Quality Assessment of Systematic Reviews of Temporomandibular Joint Ankylosis Surgical Treatment Outcomes
1Department of Oral and Maxillofacial Surgery, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
2Faculty of Dentistry, AIMST University, Jalan Bedong-Semeling Bedong Kedah, Malaysia
3Department of Oral and Maxillofacial Surgery, Sree Anjaneya Institute of Dental Sciences, Modakkalloor, Calicut, Kerala, India
4Department of Oral and Maxillofacial Surgery and Dentistry, Jubilee Mission Medical College Hospital and Research Institute, Thrissur, Kerala, India
5,6Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Bilaspur, Chhattisgarh, India
7Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
Corresponding Author: Vivekanand S Kattimani, Department of Oral and Maxillofacial Surgery, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India, Phone: +91 9912400988, e-mail: firstname.lastname@example.org
How to cite this article Kattimani VS, Jairaj A, Govindan NO, et al. Quality Assessment of Systematic Reviews of Temporomandibular Joint Ankylosis Surgical Treatment Outcomes. J Contemp Dent Pract 2020;21(3):337–349.
Source of support: Nil
Conflict of interest: None
Aim: Temporomandibular joint ankylosis (TMJA) management involves many surgical treatment modalities depending on the experience of the operator. A lot of literature has been published on various treatment modalities. Many systematic reviews (SRs) were published without any published prior protocol. So, the study aimed to evaluate the quality of SRs with meta-analysis of TMJA management.
Materials and methods: Systematic reviews with meta-analysis were included for the quality assessment using AMSTAR (assessment of multiple SRs) and Glenny et al. checklist by two independent teams. The search was limited to the Medline database archival (from January 1980 to December 2018).
Results: The primary search identified 1,507 related articles. After activation of different filters, abstracts screening, and cross-referencing, finally, a total of six studies were assessed to make the overview up-to-date.
Conclusion: The articles scored 8 to 11 with AMSTAR and 7 to 13 with the Glenny et al. checklist. None of the published reviews received maximum scores. The methodology and heterogeneity are essential factors to assess the quality of the published literature.
Clinical significance: None of the included meta-analysis was registered or published protocol with Prospero or Cochrane before publication for better validity of the studies. The authors are advised to follow reporting criteria so that in the future it is possible to provide the standards of care for TMJA with the highest quality of evidence.
Keywords: Condyle, Cranium, Diarthrodial joint, Evidenced-based dentistry, Systematic review.
Clinical decision making for the treatment approach in dentistry or medicine depends on evidence, published in peer-reviewed journals.1–3 The decision for the standard of care for any treatment and recommendation depends on remarks of systematic reviews (SRs), randomized-controlled trials (RCTs), cohort studies, and least with retrospective studies.4 For few entities like temporomandibular joint ankylosis (TMJA), it is difficult to find RCTs because of less number of patients with similar clinical presentation, availability of many surgical modalities, and varied clinical scenario of ankylosis. So, it is difficult to ascertain and recommend a single modality of treatment or standardization of methodology. Because of these prevailing factors, the clinician will be in a dilemma during the selection of treatment modality.5 In recent years different protocols were developed, modified for the management of ankylosis.6,7 Thousands of articles were published regarding the management of TMJA. But this evidence is questionable because of varying methodologies and difficulty in reproducibility as ankylosis management and prognosis are multifactorial. So, biomedical journals started following standard publishing guidelines to maintain uniformity while reporting.8
In recent past, publishers adopted various reporting guidelines like CONSORT (Consolidated Standards of Reporting Trials), STROBE (STrengthening the Reporting of OBservational studies in Epidemiology), SPIRIT (standard protocol items for clinical trials), SQQR (standards for reporting qualitative research), etc., for various types of article publications.8 These guidelines help clinicians to prevent publication bias. Multiple tools were also developed to critically analyze the methodological quality of SRs and provide the recommendations based on the highest evidence.9–12
The available SRs showed that only 40.5% of the studies assessed the risk of bias/quality.3 Till date, quality assessment of the published reviews on TMJA had not been performed.2,13 In the wake of this diversity, the overview of SR articles with meta-analysis (MA) regarding comparative surgical treatment outcomes of TMJA was planned to assess and compare the quality using two types of tools: AMSTAR9 (assessment of multiple SRs) and the Glenny10 checklist.
