scholarly journals Assessment and Trends of the Methodological Quality of the Top 50 Most Cited Articles on Patellar Instability

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097201
Author(s):  
Avinesh Agarwalla ◽  
Kaisen Yao ◽  
Christon Darden ◽  
Anirudh K. Gowd ◽  
Seth L. Sherman ◽  
...  
Keyword(s):  
Methodological Quality ◽  
Patellar Instability ◽  
Treatment Options ◽  
The United States ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Wide Range ◽  
Significant Difference ◽  
The Mean ◽  
Number Of Citations

Background: Studies with a low level of evidence (LOE) have dominated the top cited research in many areas of orthopaedics. The wide range of treatment options for patellar instability necessitates an investigation to determine the types of studies that drive clinical practice. Purpose: To determine (1) the top 50 most cited articles on patellar instability and (2) the correlation between the number of citations and LOE or methodological quality. Study Design: Cross-sectional study. Methods: The Scopus and Web of Science databases were assessed to determine the top 50 most cited articles on patellar instability between 1985 and 2019. Bibliographic information, number of citations, and LOE were collected. Methodological quality was calculated using the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-Randomized Studies (MINORS). Mean citations and mean citation density (citations per year) were correlated with LOE, MCMS, and MINORS scores. Results: Most studies were cadaveric (n = 10; 20.0%), published in the American Journal of Sports Medicine (n = 13; 26.0%), published between 2000 and 2009 (n = 41; 82.0%), and conducted in the United States (n = 17; 34.0%). The mean number of citations and the citation density were 158.61 ± 59.53 (range, 95.5-400.5) and 12.74 ± 5.12, respectively. The mean MCMS and MINORS scores were 59.62 ± 12.58 and 16.24 ± 3.72, respectively. No correlation was seen between mean number of citations or citation density versus LOE. A significant difference was found in the mean LOE of articles published between 1990 and 1999 (5.0 ± 0) versus those published between 2000 and 2009 (3.12 ± 1.38; P = .03) and between 2010 and 2019 (3.00 ± 1.10; P = .01). Conclusion: There was a shift in research from anatomy toward outcomes in patellar instability; however, these articles demonstrated low LOE and methodological quality. Higher quality studies are necessary to establish informed standards of management of patellar instability.

scholarly journals Correlation Between Quality of Evidence and Number of Citations in Top 50 Cited Articles on Elbow Medial Ulnar Collateral Ligament Surgery

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876821 ◽  
Author(s):  
Robert A. Jack ◽  
Kyle R. Sochacki ◽  
Hannah A. Morehouse ◽  
Patrick C. McCulloch ◽  
David M. Lintner ◽  
...  
Keyword(s):  
Methodological Quality ◽  
Ulnar Collateral Ligament ◽  
The United States ◽  
Publication Date ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
The Mean ◽  
Level 1 ◽  
Number Of Citations

Background: Several studies have analyzed the most cited articles in shoulder, elbow, pediatrics, and foot and ankle surgery. However, no study has analyzed the quality of the most cited articles in elbow medial ulnar collateral ligament (UCL) surgery. Purpose: To (1) identify the top 50 most cited articles related to UCL surgery, (2) determine whether there was a correlation between the top cited articles and level of evidence, and (3) determine whether there was a correlation between study methodological quality and the top cited articles. Study Design: Systematic review. Methods: Web of Science and Scopus online databases were searched to identify the top 50 cited articles in UCL surgery. Level of evidence, number of times cited, year of publication, name of journal, country of origin, and study type were recorded for each study. Study methodological quality was analyzed for each article with the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-randomized Studies (MINORS). Correlation coefficients were calculated. Results: The 50 most cited articles were published between 1981 and 2015. The number of citations per article ranged from 20 to 301 (mean ± SD, 71 ± 62 citations). Most articles (92%) were from the United States and were level 3 (16%), level 4 (58%), or unclassified (16%) evidence. There were no articles of level 1 evidence quality. The mean MCMS and MINORS scores were 28.1 ± 13.4 (range, 3-52) and 9.2 ± 3.6 (range, 2-19), respectively. There was no significant correlation between the mean number of citations and level of evidence or quality ( rs = –0.01, P = .917), MCMS ( rs = 0.09, P = .571), or MINORS ( rs = –0.26, P = .089). Conclusion: The top 50 cited articles in UCL surgery constitute a low level of evidence and low methodological quality, including no level 1 articles. There was no significant correlation between the mean number of citations and level of evidence or study methodological quality. However, weak correlations were observed for later publication date and improved level of evidence and methodological quality.

