title: Knee surgery and its evidence base.
abstract: BACKGROUND
  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.
authors.affiliation: Royal National Orthopaedic Hospital NHS Trust , UK.
authors.forename: A
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Barts Health NHS Trust , UK.
authors.forename: K
authors.initials: K
authors.lastname: Hasan
authors.affiliation: South Warwickshire NHS Foundation Trust , UK.
authors.forename: A
authors.initials: A
authors.lastname: Carter
authors.affiliation: Royal National Orthopaedic Hospital NHS Trust , UK.
authors.forename: R
authors.initials: R
authors.lastname: Zaidi
authors.affiliation: Medical Research Council , UK.
authors.forename: S
authors.initials: S
authors.lastname: Cro
authors.affiliation: Royal National Orthopaedic Hospital NHS Trust , UK.
authors.forename: T
authors.initials: T
authors.lastname: Briggs
authors.affiliation: Royal National Orthopaedic Hospital NHS Trust , UK.
authors.forename: A
authors.initials: A
authors.lastname: Goldberg
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D019317:Evidence-Based Medicine; D006801:Humans; D007717:Knee / Q000601:surgery*; D009985:Orthopedics
keywords: Arthroplasty; Evidence-based medicine; Knee; Review