MATERIALS AND METHODS
An electronic search was performed with the date and no language restriction. The search included articles published from January 1980 to December 2018 using various Boolean operators with multiple combinations of search strings in the Medline database. Depending on the title, abstract and full-text articles published in the English language were selected for reading with the following selection criteria to ascertain the objective. Only published articles of TMJA surgical treatment outcomes SR with MA were included for assessment. After initial screening, full-text articles were selected for critical reading and analysis. The authors were contacted for further clarification if the ambiguity in the published data exists. Two independent teams assessed the quality of included studies using AMSTAR9 and the Glenny et al.10 checklist.
The scoring was performed according to the characteristics of the study for a quality check as per the checklist. These criteria were based on the questions framed by AMSTAR9 and Glenny et al.10 for the assessment of quality check of published SR and MA. These questions assess how well the SR and MA were performed to reach the consensus on the treatment outcomes depending on the objectives of the study. The AMSTAR9 checklist consists of 11 questions, whereas the Glenny et al.10 list consists of 14 questions to assess quality. These questions/evaluative factors assess search criteria, methodology, the prior publication of the protocol, the validity of statistics of included studies, consideration of bias factors, any missing data, method of data collection, scientific quality, heterogeneity, and conclusive remarks based on the rationale supported by outcomes of the included primary studies. Differences in scoring among the two teams sorted with discussion. The methodological quality and statistics was assessed by a team of review members involving a public health dentist. The following search criteria with MeSH words were applied to generate the required data from the Medline archival.
Search Criteria and Data Screening
A literature search was performed using four search categories, which included various Boolean operators and MeSH keywords related to treatment outcomes of surgical management of TMJ ankylosis (Table S1 supplementary material).
The data were collected using both quality assessment tools and were analyzed using descriptive statistics. The Spearman correlation test was performed for determining correlation between the two scoring criteria.
After going through the abstract of all final results of four search categories (Table S1) and narrowing down the search to address the objective of quality assessment, authors found 10 publications (Flowchart 1). After going through full-length articles, out of ten, one was in the French language, another was American Association of Oral and Maxillofacial Surgeons (AAOMS) guidelines not focused on comparisons, and three were descriptive reviews focused mainly on the effects of various surgical treatment modalities in ankylosis without MA (Table 1).14–18 Five studies were found eligible for the review, but our team found one more recently published study,5 which has been added for final assessment to make an effort more complete and up-to-date and which rose the total number of included studies to six.
|Author and year||Reason for exclusion|
|Sporniak-Tutak et al.14 (2011)||Descriptive review|
|Movahed and Mercuri15 (2015)||Descriptive review|
|Sharma et al.16 (2017)||Descriptive review|
|Bénateau et al.17 (2016)||Other than the English language (in French)|
|AAOMS ParCare18 (2012)||Not focused exclusively on comparative TMJ surgeries|
The scoring for included studies is presented in Table 2 (other characteristics continued in Tables S2 and S3 as supplementary material). Katsnelson19 included four studies20–23 searched between 1966 and May 2010. Al-Moraissi et al.24 included 16 publications20–23,25–36 (nine retrospective studies and seven controlled clinical trials) searched in December 2013 without date restrictions. Ma et al.37 included eight retrospective cohort studies and were searched up to October 11, 2014. Ma et al.38 published one more study that included eight studies23,26,28,30,31,36,39,40 searched between 1946 and July 28, 2014. De Roo et al.41 publication included 38 studies21–23,28,31,42–73 with four prospective and one RCT, and other study types were not mentioned. Mittal et al.5 included 26 studies20–23,26–28,30–32,34,39,40,48,53,66,72,74–82 for MA.
