Meta-Analyses and Systematic Reviews: New Guidelines for JBJS

Meta-analyses and systematic reviews are increasingly published in the medical and surgical literature and are proliferating in the orthopaedic literature as well. "A systematic review is a review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyze and summarize the results of the included studies. Meta-analysis refers to the use of statistical techniques in a systematic review to integrate the results of included studies."1 Thus, a systematic review is a formal and comprehensive review of the literature, whereas a meta-analysis involves the additional step of statistically combining studies. Given the latter, it is critically important, as discussed below, that only the highest-quality studies be included in meta-analyses. The quality of meta-analyses and systematic reviews, particularly in the orthopaedic literature, has varied substantially2. Furthermore, many meta-analyses substantially overlap in content, including the articles reviewed and the conclusions. This overlap raises concerns about redundant publication and is confusing for readers. To improve the quality of reporting, the following criteria will guide the acceptance of meta-analyses and systematic reviews in The Journal of Bone and Joint Surgery, Clinical Orthopaedics and Related Research, and the Journal of Pediatric Orthopaedics. First, authors will be expected to identify all meta-analyses and systematic overviews published in the past five years on related or identical topics. JBJS will not accept meta-analyses or systematic reviews on the same topic published within five years unless the authors can demonstrate that the literature has dramatically changed. Second, meta-analyses or systematic reviews will not be accepted if the same (or largely the same) papers are used to arrive at similar conclusions. Third, for meta-analyses in which the authors use statistical methods to combine and summarize results, only summaries of randomized trials will be accepted. Moreover, only studies with sufficient homogeneity of inclusion and exclusion criteria will be considered appropriate for meta-analysis. In addition to these basic requirements, authors should familiarize themselves with reporting checklists such as the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) to improve the quality of reporting1. We believe that these criteria will improve the reporting of systematic reviews and meta-analyses in JBJS and throughout the orthopaedic literature.