Meta-analyses are the basis of professional and healthcare agencies recommendations and have a growing importance. Quality of meta-analyses has been investigated in some medical fields but to our best knowledge this issue remains fairly investigated in orthopedics. Therefore, we performed a systematic analysis to assess: (1) the quality of meta-analyses before and after the introduction of PRISMA statement as a comprehensive guideline and the use of the AMSTAR tool? (2) Have some general characteristics influenced the quality of meta-analyses (country, funding source)?

We systematically searched the meta-analyses in the top four journals with the impact factor (2015) as following: Journal of Bone and Joint Surgery (JBJS), Osteoarthritis Cartilage, Arthroscopy, and Clinical Orthopaedics Related Research (CORR) from 2005 to 2008 and from 2012 to 2015. Likewise, from 2012–2015, we also analyzed the meta-analyses from Orthopaedics & Traumatology: Surgery & Research (OTSR). Characteristics were extracted based on the PRISMA statement and the AMSTAR tool. Country, number of authors, funding source were also extracted.

A total of 154 meta-analyses were included in the present study. Score with PRISMA statement and the AMSTAR checklist were 20.86±3.04 out of a maximum of 27 and 7.86±1.55 out of a maximum of 11. The PRISMA score was 21.50±2.69 in 2012–2015 (77% of items adequately reported, on average), has significant improvements compared with the PRISMA score in 2005–2008 (18.27±3.03, P<0.001). The AMSTAR score was 8.20±1.38 in 2012–2015 (74% of items adequately reported, on average), which was improved when compared with the AMSTAR score in 2005–2008 (6.54±1.39, P<0.001). The best journal was OTSR according to the PRISMA (23.06±1.92) and AMSTAR (9.13±0.87) scores. And the worst journal was CORR according to the PRISMA score (19.4±2.70) and JBJS according to the AMSTAR score (6.78±1.65). Twelve items showed significant difference in the PRISMA statement, and five items in the AMSTAR checklist. Integral score of PRISMA statement and AMSTAR checklist has a significant difference between 2005–2008 and 2012–2015. The meta-analyses reported from US (56, 36.4%) were more than any other region in the world. And the meta-analyses published by Asia/Oceania increased remarkably between these two period times (from [4, 10.8%] to [45, 38.5%]). Publication of articles supported by public increased in 0.421 score of AMSTAR score compared with that supported by the industry (95% CI [−0.430, −1.272], P<0.001).

This study showed that methodological reporting quality of meta-analyses in the major orthopedics journals has improved after the publication of the PRISMA statement.

Level III case control study based on survey article.