Updating the Assignment of Levels of Evidence

Marx, Robert G.; Wilson, Sean; Swiontkowski, Marc F.

doi:10.2106/jbjs.n.01112

Cited by 230 publications

(170 citation statements)

References 6 publications

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“…The idea of such a system would be that research that has been conducted using study designs that inherently limit the chance of bias would be more likely to have meaningful clinical impact than research conducted using a study design that is less rigorous. However, Marx et al have demonstrated that the level of evidence of a paper may not provide a direct reflection of its clinical importance (Marx et al 2015). …”

Section: Discussionmentioning

confidence: 99%

The rate of publication of free papers at the 2008 and 2010 European Society of Sports Traumatology Knee Surgery and Arthroscopy congresses

et al. 2017

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BackgroundThe purpose of this study was to evaluate the frequency with which free papers presented at the 2008 and 2010 European Society of Sports Traumatology Knee Surgery and Arthroscopy (ESSKA) congress were ultimately published in peer-reviewed journals. Moreover, this study evaluated whether any correlations exist between the level of evidence of the free papers and their frequency of publication or the impact factor of the journals in which they are published.MethodsFree papers presented at the 2008 and 2010 ESSKA congresses were included for assessment. Clinical papers (observational studies and trials involving direct interaction between an investigator and human subjects) were graded for level of evidence by two independent reviewers. A comprehensive strategy was used to search the databases PubMed, Ovid (MEDLINE), and EMBASE for all publications corresponding to the included free papers.ResultsThree hundred-ninety presentations were evaluated, of which 215 (55%) were ultimately published in a peer-reviewed journal within five years of the presentation date. The mean time from presentation to publication was 16 months (SD 25 months). There was no significant difference in the distribution of the level of evidence between studies that were ultimately published, versus those that were not published (n.s.). The level of evidence of the published study was not a significant predictor of the impact factor of the journal in which it was published (n.s.). Presentations were most commonly published in Knee Surgery, Sports Traumatology, Arthroscopy (24%) and The American Journal of Sports Medicine (22%).ConclusionFree papers at the 2008 and 2010 ESSKA congress were published at a frequency that is comparable to that at other orthopaedic meetings. The publication rate was similar across all levels of evidence. Further encouragement of manuscript preparation and submission following these meetings could help to ensure important research findings are disseminated to large audiences.

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Section: Discussionmentioning

confidence: 99%

The rate of publication of free papers at the 2008 and 2010 European Society of Sports Traumatology Knee Surgery and Arthroscopy congresses

et al. 2017

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“…independently evaluated all included studies and assigned a level of evidence (level 1-4). 38 The methodological quality of each study was evaluated using the Coleman Methodology Score (CMS). 10 The CMS is calculated from a 2-part, 10-item questionnaire, scored from 0 to 100 (excellent, 85-100; good, 70-84; fair, 55-69; poor, <55), that has been used in the evaluation of both randomized controlled trials and nonrandomized controlled trials.…”

