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The Journal of Bone and Joint Surgery. British volumeVol. 88-B, No. 2 AnnotationFree AccessThe international rank order of publications in major clinical orthopaedic journals from 2000 to 2004B. H. Bosker, C. C. P. M. VerheyenB. H. BoskerResearch FellowDepartment of Orthopaedic Surgery and Traumatology, Isala Clinics, Weezenlanden Hospital, P. O. Box 10500, 8000 GM Zwolle, The Netherlands.Search for more papers by this author, C. C. P. M. VerheyenConsultant Orthopaedic SurgeonDepartment of Orthopaedic Surgery and Traumatology, Isala Clinics, Weezenlanden Hospital, P. O. Box 10500, 8000 GM Zwolle, The Netherlands.Search for more papers by this authorPublished Online:1 Feb 2006https://doi.org/10.1302/0301-620X.88B2.17018AboutSectionsPDF/EPUB ToolsDownload CitationsTrack CitationsPermissionsAdd to Favourites ShareShare onFacebookTwitterLinked InRedditEmail Publications in peer-reviewed journals are the most important determinant by which research is rated and funding awarded. In this study, the publication rate in orthopaedic surgery of individual countries was scored in selected clinical journals in order to identify those which are making the principal contributions to the development of the orthopaedic discipline.A total of 15 major clinical orthopaedic journals was selected. All articles with abstracts were scored for the country of the corresponding author through a bibliometric search in Medline/PubMed over a period of five years (2000 to 2004). The total number of publications, the number adjusted for size of population and the impact factor of the journal were assessed for each country.A total of 13 311 articles were scored, of which 92% were generated by 15 countries with 47.4% by the United States, followed by Japan (8.0%) and the United Kingdom (7.3%). Corrected for population size, eight smaller European countries led this ranking with Sweden, Switzerland and Finland at the top, with the United States in their midst in sixth place. Japan and Finland scored the highest mean impact factor.This observational study demonstrates that the United States is the most productive country in absolute number of publications in the selected clinical orthopaedic journals, and when normalised for population size, the smaller European countries with a high proficiency in English were most successful.Our objective was to identify the countries which generate knowledge and progress in orthopaedic surgery and consider the factors that enabled them to be major contributors.MethodsThe major clinical orthopaedic journals were selected and ranked by the senior author (CCPMV) from the ‘orthopedics’ category of journals established by the Institute for Scientific Information as searched in April 2005.1 He chose to add the American Journal of Sports Medicine to that list. The 15 journals with the highest impact factor were chosen. The Medline/PubMed Journals Database2 was searched for these journals, and all articles with an abstract, as indicated in the ‘limits’ function in PubMed, were selected. The country of the corresponding author was used as the source nation for the article. Countries with fewer than 50 publications during the period tested were excluded. The mean impact factor for the period of review was calculated, as were the totals for each journal and country. For the calculation of publications per million inhabitants, the 2005 national population data were derived from the UN Population Information Network.3 The domestic expenditure on research as a percentage of the gross domestic product was taken as an indicator for the amount of national research funding.ResultsThere was a total of 13 311 articles with abstracts in the 15 chosen journals during the period of the review. All the selected journals were in English, 11 from the United States and four from Europe. The figures for the top 15 journals and countries are shown in Table I, in which the ranking order is determined by impact factor for the journals and by the total number of publications for the countries. The 15 countries listed account for 92% of the total number of articles, the first five countries for 71.9% and the United States by itself for 47.4%. The contribution from the United States was the highest in Orthopedic Clinics of North America (89.5%) and the American volume of the Journal of Bone and Joint Surgery (69.1%). The United Kingdom was responsible for 7.3% of the total scored articles. Its share in the British volume of the Journal of Bone and Joint Surgery was 37.7% of the 974 publications. Of these 367 articles, England had the highest share with 324 (88.2%), followed by Scotland with 38 (10.4%), Northern Ireland with four and Wales with one. Sweden scored 23.6% of the papers in the Acta Orthopedica Scandinavica, now Acta Orthopaedica. Table II ranks the publications per million inhabitants and establishes the position of each country. The data for domestic expenditure on research are listed as a percentage of the gross domestic product and are from 2002 or the last available year.4–6DiscussionThe United States has traditionally led the rankings in the output of publications in each of the 20 fields of science defined by the Institute for Scientific Information, and consequently also in clinical medicine overall.1 It is therefore not surprising that the same country also tops the ranking for total publications in major clinical orthopaedic journals. In similar recent studies of high-ranked journals in other medical specialties, their mean percentage was 37 (24 to 48).7–14When corrected for the size of population, the smaller western European countries (ranks 1 to 5, 7, 8) outrank the others, with the United States in their midst. The sixth place of the United States with clinical orthopaedic papers is substantially higher than their rank of 13 in the comparable list of publications in clinical medicine (1992 to 2002).15Some major western European countries perform rather poorly. France, Italy, Spain and Germany are low in lists normalised for population size in both clinical medicine and orthopaedics, as is Japan. Germany has some fine orthopaedic journals published in the native language such as Zeitschrift für Orthopädie und ihre Grenzgebiete, Der Unfallchirurg and Der Orthopäde with impact factors of approximately 0.50, but not sufficient to qualify for selection in the present study.We chose 15 major clinical orthopaedic journals since a broader selection would include a larger number of articles which will never be cited and therefore lack scientific impact. Narrowing the selection enhances the scientific quality of the selected papers but this disqualifies mainstream contributions. Many important contributions to orthopaedics are in publications which are not specific to orthopaedics and may be ranked higher than any journal in our list.The number of citations in top journals might be a more sensitive marker of scientific impact than the impact factor and the number of publications. However, it is hard to assess, and there is also a potential selection bias. We, therefore, decided to use the mean impact factor as an autonomous indicator of the prestige of a journal. Its limitations are acknowledged when used to compare large series but it has become an influential tool within the scientific world to evaluate research and award funding.16We originally planned to relate the total of clinical orthopaedic publications to the number of orthopaedic surgeons practising in a country, but it was not possible to construct such a list. It could also be argued that the number of scientists working in musculoskeletal research should also be included.The editorial process differs in the selected journals. Peer-reviewed journals such as both the American and British volumes of the Journal of Bone and Joint Surgery and Acta Orthopaedica are treated identically to those such as Clinical Orthopaedics and Related Research and Orthopedic Clinics of North America which have a relatively large number of invited manuscripts.It may be suggested that our findings are merely a reflection of the preference of editorial boards to select manuscripts written in proper English. Apart from the evident factor of size of population, national funding capacity and proficiency in English may also be important factors in the ranking.17The gross domestic expenditure on research as a percentage of gross domestic product was used as a determinant for the national funding capacity. Norway, Denmark, The Netherlands and Austria do well in clinical orthopaedic publications corrected for population size with relatively modest research funding, particularly when contrasted with Israel, Japan, Germany, Taiwan, South Korea and France. This finding contradicts the study from Man et al,17 who stated that publication output in major medical journals is linked to research funding at a national level. Their paper also suggested that proficiency in English may be an important determinant for publication in English-language medical journals. It is remarkable that five European countries where English is not the native language outrank all five where it is. The poor proficiency in English of the Mediterranean countries, as well as Japan, may partly explain their lower scores in publications corrected for population size.We are aware of only one other article that focuses on the ranking of countries with respect to publications in orthopaedic literature (1991 to 2001) which, in particular analysed the share of Japan.18 The selection of journals and articles was different from ours in that the top seven orthopaedic journals from the Institute for Scientific Information list were picked and it was not limited to articles with an abstract on Medline/PubMed. It therefore included editorials, letters to the editor and case reports. It focused on total production only, not taking population size into account.The conclusions from our study cannot be strict or definitive. However, it is obvious that, as in all other fields of science, the United States is the most productive country in terms of absolute number of publications (47.4%) in the selected clinical orthopaedic journals. When corrected for population size, the smaller European countries with a high proficiency in the English language were most successful.Table I. Top 15 countries ranked according to total of publications in clinical orthopedic journals (2000 to 2004)15 countries*IF†meanPublications totalUSJPUKGECASENLCHTRKOAUFRITFIAT* US, United States; JP, Japan; UK, United Kingdom; GE, Germany; CA, Canada; SE, Sweden; NL, Netherlands; CH, Switzerland; TR, Turkey; KO, South Korea; AU, Australia; FR, France; IT, Italy; FI, Finland; AT, Austria† mean impact factor between 2000 and 2004Spine2.20240910493371249714458812357485852255515Am J Sports Med2.1871344342173614241320-42348223J Bone Joint Surg [Am]2.061040719423224551015213199189810Arthroscopy1.5110124721094064211314133164101640520J Bone Joint Surg [Br]1.479747311936755293130351030342913627Eur Spine J1.30537572146803247514223492613127Clin Orthop1.262188140816451818028314514391934271333Knee Surg Sp Tr Arthrosc1.114074221316543413176251283064Orthop Clin North Am1.01257230-1281----7----Acta Orthop Scand1.0048321382247411434111277682410J Arthroplasty0.971019523681272164302020215231114613J Shoulder Elbow Surg0.93435206432925147618212117564J Orthop Trauma0.93541306242331326921141113322J Pediatric Orthop0.756453811933634-4323231916773Foot Ankle Int0.6665138523313413411182810271175Total publications (Ranking)133116315 (1)1070 (2)974 (3)668 (4)548 (5)407 (6)332 (7)307 (8)281 (9)280 (10)279 (11)241 (12)213 (13)179 (14)156 (15)Publ/10E6 inhabitants (Ranking)21.2 (6)8.4 (16)16.2 (11)8.1 (17)17.0 (9)45.0 (1)20.4 (7)41.3 (2)3.8 (21)5.9 (19)13.8 (13)4.0 (20)3.7 (22)34.1 (3)19.0 (8)Table II. Country ranking according to publications, impact factor and research spendingCountryPublications/10E6 (Ranking)Total publications (Ranking)Mean impact factor (Ranking)Research spending (% GDP*) (Ranking)* GDP, gross domestic productSweden45.0 (1)407 (6)1.36 (17)4.27 (2)Switzerland41.3 (2)307 (8)1.35 (18)2.63 (7)Finland34.1 (3)179 (14)1.58 (1)3.40 (3)Norway23.6 (4)109 (20)1.54 (3)1.62 (16)Denmark21.7 (5)118 (18)1.33 (19)2.19 (11)United States21.2 (6)6315 (1)1.44 (9)2.82 (6)Netherlands20.4 (7)332 (7)1.49 (5)1.94 (13)Austria19.0 (8)156 (15)1.39 (13)1.34 (18)Canada17.0 (9)548 (5)1.50 (4)1.85 (15)Israel16.8 (10)113 (19)1.25 (22)4.90 (1)United Kingdom16.2 (11)974 (3)1.41 (11)1.90 (14)Ireland14.5 (12)60 (23)1.24 (23)1.17 (19)Australia13.8 (13)279 (11)1.42 (10)1.53 (17)Greece9.2 (14)102 (21)1.38 (14)0.67 (22)Belgium9.0 (15)94 (22)1.33 (20)1.96 (12)Japan8.4 (16)1070 (2)1.58 (1)3.09 (4)Germany8.1 (17)668 (4)1.40 (12)2.50 (8)Taiwan6.2 (18)142 (16)1.46 (7)2.45 (9)South Korea5.9 (19)280 (10)1.45 (8)2.96 (5)France4.0 (20)241 (12)1.48 (6)2.20 (10)Turkey3.8 (21)281 (9)1.31 (21)0.64 (23)Italy3.7 (22)213 (13)1.38 (15)1.07 (20)Spain2.9 (23)125 (17)1.36 (16)0.96 (21)References1 Institute for Scientific Information. http://www.isinet.com (accessed 17/03/05). 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The Journal of Bone and Joint Surgery. British volumeVol. 86-B, No. 3 Aspects of Current ManagementFree AccessPosterior dislocation of the shoulderN. CicakN. CicakOrthopaedic SurgeonSearch for more papers by this authorPublished Online:1 Apr 2004https://doi.org/10.1302/0301-620X.86B3.14985AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited bySurgical management of bilateral concomitant posterior fracture-dislocation of the shoulderTrauma Case Reports, Vol. 41Posterior shoulder dislocation with associated reverse Hill–Sachs lesion: clinical outcome 10 years after joint-preserving surgery3 June 2022 | Archives of Orthopaedic and Trauma Surgery, Vol. 39Posterior Shoulder InstabilityTreatment of chronic locked posterior dislocation of the shoulder with the modified McLaughlin procedureJournal of Shoulder and Elbow Surgery, Vol. 31, No. 1Principles of Radiological Examination28 September 2022Posterior Instability4 October 2022Mid-Term outcomes following fresh-frozen humeral head osteochondral allograft reconstruction for reverse Hill Sachs lesion: a case series8 September 2021 | BMC Musculoskeletal Disorders, Vol. 22, No. 1Management of Locked Posterior Shoulder Dislocation with Reverse Hill–Sachs Lesions via Anatomical Reconstructions11 October 2021 | Orthopaedic Surgery, Vol. 232Traumi della spalla e del braccioEMC - Urgenze, Vol. 25, No. 3Arthroscopic Knotless Subscapularis Bridge Technique for Reverse Hill-Sachs Lesion With Posterior Shoulder InstabilityArthroscopy Techniques, Vol. 10, No. 1A Modified Reverse Remplissage Procedure for Management of a Locked Posterior Shoulder DislocationCase Reports in Orthopedics, Vol. 2020Shoulder Dislocations in the Emergency Department: A Comprehensive Review of Reduction TechniquesThe Journal of Emergency Medicine, Vol. 58, No. 4Missed posterior shoulder fracture dislocations: a new protocol from a London major trauma centre18 March 2020 | BMJ Open Quality, Vol. 9, No. 1New Reduction Technique for Traumatic Posterior Glenohumeral Joint Dislocations24 January 2020 | Clinical Practice and Cases in Emergency Medicine, Vol. 4, No. 1Glenohumeral Joint16 April 2020Conservative Treatment in Posterior Dislocation16 June 2020Surgical Treatment of Humeral Head Defect in Shoulder Posterior Instability16 June 2020Shoulder and proximal humerusIndications for Reverse Shoulder ArthroplastyAll-Arthroscopic McLaughlin's Procedure in Patients with Reverse Hill–Sachs Lesion Caused by Locked Posterior Shoulder Dislocation31 December 2019 | Joints, Vol. 07, No. 03The dual subscapularis procedure: a modified Hawkins’ technique for neglected posterior fracture/dislocation of the shoulder19 March 2019 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 29, No. 5Remplissage With Bankart Repair in Anterior Shoulder Instability: A Systematic Review of the Clinical and Cadaveric LiteratureArthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 35, No. 4McLaughlin artroscópico modificado no tratamento de luxação glenoumeral posterior – nota técnica10 May 2019 | Revista Brasileira de Ortopedia, Vol. 54, No. 02Posterior Shoulder Dislocation During Morning PT: A Case Report13 June 2018 | Military Medicine, Vol. 184, No. 3-4The aetiology of posterior glenohumeral dislocations and occurrence of associated injuriesa systematic reviewM. 