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Search strategy and evidence selection

Search strategy and evidence selection

Search strategy

The search strategy was designed to identify evidence on the clinical and cost effectiveness of the LARS ligaments in patients undergoing reconstruction of knee ligaments.

The strategy was developed for MEDLINE (Ovid interface). The strategy was devised using a combination of subject indexing terms and free text search terms in the title, abstract, and keyword heading word fields. The search terms were identified through discussion within the research team, scanning background literature, browsing database thesauri and use of the PubMed PubReminer tool. The strategy reflected the nature of the MIB assessments as rapid evidence reviews.

The search comprised 2 concepts:

1) Population: patients undergoing reconstruction of knee ligaments

2) Intervention: Ligament Augmentation & Reconstruction System (LARS).

The search concepts were combined as follows: Population AND Intervention.

Additional search lines focusing on brand name, and manufacturer name combined with ligament terms, were also used. These lines were designed to capture any records that may have been missed by the 2 concept approach.

The strategy excluded non‑English language publications. Animal studies were also excluded using a standard algorithm. No additional filters for study design were applied. Results were limited to studies published from 1990 (according to the Corin Group website, the LARS was first introduced in 1992).

The final MEDLINE strategy was peer‑reviewed by an independent information specialist. The MEDLINE strategy was translated appropriately for the other databases searched. The PubMed search was limited to records which were not fully indexed on MEDLINE. Conference‑related papers were excluded from the Embase search.

The following databases were searched:

  • Cochrane Central Register of Controlled Trials (Cochrane Library, Wiley)

  • Cochrane Database of Systematic Reviews (Cochrane Library, Wiley)

  • Database of Abstracts of Reviews of Effects (Cochrane Library, Wiley)

  • Embase (Ovid SP)

  • Health Technology Assessment Database (Cochrane Library, Wiley)

  • MEDLINE and MEDLINE in Process (Ovid SP)

  • NHS Economic Evaluation Database (Cochrane Library, Wiley)

  • PubMed.

Evidence selection

A total of 976 studies were retrieved from the literature search. After de‑duplication, 659 records remained. Two reviewers independently evaluated titles and abstracts against the exclusion criteria. Disagreement was solved through discussion between the reviewers and, if necessary, discussion with a third reviewer. In total 649 papers were removed, after evaluation against the following inclusion and exclusion criteria:

Inclusion criteria:

  • Use of the LARS in knee ligament reconstruction in an acute care setting.

  • Comparative studies which include autogenous and/or allogenous ligament reconstruction.

  • Paper reports some form of outcome.

Exclusion criteria:

  • Non‑English‑language studies.

  • Conference abstracts.

  • Review protocols (for example, Cochrane review protocols).

  • Articles if neither the abstract not the full text is available online.

Full records were retrieved for the remaining 10 papers, and a second sift was undertaken by the same reviewers. No papers were excluded at this stage.

All papers were assessed for methodological quality using the checklists provided within the NICE guidelines manual: appendices B‑I. Three systematic reviews were included in the selected papers (Machotka et al. 2010; Mulford et al. 2011; Newman et al. 2013), but these only provided narrative synthesis of the available evidence and included single‑arm case studies. Given the quality of clinical evidence is higher with comparative studies, it was decided to include only the higher quality comparative studies, thereby excluding these systematic reviews. After the assessment of quality, 1 paper (Patrascu et al. 2014) was not included in the clinical evidence section, because of poor reporting of methods and outcomes.

One additional paper (Batty et al. 2015) was submitted by the distributor and judged appropriate for inclusion in this review. This was a well‑conducted systematic review of safety outcomes that included 20 papers on 1102 knees. Several included papers compared the LARS to autograft or allograft procedures.