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Review
. 2016 Mar;98(3):170-6.
doi: 10.1308/rcsann.2016.0075.

Knee surgery and its evidence base

A Sharma  1 , K Hasan  2 , A Carter  3 , R Zaidi  1 , S Cro  4 , T Briggs  1 , A Goldberg  1
Affiliations
Review

Knee surgery and its evidence base

A Sharma et al. Ann R Coll Surg Engl. 2016 Mar.

Abstract

Introduction: Evidence driven orthopaedics is gaining prominence. It enables better management decisions and therefore better patient care. The aim of our study was to review a selection of the leading publications pertaining to knee surgery to assess changes in levels of evidence over a decade.

Methods: Articles from the years 2000 and 2010 in The Knee, the Journal of Arthroplasty, Knee Surgery, Sports Traumatology, Arthroscopy, the Journal of Bone and Joint Surgery (American Volume) and the Bone and Joint Journal were analysed and ranked according to guidelines from the Centre for Evidence-Based Medicine. The intervening years (2003, 2005 and 2007) were also analysed to further define the trend.

Results: The percentage of high level evidence (level I and II) studies increased albeit without reaching statistical significance. Following a significant downward trend, the latter part of the decade saw a major rise in levels of published evidence. The most frequent type of study was therapeutic.

Conclusions: Although the rise in levels of evidence across the decade was not statistically significant, there was a significant drop and then rise in these levels in the interim. It is therefore important that a further study is performed to assess longer-term trends. Recent developments have made clear that high quality evidence will be having an ever increasing influence on future orthopaedic practice. We suggest that journals implement compulsory declaration of a published study's level of evidence and that authors consider their study designs carefully to enhance the quality of available evidence.

Keywords: Arthroplasty; Evidence-based medicine; Knee; Review.

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Figures

Figure 1
Figure 1
The individual levels of evidence published in the included journals in 2000 and 2010 expressed as a percentage of the total number of articles published in those years
Figure 2
Figure 2
The trends between 2000 and 2010 of published high level evidence as well as the total number of articles published in the included journals
Figure 3
Figure 3
The percentage of high level evidence (I and II) versus low level evidence (III, IV and V) published in each journal across 2000 and 2010. This chart also shows the number of published studies from each journal across our main calendar years of 2000 and 2010.
Figure 4
Figure 4
The volume of publications from different countries in the included journals in 2000 and 2010
See this image and copyright information in PMC

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