A systematic review of systematic reviews comparing simple trapeziectomy versus trapeziectomy with ligament reconstruction and tendon interposition for trapeziometacarpal osteoarthritis

Background: The outcomes of simple trapeziectomy (T) versus trapeziectomy with ligament reconstruction and tendon interposition (LRTI) for trapeziometacarpal (TMC) osteoarthritis have been compared in several systematic reviews (SRs) with conflicting results across the various outcomes studied. Despite a lack of conclusions regarding the superiority of one treatment versus the other, LRTI remains the most popular surgical option. This raises the questions of whether published SRs are of high methodological quality, and whether discordant conclusions can be attributed to differences in methodologic quality. To answer these, a SR of SRs comparing T vs LRTI was conducted. Methods: A search of MEDLINE, EMBASE, and the Cochrane Database of SRs was performed from 1946 to September 18, 2023. SRs directly comparing T vs LRTI for TMC osteoarthritis were selected for inclusion. Methodological characteristics, results and conclusions of the selected SRs were extracted. Outcomes and conclusions were assessed for disagreement in the context of methodological differences. Quality of the included reviews was assessed using the AMSTAR 2 tool. Results: Seven SRs, published between 2004 and 2022, were included. Based on AMSTAR 2 criteria, all seven SRs received a quality rating of "critically low" due to weaknesses in more than one critical domain. The most frequent weaknesses in critical domains included: failure to indicate that the review followed an a priori protocol (5 of 7 SRs), failure to provide a list of excluded studies and justification for each (5 of 7 SRs), failure to account for risk of bias from primary studies when discussing results (4 of 7 SRs), and failure to justify methods used for meta-analysis (4 of 5 meta-analyses). Conclusions: SRs comparing T vs LRTI have had methodological or reporting flaws which limit confidence in results. Future SRs should ensure a rigorous methodology is followed and clearly reported in the publication.