TABLE 1.

Scoring Results

Study	Risk of Bias			Imprecision	Indirectness	Other Considerations			GRADE Score
	Blinding	Incomplete Reporting or Analysis	Methodological Bias			Dose Response	Adjustment for Confounders Increases Effect Size	Large Effect Size
Soft tissue injury
Gray et al25	Yes	No	Flawed measurement	Not serious	Serious	No	Yes	Very large	High
Rahr-Wagner et al54	Yes	No	Flawed measurement	Not serious	Not serious	Yes	Yes	Very large	High
Agel et al1	No	Yes	None	Very serious	Serious	No	No	No	Very low
Dragoo et al14	No	No	None	Serious	Serious	No	No	No	Very low
Liederbach et al44	No	Yes	None	Serious	Serious	No	No	No	Very low
Ruedl et al58	Yes	Yes	None	Serious	Serious	No	No	No	Very low
Holmes and Lin35	No	Yes	None	Very serious	Serious	No	No	Very large	Very low
Soft tissue laxity
Martineau et al47	Yes	No	None	—	Not serious	No	Yes	Large	High
Lee et al41	No	No	None	—	Not serious	No	No	Large	Low
Pokorny et al53	Yes	No	None	—	Not serious	No	No	No	Low
Shultz et al64	No	No	Confounding risk	—	Not serious	No	Yes	No	Low
Casey et al10	Yes	Yes	None	—	Not serious	No	No	No	Very low
Hicks-Little et al33	No	No	Confounding risk	—	Not serious	No	No	No	Very low
Lee et al42	No	No	None	—	Not serious	No	No	No	Very low
Cammarata and Dhaher9	No	No	None	—	Not serious	No	No	Large	Low
Bryant et al8	Yes	No	Confounding risk, flawed measurement	—	Not serious	No	No	No	Very low
Hansen et al27	No	Yes	Flawed measurement	—	Not serious	No	No	No	Very low
Muscle strength
Wirth and Lohman68	No	No	Confounding risk	—	Not serious	No	No	Very large	Low
Sarwar et al61	No	No	Confounding risk	—	Not serious	No	No	Large	Very low
Ekenros et al17	No	Yes	Confounding risk, flawed measurement	—	Not serious	No	No	No	Very low
Petrofsky et al51	No	No	Confounding risk	—	Not serious	No	No	No	Very low
Elliott et al18	No	No	Confounding risk	—	Not serious	No	No	No	Very low
Phillips et al52	No	No	Confounding risk	—	Not serious	No	No	No	Very low
Savage and Clarkson62	No	No	Confounding risk	—	Not serious	No	No	Very large	Low
Gordon et al24	No	No	Confounding risk	—	Not serious	No	No	No	Very low
Nichols et al50	Yes	No	None	—	Not serious	No	No	No	Low
Minahan et al48	No	No	None	—	Not serious	No	No	No	Very low
Casey et al10	Yes	Yes	None	—	Not serious	No	No	No	Very low
Allali et al2	No	No	None	—	Serious	No	Yes	Large	Low