|Authors||Reference number||No. of studies included||Outcome measures||AMSTAR score (lowest 0, highest 11)||Checklist of Glenny et al. (lowest 0, highest 14)|
|Katsnelson||19||4||Maximal inter-incisal opening||8||7|
|Al-Moraissi||24||16||Maximal inter-incisal opening||11||10|
|Ma et al.||37||8||Maximal inter-incisal opening and incidence of reankylosis||11||12|
|Ma et al.||38||8||Maximal inter-incisal opening and incidence of reankylosis||11||13|
|De Roo et al.||41||38||Maximal inter-incisal opening||11||11|
|Mittal et al.||5||26||Incidence of reankylosis and maximal inter-incisal opening||11||11|
|S. no.||AMSTAR questions||Katsnelson19||Al-Moraissi et al.24||Ma et al.37||Ma et al.38||De Roo et al.41||Mittal et al.5|
|1||Was an a priori design provided?||Yes||Yes||Yes||Yes||Yes||Yes|
|2||Is there a duplicate study selection and data extraction?||Yes||Yes||Yes||Yes||Yes||Yes|
|3||Was a comprehensive literature search performed?||Yes||Yes||Yes||Yes||Yes||Yes|
|4||Was the status of the publication (i.e., grey literature) used as an inclusion criterion?||Yes, no mention of grey literature||Yes, no mention of grey literature||Yes, no mention of grey literature||Yes, no mention of grey literature||Yes, no mention of grey literature||Yes, no mention of grey literature|
|5||Was a list of studies (included and excluded) provided?||No||Yes||Yes||Yes, but no list of excluded studies||Yes, but no record of excluded studies||Yes|
|6||Were the characteristics of the included studies provided?||Yes||Yes||Yes||Yes||Yes||Yes|
|7||Was the scientific quality of the included studies assessed and documented?||No||Yes||Yes||Yes||Yes||Yes|
|8||Was the scientific quality of the included studies used appropriately in formulating conclusions?||Yes||Yes||Yes||Yes||Yes, using a customized framework||Yes|
|9||Were the methods used to combine the findings of studies appropriate?||Yes||Yes||Yes||Yes||Yes||Yes|
|10||Was the likelihood of publication bias assessed?||Yes||Yes||Yes||Yes||Yes||Yes|
|11||Was the conflict of interest stated?||No||Yes||Yes||Yes||Yes||Yes|
None of the published reviews included in this overview met all the AMSTAR criteria (Table 3). The scores ranged from 8 points to 11 points. Point 4 of the AMSTAR guideline was partly explained in all publications. One study19 received the lowest score indicating poorly performed study involving four articles for review and MA, whereas the other publications5,24,37,38,41 received a score of 11. Two of the MA were published in the same year by the same author with different objectives involving eight studies each for MA.37,38
The scores for the Glenny et al.10 checklist varied between 7 points and 13 points (Table 4). Spearman’s correlation was positive between the scores of two quality assessment tools, with a coefficient of 0.66 (p = 0.15) (Fig. 1). The mean and SD score for AMSTAR was 10.50 ± 1.22 and for Glenny et al. was 10.67 ± 2.06 (Table S4 supplementary material).
