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* Department of Orthopaedic Surgery, University of Aberdeen Medical School, Aberdeen, Scotland
The Victorian Institute of Sport Tendon Study Group, Melbourne, Australia
School of Human Kinetics & Allan McGavin Sports Medicine Centre, University of British Columbia, Vancouver, Canada
Department of Trauma and Orthopaedic Surgery, Keele University, School of Medicine, Stoke on Trent, England
|| Address correspondence and reprint requests to Nicola Maffulli, MD, MS, PhD, FRCS(Orth), Department of Trauma and Orthopaedic Surgery, Keele University, School of Medicine, North Staffordshire Hospital, Thornburrow Drive, Hartshill, Stoke on Trent, Staffordshire, ST4 7QB, England.
Achilles tendinopathy is often treated surgically after failure of nonoperative management, but results are not uniformly excellent. We critically assessed the methods of 26 studies that reported surgical outcomes of patients with this condition. Using 10 previously published criteria, and blinded to study outcomes, we derived a "methodology score" (0 to 100) for each study. This score was highly reproducible (r = 0.99, P < 0.01). Scores were generally low concerning the type of study, subject selection process, and outcome measures, which indicates methods deficiency in the way the study was designed, performed, and analyzed. We found a negative correlation between reported success rate and overall methods scores (r = -0.53, P < 0.01), and a positive correlation between year of publication and overall methods score (r = 0.70, P < 0.01). Study methods may influence reported surgical outcome, and we suggest guidelines for improving study design in this area of clinical research. We acknowledge that study methods have improved over the course of the past 20 years.
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