title: Systematic Reviews in Sports Medicine.
abstract: BACKGROUND
  The number of systematic reviews published in the orthopaedic literature has increased, and these reviews can help guide clinical decision making. However, the quality of these reviews can affect the reader's ability to use the data to arrive at accurate conclusions and make clinical decisions.
  
  
  OBJECTIVE
  To evaluate the methodological and reporting quality of systematic reviews and meta-analyses in the sports medicine literature to determine whether such reviews should be used to guide treatment decisions. The hypothesis was that many systematic reviews in the orthopaedic sports medicine literature may not follow the appropriate reporting guidelines or methodological criteria recommended for systematic reviews.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  All clinical sports medicine systematic reviews and meta-analyses from 2009 to 2013 published in The American Journal of Sports Medicine (AJSM), The Journal of Bone and Joint Surgery (JBJS), Arthroscopy, Sports Health, and Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) were reviewed and evaluated for level of evidence according to the guidelines from the Oxford Centre for Evidence-Based Medicine, for reporting quality according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and for methodological quality according to the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Analysis was performed by year and journal of publication, and the levels of evidence included in the systematic reviews were also analyzed.
  
  
  RESULTS
  A total of 200 systematic reviews and meta-analyses were identified over the study period. Of these, 53% included evidence levels 4 and 5 in their analyses, with just 32% including evidence levels 1 and 2 only. There were significant differences in the proportion of articles with high levels of evidence (P < .001) and low levels of evidence (P = .005) by journal. The average PRISMA score was 87% and the average AMSTAR score was 73% among all journals. The average AMSTAR and PRISMA scores were significantly different by journal (P = .002 and .001, respectively) and by year (P = .046 and .019, respectively). Arthroscopy, AJSM, and JBJS all scored higher than Sports Health and KSSTA on the PRISMA and AMSTAR. The average PRISMA score by year varied from 85% to 89%, and the average AMSTAR score varied from 70% to 76%.
  
  
  CONCLUSIONS
  Systematic reviews and meta-analyses in orthopaedics sports medicine literature relied on evidence levels 4 and 5 in 53% of studies over the 5-year study period. Overall, PRISMA and AMSTAR scores are high and may be better than those in other disciplines. Readers need to be conscious of potential shortcomings when reading systematic reviews and using them in practice.
authors.affiliation: University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: DiSilvestro
authors.affiliation: Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Fotios P
authors.initials: FP
authors.lastname: Tjoumakaris
authors.affiliation: Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Maltenfort
authors.affiliation: Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, Ohio, USA.
authors.forename: Kurt P
authors.initials: KP
authors.lastname: Spindler
authors.affiliation: Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA kevin.freedman@rothmaninstitute.com.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Freedman
mesh_terms: D001182:Arthroscopy / Q000592:standards; D019317:Evidence-Based Medicine; D006801:Humans; D015201:Meta-Analysis as Topic; D009985:Orthopedics / Q000592:standards; D010506:Periodicals as Topic / Q000592:standards; D012107:Research Design / Q000592:standards; D012196:Review Literature as Topic; D013178:Sports Medicine / Q000592:standards*
keywords: AMSTAR; PRISMA; level of evidence; orthopaedics; sports medicine