Declining Quality of Systematic Reviews in Orthopaedic Sports Medicine: An Updated Systematic Review

Abstract

Purpose: To evaluate the quality and characteristics of systematic reviews, including meta-analyses, in the clinical orthopaedic sports medicine literature from 2015 to 2019 and to compare the results to previous findings from a similar analysis from 2009 to 2013. Methods: All clinical orthopaedic sports medicine and meta-analyses published from 2015 to 2019 published in The American Journal of Sports Medicine, Arthroscopy, The Journal of Bone and Joint Surgery, Knee Surgery, Sports Traumatology, Arthroscopy, and Sports Health were reviewed. These were evaluated according to guidelines from Oxford Centre for Evidence-Based Medicine, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and the Assessment of Multiple Systematic Reviews tool. Results were compared to the quality of publications from 2009 to 2013. Results: A total of 516 systematic reviews and meta-analyses were included in this study. Of these, 17.1% of studies included Level I or II evidence only, whereas 79.1% included Level IV or V studies. When compared to the previous study from 2009 to 2013, which demonstrated 32% of Level I or II evidence studies and 53% Level IV or V, there was a significant decrease in the level of evidence in the more recent study period (P < .001). The average Preferred Reporting Items for Systematic Reviews and Meta-Analyses scores were 81% and the average Assessment of Multiple Systematic Reviews scores 56%, which are declines from 87% and 73%, respectively (P < .001, P < .001). Conclusions: There has been a significant increase in the volume of systematic reviews and meta-analyses published in orthopaedic sports medicine. This has coincided with significant declines in the level of evidence, as well as declines in methodologic and reporting quality. Clinical Relevance: Clinicians increasingly use systematic reviews to drive their treatment decisions. Therefore, the quality of systematic reviews in orthopaedic sports medicine merits assessment.

Evidence-Based Medicine in Orthopedic

“…The quality of systematic reviews can only be as good as the primary studies included. There is an increasing concern regarding the low quality of orthopedic primary studies as they may not hold significant clinical applications, which in the end will affect the quality of their systematic reviews and meta-analysis [1][2][3][4].…”