Level of evidence in wrist ligament repair and reconstruction research: a systematic review

Jonny K Andersson,Jón Karlsson,Bo Rööser

doi:10.1186/s40634-018-0135-7

Abstract

There have been numerous studies on surgery of wrist ligament injuries, but a quick assessment reveals few with a high level of evidence (LoE). The primary aim of this study was to categorize the study type and LoE of studies on repair and reconstruction of the scapholunate ligament, the lunotriquetral ligament and the triangular fibrocartilage complex by applying the LoE rating system proposed by the Oxford Centre for Evidence-Based Medicine. The secondary aims were to evaluate the journal- and geographic- distribution of the included studies.An electronic literature search of articles published 1985–2016, in PubMed, Embase, and Cochrane Library was carried out in May 2016 and updated in April 2017. Therapeutic studies written in English were included. The PRISMA checklist guided the extraction and reporting of data.A total of 1889 studies were analyzed, of which 362 were included. Three journals represented 40% of the included studies and American authors dominated.Most studies (97%) had low LoE (IV-V). No studies of LoE I-II were found. There is insufficient evidence to recommend one technique over the other in terms of wrist ligament surgery in clinical practice. There is an immense lack of comparison studies with high level of evidence in the area of wrist ligament repair and reconstruction.

Highlights

Wrist ligament injuries are known to result in persistent pain, instability, reduced grip force and range of motion, as well as degenerative osteoarthritis
Outcome measures Level of evidence Analysis of the study types revealed that expert opinions, level of evidence (LoE) V (n = 203) was the most frequent study type
Level of evidence This systematic review shows that most therapeutic studies on repair and reconstruction of wrist ligament injuries were of low level of evidence (LoE IV-V)

Summary

Introduction

Wrist ligament injuries are known to result in persistent pain, instability, reduced grip force and range of motion, as well as degenerative osteoarthritis. Ligament repair and reconstruction has become a highly technical developing area in wrist surgery in the last years. There are still controversies in the recommendations on surgical preferences in terms of injuries to the scapholunate ligament (SLL), the lunotriquetral ligament (LTL), the triangular fibrocartilage complex (TFCC) and instability of the distal radioulnar joint (DRUJ). In 1986, Sackett (Sackett, 1986) proposed a system for grading different levels of medical evidence and Andersson et al Journal of Experimental Orthopaedics (2018) 5:15 Level I. High-quality RCT with statistically significant difference or no statistically significant difference but narrow confidence intervals. Systematic review of level I RCTs (and study results were homogenous) Level II. Lesser-quality RCT (e.g. 80% follow up, no blinding, or improper randomization).

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