Three in every four systematic reviews and meta-analyses on concomitant anterior cruciate ligament reconstruction and anterolateral complex procedures present at least one type of spin in the abstract.
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PURPOSE: Spin is a form of bias that misrepresents research findings, potentially influencing clinical decisions and patient care. This meta-research study evaluates the prevalence and types of spin in abstracts of systematic reviews and meta-analyses comparing anterior cruciate ligament reconstruction (ACLR) with and without lateral extra-articular tenodesis (LET) and anterolateral ligament reconstruction (ALLR). A secondary aim is to assess review quality per AMSTAR-2 criteria and associations between spin and review characteristics. METHODS: A systematic search of PubMed, EMBASE and MEDLINE[Ovid] in May 2024 identified eligible reviews. Two reviewers independently assessed the nine most severe types of spin and methodological quality using AMSTAR-2. Review characteristics, including publication year, total citations, average yearly citations and journal impact factor, were analyzed for associations with spin. RESULTS: Of 24 included reviews, 75% (18/24) contained at least one form of spin, with Type 3 spin, 'Selective reporting or overemphasis on efficacy outcomes favoring the experimental intervention', being the most common (62.5%, 15/24). Reviews with spin had a significantly more recent median publication year (p = 0.011), while those without spin had significantly higher total citation counts (p = 0.021). No significant differences were observed in average yearly citations or impact factors between groups. Reviews with three or more types of spin were published more recently than those with fewer (p = 0.007), with no significant differences in total citations, average yearly citations or impact factor. Most reviews (91.7%) were rated as critically low-quality using AMSTAR-2, with substantial inter-reviewer agreement (κ = 0.839). CONCLUSION: Spin is highly prevalent in systematic reviews and meta-analyses evaluating ACLR with and without LET or ALLR, particularly in recent publications. Given that many reviews exhibit critically low methodological quality, efforts should focus on strengthening adherence to reporting standards and reducing spin to ensure the publication of unbiased evidence that informs clinical practice. LEVEL OF EVIDENCE: Level IV.