scholarly journals Correlation Between Quality of Evidence and Number of Citations in Top 50 Cited Articles in Rotator Cuff Repair Surgery

2018 ◽  
Vol 6 (6) ◽  
pp. 232596711877663 ◽  
Author(s):  
Kyle R. Sochacki ◽  
Robert A. Jack ◽  
Richard Nauert ◽  
Joshua D. Harris
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Methodological Quality ◽  
The United States ◽  
Study Quality ◽  
Level Of Evidence ◽  
The Mean ◽  
Number Of Citations ◽  
The Impact ◽  
Cuff Repair

Background: The number of article citations has been used as a measure for the impact of an article in the medical literature, with little emphasis on quality. Purpose: To (1) identify the top 50 most cited articles related to rotator cuff repair surgery, (2) determine whether there was a correlation between the top cited articles and level of evidence, and (3) determine whether there was a correlation between the top cited articles and study quality. Study Design: Cross-sectional study. Methods: The Web of Science and Scopus online databases were searched to identify the top 50 cited articles in rotator cuff repair surgery. Methodological quality was analyzed for each article using the Modified Coleman Methodology Score (MCMS), Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS). Correlation coefficients were calculated to determine the degree of correlation between the top cited articles and level of evidence and study quality using each quality score. Results: The mean number of citations for each article in each of the 2 databases was 319 ± 187 (range, 177.5-1033.5). Twenty-nine articles (58%) were from the United States. The most common level of evidence was level 4 (54%), with 3 (6%) articles being level 1. There was no significant correlation between the mean number of citations and level of evidence ( rs = –0.28), the MCMS ( rs = –0.29), and the MINORS score ( rs = –0.25). There was a weak negative correlation between the mean number of citations and the Jadad score ( rs = –0.36). Conclusion: The top 50 cited articles in rotator cuff repair surgery comprise a variety of years, journals, countries of origin, and study types. Despite being the 50 most cited articles, the most common type of article was the level 4 case series with a poor mean quality assessment score. There was no significant correlation between the mean number of citations and level of evidence or methodological quality using a variety of scores.

scholarly journals Assessment and Trends in the Methodological Quality of the Top 50 Most Cited Articles in Shoulder Instability

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096708
Author(s):  
Avinesh Agarwalla ◽  
Kaisen Yao ◽  
Anirudh K. Gowd ◽  
Nirav H. Amin ◽  
J. Martin Leland ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Methodological Quality ◽  
Surgical Techniques ◽  
Case Series ◽  
Cross Sectional Study ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Number Of Citations

Background: Citation counts have often been used as a surrogate for the scholarly impact of a particular study, but they do not necessarily correlate with higher-quality investigations. In recent decades, much of the literature regarding shoulder instability is focused on surgical techniques to correct bone loss and prevent recurrence. Purpose: To determine (1) the top 50 most cited articles in shoulder instability and (2) if there is a correlation between the number of citations and level of evidence or methodological quality. Study Design: Cross-sectional study. Methods: A literature search was performed on both the Scopus and the Web of Science databases to determine the top 50 most cited articles in shoulder instability between 1985 and 2019. The search terms used included “shoulder instability,” “humeral defect,” and “glenoid bone loss.” Methodological scores were calculated using the Modified Coleman Methodology Score (MCMS), Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS) score. Results: The mean number of citations and mean citation density were 222.7 ± 123.5 (range, 124-881.5) and 16.0 ± 7.9 (range, 6.9-49.0), respectively. The most common type of study represented was the retrospective case series (evidence level, 4; n = 16; 32%) The overall mean MCMS, Jadad score, and MINORS score were 61.1 ± 10.1, 1.4 ± 0.9, and 16.0 ± 3.0, respectively. There were also no correlations found between mean citations or citation density versus each of the methodological quality scores. Conclusion: The list of top 50 most cited articles in shoulder instability comprised studies with low-level evidence and low methodological quality. Higher-quality study methodology does not appear to be a significant factor in whether studies are frequently cited in the literature.