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Molony2 January 2019 | The Bone & Joint Journal, Vol. 101-B, No. 1Luxación posterior inveterada de hombro asociada a lesión de Hill-Sachs reversa tratada con modificación de la técnica de McLaughlinActa Ortopédica Mexicana, Vol. 33, No. 5Inestabilidad posterior del hombroActa Ortopédica Mexicana, Vol. 33, No. 5National Athletic Trainers' Association Position Statement: Immediate Management of Appendicular Joint DislocationsJournal of Athletic Training, Vol. 53, No. 12痙攣により生じた肩関節後方脱臼骨折の1例Orthopedics & Traumatology, Vol. 67, No. 3Posterior shoulder dislocation in a 10-year-old child: Case reportAnnals of Medicine and Surgery, Vol. 33Arthroscopic Management of Locked Posterior Shoulder DislocationsArthroscopy Techniques, Vol. 7, No. 9Posterior Shoulder Dislocation Associated With the Head (Splitting) and Humeral Neck Fracture: Impact of Understanding Radiologic Signs and Experience With an Extended Deltopectoral ApproachTechniques in Hand & Upper Extremity Surgery, Vol. 22, No. 2A treatment algorithm for locked posterior dislocation of shoulderJournal of Arthroscopy and Joint Surgery, Vol. 5, No. 2Reverse-Hill-Sachs-Läsion bei dorsal verhakter Schulterluxation16 October 2017 | Arthroskopie, Vol. 31, No. 1Posterieure instabiliteit30 November 2017Posterior Shoulder InstabilityPosterior shoulder dislocation with associated reverse Hill-Sachs lesion: treatment options and functional outcome after a 5-year follow up13 November 2017 | BMC Musculoskeletal Disorders, Vol. 18, No. 1Dimple on the shoulder after a ski injury23 October 2017 | Emergency Medicine Journal, Vol. 34, No. 11Posterior shoulder dislocation with a reverse Hill–Sachs lesion treated with frozen femoral head bone allograft combined with osteochondral autograft transfer23 June 2016 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 25, No. 10Transfer of the lesser tuberosity for reverse Hill-Sachs lesions after neglected posterior dislocations of the shoulder: A retrospective clinical study of 13 casesActa Orthopaedica et Traumatologica Turcica, Vol. 51, No. 5Risk of Engagement of Bipolar Bone Defects in Posterior Shoulder Instability28 June 2017 | The American Journal of Sports Medicine, Vol. 45, No. 12EXPERIENCE IN USE OF MODIFIED MCLAUGHLIN PROCEDURE FOR NEGLECTED LOCKED POSTERIOR SUBLUXATION OF THE HUMERAL HEAD30 September 2017 | Vestnik travmatologii i ortopedii imeni N.N. Priorova, No. 3Experience in Use of Modified McLaughlin Procedure for Neglected Locked Posterior Subluxation of the Humeral Head15 September 2017 | N.N. Priorov Journal of Traumatology and Orthopedics, Vol. 24, No. 3Treatment of The Posterior Unstable ShoulderThe Open Orthopaedics Journal, Vol. 11, No. 1Luxación glenohumeral posteriorFMC - Formación Médica Continuada en Atención Primaria, Vol. 24, No. 7Complete avulsion of the rotator cuff footprint in an irreducible traumatic posterior glenohumeral fracture-dislocation due to infraspinatus interpositionJournal of Shoulder and Elbow Surgery, Vol. 26, No. 8Orthopedic Pearls and PitfallsPhysician Assistant Clinics, Vol. 2, No. 3Rekonstruktion anteromedialer Humeruskopfimpressionsfrakturen mit knöchernen Auto- oder Allografts26 April 2017 | Obere Extremität, Vol. 12, No. 2Step-by-Step Technique for Segmental Reconstruction of Reverse Hill-Sachs Lesions Using Homologous Osteochondral AllograftTechniques in Hand & Upper Extremity Surgery, Vol. 21, No. 2Treatment of Locked Posterior Shoulder Dislocation With Bone DefectOrthopedics, Vol. 40, No. 3Posterior shoulder fracture–dislocation: an update with treatment algorithm25 August 2016 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 27, No. 3Pitch-side management of acute shoulder dislocations: a conceptual review12 March 2017 | BMJ Open Sport & Exercise Medicine, Vol. 2, No. 1Glenohumeral Instability9 February 2018Dislocations and Fracture Dislocations of the Shoulder Girdle11 October 2017Shoulder: Glenohumeral Instability20 April 2017Locked Posterior Shoulder Dislocation (LPSD)9 May 2017Posterior Shoulder Instability in the Young Patient9 May 2017Orthopedics & Traumatology, Vol. 66, No. 2Modified technique for reconstructing reverse Hill–Sachs lesion in locked chronic posterior shoulder dislocation19 August 2016 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 26, No. 8A systematic and technical guide on how to reduce a shoulder dislocationTurkish Journal of Emergency Medicine, Vol. 16, No. 4Balloon-guided inflation osteoplasty in the treatment of Hill-Sachs lesions of the humeral head: case report of a new technique1 February 2016 | Patient Safety in Surgery, Vol. 10, No. 1Locked Posterior Dislocation of Shoulder With Fracture of the Lesser Tuberosity of the Humerus: A Case Report and Review of the Literature5 November 2016 | Archives of Trauma Research, Vol. 6, No. 2Traumatic posterior shoulder dislocation with a large engaging Hill-Sachs lesion: splinting techniqueThe American Journal of Emergency Medicine, Vol. 34, No. 3Defect Characteristics of Reverse Hill-Sachs Lesions8 January 2016 | The American Journal of Sports Medicine, Vol. 44, No. 3Bone block procedures in posterior shoulder instability24 April 2015 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 24, No. 2Evaluation of Bone Loss and the Glenoid Track30 December 2015Sideline Management of Joint DislocationsCurrent Sports Medicine Reports, Vol. 15, No. 3Posterior Glenohumeral DislocationBilateral posterior shoulder dislocation after electrical shock: A case reportAnnals of Medicine and Surgery, Vol. 4, No. 4Proximal humerus derotational osteotomy for internal rotation instability after locked posterior shoulder dislocation: early experience in four patients8 May 2015 | Patient Safety in Surgery, Vol. 9, No. 1New technique in reconstructing humeral head defect in locked posterior dislocation of the shoulder: a case series of nine patients1 July 2015 | European Orthopaedics and Traumatology, Vol. 6, No. 3Luxación de hombro posterior y bilateral en contexto de crisis convulsivaSEMERGEN - Medicina de Familia, Vol. 41, No. 3Posterior capsular release and coracoid transfer for cases of neglected locked anterior shoulder dislocation in tramadol addicts14 September 2014 | European Orthopaedics and Traumatology, Vol. 6, No. 1Acute Shoulder Trauma: What the Surgeon Wants to KnowRadioGraphics, Vol. 35, No. 2Influence of Defect Size and Localization on the Engagement of Reverse Hill-Sachs Lesions2 February 2015 | The American Journal of Sports Medicine, Vol. 43, No. 3Reverse shoulder arthroplasty in acute fractures provides better results than in revision procedures for fracture sequelae31 December 2014 | International Orthopaedics, Vol. 39, No. 2Acute Posterior Dislocations and Posterior Fracture–Dislocations of the Shoulder10 June 2015Neglected Posterior Dislocations and Treatment Modalities10 June 2015Posterior Shoulder Instability in the Contact AthleteReconstruction of Humeral Head Defect in Locked Posterior Dislocation Shoulder. A Case Series of Nine PatientsOpen Journal of Orthopedics, Vol. 05, No. 02Konservative Therapie der akuten verhakten posterioren Schultergelenkluxation20 September 2013 | Der Unfallchirurg, Vol. 117, No. 12Operative Versorgung der posterioren Schulterluxation9 March 2014 | Der Unfallchirurg, Vol. 117, No. 12Bilateral Posterior Fracture Dislocation of the Shoulder Following an Epileptic Seizure17 October 2014 | MOJ Orthopedics & Rheumatology, Vol. 1, No. 2Posterior Shoulder Instability with a Reverse Hill-Sachs Defect: Repair with Use of Combined Arthroscopic Labral Repair and Fracture DisimpactionJBJS Case Connector, Vol. 4, No. 3Tratamiento artroscópico de lesión tipo Hill-Sachs inversa sin uso de material de osteosíntesis para su fijación: Reporte de casoRevista Colombiana de Ortopedia y Traumatología, Vol. 28, No. 2Acute Traumatic Posterior Shoulder DislocationJournal of the American Academy of Orthopaedic Surgeons, Vol. 22, No. 3Acute Posterior Dislocations and Posterior Fracture–Dislocations of the Shoulder26 December 2014Neglected Posterior Dislocations and Treatment Modalities14 October 2014Addendum: schouderluxatie1 April 2014Fused 99mTc-HDP SPECT/MR Imaging of Reverse Hill-Sachs DeformityClinical Nuclear Medicine, Vol. 39, No. 1Excellent results of lesser tuberosity transfer in acute locked posterior shoulder dislocation26 September 2012 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 21, No. 12Lussazioni posteriori della scapolo-omerale: diagnosi e terapia1 January 2014 | Aggiornamenti CIO, Vol. 19, No. 2Locked posterior dislocation of the shoulder joint: Report of two casesFormosan Journal of Musculoskeletal Disorders, Vol. 4, No. 4Posterieure schouderluxatie bij een claviculafractuur1 November 2013 | Nederlands Tijdschrift voor Traumatologie, Vol. 21, No. 5Posterior Shoulder Instability in the Contact AthleteClinics in Sports Medicine, Vol. 32, No. 4Traumatic Shoulder Injuries: A Force Mechanism Analysis—Glenohumeral Dislocation and InstabilityAmerican Journal of Roentgenology, Vol. 201, No. 2Modified arthroscopic McLaughlin procedure for treatment of posterior instability of the shoulder with an associated reverse Hill-Sachs lesion7 October 2012 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 21, No. 7Modified McLaughlin Technique for Neglected Locked Posterior Dislocation of the ShoulderOrthopedics, Vol. 36, No. 7Posterior shoulder dislocationReliability of a New Standardized Measurement Technique for Reverse Hill-Sachs Lesions in Posterior Shoulder DislocationsArthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 29, No. 3Bilateral locked posterior shoulder dislocation after an undiagnosed brain tumorCurrent Orthopaedic Practice, Vol. 24, No. 2WITHDRAWN: Posterior dislocation of the shoulder: a case reportJournal of Clinical Orthopaedics and TraumaTraumatic bilateral posterior dislocation of the shoulder: a case reportOpen Medicine, Vol. 8, No. 6Uncommon Indications for Reverse Total Shoulder ArthroplastyClinics in Orthopedic Surgery, Vol. 5, No. 4Orthopedic Pitfalls of the Upper Extremity15 November 2012Recurrent Posterior Shoulder Instability After Rifle ShootingOrthopedics, Vol. 35, No. 11Shoulder and Proximal Humerus22 October 2012Shoulder Resurfacing for Acute Locked Posterior Dislocation Allows Early Rehabilitation6 February 2017 | Shoulder & Elbow, Vol. 4, No. 4Bilateral Neglected Posterior Fracture–Dislocation of the ShouldersOrthopedics, Vol. 35, No. 10Eine neue Repositionstechnik für die verhakte hintere Schulterluxation9 December 2011 | Der Unfallchirurg, Vol. 115, No. 8Delayed Diagnosis of Bilateral Scapula Fractures in a Patient with Cardiac Syncope1 July 2012 | Shoulder & Elbow, Vol. 4, No. 3Bilateral Talar Avulsion Fractures Secondary to Seizure: A Case ReportThe Journal of Foot and Ankle Surgery, Vol. 51, No. 3Anatomical Reconstruction of Reverse Hill-Sachs Lesions Using the Underpinning TechniqueOrthopedics, Vol. 35, No. 5Acute bilateral posterior dislocation of the shoulder: One-stage reconstruction of both humeral heads with cancellous autograft and cartilage preservationChirurgie de la Main, Vol. 31, No. 1Recurrent, Locked Posterior Glenohumeral Dislocation Requiring Hemiarthroplasty and Posterior Bone Block With Humeral Head AutograftOrthopedics, Vol. 35, No. 2Acute Posterior Dislocations22 June 2011Failed Arthroscopic Repair of a Large Reverse Hill-Sachs Lesion Using Bone Allograft and Cannulated Screws: A Case ReportArthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 28, No. 1Posterior Shoulder Dislocation: Systematic Review and Treatment AlgorithmArthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. 27, No. 11Lateral Clavicular Autograft for Repair of Reverse Hill-Sachs DefectThe Open Orthopaedics Journal, Vol. 5, No. 1Bilateral posterior shoulder dislocation with defect secondary to hypoglycemic comaJournal of Orthopaedic Science, Vol. 16, No. 1Shoulder and humerusGlenohumeral instabilityClosed Reduction of Bilateral Posterior Shoulder Dislocation with Medium Impression Defect of the Humeral Head: A Case Report and Review of Its TreatmentCase Reports in Medicine, Vol. 2011Die dorsal verhakte Schulterluxation6 November 2010 | Obere Extremität, Vol. 5, No. 4Articular cartilage and labral lesions of the glenohumeral joint: diagnostic performance of 3D water-excitation true FISP MR arthrography17 December 2009 | Skeletal Radiology, Vol. 39, No. 5Chronic locked posterior shoulder dislocation with severe head involvement20 March 2009 | International Orthopaedics, Vol. 34, No. 1ShoulderSHOULDERLes luxations invétérées de l’épauleRéférencesBilateral Traumatic Locked Posterior Dislocation of the Shoulder - A Case Report -The Journal of the Korean Shoulder and Elbow Society, Vol. 12, No. 2Reconstruction of Humeral Head Defect for Locked Posterior Shoulder DislocationOrthopedics, Vol. 32, No. 9Rehabilitation and Functional Outcomes in Collegiate Wrestlers Following a Posterior Shoulder Stabilization ProcedureJournal of Orthopaedic & Sports Physical Therapy, Vol. 39, No. 7Modified MacLaughlin procedure in the treatment of neglected posterior dislocation of the shoulder16 March 2009 | MUSCULOSKELETAL SURGERY, Vol. 93, No. S1Tratamiento quirúrgico de la inestabilidad posterior del hombroEMC - Técnicas Quirúrgicas - Ortopedia y Traumatología, Vol. 1, No. 1Reconstruction of a missed posterior locked shoulder fracture-dislocation with bone graft and lesser tuberosity transfer: a case report5 August 2008 | Journal of Medical Case Reports, Vol. 2, No. 1Acute Traumatic Posterior Shoulder Dislocation: MR FindingsRadiology, Vol. 248, No. 1Arthroscopy-assisted reduction of impression fracture of the humeral head: A case reportJournal of Shoulder and Elbow Surgery, Vol. 17, No. 3Diagnostik und Behandlungsregime der traumatischen dorsalen Schulterluxation2 June 2007 | Der Unfallchirurg, Vol. 110, No. 12Posterior shoulder subluxation most likely caused by retching in the lateral head-down position for prevention of aspirationJournal of Clinical Anesthesia, Vol. 19, No. 8Allografts in the Treatment of Athletic Injuries of the ShoulderSports Medicine and Arthroscopy Review, Vol. 15, No. 3Anatomical reconstruction for Reverse Hill-Sachs lesions after posterior locked shoulder dislocation fracture: a case series of six patients24 May 2007 | Archives of Orthopaedic and Trauma Surgery, Vol. 127, No. 7Emergency Department Management of Selected Orthopedic InjuriesEmergency Medicine Clinics of North America, Vol. 25, No. 3One-stage operation for locked bilateral posterior dislocation of the shoulderA. Ivkovic, I. Boric, N. Cicak1 June 2007 | The Journal of Bone and Joint Surgery. British volume, Vol. 89-B, No. 6Closed Reduction for Traumatic Posterior Dislocation of the Shoulder Using the ‘Lever Principle’: Two Case Reports and a Review of the Literature4 December 2016 | Journal of Orthopaedic Surgery, Vol. 14, No. 3The success of closed reduction in acute locked posterior fracture-dislocations of the shoulderJournal of Shoulder and Elbow Surgery, Vol. 15, No. 6Humeral head impression fracture in acute posterior shoulder dislocation: new surgical technique5 January 2006 | Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 14, No. 7Traitement chirurgical de la luxation post-traumatique gléno-humérale postérieureJournal de Traumatologie du Sport, Vol. 23, No. 2Traitement chirurgical de l'instabilité postérieure de l'épauleEMC - Techniques chirurgicales - Orthopédie - Traumatologie, Vol. 1, No. 1POSTERIOR SHOULDER DISLOCATIONS AND FRACTURE-DISLOCATIONSThe Journal of Bone and Joint Surgery-American Volume, Vol. 87, No. 3 Vol. 86-B, No. 3 Metrics History Published online 1 April 2004 Published in print 1 April 2004 InformationCopyright © 2004, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

