To The Editor:We read with interest the article by Khan et al. entitled "Treatment
of Acute Achilles Tendon Ruptures. A Meta-Analysis of Randomized, Controlled
(2005;87:2202-210), and we have
some concerns regarding the papers that they included in the meta-analysis.
The authors state that their intention was to provide a meta-analysis of
randomized, controlled trials, and they clearly state their selection criteria
and methodology scoring system.However, we found that four papers1-4 had a score of 0 for the
method of randomization and were thus recognized to be poorly randomized, if
randomized at all. On our review of these papers, we noted that Kerkhoffs et
al.1 clearly stated that their study was only quasi-randomized and
that the study by Maffulli et al.2 was not randomized for patient
selection, with treatment selection being only quasi-randomized on the basis
of the day of attendance.