Evaluation of Reduction Accuracy of Suture-Button and Screw Fixation Techniques for Syndesmotic Injuries

2016 ◽  
Vol 37 (12) ◽  
pp. 1317-1325 ◽  
Author(s):  
Onur Kocadal ◽  
Mehmet Yucel ◽  
Murad Pepe ◽  
Ertugrul Aksahin ◽  
Cem Nuri Aktekin
Keyword(s):  
Screw Fixation ◽  
Ct Scans ◽  
Functional Evaluation ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Suture Button ◽  
Fixation Group ◽  
Significant Difference ◽  
The Mean

Background: Among the most important predictors of functional results of treatment of syndesmotic injuries is the accurate restoration of the syndesmotic space. The purpose of this study was to investigate the reduction performance of screw fixation and suture-button techniques using images obtained from computed tomography (CT) scans. Methods: Patients at or below 65 years who were treated with screw or suture-button fixation for syndesmotic injuries accompanying ankle fractures between January 2012 and March 2015 were retrospectively reviewed in our regional trauma unit. A total of 52 patients were included in the present study. Fixation was performed with syndesmotic screws in 26 patients and suture-button fixation in 26 patients. The patients were divided into 2 groups according to the fixation methods. Postoperative CT scans were used for radiologic evaluation. Four parameters (anteroposterior reduction, rotational reduction, the cross-sectional syndesmotic area, and the distal tibiofibular volumes) were taken into consideration for the radiologic assessment. Functional evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale at the final follow-up. The mean follow-up period was 16.7 ± 11.0 months, and the mean age was 44.1 ± 13.2. Results: There was a statistically significant decrease in the degree of fibular rotation ( P = .03) and an increase in the upper syndesmotic area ( P = .006) compared with the contralateral limb in the screw fixation group. In the suture-button fixation group, there was a statistically significant increase in the lower syndesmotic area ( P = .02) and distal tibiofibular volumes ( P = .04) compared with the contralateral limbs. The mean AOFAS scores were 88.4 ± 9.2 and 86.1 ± 14.0 in the suture-button fixation and screw fixation group, respectively. There was no statistically significant difference in the functional ankle joint scores between the groups. Conclusion: Although the functional outcomes were similar, the restoration of the fibular rotation in the treatment of syndesmotic injuries by screw fixation was troublesome and the volume of the distal tibiofibular space increased with the suture-button fixation technique. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Social Media and Academic Impact: Do Early Tweets Correlate With Future Citations?

2021 ◽  
pp. 014556132110421
Author(s):  
Nilan G. Vaghjiani ◽  
Vatsal Lal ◽  
Nima Vahidi ◽  
Ali Ebadi ◽  
Matthew Carli ◽  
...  
Keyword(s):  
Social Media ◽  
Citation Rate ◽  
Cross Sectional Study ◽  
Academic Impact ◽  
Cross Sectional ◽  
Significant Difference ◽  
Social Media Platforms ◽  
The Mean ◽  
The Difference ◽  
Number Of Citations

Objective: Determine whether social media platforms can influence article impact as measured by citations. Methods: Cross-sectional study that analyzed articles published in the top 10 otolaryngology journals by Eigenfactor score in January 2015. Total accumulated Twitter mentions and citations were recorded in 2021. The main outcomes examined the difference in citations, tweets, article types, and author counts accumulated over a 5-year period for all articles that were either tweeted or nontweeted. Results: A total of 3094 articles were included for analysis. The average article was cited 11.2 ± 13.2 times and tweeted 2.10 ± 4.0 times. Sixty-four percent of the articles had at least one tweet. Over the study period, there was a statistically significant difference in mean number of citations between tweeted articles (12.1 ± 15.0) versus nontweeted articles (9.6 ± 10.5) citations, representing a 26% difference ( P < .001). Review articles had the highest mean citations (19.4 ± 23.4) while editorials had the lowest mean citations (2.8 ± 6.9). Tweets peaked in the year of publication, but citations continued to rise in the subsequent years. Tweeted articles’ peak citation rate change was +1.27 mean citations per year, compared to +0.99 mean citations per year in nontweeted articles. The mean author count in tweeted articles (5.40 ± 3.1) was not significantly different than the mean author count in nontweeted articles (5.19 ± 2.65, P = .0794). Conclusion: These data suggest a moderate correlation between tweets and article citations, but a clear difference in the number of citations in articles tweeted versus those with no tweets. Thus, dissemination of knowledge may be impacted by social medial platforms such as Twitter.

scholarly journals The Cost Variability of Orthobiologics

2019 ◽  
Vol 12 (1) ◽  
pp. 94-98
Author(s):  
Amit Mukesh Momaya ◽  
Andrew Sullivan McGee ◽  
Alexander R. Dombrowsky ◽  
Alan Joshua Wild ◽  
Naqeeb M. Faroqui ◽  
...  
Keyword(s):  
United States ◽  
Sports Medicine ◽  
Platelet Rich Plasma ◽  
Treatment Options ◽  
The United States ◽  
Median Income ◽  
Level Of Evidence ◽  
Significant Variability ◽  
The Mean ◽  
The Cost