|S. no.||Glenny et al. questions||Katsnelson19||Al-Moraissi et al.24||Ma et al.37||Ma et al.38||De Roo et al.41||Mittal et al.5|
|1||Did the reviewer address a focused question?||Yes||Yes||Yes||Yes||Yes||Yes|
|2||Did the authors look for appropriate papers?||Yes||Yes||Yes||Yes||Yes||Yes|
|3||Did the authors attempt to identify all relevant studies?||Yes||Yes||Yes||Yes||Yes||Yes|
|4||Did the authors search for published and unpublished literature?||Unpublished not mentioned||Unpublished not mentioned||Unpublished not mentioned||Unpublished not mentioned||Unpublished not mentioned||Unpublished not mentioned|
|5||Were all languages considered?||Not mentioned||Yes||Not mentioned||Yes||Yes||Not mentioned|
|6||Was any hand-searching carried out?||Yes||Yes||Yes||Yes||Yes||Yes|
|7||Was it stated that at least two reviewers applied the inclusion criteria?||No, one author performed||Not mentioned||Yes||Yes||Yes||Yes|
|8||Did reviewers attempt to assess the quality of the included studies?||Partly assessed using publication bias||Assessed||Yes||Yes||Yes||Yes|
|9||If so, did they include this quality assessment in the analysis?||No, only publication bias assessed||Yes||Yes||Yes||No||Yes|
|10||Was it stated that the quality assessment was carried out by at least two reviewers?||No||No||Yes||Yes||No||Not mentioned|
|11||If the results have been combined, was it reasonable to do so?||Yes||Yes||Yes||Yes||Yes||Yes|
|12||Are the results clearly displayed?||Yes||Yes||Yes||Yes||Yes||Yes|
|13||Was an assessment of heterogeneity made, and were reasons for variation discussed?||No||Yes||Yes||Yes||Yes||Yes|
|14||Were the results of the review interpreted appropriately?||Yes||Yes||Yes||Yes||Yes||Yes|
This overview is limited to SRs with a MA that evaluated the various surgical techniques used in the management of TMJA and its outcomes in humans. The TMJA prognosis is multifactorial; to date, no consensus on the standards of care has been advised. It might be attributed to patient and clinician factors broadly. Many attempts have been made in the past to assess the published literature.5,19,24,37,38,41 Few SRs are published with and without MA.5,14,15,19,24,37,38,41 Surprisingly, it was noted that variations in the number of included studies despite almost the same outcomes are being evaluated and published in the same year and same journal.37,41 This variation might be attributed to the inclusion and exclusion criteria. Despite the increased number of publications, the quality of the publications has not reached the highest scoring.
The recent study5 is published after a gap of 4 years from the last published literature,41 but it includes a lesser number of studies compared to the previous research for interpretation even though the scope has been broadened by adding the distraction osteogenesis.5 The lack of inclusiveness of the previous MA (Ma et al., 201537,38) in discussion indicates methodological flaws in the search criteria.41 So, a more rigorous researching and reviewing approach is necessary for better evidence and conclusive remarks. The authors have not found the Prospero/Cochrane protocol for the published studies included in this overview. The SRs with or without MA should register its protocol in Prospero or Cochrane systemic protocol reviews for validity, which in turn prevents duplication of studies and methodological flaws. Leaving apart the Kabans protocol, the existing literature is unable to draw any further conclusive remarks.6,7 So, the readers should exercise caution while adopting the interpretation and conclusive remarks.
The increase in scoring indicates an improvement in the reporting pattern from the first MA19 (the year 2012) to the latest published5 (the year 2019). The number of published articles were increased because of the shift of the thought process from gap arthroplasty to interposition arthroplasty and reconstruction arthroplasty using various techniques that have widened the scope of the study.5,19,24,37,38,41 This paradigm shift in surgical management made the prognosis better with reduced postoperative complications and improved patient compliance, function, and aesthetics. The reporting quality of RCT, controlled clinical trail (CCT), or case series needs to be improved for better evidence.83 None of the published studies reported TMJA classification before intervention, so it might have given a better edge for correlation of the surgical method and prognosis. Although the publications reviewed had similar objectives in this overview, but they had high methodological heterogeneity. However, these SRs did not meet all of the criteria of the checklists used, indicating potential publication bias.
