New Level of Evidence Guidelines Change Previously Published Manuscripts’ Designation

In 2015, The Journal of Bone and Joint Surgery (JBJS) updated its level of evidence (LOE) scale. We reviewed all studies published in JBJS in the two years before updating the LOE scale, and re-designated according to the updated scale. Level 4 therapeutic studies were the most common (32%). Level 2 prognostic studies had the greatest number of LOE designation changes (26). Near perfect agreement was met for therapeutic (k:0.96) and diagnostic studies (k:0.96). Prognostic studies demonstrated a lower agreement (k:0.65). Studies published in JBJS before 2015 may have different LOE designations if published today.