Background: Mixed results exist regarding the benefit of orthobiologic injections. The purpose of this study was to assess the variability in costs for platelet-rich plasma (PRP) and stem cell (SC) injections and evaluate for variables that influence pricing. Hypothesis: There will be significant variability in the cost of PRP and SC injections throughout the United States. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Methods: Calls were made to 1345 orthopaedic sports medicine practices across the United States inquiring into the availability of PRP or SC knee injections and associated costs. In addition to pricing, the practice type, number of providers, and population and income demographics were recorded. Univariate statistical analyses were used to identify differences in availability and cost between variables. Results: Of the contacted offices that provided information on both PRP and SC availability (n = 1325), 268 (20.2%) offered both treatments, 550 (41.5%) offered only PRP injections, 20 (1.5%) offered only SC injections, and 487 (36.8%) did not offer either treatment. The mean ± SD cost of a PRP injection was $707 ± $388 (range, $175-$4973), and the mean cost of an SC injection was $2728 ± $1584 (range, $300-$12,000). Practices offering PRP and SC injections tended to be larger (PRP, 12.0 physicians per practice vs. 8.1 [ P < 0.001]; SC, 13.6 vs 9.7 [ P < 0.001]). Practices that offered PRP injections were located in areas with higher median household income ( P = 0.047). Variables associated with higher cost of PRP injections included city population ( P < 0.001) and median income of residents ( P < 0.001). Conclusion: While the majority of sports medicine practices across the United States offer some type of orthobiologic injection, there exists significant variability in the cost of these injections. Clinical Relevance: This study demonstrates the significant variability in costs of orthobiologic injections throughout the country, which will allow sports medicine physicians to appreciate the value of these injections when counseling patients on available treatment options.

scholarly journals Predictors of 5-Year Citation Rate in the Orthopaedic Sports Medicine Literature

2018 ◽  
Vol 47 (1) ◽  
pp. 206-211 ◽  
Author(s):  
Kamran Movassagi ◽  
Kyle N. Kunze ◽  
Edward C. Beck ◽  
Michael C. Fu ◽  
Shane J. Nho
Keyword(s):  
Sports Medicine ◽  
Conflicts Of Interest ◽  
Citation Rate ◽  
Final Analysis ◽  
Cross Sectional Study ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Interest Level ◽  
The Mean ◽  
Number Of Citations

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.

scholarly journals Psychological well-being of infertile women and its relationship with demographic factors and fertility history: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Farnaz Sohbati ◽  
Seyedeh Batool Hasanpoor-Azghady ◽  
Mina Jafarabadi ◽  
Leila Amiri-Farahani ◽  
Marzieh Mohebbi
Keyword(s):  
Demographic Factors ◽  
Well Being ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Psychological Well Being ◽  
Infertile Women ◽  
Wide Range ◽  
Significant Difference ◽  
The Mean

Abstract Background Infertility leads to a wide range of psychological injuries that may reduce psychological well-being. This study aimed to determine the psychological well-being of infertile women and its relation with demographic factors and fertility history. Methods This cross-sectional study was conducted on 300 infertile women referred to three infertility centres, Tehran, Iran. The sampling was continuous. We collected data from a self-generated demographic and fertility questionnaire and Ryff's Psychological Well-being Scale (PWB). Data analysis was done by independent t-test, one way ANOVA. The significance level was set at P < 0.05. Results The results showed that there was no significant relationship between demographic variables including age, occupation of each couple, spousal’s education, economic status and place of residence with PWB, but the mean score of PWB was significantly different in women's educational levels (P = 0.03). There was also a significant difference between the mean score of PWB among different groups in the duration of marriage (P = 0.01). Fertility characteristics variables include the duration of infertility, duration of treatment of infertility, and current treatment were not the relation with PWB. However, the mean score of PWB in the number of IVF (P = 0.003) and the failed IVF pregnancies (P = 0.01) had a significant statistical difference. Conclusion The results showed that PWB related to several variables. Paying attention to these variables can help in the preparation and development of counseling or educational programs.

scholarly journals Consumer Prices for Surgical Management of Ankle Arthritis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0045
Author(s):  
Niall Smyth ◽  
Brody Dawkins ◽  
Joshua Goldstein ◽  
Jonathan Kaplan ◽  
Amiethab Aiyer
Keyword(s):  
Surgical Management ◽  
Operative Management ◽  
The United States ◽  
Ankle Arthrodesis ◽  
Ankle Arthritis ◽  
Consumer Prices ◽  
Wide Range ◽  
Significant Difference ◽  
Private Center ◽  
The Mean

