Positive-outcome bias was present during peer review. A fabricated manuscript with a positive outcome was more likely to be recommended for publication than was an otherwise identical no-difference manuscript.

The available evidence indicates that arthroscopic approaches are not as effective as open approaches in preventing recurrent instability or enabling patients to return to work. Arthroscopic approaches resulted in better function as reflected by the Rowe scores in the randomized clinical trials. The study design and the arthroscopic technique had substantial effects on the results of the analysis.

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Most medical journals practice single-blind review 1 (authors' identities known to reviewers), but double-blind review (authors' identities masked to reviewers) may improve the quality of reviews. 2 Bias with single-blind review might be greatest in the setting of author or institutional prestige. 2 Methods | This study was approved by the University of Washington institutional review board and conducted at Clinical Orthopaedics and Related Research (CORR), an orthopedic journal (2015 impact factor, 3.127; acceptance rate, 20%) that allows authors to select single-blind or double-blind peer review. Potential reviewers (based on expertise) were identified from the journal's database, informed that a study on peer review would occur in the coming year, and allowed to opt out. To avoid influencing behavior, the details and timing of the study were not described and the trial was registered after completion. The protocol appears in the Supplement. Between June 2014 and August 2015, reviewers were randomized via random number table (1:1 ratio in blocks of 8) to receive single-blind or double-blind versions of an otherwise identical fabricated manuscript, which was putatively writ

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