Note: To access the supplementary tables accompanying this report, visit the July issue of Arthroscopy at www.arthroscopyjournal.org.
Arthroscopy: The Journal of Arthroscopic & Related Surgery
Systematic ReviewMethodologic Quality of Knee Articular Cartilage Studies
Section snippets
Methods
We conducted a systematic review of multiple medical databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with a PRISMA checklist without a formal protocol or registration number.12 Two independent reviewers completed the search individually on August 10, 2012, using search databases PubMed (Medline), CINAHL (Cumulative Index to Nursing and Allied Health Literature), SportDiscus, and Cochrane Central Register of Controlled Trials for trials
Results
There were 194 studies identified overall (11,787 subjects). Most studies (76%) were Level IV evidence, with Level I, II, and III evidence being nearly equally represented (8%, 7%, and 9%, respectively) (Table 1). Nearly half (48%) of all studies self-reported the study’s level of evidence. Study level of evidence showed no significant improvement with time (P = .839) (Fig 2A). There were 16 RCTs (9%). The methodologic quality of RCTs was significantly greater than that of non-RCTs, assessed by
Discussion
The purposes of this systematic review were to characterize the methodologic quality of all knee articular cartilage studies in the literature, to identify strengths and weaknesses, and to evaluate for a temporal relation of study quality. We hypothesized that the quality of evidence has been improving with time but that it would be inherently limited in certain aspects of study design and reporting because of the use of inappropriate questionnaires.
Our hypotheses were partially confirmed.
Conclusions
The methodologic quality of knee articular cartilage surgery studies was poor overall and also for individual techniques (ACI, OAT, osteochondral allograft transplant, and microfracture). However, the overall quality of the investigations in this review (after June 2004) has significantly improved in comparison to those published before 2004. The quality of RCTs was significantly higher than that of non-RCTs. Level of evidence, CMS, CONSORT score, and Jadad score did not significantly improve
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The authors report that they have no conflicts of interest in the authorship and publication of this article.