Jane Fitzpatrick, MBBS, FACSP⇑, Max Bulsara, BSc(Hons), MSc, PhD and Ming Hao Zheng, MD, PhD, FRCPath, FRCPA, Jane Fitzpatrick, MBBS, FACSP (email: firstname.lastname@example.org).
We reported “strong evidence that LR-PRP [leukocyte-rich platelet-rich plasma] improves outcomes in tendinopathy.”2 This meta-analysis was based on the highest level of evidence available in the scientific literature. The Cochrane guidelines for systematic reviews state that the highest level of evidence is provided by the inclusion of randomized controlled trials (RCTs). We have not included any articles with a lower level of evidence, and thus, the meta-analysis is based on the highest level of evidence possible in line with the Cochrane guidelines.4
Three different systems are used to assess the quality of reporting, methodology, and evidence in systematic reviews: the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), AMSTAR (Assessing the Methodological Quality of Systematic Reviews), and GRADE (Grading of Recommendations Assessment, Development and Evaluation) systems. The GRADE system is used to ensure that the level of evidence is high; however, we have used the PRISMA guidelines for meta-analyses, in line with the accepted standards of the AJSM, Journal of the American Medical Association, and BMJ. With the GRADE system, the level of quality is the highest when only RCT studies are included in the analysis, as we have done. We have also used the Cochrane Collaboration’s tool for assessing the risk of bias in randomized trials.5 …