Clinical Review

The Top 100 Cited Articles in Clinical Orthopedic Sports Medicine

Am J Orthop. 2015 August;44(8):E252-E261

Orthopedic sports medicine continues to evolve, owing much of its clinical management and practice to rigorous academic research. In this review, we identify and describe the top 100 cited articles in clinical sports medicine and recognize the authors and institutions driving the research.

We collected articles (excluding basic science, animal, and cadaveric studies) from the 25 highest-impact sports medicine journals and analyzed them by number of citations, journal, publication date, institution, country, topic, and author.

Mean number of citations was 408 (range, 229-1629). The articles were published in 7 journals, most in the 1980s to 2000s, and represented 15 countries. Thirty topics were addressed, with a heavy emphasis on anterior cruciate ligament injury and reconstruction, knee rating systems, rotator cuff reconstruction, and chondrocyte transplantation. The 3 most cited articles, by Insall and colleagues, Constant and Murley, and Tegner and Lysholm, addressed a knee, a shoulder, and another knee rating system, respectively. Several authors contributed multiple articles. The Hospital for Special Surgery and the University of Bern contributed the most articles (5 each).

This study provides a comprehensive list of the past century’s major academic contributions to sports medicine. Residents and fellows may use this list to guide their scholarly investigations.

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References

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Orthopedics and the sports medicine subspecialty are continually evolving fields that depend on research investigation and publication to further knowledge and advance practice. Research has produced new findings that have changed the way we practice sports medicine. In this review, we identify the most widely referenced sports medicine topics and articles, which we believe by their permeative presence in the literature have made lasting contributions to the field.

Many factors can be used to quantify the influence of an academic article on the practice of medicine. Citation analysis is one method that reflects the impact of a publication on the academic medical community.^1-3Total citations record the number of times a journal article has been credited by another study. Therefore, citation count indirectly highlights the articles that are widespread, relevant, and that form the foundation for other investigations on the topic. Related to the impact of the article is the impact of the journal that published the study. We examined journals by impact factor, a score based on the mean number of citations a published article received during the preceding 2 years.

Similar analyses have been performed of publication history in orthopedics and other medical fields. Investigators have examined which historical articles were the most influential in orthopedics as a whole,⁴ pediatric orthopedics,^5,6shoulder surgery,⁷ and arthroscopy.⁸ This influence has also been studied in general surgery,⁹ otolaryngology,¹⁰ plastic surgery,¹¹ dermatology,¹² critical care,¹³ and other disciplines. To our knowledge, the present study is the first bibliometric analysis of the highest-impact articles in orthopedic sports medicine.

Our goal was to identify the 100 articles that have had the highest impact on the clinical orthopedic sports medicine literature. We hypothesized that the most widely recognized articles would be from the highest-impact journals and may also have earlier publication dates. We describe the topics and objectives of these articles to highlight the sports medicine areas on which most research has focused during the past century.

Materials and Methods

Our bibliometric analysis used the Thomson Reuters Web of Knowledge, which consists of all publications from 1900 to the present. This research modality ranks journal articles by frequency of citation. Similar analyses have identified the most often cited articles in pediatric orthopedics,⁵ shoulder surgery,⁷ and arthroscopy.⁸ In our analysis, we included the top 25 journals by impact factor in the field of sports medicine, as rated by the Journal Citation Reports database. Within the highest-impact journals, we sorted all articles by those most often cited, and read them all to identify which ones discuss conditions commonly encountered in the clinical practice of sports medicine. We focused on clinical articles only and therefore excluded related basic science and cadaveric biomechanical studies. The 100 most cited articles were then further evaluated by primary author, journal of publication, institution, country of origin, year of publication, topic, and total number of citations. One-way analysis of variance (ANOVA) and linear regression analyses were used to determine if publication date correlated with mean number of citations.

Results

Eighty authors wrote the top 100 articles in sports medicine, and each publication garnered several hundred citations, ranging from 229 to 1629 with a mean of 408 (Table 1^14-113). Most of these articles were written in the past 3 decades, with equal distribution from the 1980s, 1990s, and 2000s (Figure 1A). We ran a linear regression to determine if publication date correlated with higher number of citations by virtue of longer time available for citation. The analysis poorly modeled the variability (R² = 0.05), revealing no correlation between number of citations and publication date. Further, 1-way ANOVA found no significant difference between the number of citations per decade, F(5, 93) = 1.60, P = .17 (Figure 1B). Despite this finding, the oldest cited article, written by Fairbank³⁹ in 1948, ranked high (position 7). Of these top 100 publications, the most recent, written by Knutsen and colleagues⁶⁹ in 2007, ranked in the second half at position 66.

Seven journals published the top 100 articles, with the American volume of the Journal of Bone and Joint Surgery publishing nearly half (44%) (Table 2). In second place, with 28 articles, was the American Journal of Sports Medicine, followed by the British volume of the Journal of Bone and Joint Surgery, with 10 articles.

Thirty different topics were investigated in this collection of articles, encompassing nearly every major research area of sports medicine. There was a heavy emphasis on anterior cruciate ligament (ACL) injury and reconstruction, knee rating systems, rotator cuff reconstruction, and chondrocyte transplantation (Table 3).