The purpose of this study was to determine the publication rates of presentations made at the annual meetings of 2 sports medicine specialty societies--the American Orthopaedic Society for Sports Medicine (AOSSM) and the Arthroscopy Association of North America (AANA). We created a database covering annual AOSSM meetings from 1990 to 1993 (4 years) and annual AANA meetings from 1991 to 1993 (3 years) and searched the Melvyl Medline Plus database for abstracts from 1990 through 1998 to determine which had been published in peer-reviewed journals. Of the 333 abstracts listed for the 1990 to 1993 meetings, 198 (59.5%) were published in peer-reviewed journals. Publication rates of the AOSSM and AANA meetings were 68.1% and 50.9%, respectively. The majority of articles were published in American Journal of Sports Medicine (40.1%) and Arthroscopy (30.3%). Publication rates of presentations made at meetings of these sports medicine specialty societies are high and exceed the publication rates associated with meetings of other medicine specialty societies.

BACKGROUND: The gender gap among authors publishing research in journals is narrowing in general medicine and various medical and surgical subspecialties. However, little is known regarding the gender gap among authors publishing research in orthopaedic journals. QUESTIONS/PURPOSES: (1) What is the proportion of women first and last authors of original research articles in three high-impact orthopaedic journals from 2006 to 2017? (2) What is the proportion women first authors of original research by orthopaedic subspecialty from 2006 to 2017? METHODS: A sample of original research publications from the even numbered months of issues of Clinical Orthopaedics and Related Research® (CORR®), the Journal of Bone and Joint Surgery, American volume (JBJS), and the American Journal of Sports Medicine (AJSM) were examined from 2006 to 2017. These journals were selected because of their clinical relevance, target audience, and relatively high impact factors. Over the studied period, a single author extracted and reviewed pertinent data, including the gender of the first and last authors and the primary subspecialty of the research article. The senior author refereed disputes regarding the primary subspecialty of each included article. The proportion of women first and last authors in each journal was compared between 2006 to 2017 using chi-square analysis. The proportion of women first authors according to orthopaedic subspecialty in which an article primarily focused its study was also compared between 2006 to 2017 using chi-square analysis. RESULTS: Data were collected from 6292 articles, 13% (800) of which were first-authored by women and 10% (604) of which were last-authored by women. From 2006 to 2017, the overall percentage of women first authors in the examined journals increased (from 11% in 2006 to 17% in 2017; odds ratio 1.6563 [95 % CI 1.4945 to 1.8356]; p < 0.001). Overall across the period studied, the percentage of women first authors in JBJS was 14% while 12% of first authors in CORR and AJSM were women. Regarding subspecialty, the percentage of women first authorship ranged from 9% in the shoulder subspecialty to 21% in pediatric orthopaedics across all three journals. CONCLUSIONS: There has been an increase in the percentage of women first authors in articles published in three high-impact orthopaedic journals from 2006 to 2017. This observed increase is encouraging in terms of promoting gender diversity in orthopaedics and may be reflective of a modest increase in the number of women entering the orthopaedic workforce. CLINICAL RELEVANCE: Between 2006 and 2017, the overall number of women first authors in CORR, JBJS, and AJSM modestly increased. This may suggest a nascent narrowing of the gender gap in orthopaedics. Although this is a welcome finding in terms of promoting and encouraging gender diversity in this man-dominated field, the overall percentage of women authorship remains modest, at best. Future investigations should examine whether the modest increase in women first authorship over time found in this study translates into an increased percentage of senior/last authorship in the future, as this may have implications for women orthopaedic workforce retention.