Category: Ankle Arthritis Introduction/Purpose: In the United States alone there are over 50,000 new cases of ankle arthritis every year. The financial healthcare burden for surgical management of ankle arthritis likely continues to rise with the volume of total ankle replacements (TAR) increasing 100-fold over the last 20 years. Healthcare consumers however are generally unaware of the costs of the services they use. Understanding the costs associated with operative management of ankle arthritis is an important facet of patient care although access to this information may not be readily available. The purpose of this study was to determine the access to the surgical cost of TARs and ankle arthrodesis and the variability of the cost between the two procedures. Methods: 50 foot and ankle centers (25 academic, 25 private) that perform TARs and ankle arthrodeses were contacted using a standardized patient script. The described patient was a healthy 63-year-old male who had failed conservative treatment of ankle arthritis. Each institution was contacted up to three times to attempt to obtain a full bundled operative quote for a TAR and an ankle arthrodesis. Results: 21 centers (42%, 14 academic, 7 private) were able to provide a quote for a TAR and ankle arthrodesis. The mean bundled price for a TAR was $50,332 (SD +/- $25,744) with the mean academic and private center quote being $56,529 and $37,937 respectively. The mean bundled price for an ankle arthrodesis was $41,756 (SD +/- $26,033) with the mean academic and private center quote being $48,116 and $29,037 respectively. There was no statistically significant difference between the bundled price for TAR and ankle arthrodesis. Conclusion: There was limited availability of consumer prices for TAR and ankle arthrodesis thus hindering healthcare consumers’ decision making. When comparing different institutions for surgical management of ankle arthritis, there was a wide range of quotes for both TAR and ankle arthrodesis. When comparing the choice of surgical management for ankle arthritis, there was no difference in price between TAR and ankle arthrodesis.

scholarly journals Influential and Highest Cited Shoulder Instability Articles: A Bibliometric Analysis

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199257
Author(s):  
Sachin Allahabadi ◽  
Ava Eftekhari ◽  
Sonali E. Feeley ◽  
Brian T. Feeley ◽  
Drew A. Lansdown
Keyword(s):  
Shoulder Instability ◽  
Methodological Quality ◽  
Case Series ◽  
Cross Sectional Study ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Online Databases ◽  
Jadad Scale ◽  
P 16 ◽  
Number Of Citations

Background: In orthopaedic surgery and other fields, the effect of influential journal articles has been evaluated by their citation counts and their correlation with methodological quality. Purpose: To identify and characterize the 50 most cited articles on shoulder instability, examine trends in publication characteristics, and evaluate the correlation of citations with quality of evidence. Study Design: Cross-sectional study. Methods: The Web of Science and Scopus online databases were searched to identify the top 50 most cited articles on shoulder instability, based on the average number of citations from each database. Article characteristics were recorded, and level of evidence and methodological quality were assessed using the modified Coleman Methodology Score (mCMS), Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS). Spearman correlation was used to evaluate relationships between citations or citation density (citations/y) and level of evidence or methodological scoring. Top cited articles from recent years were also aggregated. Results: The top 50 most cited papers had a mean ± SD number of citations of 381.5 ± 166.7, with a mean of 15.0 ± 8.8 citations/y. Overall, 15 articles (30%) were biomechanical/cadaveric studies, and 15 (30%) were case series. Only 3 (6%) were considered to have level 1 evidence. The mean ± SD mCMS was 54.4 ± 12.7, mean ± SD Jadad score was 3.1 ± 1.4, and mean ± SD MINORS score was 10.5 ± 3.3. There were no significant correlations between citation rank or density and methodological assessments. There were weak correlations between citation rank and publication year ( rs = 0.32; P = .022) and between rank and level of evidence ( rs = –0.38; P = .047). The correlation between citation density and publication year was moderate ( rs = 0.70; P < .0001). There was no difference in citation density of the top 10 articles from 2010 to 2020 compared with the top 10 from the overall list (23.8 ± 5.3 vs 28.8 ± 9.5; P = .16). Conclusion: Influential articles in shoulder instability included a high proportion of biomechanical/cadaveric studies. The majority of top cited articles had lower evidence levels and poorer methodological quality without strong correlation with citations or citation density. There was a moderate correlation between citation density and year of publication.

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