Therefore, more prospective randomized trials with the same units of the outcome variables would be necessary.
However, more prospective randomized controlled trials needed to extract firm conclusions.
More prospective randomized studies using validated outcome measures are needed to identify the suitable operation techniques for the acute injuries.
To give a unambigious conclusion on the fact if repair of the pronator quadratus after volar plate fixation is necessary, more prospective randomized trials with the same units of the outcome variables are needed.
Moreover, to perform a meta-analysis evaluation more prospective randomized studies using validated outcome measures are needed and future studies should include contemporary operative methods and seek to stratify certain populations that place high demands on the shoulder.
More prospective randomized controlled trials are needed to overcome the limitations of our study.
Furthermore, we had no data on peritoneal membrane characteristics; high peritoneal solute transport has been associated with PD technique failure and mortality in observational studies [ 23, 41] but not in a more recent prospective, randomized, controlled trial [ 42].
Although these initial clinical trials have several limitations, including an open-label design, unblinded evaluation, lack of appropriate controls, and small sample size, the data from these studies warrant further study of the effects of HA on cartilage protection and disease progression in more rigorous, prospective, randomized, controlled, double-blind clinical studies.
To obtain more confidence in this treatment, a prospective, randomized, multicentre study would be beneficial, since the results that are reported so far are all from the same medical centre with the same surgeons.
First, although we did not detect significant publication bias except for ESR between studies, it is uncertain whether the cases are comparably representative, and they are observational studies, more prone to many biases than prospective randomized controlled studies [ 35].
Clinical research need to be carried out more tightly under controlled condition with a prospective, randomized design rather than demonstration of successful case series.