This study reports on the disability of 103 patients with symptomatic chronic laxity of the an tenor cruciate ligament that was uncomplicated by other associated major ligament deficiency or prior lig ament reconstructive procedures. All of the patients were evaluated at an average of 5.5 years after injury but a subgroup of thirty-nine patients was evaluated at an average of 11.2 years after injury. All had been ac tive in sports, with two-thirds participating in high school or college athletics. The diagnosis of a tear of the anterior cruciate ligament was made by the original treating physician in only seven (6.8 per cent) of the 103 knees. Sixty-four patients (62 per cent) stated that the pain that followed the injury restricted normal ac tivities for longer than three weeks. Eighty-five patients (82 per cent) had returned to some form of sports ac tivity. This gave a false initial impression that the in jury was not eventually disabling for sports, as a sig nificant reinjury occurred in thirty-six patients (35 per cent) within six months and in fifty-three patients (51 per cent) within one year after the original injury. At follow-up five years later, only thirty-six patients (35 per cent) were participating in strenuous sports. A significantumber of patients withlonger follow-up had knee symptoms that affected their routine daily and recreational activities. A subjective moderate to severe over-all disability was reported by thirty-two patients (31 per cent) for walking activities alone, by forty-five patients (44 per cent) for over-all routine activities of daily living, and by seventy-seven patients (74 per cent) for turning or twisting sports ac tivities. Pain occurred in thirty-one patients (30 per cent) during walking activities, in forty-eight patients (47 per cent) during recreational activities, and in seventy-one patients (69 per cent) during strenuous sports activities. Twenty-two patients (21 per cent) complained of giving-way during walking activities; thirty-four patients (33 per cent), during recreational sports; and sixty-six patients (65 per cent), during 4 Supported in part by National Institutes of Health Grants AM2I 172 and AM27517 from the Musculoskeletal Disease Program of the National Institute of Arthritis, Diabetes, Digestive and Kidney Dis eases. t Cincinnati Sports Medicine and Orthopaedic Center, 1 Lytle Place, Cincinnati, Ohio 45202. @ Department ofOrthopaedic Surgery, Hospital ofthe University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104. §Department of OrthopaedicSurgery,Universityof Pittsburgh, Pittsburgh, Pennsylvania 15213. strenuous sports. Joint swelling occurred four to five times as frequently in the patients who had had the in jury for the longest time (average, 11.2 years). If the patient had had a meniscectomy, there was a statisti cally significant twofold to fourfold increase in symp toms of pain and swelling related to activity. Giving way was not affected, as this is related to instability of the anterior cruciate ligament. Significant roentgeno graphic changes of arthritis were noted in nineteen (21 per cent) of ninety-one patients starting at an average of 109 months after injury. Seventeen patients (44 per cent) in the subset with the longest follow-up had sig nificant roentgenographic changes. These changes cor related statistically with participation in strenuous sports activities, with running activities, and with giving-way. Important qualifications to this retrospective study are: (1) the patients studied were limited to those with tears of the anterior cruciate ligament who sought treatment for relief of their symptoms, (2) these pa tients continued to be active athletically and thus con tinued to abuse their knees, and (3) none of the patients had had proper initial treatment, rehabilitation, or counseling which might have prevented joint deterio ration. As a whole, the results show the significant functional disability found in the patient with a symp tomatic anterior cruciate-deficient knee, initially for sports activities but later, following reinjury, for meniscal damage, joint arthritis, and the activities of daily living. A dilemma still exists concerning the proper treat ment of a knee with a deficient anterior cruciate ligament, largely because of a lack of knowledge of the extent of the functional disability caused by such an injury'5'8'9―2―@ 21.23.25.27 Our goal was to study a sufficient number of pa tients whose knees demonstrated anterior cruciate laxity alone, without the superimposed variables introduced by previous operative procedures or complicated by other types of ligament instability. The study group also had to contain a sufficient number of patients whose injuries had been sustained at least five years and ten years previously, to allow statistical evaluation of long-term disability. Of importance in this study, as contrasted to many prior studies, is the rigorous grading of symptoms and their severity as related to the specific type of activity during which they occurred. 154 THE JOURNAL OF BONE AND JOINT SURGERY on December 4, 2006 www.ejbjs.org Downloaded from THE SYMPTOMATIC ANTERIOR CRUCIATE-DEFICIENT KNEE 155 years earlier (range, three months to 33.3 years). Twelve patients had been injured one year earlier and thirty-three, two years earlier. For a portion of the analysis, the group was divided into sixty-four patients who had been injured less than five years earlier and thirty-nine patients who had been injured at or more than five years earlier. The symptoms of pain, swelling, and giving-way were ranked as slight, moderate, or severe, as follows: slight —? occasional recurrent minor discomfort, not inter fering with activity; moderate —? symptoms usually brought on by an activity, interfering with activity, and relieved by stopping activity or rest; and severe —? symp toms occurring with activity, persisting and lasting over night or days, significantly interfering with activity (usu ally the patient must stop activity). Of the 103 patients in this study, fifty-one had had a meniscectomy, including six patients who had two menis cectomies. A total ofsixty-five menisci had been removed, of which forty-seven were medial, thirteen were lateral, and five were unknown. Fourteen patients had had both menisci removed. Fourteen meniscectomies had been per formed within three weeks after the initial injury and thirty-seven, within one year after injury. The remainder of the procedures were distributed throughout the remain ing years. Roentgenograms of ninety-one of the 103 knees were graded for degenerative arthritic changes, as follows: mm imum —? squaring of femoral and tibial margins, sub chondral sclerosis, no joint narrowing, and no significant osteophyte formation; moderate —? narrow joint-cartilage space, significant subchondral sclerosis, and osteophyte formation; or severe —? the aforementioned criteria plus obliteration of the joint-cartilage space.

