Comment on Schepers: acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair

Abstract

Schepers systematic review offers valuable insight into a controversial topic [1]. However, Schepers does not indicate that two of the studies included in his analysis report on the same patient pool. These patients are therefore double counted in his analysis.In 2004, Høiness and Strømsøe published short-term results of a prospective, randomised trial comparing tricortical and quadricortical syndesmotic screw fixation [2]. In 2010, Wikerøy et al. published long-term results of the same patient population [3]. Schepers includes both studies in his calculation of prevalence of screw removal, giving greater representation to these patients in his analysis. Double counting and other errors that overstate evidence have been reported in meta-analyses in many prestigious journals by many expert researchers [4]. These errors can heavily influence analysis. One case study found that duplicating data resulted in a 23 % overestimation of a treatment effect [5].