Surgeons use the literature to determine the best treatment for their patients. Although practice can be changed by a single study, we often find multiple studies more convincing. The appropriate literature can be identified in many ways. First, we can search the literature ourselves. However, this takes a lot of time and the search may not be comprehensive. Second, we can identify meta-analyses or systematic overviews, which collect and combine studies together to assemble a larger sample size in order to provide greater precision around treatment effects. However, meta-analyses pose many methodologic challenges and are not always available. Finally, we can use review articles such as the Current Concepts Reviews published by The Journal as a source for treatment recommendations. The difficulty with review articles is uncertainty about the quality of the recommendations they contain.

In this issue, The Journal introduces the latest in a series of changes to help surgeons appraise the literature to make the best decisions with and for their patients. In June 2000, The Journal featured a new section called Evidence-Based Orthopaedics1. On a quarterly basis, structured abstracts derived from high-quality evidence from journals other than JBJS are published with a commentary from a clinical expert. This section provides the latest and highest-quality evidence for orthopaedic surgeons. In January 2003, The Journal began publishing a Levels of Evidence rating at the end of the abstract for every clinical article2. This system rates the quality of the evidence with use of five levels that are based on the study methods. Levels of Evidence ratings provide a measure of the quality of clinical articles published in JBJS.