Manuscripts submitted to musculoskeletal journals have several key components that need to be critically evaluated. There are specific methods to assess the abstract, illustrations, references, and other major elements of a manuscript under review. If each of these elements is assessed methodically, not only does the quality of the review improve, but it becomes more useful for the journal editor. Additionally, the method in which the review is conveyed has a marked impact on its usefulness. There should be a concise evaluation of the entire work, stating whether a publication should or should not be pursued. For poor manuscripts, several bulleted points that indicate the fatal flaw(s) are sufficient, but for good manuscripts, a systematic itemization of weaknesses will improve the quality of the manuscript. Reviews should not be derogatory and should be prompt and to the point.