Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Knee Surg Sports Traumatol Arthrosc. 2024 Mar;32(3):583-598. doi: 10.1002/ksa.12062. Epub 2024 Feb 19.
PURPOSE: There remains a lack of consensus around autograft selection in anterior cruciate ligament reconstruction (ACLR), though there is a large body of overlapping systematic reviews and meta-analyses. Systematic reviews and their methodological quality were aimed to be further assessed, using a validated tool known as assessing the methodological quality of systematic reviews (AMSTAR-2). METHODS: MEDLINE, Embase and CENTRAL were searched from inception to 23 April 2023 for systematic reviews (with/without meta-analysis) comparing primary ACLR autografts. A final quality rating from AMSTAR-2 was provided for each study ('critically low', 'low', 'moderate' or 'high' quality). Correlational analyses were conducted for ratings in relation to study characteristics. RESULTS: Two thousand five hundred and ninety-eight studies were screened, and 50 studies were ultimately included. Twenty-four studies (48%) were rated as 'critically low', 17 (34%) as 'low', seven (14%) as 'moderate' and two (4%) as 'high' quality. The least followed domains were reporting on sources of funding (1/50 studies), the impact of risk of bias on results of meta-analyses (11/36 studies) and publication bias (17/36 studies). There was a significant increase in the frequency of studies graded as 'moderate' compared to 'low' or 'critically low' quality over time (p = 0.020). CONCLUSION: The methodological quality of systematic reviews comparing autografts in ACLR is low, with many studies being rated lower due to commonly absent aspects of systematic review methodology such as investigating sources of funding and publication bias. More recent studies were generally more likely to be of higher quality. Authors are advised to consult AMSTAR-2 prior to conducting systematic reviews in ACLR. LEVEL OF EVIDENCE: Level IV.
目的:尽管有大量重叠的系统评价和荟萃分析,但在前交叉韧带重建 (ACLR) 中,关于移植物的选择仍然缺乏共识。旨在使用一种称为评估系统评价方法学质量 (AMSTAR-2) 的经过验证的工具,进一步评估系统评价及其方法学质量。
方法:从建库到 2023 年 4 月 23 日,在 MEDLINE、Embase 和 CENTRAL 中搜索比较 ACLR 自体移植物的系统评价(有/无荟萃分析)。为每项研究提供 AMSTAR-2 的最终质量评分(“极低”、“低”、“中”或“高”质量)。对与研究特征相关的评分进行了相关性分析。
结果:筛选了 2598 项研究,最终纳入了 50 项研究。24 项研究(48%)被评为“极低”,17 项研究(34%)被评为“低”,7 项研究(14%)被评为“中”,2 项研究(4%)被评为“高”。报告资金来源(50 项研究中的 1 项)、偏倚风险对荟萃分析结果的影响(36 项研究中的 11 项)和发表偏倚(36 项研究中的 17 项)等方面遵循得最差。随着时间的推移,被评为“中”的研究频率明显高于“低”或“极低”质量的研究(p=0.020)。
结论:比较 ACLR 中自体移植物的系统评价的方法学质量较低,许多研究因系统评价方法中常见的缺失方面而被评为较低质量,例如调查资金来源和发表偏倚。最近的研究通常更有可能质量更高。建议作者在进行 ACLR 系统评价之前咨询 AMSTAR-2。
证据水平:IV 级。
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