Purpose
(1) To evaluate the quality of knee articular cartilage surgery literature using established
methodologic quality instruments, and (2) to assess whether study quality has improved
with time.
Methods
A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic
Reviews and Meta-Analyses) guidelines. Studies of autologous chondrocyte implantation
(ACI), osteochondral autograft and allograft transplant, and microfracture were analyzed.
Study methodologic quality was assessed by the level of evidence and 9 different methodologic
quality questionnaires. Comparisons were made between different surgical technique
groups by use of Student's t tests. Assessment of study quality improvement with time was performed by comparison
of the Coleman Methodology Score (CMS) from the included studies (2004 to present)
and CMS from a prior study assessing quality of articular cartilage studies (1985
to 2004). Furthermore, assessment of study quality improvement with time was performed
over the period of the included studies (2004 to present).
Results
We included 194 studies (11,787 subjects). Most evidence was Level IV (76%) and nonrandomized
(91%). ACI was the most commonly reported technique (62% of studies). Only 34% of
studies denied the presence of a financial conflict of interest. The mean subject
age was 33.5 ± 8.2 years, and the mean length of follow-up was 3.7 ± 2.3 years. By
use of study quality questionnaires, the methodologic quality of articular cartilage
studies was poor. However, study quality (after 2004) was significantly improved versus
that reported from a prior study (before 2004) using the CMS (P < .01). The mean level of evidence, CMS, CONSORT (Consolidated Standards of Reporting
Trials) score, and Jadad score showed no significant improvement over the period of
the included studies (P > .05). The quality of randomized controlled trials (RCTs) was significantly higher
than that of non-RCTs (P < .05). The most common study weaknesses included blinding, subject selection process,
study type, sample size calculation, and outcome measures and assessment.
Conclusions
The methodologic quality of knee articular cartilage surgery studies was poor overall
and also for individual techniques (ACI, osteochondral autograft transplant, 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
with later publication date within the period of the studies analyzed. Methodologic
quality deficiencies identified in this investigation may be used to guide future
articular cartilage studies’ design, conduct, and reporting.
Level of Evidence
Level IV, systematic review of studies with Levels of Evidence I-IV.
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Article Info
Publication History
Published online: April 29, 2013
Accepted:
February 20,
2013
Received:
January 10,
2013
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Note: To access the supplementary tables accompanying this report, visit the July issue of Arthroscopy at www.arthroscopyjournal.org.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
