeoCart , an autologous cartilage tissue implant , was compared with microfracture in a multisite prospect i ve , r and omized trial of a tissue-engineered bioimplant for treating articular cartilage injuries in the knee . METHODS Thirty patients were r and omized at a ratio of two to one ( two were treated with an autologous cartilage tissue implant [ NeoCart ] for each patient treated with microfracture )  at the time of arthroscopic confirmation of an International Cartilage Repair Society ( ICRS ) grade -III lesion(s ) . Microfracture or cartilage biopsy was performed . NeoCart , produced by seeding a type-I collagen matrix scaffold with autogenous chondrocytes and bioreactor treatment , was implanted six weeks following arthroscopic cartilage biopsy . St and ard evaluations were performed with vali date d clinical outcomes measures . RESULTS Three , six , twelve , and twenty-four-month data are reported . The mean duration of follow-up ( and st and ard deviation ) was 26 ± 2 months . There were twenty-one patients in the NeoCart group and nine in the microfracture group . The mean age ( 40 ± 9 years ) , body mass index ( BMI ) ( 28 ± 4 kg/m2 ) , duration between the first symptoms and treatment ( 3 ± 5 years ) , and lesion size ( 287 ± 138 mm2 in the NeoCart group and 252 ± 135 mm2 in the microfracture group ) were similar between the groups . Adverse event rates per procedure did not differ between the treatment arms . The scores on the Short Form-36 ( SF-36 ) , Knee Injury and Osteoarthritis Outcome Score ( KOOS ) activities of daily living ( ADL ) scale , and International Knee Documentation Committee ( IKDC ) form improved from baseline ( p < 0.05 ) to two years postoperatively in both treatment groups . In the NeoCart group , improvement , compared with baseline , was significant ( p < 0.05 ) for all measures at six , twelve , and twenty-four months . Improvement in the NeoCart group was significantly greater ( p < 0.05 ) than that in the microfracture group for the KOOS pain score at six , twelve , and twenty-four months ; the KOOS symptom score at six months ; the IKDC , KOOS sports , and visual analog scale ( VAS ) pain scores at twelve and twenty-four months ; and the KOOS quality of life ( QOL ) score at twenty-four months . Analysis of covariance ( ANCOVA ) at one year indicated that the change in the KOOS pain ( p = 0.016 ) and IKDC ( p = 0.028 ) scores from pretreatment levels favored the NeoCart group . Significantly more NeoCart-treated patients ( p = 0.0125 ) had responded to therapy ( were therapeutic responders ) at six months ( 43 % versus 25 % in the microfracture group ) and twelve months ( 76 % versus 22 % in the microfracture group ) . This trend continued , as the proportion of NeoCart-treated patients ( fifteen of nineteen ) who were therapeutic responders at twenty-four months was greater than the proportion of microfracture-treated participants ( four of nine ) who were therapeutic responders at that time . CONCLUSIONS This r and omized study suggests that the safety of autologous cartilage tissue implantation , with use of the NeoCart technique , is similar to that of microfracture surgery and is associated with greater clinical efficacy at two years after treatment Autologous chondrocyte implantation is being used increasingly for the treatment of cartilage defects . In spite of this , there has been a paucity of objective , st and ardised assessment of the outcome and quality of repair tissue formed . We have investigated patients treated with autologous chondrocyte implantation ( ACI ) , some in conjunction with mosaicplasty  , and developed objective , semiquantitative scoring schemes to monitor the repair tissue using MRI and histology . Results indicate repair tissue to be on average 2.5 mm thick . It was of varying morphology ranging from predominantly hyaline in 22 % of biopsy specimens , mixed in 48 % , through to predominantly fibrocartilage , in 30 % , apparently improving with increasing time postgraft . Repair tissue was well integrated with the host tissue in all aspects viewed . MRI scans provide a useful assessment of properties of the whole graft area and adjacent tissue and is a noninvasive technique for long-term follow-up . It correlated with histology ( P = 0.02 ) in patients treated with ACI alone Purpose Chondromalacia patella is a distinct clinical entity of abnormal softening of the articular cartilage of the patella , which results in chronic retropatellar pain . Its aetiology is still unclear but the process is thought to be a due to trauma to superficial chondrocytes result ing in a proteolytic enzymic breakdown of the matrix . Our aim was to assess the effectiveness of autologous chondrocyte implantation on patients with a proven symptomatic retropatellar lesion who had at least one failed conventional marrow-stimulating therapy . Methods We performed chondrocyte implantation on 48 patients : 25 received  autologous chondrocyte implantation with a type I/III membrane ( ACI-C ) method ( Geistlich Bio material s , Wolhusen , Switzerl and ) , and 23 received the Matrix-assisted Chondrocyte Implantation ( MACI ) technique ( Genzyme , Kastrup , Denmark ) . Results Over a mean follow-up period of 40.3 months , there was a statistically significant improvement in subjective pain scoring using the visual analogue scale ( VAS ) and objective functional scores using the Modified Cincinnati Rating System ( MCS 
    Output:
    