Section: Methodsmentioning

confidence: 99%

The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence

Tischer

Paul²,

Pape

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Failure rates of knee ligament surgery may be high, and the impact of osseous alignment on surgical outcome remains controversial. Basic science studies have demonstrated that osseous malalignment can negatively affect ligament strain and that realignment procedures may improve knee joint stability.Hypothesis/Purpose:The purpose of this review was to summarize the clinical evidence concerning the impact of osseous malalignment and realignment procedures in knee ligament surgery. The hypotheses were that lower extremity malalignment would be an important contributor to knee ligament surgery failure and that realignment surgery would contribute to increased knee stability and improved outcome in select cases.Study Design:Systematic review; Level of evidence, 4.Methods:According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic electronic search of the PubMed database was performed in November 2015 to identify clinical studies investigating (A) the influence of osseous alignment on postoperative stability and/or failure rates after knee ligament surgery and (B) the impact of osseous realignment procedures in unstable knees with or without additional knee ligament surgery on postoperative knee function and stability. Methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the Coleman Methodological Score (CMS).Results:Of the 1466 potentially relevant articles, 28 studies fulfilled the inclusion and exclusion criteria. Average study quality was poor (CMS, 40). For part A, studies showed increased rerupture rate after anterior cruciate ligament (ACL) replacement in patients with increased tibial slope. Concerning the posterior cruciate ligament (PCL)/posterolateral corner (PLC)/lateral collateral ligament (LCL), varus malalignment was considered a significant risk factor for failure. For part B, studies showed decreased anterior tibial translation after slope-decreasing high tibial osteotomy in ACL-deficient knees. Correcting varus malalignment in PCL/PLC/LCL instability also showed increased stability and better outcomes.Conclusion:In cases of complex knee instability, the 3-dimensional osseous alignment of the knee should be considered (eg, mechanical weightbearing line and tibial slope). In cases of failed ACL reconstruction, the tibial slope should be considered, and slope-reducing osteotomies are often helpful in the patient revised multiple times. In cases of chronic PCL and/or PLC instability, osseous correction of the varus alignment may reduce the failure rate and is often the first step in treatment. Changes in the mechanical axis should be considered in all cases of instability accompanied by early unicompartmental osteoarthritis.

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“…Only research articles (levels 1-4), systematic reviews, meta-analyses, non-solicited review articles, and case reports were included. The level of evidence was recorded for each published article; if the journal did not assign the level of evidence, the levels of evidence chart published by the Journal of Bone and Joint Surgery was used[10]. Each publication was assigned a country of origin defined by the location of the the authors’ principal institution, or defined by the country of origin of the corresponding author if the manuscript did not provide details about study location.…”

Section: Methodsmentioning

confidence: 99%

Worldwide orthopaedic research activity 2010-2014: Publication rates in the top 15 orthopaedic journals related to population size and gross domestic product

Hohmann¹,

Glatt²,

Tetsworth³

2017

WJO

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AIMTo perform a bibliometric analysis of publications rates in orthopedics in the top 15 orthopaedic journals.METHODSBased on their 2015 impact factor, the fifteen highest ranked orthopaedic journals between January 2010 and December 2014 were used to establish the total number of publications; cumulative impact factor points (IF) per country were determined, and normalized to population size, GDP, and GDP/capita, comparison to the median country output and the global leader.RESULTSTwenty-three thousand and twenty-one orthopaedic articles were published, with 66 countries publishing. The United States had 8149 publications, followed by the United Kingdom (1644) and Japan (1467). The highest IF was achieved by the United States (24744), United Kingdom (4776), and Japan (4053). Normalized by population size Switzerland lead. Normalized by GDP, Croatia was the top achiever. Adjusting GDP/capita, for publications and IF, China, India, and the United States were the leaders. Adjusting for population size and GDP, 28 countries achieved numbers of publications to be considered at least equivalent with the median academic output. Adjusting GDP/capita only China and India reached the number of publications to be considered equivalent to the current global leader, the United States.CONCLUSIONFive countries were responsible for 60% of the orthopaedic research output over this 5-year period. After correcting for GDP/capita, only 28 of 66 countries achieved a publication rate equivalent to the median country. The United States, United Kingdom, South Korea, Japan, and Germany were the top five countries for both publication totals and cumulative impact factor points.

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Updating the Assignment of Levels of Evidence

Cited by 230 publications

References 6 publications

The rate of publication of free papers at the 2008 and 2010 European Society of Sports Traumatology Knee Surgery and Arthroscopy congresses

The rate of publication of free papers at the 2008 and 2010 European Society of Sports Traumatology Knee Surgery and Arthroscopy congresses

The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence

Worldwide orthopaedic research activity 2010-2014: Publication rates in the top 15 orthopaedic journals related to population size and gross domestic product

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