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Living evidence: a new approach to the appraisal of rapidly evolving musculoskeletal research
  1. Bálint Zsidai1,
  2. Janina Kaarre1,
  3. Eric Hamrin Senorski2,
  4. Robert Feldt3,
  5. Alberto Grassi4,
  6. Olufemi R Ayeni5,
  7. Volker Musahl6,
  8. Mohit Bhandari7,8,
  9. Kristian Samuelsson1,9
  1. 1 Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  2. 2 Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Gothenburg, Sweden
  3. 3 Chalmers University of Technology, Gothenburg, Sweden
  4. 4 IIa Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli Istituto di Ricovero e Cura a Carattere Scientifico, Bologna, Italy
  5. 5 Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
  6. 6 Department of Orthopaedic Surgery, UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA
  7. 7 Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
  8. 8 Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
  9. 9 Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
  1. Correspondence to Dr Bálint Zsidai, Department of Orthopaedics, Göteborgs universitet Institutionen för kliniska vetenskaper, 405 30 Goteborg, Sweden; balint.zsidai{at}

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Practising appropriate evidence-based medicine requires a continuous flow of high-quality, peer-reviewed research. The emergence of new research has increased exponentially in some fields of sport and exercise medicine. As an example, between 2008 and 2018, the number of yearly publications related to the anterior cruciate ligament has more than doubled (from 650 to 1380 per year!), showcasing the breakneck speed at which new evidence is produced.1

Current practice

Systematic reviews and meta-analyses are considered the standard of data collection and appraisal and are based on manual screening of studies available in the literature at a given time. However, it is increasingly clear that clinical guidelines developed using such methods are unable to incorporate evidence from the deluge of new studies every month and may be outdated by the time of publication. A future challenge in musculoskeletal medicine is to promote efficient evidence synthesis from rapidly advancing fields by creating platforms for the near real-time assessment of new data. This ambitious goal requires rigorous appraisal of studies to maintain high-quality, cyclically updated clinical guidelines derived from continuously synthesised evidence.

Need for living evidence

Living evidence involves continuous updating of meta-analyses and clinical practice guidelines as new data are available in rapidly evolving fields of medicine, resulting in a series of ‘living meta-analyses and practice guidelines’.2 3 Do …

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  • Contributors The initial manuscript was drafted by BZ and JK. All authors contributed substantially to the conception of the idea for this editorial, reviewed and edited the text, and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests VM reports educational grants, consulting fees and speaking fees from Smith & Nephew plc, educational grants from Arthrex, and is a board member of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine. In addition, VM is the deputy editor-in-chief of Knee Surgery, Sports Traumatology, Arthroscopy and has a patent Quantifed injury diagnostics-US Patent No. 9,949,684, issued on 24 April 2018, issued to University of Pittsburgh. MB reports consulting fees from Bioventus, Pendopharm and Acumed. KS is a member on the board of directors of Getinge AB (publ).

  • Provenance and peer review Not commissioned; externally peer reviewed.