BACKGROUND: Orthopaedic studies have reported the prevalence of injuries and outcomes after treatment in men and women patients, and although these differences have been recognized, few studies have evaluated for gender-specific injury patterns, disease progression, and treatment outcomes. A thorough understanding of gender-related differences is important to better individualize treatment and improve outcomes. QUESTIONS/PURPOSES: In this study, we sought (1) to determine the proportion of studies published in six orthopaedic journals that provided sex- or gender-specific analyses in 2016 and whether a difference was found in outcomes between men and women and (2) to evaluate whether this proportion varied across several orthopaedic subspecialty journals or between general orthopaedic journals and subspecialty journals. METHODS: Six leading orthopaedic surgery journals were selected for review, including two general orthopaedic journals (Journal of Bone and Joint Surgery and Clinical Orthopaedics and Related Research®) and four subspecialty journals (American Journal of Sports Medicine, Journal of Arthroplasty, Journal of Shoulder and Elbow Surgery, and Spine). Journal issues published in the even-numbered months of 2016 were reviewed for clinical randomized controlled, cohort, and case-control studies in which women were a part of the study population. A total of 712 studies evaluating 24,607,597 patients met the criteria and were included in our review of publications from 2016. The selected studies were stratified based on whether gender was a variable in a multifactorial statistical model. Outcomes of interest included the proportion of patients who were women and the presence or absence of a gender-specific analysis. These endpoints were compared between journals. RESULTS: Overall, 55% (13,565,773 of 24,607,597) of patients analyzed in these studies were women. Only 34% (241 of 712) of the studies published in 2016 included gender as variable in a multifactorial statistical model. Of these, 39% (93 of 241) demonstrated a difference in the outcomes between patients who were men and women. The Journal of Arthroplasty had the greatest percentage of patients who were women (60%, 9,251,068 of 15,557,187) and the American Journal of Sports Medicine had the lowest (44%, 1,027,857 of 2,357,139; p < 0.001). Orthopaedic subspecialty journals tended to include a greater percentage of women (54%) than did general orthopaedic journals (50%; p = 0.04). CONCLUSION: Currently, it is unclear what percentage of published orthopaedic studies should include a gender-specific analysis. In the current study, more than one-third of publications that performed a gender-specific analysis demonstrated a difference in outcomes between men and women, thereby emphasizing the need to determine when such an analysis is warranted. CLINICAL RELEVANCE: Future studies should aim to determine when a gender-specific analysis is necessary to improve the management of orthopaedic injuries in men and women. It is important for investigators at the individual-study level to look for every opportunity to ensure that both men's and women's health needs are met by performing appropriate by-sex and by-gender analyses, but not to perform them when they are unnecessary or inappropriate.

