Author summary
The addition of level of evidence ratings to the journal has several benefits: improve
studies by an explicit delineation of the primary research question; allow monitoring
and reporting of trends in the quality of the orthopedic clinical research; and, most
importantly, place a clinical research study into context for the reader. It is important
to remember that levels of evidence are only a cursory guide to study quality and
comprehensive assessment requires a critical appraisal of the specific study. Furthermore,
level-I evidence may not be available for all clinical situations as randomized controlled
trials (RCTs) may not be possible, and level-III or IV evidence can still be of value.
Lastly, a composite assessment of all evidence types is necessary to thoroughly answer
a clinical question.
