title: Credibility and quality of meta-analyses addressing graft choice in anterior cruciate ligament reconstruction: a systematic review.
abstract: OBJECTIVE
  This systematic review examined the methodological credibility and quality of reporting of all meta-analyses which have compared bone-patellar tendon-bone (BPTB) versus hamstring tendon (HT) for anterior cruciate ligament (ACL) reconstruction (ACLR).
  
  
  METHODS
  EMBASE, MEDLINE, and The Cochrane Library were systematically searched, and two reviewers independently assessed eligibility, credibility according to the Users' Guide to medical literature, and completeness of reporting according to the preferred reporting items for systematic review and meta-analyses (PRISMA) checklist. Inter-rater agreement was quantified using Kappa, and we used Pearson's correlation coefficient to evaluate potential associations.
  
  
  RESULTS
  Seventeen meta-analyses were identified comparing BPTB versus HT for ACLR. The majority of meta-analyses were published in 2011 (5; 29 %), and North America was the most common continent of publication (6; 35 %). The three most commonly reported outcomes were stability (82 %), complications (76 %), and function (return to sport, IKDC score) (71 %). The median number of satisfactorily reported items in the Users' Guide was three out of seven (IQR 2-4). The median number of satisfactorily reported items in PRISMA for the meta-analyses was 20 out of 27 (IQR 19-22).
  
  
  CONCLUSIONS
  The credibility of the meta-analyses comparing BPTB versus HT autograft for ACLR although limited is improving with time. Earlier studies had limited methodological rigour; however, the more recent studies have shown promise in improved methodology. The study findings suggest that decisions should be made on a case-to-case basis with coordination of patient factors and preferences as well as surgeon experience on the background of the best available evidence.
  
  
  METHODS
  IV.
authors.affiliation: Division of Orthopaedics, Department of Surgery, McMaster University, 293 Wellington St. N, Hamilton, ON, L8L 8E7, Canada.
authors.forename: Adrian
authors.initials: A
authors.lastname: Kurz
authors.affiliation: Division of Orthopaedics, Department of Surgery, McMaster University, 293 Wellington St. N, Hamilton, ON, L8L 8E7, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Evaniew
authors.affiliation: Division of Orthopaedics, Department of Surgery, McMaster University, 293 Wellington St. N, Hamilton, ON, L8L 8E7, Canada.
authors.forename: Marco
authors.initials: M
authors.lastname: Yeung
authors.affiliation: Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.|Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
authors.forename: Kristian
authors.initials: K
authors.lastname: Samuelsson
authors.affiliation: Division of Orthopaedics, Department of Surgery, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada.
authors.forename: Devin
authors.initials: D
authors.lastname: Peterson
authors.affiliation: Division of Orthopaedics, Department of Surgery, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada. ayenif@mcmaster.ca.
authors.forename: Olufemi R
authors.initials: OR
authors.lastname: Ayeni
mesh_terms: D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D050376:Bone-Patellar Tendon-Bone Grafting; D000070632:Hamstring Tendons / Q000637:transplantation; D006801:Humans; D015201:Meta-Analysis as Topic
keywords: ACL; Anterior cruciate ligament; BPTB; Bone-patellar tendon-bone; HT; Hamstrings tendon; Meta-analysis; Systematic review