Over the past thirty years, the subspecialty of sports medicine has evolved into a major component of the practice of orthopaedic surgery. Since its genesis in the early 1970s, sports medicine has evolved from the province of a small group of orthopaedists covering athletic teams into a major body of knowledge fueled by clinicians, scientists, and industry. Well-established educational curricula defining and prioritizing all areas of sports medicine now exist at the resident, fellowship, and subspecialty-society levels. The purpose of this article is to review and to put into perspective recent scientific and educational advancements in sports medicine. This overview is based on papers presented in 2000 at both the annual and subspecialty meetings of the American Orthopaedic Society for Sports Medicine (AOSSM), the Arthroscopy Association of North America (AANA), the Orthopaedic Research Society (ORS), and the American Academy of Orthopaedic Surgeons (AAOS). Papers published from September 1999 through August 2000 in the American Journal of Sports Medicine (six volumes), Arthroscopy (twelve volumes), and The Journal of Bone and Joint Surgery (twelve volumes) are reviewed, and their major contributions to orthopaedic sports medicine are summarized. This general overview of papers and presentations is followed by a summary of new developments in the study of the knee and shoulder as well as in other aspects of sports medicine, a discussion of emerging technologies in basic-science research, and an update on educational and socioeconomic issues. Between September 1999 and August 2000, research in orthopaedic sports medicine was featured in over 250 oral presentations at the annual and Specialty Day meetings of the American Orthopaedic Society for Sports Medicine, the Arthroscopy Association of North America, the Orthopaedic Research Society, and the American Academy of Orthopaedic Surgeons. Almost two-thirds of the studies focused on surgical techniques or clinical outcomes data, with just over a …

Beginning this month, the Journal is introducing the routine reporting of a level of evidence rating with all therapeutic, prognostic, diagnostic, and economic studies. The level of evidence system is an evidence-based medicine tool that applies a hierarchal rating to a study's strength of evidence based on its study design. Many readers are quite familiar with this tool, as its use has become widespread in medicine and orthopaedics. The purpose of this editorial is to briefly outline the new process for assigning the level of evidence, the rationale for its use, and future directions for the Journal. For all new manuscript submissions, authors will be asked to include a level of evidence rating as part of the structured abstract. An online level of evidence calculator and reference table has been developed to simplify the process. Once a manuscript is accepted for publication, an evidence-based orthopaedic section editor will confirm the level of evidence. The rating system is summarized in Table 1.TABLE 1: Levels of Evidence by Study TypeThe purpose of implementing the level of evidence system is primarily 3-fold. First, this rating system provides a concise description of a study's design, which allows readers to quickly identify potential high impact research. Second, drawing attention to a study's design may encourage authors to clarify their primary research question and to elevate the strength of their studies by including control groups or prospective study designs when possible. Finally, the widespread use of the levels of evidence rating system in other orthopaedic journals and subspecialty meetings has created a readership that is accustomed to obtain this information in a manuscript's abstract. Currently, leading journals in general orthopaedics, sports, pediatrics, and shoulder and elbow surgery have adopted the use of this rating system for their published manuscripts. Despite the benefits and enthusiasm for the levels of evidence rating system in the orthopaedic literature, we realize that there are limitations of the current system. Because it is based primarily on the study's design, other important quality criteria are not directly considered. Furthermore, level I studies are not possible for every clinical situation, particularly in trauma populations. For some research questions, a well-designed level III or IV study remains important to generate hypotheses and to fuel further research. This is demonstrated in the present issue by the prospective level IV study from Paul et al providing early data on the effects of fracture pattern and trochanteric entry nailing on gait parameters in intertrochanteric hip fractures. Finally, introducing the levels of evidence rating system to the Journal will serve as a springboard for several other Journal led innovations to promote evidence-based orthopaedic traumatology. In the near future, we will begin to offer evidence-based reports for select high impact articles as an adjunct resource for the Journal's readership. These Advanced Clinical Evidence reports will be available online and will provide an independent critical appraisal in a journal club friendly format. We encourage comments and feedback throughout the implementation process of the levels of evidence rating system and the other proposed changes.

Background: Inappropriate referencing of the existing literature has the potential to propagate false information. Quotation errors are defined as citations in which the referenced article fails to substantiate the authors’ claims. The aim of this study was to determine the rate of quotation errors in high-impact general orthopaedic and sports medicine journals and to determine whether there are article or journal-related factors that are related to the rate of inaccuracies. Methods: A total of 250 citations from the 5 orthopaedic and sports medicine journals with the highest impact factors in 2019 (per Journal Citation Reports) were chosen using a random sequence generator. Reviewers rated the chosen citations by comparing the claims made by the authors with the data and conclusions of the referenced source to determine whether quotation errors were present. Logistic regression was utilized to assess for article- and journal-related factors related to the rate of quotation errors. Results: The overall quotation error rate was 13.6%. A total of 2.8% of the claims were completely unsubstantiated. The number of quotation errors did not significantly differ between the included journals. Single citations were significantly more likely than string citations to result in citations that could not be fully substantiated (χ 2 = 4.57; odds ratio = 2.22; 95% confidence interval = 1.06 to 4.66; p = 0.03). No relationship was found between the rate of quotation errors and the total number of citations in the article, study type, or the graded level of evidence of the article. Conclusions: Quotation errors in high-impact factor orthopaedic and sports medicine journals are common. This is particularly important given the higher likelihood that studies in these journals are cited elsewhere, thus propagating the inaccuracies. Efforts from both authors and journals are needed to reduce quotation errors in the orthopaedic literature.

