Can We Trust Knee Meniscus Studies? One-Way Crossover Confounds Intent-to-Treat Statistical Methods

Randomized controlled studies have a high level of evidence. However, some patients are not treated in the manner to which they were randomized and actually switch to the alternative treatment (crossover). In such cases, “intent-to-treat” statistical methods require that such a switch be ignored, resulting in bias. Thus, the study conclusions could be wrong. This bias is a common problem in the knee meniscus literature.