The risk of bias assessment is essential for individual studies.83 Adopting the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for the synthesis of evidence would be a significant step for improving the quality of clinical evidence.83 The International Committee of Medical Journal Editors (ICMJE)84 set many reporting guidelines for human clinical series or CCT or RCT publications. If authors adhere strictly to these reporting criteria, then better evidence can be provided, which can be universally adopted for developing the TMJA treatment protocol. High-quality reviews may help the clinicians and patients to have the best possible results.83 The publication bias assessment and homogeneity are fundamental for the studies considered in MA.2,3 These factors clarify the reader the methodological quality opted for the same. Quality assessments, such as the Cochrane Collaboration’s tool for assessing the risk of bias for RCTs and Newcastle–Ottawa Quality Assessment Scale for cohort studies, were used in the included studies.
The TMJA surgical management outcome analysis consists of several confounding factors. Some of them should be included in inclusion or exclusion criteria so that the effect can be minimized. The time duration of ankylosis, type, age, treatment provided, postsurgical monitoring, etc., are important factors along with the surgical expertise of the clinicians for the better outcome. Even though the study included extensive quality checks using checklists but these lists lack of quantitative assessment. In our study, the lowest score obtained was 7. Despite the lack of standard reference scale for discrimination as poor or good study, the score below 3 was considered as poorly designed.4,85 But in our overview, we found moderate scored reviews.
The checklists used in this overview are more comprehensive and were used extensively with validation for the quality checks. Many other tools are available but are not so comprehensive and not provide scoring.9,11,12,86–88 Because of the scoring, it is possible to correlate using Spearman’s correlation, which measures the relationship between two variables. So, we have used these two checklists. In this study, the scores were positively correlated, indicating a lower possibility of errors and a lower risk of bias in the scoring system implemented.
The study has limited the critical assessment to the English language literature archived in the Medline database for the accuracy, reproducibility, and quality of publications for evaluation. The increase in predatory journal publications is worrying some for the evidence published, and the involvement of such studies as reference might mislead the outcome or recommendation.13,84
The clinicians and researchers, as a result of this, advised to look after the reporting guidelines and adhere to the protocol of reviews for better evidence. Authors cautioned to refer the valid, researchable, and indexed journals for better validity as few of the MA referenced predatory journals in their research, which may undermine the objective of SR and MA. The word of caution is always better for better evidence creation for the future generation and the standard of care.
Vivekanand S Kattimani and Abhishek Jairaj drafted the protocol; Vivekanand S Kattiman, Abhishek Jairaj, and Shaik Parveen Sultana developed a search strategy. Team 1, Vivekanand S Kattimani, Abhishek Jairaj, Shaik Parveen Sultana, and Team 2, Nikhil O Govindan, Paul Mathai, Swati Sahu, Abhishek Patley, searched for literature. Vivekanand S Kattimani, Abhishek Jairaj, and Swati Sahu selected articles to include in this analysis. Paul Mathai and Abhishek Patley obtained copies of publications of all included studies. Vivekanand S Kattimani, Nikhil O Govindan and Swati Sahu extracted data from publications. Abhishek Jairaj and Shaik Parveen Sultana verified the data entered for analysis. Shaik Parveen Sultana carried out the analysis part. Vivekanand S Kattimani, Abhishek Jairaj, and Shaik Parveen Sultana interpreted the analysis; Vivekanand S Kattimani and Abhishek Jairaj drafted the final review. All the authors read and approved the final version.
Not required, as it does not involve humans or animals in the study.
All authors have viewed and agreed to the submission.