BACKGROUND: The citation rate of a research published article is an indicator of its quality and impact and contributes to the journal's impact factor. Within the orthopaedic sports medicine literature, predictors of citation rates have not been previously described. PURPOSE: To identify characteristics of published articles that predict 5-year citation rates of studies in the orthopaedic sports medicine literature. STUDY DESIGN: Cross-sectional study. METHODS: Research articles published in The American Journal of Sports Medicine (AJSM), Arthroscopy: The Journal of Arthroscopic and Related Surgery, and Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) from 2012 were analyzed. Extracted characteristics of published articles included journal, author number, origin of study, first author degree, subject of study, study type, sample size, number of references and institutions, conflicts of interest, level of evidence, and 5-year citation rates. Multivariate logistic regression was used to determine predictors of greater than the mean number of citations at 5 years. RESULTS: A total of 825 published articles ( AJSM, n = 313; Arthroscopy, n = 173; KSSTA, n = 339) were included in the final analysis. The mean number of 5-year citations was 23.2 (95% CI, 21.6-24.9; range, 1.0-260.0). AJSM had a significantly greater citation rate (32.4) than Arthroscopy (21.7) and KSSTA (15.2) ( P < .001 for both). Arthroscopy had a greater citation rate than KSSTA ( P = .008). Independent predictors of greater than the mean number of citations at 5 years were published articles in AJSM (odds ratio [OR], 5.17; 95% CI, 2.81-9.52; P < .0001), published articles of North American origin (OR, 1.79; 95% CI, 1.25-2.58; P = .002), and published articles regarding the hip (OR, 2.68; 95% CI, 1.08-6.67; P = .035). CONCLUSION: Published articles in AJSM, those from North America, and those examining the hip were independent predictors of greater citation rates at 5 years.

BACKGROUND: With the advent of smartphones together with their downloadable applications (apps), there is increasing opportunities for doctors, including orthopaedic sports surgeons, to integrate such technology into clinical practice. However, the clinical reliability of these medical apps remains questionable. We reviewed available apps themed specifically towards Orthopaedic Sports Medicine and related conditions and assessed the level of medical professional involvement in their design and content, along with a review of these apps. METHOD: The most popular smartphone app stores (Android, Apple, Blackberry, Windows, Samsung, Nokia) were searched for Orthopaedic Sports medicine themed apps, using the search terms; Orthopaedic Sports Medicine, Orthopaedics, Sports medicine, Knee Injury, Shoulder Injury, Anterior Cruciate Ligament Tear, Medial Collateral Ligament Tear, Rotator Cuff Tear, Meniscal Tear, Tennis Elbow. All English language apps related to orthopaedic sports medicine were included. RESULTS: A total of 76 individual Orthopaedic Sports Medicine themed apps were identified. According to app store classifications, there were 45 (59 %) medical themed apps, 28 (37 %) health and fitness themed apps, 1 (1 %) business app, 1 (1 %) reference app and 1 (1 %) sports app. Forty-nine (64 %) apps were available for download free of charge. For those that charged access, the prices ranged from £0.69 to £69.99. Only 51 % of sports medicine apps had customer satisfaction ratings and 39 % had named medical professional involvement in their development or content. CONCLUSIONS: We found the majority of Orthopaedic Sports Medicine apps had no named medical professional involvement, raising concerns over their content and evidence-base. We recommend increased regulation of such apps to improve the accountability of app content.

Purpose To evaluate the quality and content of internet‐based information available for some of the most common orthopaedic sports medicine terms. Methods A search of the PubMed, Embase, and Cochrane databases following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐analyses) guidelines was performed. All English‐language literature published from 2010 to 2020 discussing information quality pertaining to orthopaedic sports medicine terms was included. Outcomes included the search engines used, number and type of websites evaluated, platform, and quality scoring metrics. Descriptive statistics are presented. Results This review includes 21 studies. Of these, 3 evaluated both the upper and lower extremity. Twelve focused on either the upper or lower extremity, most commonly rotator cuff tears (3 of 12) and/or anterior cruciate ligament pathologies (7 of 12). The most common engines were Google (18 of 21), Bing (16 of 21), Yahoo (16 of 21), YouTube (3 of 21), Ask (3 of 21), and AOL (2 of 21). The average number of media files assessed per study was 87 ± 55. Website quality was assessed with DISCERN (7 of 21), Flesch‐Kincaid (9 of 21), Health on the Net (7 of 21), and/or Journal of the American Medical Association Benchmark (7 of 21) scores. YouTube was evaluated with Journal of the American Medical Association Benchmark scores (1.74 ± 1.00). Image quality was reported in 2 studies and varied with search terminology. Conclusions The results of this systematic review suggest that physicians should improve the quality of online information and encourage patients to access credible sources when conducting their own research. Clinical Relevance Doctors can and should play an active role in closing the gap between the level of health literacy of their patients and that of most common online resources.

The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016, an open meeting held in the UK on 27-29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0-10. Substantial agreement (range 9.5-10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term 'femoroacetabular impingement syndrome' was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.Author note The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise Medicine (BASEM), British Association of Sport Rehabilitators and Trainers (BASRaT), Canadian Academy of Sport and Exercise Medicine (CASEM), Danish Society of Sports Physical Therapy (DSSF), European College of Sports and Exercise Physicians (ECOSEP), European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), Finnish Sports Physiotherapist Association (SUFT), German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), International Federation of Sports Physical Therapy (IFSPT), International Society for Hip Arthroscopy (ISHA), Groupo di Interesse Specialistico dell'A.I.F.I., Norwegian Association of Sports Medicine and Physical Activity (NIMF), Norwegian Sports Physiotherapy Association (FFI), Society of Sports Therapists (SST), South African Sports Medicine Association (SASMA), Sports Medicine Australia (SMA), Sports Doctors Australia (SDrA), Sports Physiotherapy New Zealand (SPNZ), Swedish Society of Exercise and Sports Medicine (SFAIM), Swiss Society of Sports Medicine (SGMS/SGSM), Swiss Sports Physiotherapy Association (SSPA).

Purpose To determine how well the orthopaedic sports medicine literature reported sex‐specific analysis (SSA) in 2011 and 2016. Methods The 3 highest‐impact orthopaedic sports medicine subspecialty journals ( American Journal of Sports Medicine ; Arthroscopy ; and Knee Surgery, Sports Traumatology , Arthroscopy ) were selected for review. Two independent investigators reviewed all journal issues published during 2 different calendar years (2011 and 2016). All randomized controlled, prospective and retrospective group, and case–control studies were included. Studies were stratified into those that involved SSA, where sex was a variable in a multifactorial statistical model, and those that only reported sex as a demographic characteristic or used sex‐matched groups without further analysis. Results A total of 960 studies evaluating 3,400,569 patients met criteria and were included in this review. Although 44.4% of the overall study population was female, only 293 (30.5%) studies included patient sex as variable in a multifactorial statistical model. The proportion of studies that performed SSA did not differ between 2011 (29.6%) and 2016 (31.1%; P = .607), although publications from American Journal of Sports Medicine were likely to report SSA ( P &lt; .05). Of the 293 studies that reported SSA, 91 (31%) demonstrated a significant difference in outcomes. The most commonly reported differences were in outcomes following anterior cruciate ligament, medial patellofemoral ligament, and posterior cruciate ligament reconstruction; autograft preparation; postoperative use of opiates following arthroscopy; and recovery after sports‐related concussions. Conclusions Although most sports medicine studies include approximately 50% female and 50% male patients, statistical analysis differentiating the 2 subsets is not routinely performed. Only 30.5% of all studies performed SSA, 31% of which reported a statistically significant difference in the data when comparing outcomes between male and female patients with the same treatment modalities. Clinical Relevance The current study demonstrates that the orthopaedic sports medicine subspecialty literature is lacking in reporting SSA, and that there has been minimal improvement over a 5‐year time period. In addition, this study highlights the high percentage of significant findings within the studies that performed SSA and underscores the differences in sex‐specific injury patterns and treatment outcomes.

