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Editorial: Introducing CORR Synthesis—Review Articles with a Twist (Actually, Several Twists)

Leopold, Seth S. MD

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Clinical Orthopaedics and Related Research: May 2020 - Volume 478 - Issue 5 - p 925-927
doi: 10.1097/CORR.0000000000001193
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In this issue of Clinical Orthopaedics and Related Research®, I am pleased to introduce CORR Synthesis [3], a new approach to review articles that we developed in response to reader feedback. The goals of this article type are to maximize what readers like about review articles—providing cogent summaries of key information, identifying controversies and knowledge gaps, suggesting real-world-applicable practice improvements, and looking ahead—while minimizing the key shortcomings of selective review articles. CORR Synthesis articles achieve this through the use of a thoughtfully developed template that separates evidence-based findings from opinion and conjecture, and mitigates biases in the decision of what to include or leave out.

For years, we at CORR® have declined to publish what we call selective, narrative, or monograph-style review articles. Most journals in our specialty run them, and to my eye, they all look fairly similar. These articles generally suffer from selection bias in terms of the content that gets covered, and it’s tough to keep the authors’ (and sometimes the editor’s) thumbs off the scale when it comes to balance in presentation.

Despite these problems, the most-common request I’ve received from regular CORR readers is that we find a way to add selective reviews back in as a regular CORR offering.

For some time, the editors at CORR have been working on a way to accommodate this request in a way that offsets this article type’s known shortcomings.

I believe we’ve achieved the mission with the article template we will use for CORR Synthesis articles. To mitigate author (and editor) bias in terms of which articles to capture in each review, this template includes a section called “Essential Elements”, which requires the author to use systematic review methodology to guide the search, inclusion/exclusion process, and article-quality assessment (approaches consistent with the PRISMA guidelines for rigorous systematic reviews [7]). But to make for good reading, and to take best advantage of the expertise of the review writer, the template also has sections that allow the authors to share a historical anecdote or two, to focus on the argument in play, to orient the clinical reader to any relevant laboratory science, to separate what we (think) we know from what we don’t, to make specific suggestions about how those gaps might get filled, and even to look ahead. But, critically, the sections that are opinion-based and speculative are separated structurally from the content gleaned from a well-characterized search, capture, and evidence-assessment process.

And to further tap the brakes on a disturbing problem in our specialty, authors of CORR Synthesis reviews cannot have had financial relationships with any interested party or corporation in excess of USD 10,000 per year in any of the 3 years prior to manuscript submission (and smaller financial relationships must—as with all CORR content—be disclosed, described, and published in the article’s footnote along with dollar ranges).

The CORR Synthesis template and instructions for how to submit a proposal are available at www.clinorthop.org, on the right-hand side of the page (Fig. 1).

Fig. 1
Fig. 1:
The CORR Synthesis template with supporting guidelines on how to write a CORR Synthesis paper is available at www.clinorthop.org, on the right-hand side of the page under “Links to Author/Reviewer Tools” (blue arrow). You can download instructions on how to submit a proposal by clicking on the link under “Instructions (Downloadable MS Word files)” (red arrow). Proposal approval is required prior to submission of a CORR Synthesis article.

As enthusiastic as I am about CORR Synthesis—and as good as the feedback already has been on the idea in general and on its first exemplar [3]—I believe that “caveat lector” applies to this new article type as it would to any other [5]. Readers need to know that writers of review articles often have strong feelings about their topics, and sometimes editors do, too. Still, my hope is that the special template we designed based on suggestions from readers and CORR’s editors, will provide for a reading experience that is trustworthy and engaging.

Of course, my colleagues and I at CORR remain meta-analysis (and network meta-analysis) enthusiasts, and we will continue to publish [1, 4, 8, 9], promote [2], and feature [6] them at every reasonable opportunity.

But this month, I’m pushing CORR Synthesis reviews, and I’m proud to offer you one by TK Kim and colleagues [3] from Seongnam, South Korea, on one of the most-pressing topics in our specialty: The use of stem cells in patients with knee osteoarthritis. Professor Kim’s balanced appraisal of this deeply controversial subject is worth everyone’s attention, even if you do not treat this condition, as I know you’ll be as excited by the CORR Synthesis approach to reviewing difficult themes as I am. My colleagues at CORR and I look forward to bringing you more thought-provoking CORR Synthesis reviews in the months to come.

As always, we would love your feedback on this new article type, as we do with all the columns and articles we publish; please send your comments to eic@clinorthop.org. And if you would like to submit a CORR Synthesis proposal, please do see the instructions at www.clinorthop.org (Fig. 1).

References

1. Axelrod DE, Ekhtiari S, Bozzo A, Bhandari M, Johal H. What is the best evidence for management of displaced midshaft clavicle fractures? A systematic review and network meta-analysis of 22 randomized controlled trials. Clin Orthop Relat Res. [Published online ahead of print September 30, 2019]. DOI: 10.1097/CORR.0000000000000986.
2. Guyton GP. CORR Insights®. Do external supports improve dynamic balance in patients with chronic ankle instability? A network meta-analysis. Clin Orthop Relat Res. [Published online ahead of print November 13, 2019]. DOI: 10.1097/CORR.0000000000001047.
3. Kim TK, Chawla A, Meshram P. CORR Synthesis: What is the evidence for the clinical use of stem cell-based therapy in the treatment of osteoarthritis of the knee? Clin Orthop Relat Res. [Published online ahead of print December 26, 2019]. DOI: 10.1097/CORR.0000000000001105.
4. Krishnan RJ, Crawford EJ, Syed I, Kim P, Rampersaud YR, Martin J. Is the risk of infection lower with sutures than with staples for skin closure after orthopaedic surgery? A meta-analysis of randomized trials. Clin Orthop Relat Res. 2019;477:922-937.
5. Leopold SS. Editorial: Getting the most from what you read in orthopaedic journals. Clin Orthop Relat Res. 2017;475:1757-1761.
6. Leopold SS. Editor’s Spotlight/Take 5: Is the risk of infection lower with sutures than with staples for skin closure after orthopaedic surgery? A meta-analysis of randomized trials. Clin Orthop Relat Res. 2019;477:917-921.
7. PRISMA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) website! Available at: http://www.prisma-statement.org. Accessed January 16, 2020.
8. Ryan SP, Kildow BJ, Tan TL, Parvizi J, Bolognesi MP, Seyler TM; American Association of Hip and Knee Surgeons Research Committee. Is there a difference in infection risk between single and multiple doses of prophylactic antibiotics? A meta-analysis. Clin Orthop Relat Res. 2019;477:1577-1590.
9. Tsikopoulos K, Sidiropoulos K, Kitridis D, Cain SM, Metaxiotis D, Ali A. Do external supports improve dynamic balance in patients with chronic ankle instability? A network meta-analysis. Clin Orthop Relat Res. [Published online ahead of print October 14, 2019]. DOI: 10.1097/CORR.0000000000000946.
© 2020 by the Association of Bone and Joint Surgeons