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|Search||The methodology of search and use of various Boolean operators and MeSH terms||Description of search criteria and results obtained|
|First search||(“ankylosis”[MeSH Terms] OR “ankylosis”[All Fields]) AND ((“surgical procedures, operative”[MeSH Terms] OR (“surgical”[All Fields] AND “procedures”[All Fields] AND “operative”[All Fields]) OR “operative surgical procedures”[All Fields] OR “surgical”[All Fields]) AND (“organization and administration”[MeSH Terms] OR (“organization”[All Fields] AND “administration”[All Fields]) OR “organization and administration”[All Fields] OR “management”[All Fields] OR “disease management”[MeSH Terms] OR (“disease”[All Fields] AND “management”[All Fields]) OR “disease management”[All Fields])) AND (Review[ptyp] AND (“1980/01/01”[PDAT]: “2018/12/31”[PDAT]) AND “humans”[MeSH Terms])||The results obtained with the following filters activated: Review, Publication date from 1980/01/01 to 2018/12/31, Humans; the search team found total of 5 publications out of 615 items|
|Second search||(“Temporomandibular ankylosis”[Supplementary Concept] OR “Temporomandibular ankylosis”[All Fields] OR “temporomandibular ankylosis”[All Fields]) AND ((“surgical procedures, operative”[MeSH Terms] OR (“surgical”[All Fields] AND “procedures”[All Fields] AND “operative”[All Fields]) OR “operative surgical procedures”[All Fields] OR “surgical”[All Fields]) AND (“organization and administration”[MeSH Terms] OR (“organization”[All Fields] AND “administration”[All Fields]) OR “organization and administration”[All Fields] OR “management”[All Fields] OR “disease management”[MeSH Terms] OR (“disease”[All Fields] AND “management”[All Fields]) OR “disease management”[All Fields])) AND (Review[ptyp] AND (“1980/01/01”[PDAT]: “2018/12/31”[PDAT]) AND “humans”[MeSH Terms])||The results obtained with following filters activated: Review, Publication date from 1980/01/01 to 2018/12/31, Humans; the search team found 5 publications out of 46 items|
|Third search||((“Temporomandibular ankylosis”[Supplementary Concept] OR “Temporomandibular ankylosis”[All Fields] OR “temporomandibular ankylosis”[All Fields]) AND (“organization and administration”[MeSH Terms] OR (“organization”[All Fields] AND “administration”[All Fields]) OR “organization and administration”[All Fields] OR “management”[All Fields] OR “disease management”[MeSH Terms] OR (“disease”[All Fields] AND “management”[All Fields]) OR “disease management”[All Fields])) AND (Review[ptyp] AND (“1980/01/01”[PDAT]: “2018/12/31”[PDAT]) AND “humans”[MeSH Terms])||The results obtained with the following filters activated: Publication date from 1980/01/01 to 2018/12/31, Humans; the search team found 164 out of 231 items. Further activation of Filter: Review, resulted in 11 publications|
|Fourth search||(“Temporomandibular ankylosis”[Supplementary Concept] OR “Temporomandibular ankylosis”[All Fields] OR “temporomandibular ankylosis”[All Fields]) AND ((“1980/01/01”[PDAT]: “2018/12/31”[PDAT]) AND “humans”[MeSH Terms])||The results obtained with the following filters activated: Review, Publication date from 1980/01/01 to 2018/12/31, Humans; the search team found 85 publications out of 615 items|
|Study characteristics||Katsnelson19||Al-Moraissi et al.24||Ma et al.37||Ma et al.38||De Roo et al.41||Mittal et al.5|