Background: Research productivity is considered an important factor in academic advancement in sports medicine. No study to date has evaluated academic productivity and correlates of academic rank for sports medicine fellowship faculty. Purpose: To describe the academic productivity of American Orthopaedic Society for Sports Medicine (AOSSM) fellowship program faculty and to determine the association between academic productivity, fellowship characteristics, and academic rank. Study Design: Descriptive epidemiology study. Methods: Characteristics of orthopaedic sports medicine fellowship programs were obtained from the AOSSM and program websites. Metrics of academic productivity (Hirsch index [ h index], I-10 index, publications, citations, and number of publications in several journals) were obtained from Scopus. Statistical analyses were conducted to determine whether academic productivity differs with fellowship attributes and academic rank. Results: A total of 90 AOSSM sports medicine fellowship programs with 610 associated faculty members were identified. Faculty were predominantly male (94%), at academic medical centers (74%), members of AOSSM (71%), and sports medicine–fellowship trained (84%). Faculty had a median of 18 (range, 0-684) publications overall, including a median of 3 (range, 0-161) publications since 2012. All measures of academic productivity were significantly higher among faculty employed at academic medical centers compared with those not employed at academic centers ( P &lt; .05 in all cases). On multivariate ordinal regression analysis, the best correlates of higher academic rank were higher cumulative h index (1.22; P &lt; .001) and longer time in practice since fellowship (1.14; P &lt; .001), which predicted 63.8% of the variance in academic rank. Fellowships with a larger number of fellows had more publications and citations per faculty member, higher faculty cumulative h index, and more publications in the American Journal of Sports Medicine and Arthroscopy per faculty member ( P &lt; .017). Regional differences were present, with the Northeast fellowship faculty the most productive, followed by the Midwest. Conclusion: Higher cumulative h index and more years in practice were the best correlates of higher academic rank among AOSSM sports medicine fellowship faculty. Research productivity was higher among faculty employed at academic centers in the Northeast and Midwest regions and at programs with a larger number of fellows.

BACKGROUND: The number of systematic reviews published in the orthopaedic literature has increased, and these reviews can help guide clinical decision making. However, the quality of these reviews can affect the reader's ability to use the data to arrive at accurate conclusions and make clinical decisions. PURPOSE: To evaluate the methodological and reporting quality of systematic reviews and meta-analyses in the sports medicine literature to determine whether such reviews should be used to guide treatment decisions. The hypothesis was that many systematic reviews in the orthopaedic sports medicine literature may not follow the appropriate reporting guidelines or methodological criteria recommended for systematic reviews. STUDY DESIGN: Systematic review. METHODS: All clinical sports medicine systematic reviews and meta-analyses from 2009 to 2013 published in The American Journal of Sports Medicine (AJSM), The Journal of Bone and Joint Surgery (JBJS), Arthroscopy, Sports Health, and Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) were reviewed and evaluated for level of evidence according to the guidelines from the Oxford Centre for Evidence-Based Medicine, for reporting quality according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and for methodological quality according to the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Analysis was performed by year and journal of publication, and the levels of evidence included in the systematic reviews were also analyzed. RESULTS: A total of 200 systematic reviews and meta-analyses were identified over the study period. Of these, 53% included evidence levels 4 and 5 in their analyses, with just 32% including evidence levels 1 and 2 only. There were significant differences in the proportion of articles with high levels of evidence (P < .001) and low levels of evidence (P = .005) by journal. The average PRISMA score was 87% and the average AMSTAR score was 73% among all journals. The average AMSTAR and PRISMA scores were significantly different by journal (P = .002 and .001, respectively) and by year (P = .046 and .019, respectively). Arthroscopy, AJSM, and JBJS all scored higher than Sports Health and KSSTA on the PRISMA and AMSTAR. The average PRISMA score by year varied from 85% to 89%, and the average AMSTAR score varied from 70% to 76%. CONCLUSION: Systematic reviews and meta-analyses in orthopaedics sports medicine literature relied on evidence levels 4 and 5 in 53% of studies over the 5-year study period. Overall, PRISMA and AMSTAR scores are high and may be better than those in other disciplines. Readers need to be conscious of potential shortcomings when reading systematic reviews and using them in practice.

BACKGROUND: Presentations of clinically relevant data at AOSSM national meetings are presented yearly and may influence clinical decision making. HYPOTHESIS: The incidence of presentations that do not subsequently get published is high, and the numbers of major and minor inconsistencies, once published, are also high. STUDY DESIGN: Systematic review. METHODS: A database was created of all abstracts presented at AOSSM meetings from 1999 to 2001 from official program books. To assess whether each abstract had been followed by publication in a peer-reviewed journal, a PubMed search was conducted to include a 5-year follow-up for each conference. Minor inconsistencies included differences in title, authors, presentation of all outcomes, and authors' interpretation of data. Major inconsistencies included discrepancies in study objective and/or hypothesis, study design, primary and secondary outcome measures, sample size, statistical analysis, results, and standard deviations/confidence intervals. RESULTS: Overall, 98 of the 165 abstracts presented at AOSSM national meetings from 1999 to 2001 were published in a peer-reviewed journal within 5 years, a publication rate of 59.4%. The median time to publication for all articles was 21 (range, 1-60) months. The majority of articles (61) were published in the American Journal of Sports Medicine (62.2%). The median number of major and minor inconsistencies from abstract to publication was 1 (range, 0-5) and 1 (range, 0-4), respectively. Sixty-two of the 98 published abstracts (63%) had at least 1 major inconsistency, while 79 (81%) had at least 1 minor inconsistency. In 5 manuscripts (5%), the authors' interpretation of the data had changed, and in 2 (2%), the change essentially invalidated the abstract. CONCLUSION: A large number of scientific presentations do not get published in a peer-reviewed journal. In addition, those published have a significant number of changes that, in a small percentage of cases, alter the validity of the original presentation. CLINICAL RELEVANCE: Orthopaedic surgeons and other attendees as well as nonattendees who reference conference abstracts need to exercise good judgment when considering the implications of oral presentations of unpublished materials. When reviewing meeting presentation abstracts, readers should remember that the material being presented is often not in its definitive or ultimate form.

BACKGROUND: Properly designed and conducted systematic reviews can reliably produce valid pooled treatment-effect estimates and are an important resource for clinical decision-making. The purpose of this report was to assess the reporting and methodological quality of systematic reviews in orthopaedic journals. METHODS: With use of the 2010 Institute for Scientific Information (ISI) Thomson Reuters Journal Citation Reports, the five orthopaedic surgery journals with the highest impact factors were searched by one individual over a five-year period (from 2006 to 2010) for systematic reviews and meta-analyses. The two authors separately and independently assessed the included studies. The reporting quality was assessed with use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and the methodological quality was assessed with use of the Assessment of Multiple Systematic Reviews (AMSTAR) guidelines, both of which are accepted instruments. We calculated the proportions of each item reported within and across journals. RESULTS: Seventy-six systematic reviews and meta-analyses were included. Of the five journals that were examined, articles from The Journal of Bone and Joint Surgery (American Volume) had the best reporting. Articles from The American Journal of Sports Medicine fulfilled the most methodological quality items. The papers from all of the journals reported an average of only 68% of the PRISMA items and only 54% of the AMSTAR quality items. CONCLUSIONS: Both reporting and methodological quality in the top five orthopaedic journals were poor; the reporting quality was slightly superior to the methodological quality. Although there was a wide range of reporting quality and methodological quality scores across the journals, the included articles demonstrated inadequate adherence to accepted standards of quality. The use of PRISMA and AMSTAR guidelines in designing, implementing, and writing systematic reviews is recommended to improve the quality of systematic reviews and meta-analyses in orthopaedic journals. CLINICAL RELEVANCE: The validity of published systematic reviews in orthopaedics is questionable, and their contribution to clinical decision-making is suboptimal. Clinicians should be careful when interpreting and applying findings of current orthopaedic systematic reviews.