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Exploring Bias Patterns in Systematic Reviews and Meta-Analyses of Bone Marrow Aspirate Concentrate
Daman P Dhunna1, Pratik Gazula, Kenneth T Nguyen
1From the Chobanian & Avedisian School of Medicine, Boston University, Boston, MA (Dhunna and Gazula), Tulane University School of Medicine, New Orleans, LA (Nguyen and Brown), Philadelphia College of Osteopathic Medicine, Philadelphia, PA (Fink), the Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY (Yendluri, Corvi, and Parisien), the Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA (Kelly), and the Department of Orthopaedics, Boston University, Boston, MA (Li).
Most reviews on bone marrow aspirate concentrate (BMAC) show poor quality and reporting bias, overstating its effectiveness. Improved transparency and methodology are needed for accurate clinical decision-making regarding BMAC use.
Area of Science:
- Orthopaedic research
- Regenerative medicine
- Evidence-based medicine
Background:
- Bone marrow aspirate concentrate (BMAC) is increasingly utilized in orthopaedics for regenerative purposes.
- Concerns exist regarding the methodological rigor and reporting bias (spin) in systematic reviews and meta-analyses on BMAC.
- This study assesses spin prevalence and types in BMAC reviews and evaluates study quality.
Purpose of the Study:
- To evaluate the prevalence and types of reporting bias (spin) in systematic reviews and meta-analyses concerning BMAC in orthopaedics.
- To assess the methodological quality of these reviews using the AMSTAR 2 tool.
- To identify associations between study characteristics and the presence of spin.
Main Methods:
- Systematic literature search conducted across PubMed, Scopus, and EMBASE.
- Inclusion of systematic reviews and meta-analyses on BMAC in orthopaedic contexts.
- Assessment of 15 predefined spin types and methodological quality via AMSTAR 2.
Main Results:
- Spin was present in 75% of the 28 included studies, with selective outcome reporting being most common.
- Misleading interpretation was the most frequent spin category (67.9%).
- A majority of studies (67.9%) were rated as critically low confidence by AMSTAR 2.
Conclusions:
- Most BMAC reviews exhibit low methodological quality and significant reporting bias, leading to an overstatement of efficacy.
- Specific spin types, such as selective reporting and emphasis on positive outcomes, contribute most to bias.
- Enhanced transparency, adherence to reporting standards, and rigorous methodology are crucial for future reviews to guide clinical practice accurately.