|Electronic databases search sites included||PubMed, Cochrane Central Register of Controlled Trials online abstract indexes of the conference proceedings of the American Association of Oral and Maxillofacial Surgeons and the International Association for Dental Research annual meetings||PubMed, Cochrane database of systematic reviews, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, CINAH, SPORTDiscus, and Electronic Journals Center||PubMed, EMBASE, OVID EBM reviews, and Web of Science||PubMed, EMBASE, Cochrane Library, Web of Science and China National knowledge, infrastructure||PubMed and the Web of Science and Cochrane Library||PubMed, Ovid, Embase, Web of Science, Scopus, and Cochrane central register of controlled trials (CENTRAL)|
|Protocol opted for data extraction||Standardized data extraction form||Customized data extraction form||Customized data extraction form||Customized data extraction form||Customized data extraction form with following Altman, STROBE (strengthening the reporting of observational studies in epidemiology) and Cochrane Library framework||Customized data extraction form|
|Method opted for scientific quality assessment||Not assessed||As per the checklist proposed by Rangel et al. and Versteegh et al.||Newcastle-Ottawa scale (NOS)||Newcastle-Ottawa scale (NOS)||STROBE guidelines but no scoring mentioned||Newcastle Ottawa Scale|
|Method opted for publication bias assessment||Begg’s funnel plots and Egger’s test||Begg’s funnel plot||Begg’s funnel plots and Egger’s test||Begg’s funnel plots and Egger’s test||Egger’s test||Egger’s test|
|Review design method opted||QUOROM (quality of reporting of meta-analyses) guidelines||Preferred reporting items for systematic reviews and meta-analyses (PRISMA)-E 2012 checklist||Not mentioned||MOOSE guidelines||PRISMA guidelines||Not mentioned|
|Heterogeneity assessment||Not mentioned||Cochran’s test and the I2 statistic||∑2 and I2 statistic||Chi-square and I-squared tests||I-squared test||Chi-square and I-squared tests|
|Statistical analysis||STATA version 9.2||RevMan 5.2.6 software||RevMan 5.3 software and STATA version.12||RevMan 5.3 software and STATA version.12||STATA version.12||RevMan 5.3|
|Information of prior protocol publication||No||No||No||No||No||No|
|S. no.||Author and year||No. of patients included||Data search timeline||Investigator and year of publication||Type of study|
|1||Katsnelson19 (2012)||52 patients in one group and 39 patients in another group||January 1966 through May 2010||Manganello, 2003||Not mentioned|
|Balaji, 2003||Not mentioned|
|Qudah et al., 2005||Not mentioned|
|Tanrikulu et al., 2005||Not mentioned|
|2||Al-Moraissi et al.24 (2014)||Saeed et al. 2002||Retrospective study|
|Balaji, 2003||Control clinical trial|
|Manganello, 2003||Control clinical trial|
|Tanrikulu et al., 2005||Retrospective study|
|Qudah et al., 2005||Retrospective study|
|Ramezanian and Yavary et al., 2006||Control clinical trial|
|Vasconcelos et al., 2009||Retrospective study|
|Danda et al., 2009||Control clinical trial|
|Tang et al., 2009||Retrospective study|
|Zhi et al., 2009||Retrospective study|
|Elgazzar et al. 2010||Retrospective study|
|Loveless et al., 2010||Retrospective study|
|Mansoor et al., 2013||Control clinical trial|
|Shaikh et al., 2013||Control clinical trial|
|Mabongo, 2013||Retrospective study|
|Holmlund et al., 2013||Controlled clinical trail|
|3||Ma et al.37 (2015)||Reconstruction arthroplasty group 106 and Interposition arthroplasty 92 patients among 6 studies||No time restriction search performed up to October 11, 2014||Balaji, 2003||Retrospective cohort study|
|Manganello, 2003||Retrospective cohort study|
|Tanrikulu, 2005||Retrospective cohort study|
|Qudah, 2005||Retrospective cohort study|
|Erol, 2006||Retrospective cohort study|
|Loveless, 2010||Retrospective cohort study|
