The Quality of Systematic Reviews Published in Leading Orthopaedic Surgery Journals.

Abstract

Systematic reviews as a source of evidence have become increasingly important in decision-making processes across healthcare disciplines. The aim of this paper was to determine the quality of systematic reviews published in the field of orthopaedic surgery between 2019 and 2023 and to explore focus areas for quality improvement. A cross-sectional meta-epidemiological design was used, with purposive sampling to identify the top five orthopaedic journals from the 2022 journal rankings. After screening 1,481 studies, a stratified, weighted final sample of 200 systematic reviews published between January 2019 and December 2023 was included. Methodological quality was appraised using the A MeaSurement Tool to Assess systematic Reviews, version 2 (AMSTAR-2) tool. Most reviews lacked prospective registration (70%, n = 140), and only 7.5% (n = 15) used the Grading of Recommendations, Assessment, Development, and Evaluations framework to estimate certainty. Overall methodological rigor was poor: 91.5% (n = 183) were rated as critically low on AMSTAR-2, while only two reviews (1%) achieved a high-quality rating. Despite the growing volume of systematic reviews in orthopaedic surgery, their methodological quality remains insufficient to reliably inform clinical decision-making. Enhancing quality can be achieved by the proper use of evidence synthesis tools and frameworks and by building multidisciplinary teams with appropriate methodological expertise.