|Elgazzar, 2010||Retrospective cohort study|
|Sahoo, 2012||Retrospective cohort study|
|4||Ma et al.38 (2015)||Total of 272 patients among eight studies divided into two groups||From 1946 to July 28, 2014||Hu, 2005||Retrospective cohort study|
|Tanrikulu, 2005||Retrospective cohort study|
|Erol, 2006||Retrospective cohort study|
|Ramezanian, 2006||Retrospective cohort study|
|Danda, 2009||Retrospective cohort study|
|Zhi, 2009||Retrospective cohort study|
|Elgazzar, 2010||Retrospective cohort study|
|Holmlund, 2013||Retrospective cohort study|
|5||De Roo et al.41 (2015)||Total of 1,165 patients among 36 studies further divided into five groups consisting of GA-463, IA auto-341, IA allo-68, RA auto-260, and RA allo-33||Up to October 11, 2014||Rajgopal, et al., 1983||Not mentioned|
|Chossegros et al., 1997||Not mentioned|
|Karaca et al., 1998||Not mentioned|
|Chossegros et al., 1999||Not mentioned|
|Roychoudhury et al., 1999||Not mentioned|
|Erdem and Alkan, 2001||Not mentioned|
|Valentini et al., 2002||Not mentioned|
|Manganello, 2003||Not mentioned|
|Guven, 2004||Not mentioned|
|Dimitroulis, 2004||Not mentioned|
|Qudah et al., 2005||Not mentioned|
|Tanrikulu et al., 2005||Not mentioned|
|Li et al., 2006||Not mentioned|
|Huang et al., 2007||Not mentioned|
|Guven, 2008||Not mentioned|
|El-Sayed, 2008||Not mentioned|
|Krishnan, 2008||Not mentioned|
|Mehrotra et al., 2008||Not mentioned|
|Bayat et al., 2009||Not mentioned|
|Danda et al., 2009||Not mentioned|
|Yazdani et al., 2010||Prospective study|
|Liu et al., 2010||Not mentioned|
|Elgazzar et al., 2010||Not mentioned|
|Liu et al., 2011||Not mentioned|
|Singh et al., 2011a||Not mentioned|
|Singh et al., 2011b||Not mentioned|
|Yang et al., 2011||Not mentioned|
|Gaba et al., 2012||Prospective study|
|Mehrotra et al., 2012||Randomized controlled trial|
|Nitzan et al., 2012||Not mentioned|
|Sahoo et al., 2012||Not mentioned|
|Singh et al., 2012||Prospective study|
|Babu et al., 2013||Prospective study|
|Jakhar et al., 2013||Not mentioned|
|Karamese et al., 2013||Not mentioned|
|Zhu et al., 2013||Not mentioned|
|Bhatt et al., 2014||Not mentioned|
|Singh et al., 2014||Not mentioned|
|6||Mittal et al.5 (2019)||Total of 1,197 patients among 26 studies. Further divided into groups||Searched till April 2018||Valentini et al., 2002||Nonrandomized controlled trial|
|Balaji, 2003||Retrospective study|
|Souza and Mariani, 2003||Nonrandomized controlled trial|
|Hu et al., 2005||Retrospective study|
|Tanrikulu et al., 2005||Retrospective study|
|Qudah et al., 2005||Retrospective study|
|Ramezanian and Yavary, 2006||Nonrandomized controlled trial|
|Erol et al., 2007||Retrospective study|
|Güven et al., 2008||Retrospective study|
|Danda et al., 2009||Nonrandomized controlled trial|
|Kummoona et al., 2009||Nonrandomized controlled trial|
|Vasconcelos et al., 2009||Retrospective study|
|Zhi et al., 2009||Retrospective study|
|Elgazzar et al., 2010||Retrospective study|
|Loveless et al., 2010||Retrospective study|
|Sahoo et al., 2012||Retrospective study|
|Shaikh et al., 2013||Nonrandomized controlled trial|
|Bhatt et al., 2014||Retrospective study|
|Kumar et al., 2014||Retrospective study|
|Ahmad et al., 2015||Nonrandomized controlled trial|
|Bhardwaj and Arya, 2016||Retrospective study|
|Denadai et al., 2016||Retrospective study|
|Shakeel et al., 2016||Retrospective study|
|Dad and Uppal, 2017||Retrospective study|
|Jiang et al., 2017||Retrospective study|
|Xu et al., 2017||Retrospective study|
|AMSTA and Glenny et al. scores||6||0.6642||1.7770||0.1502|
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