Influential Articles on Pediatric and Adolescent Anterior Cruciate Ligament Injuries: A Bibliometric Analysis

Abstract

Background: The understanding of pediatric anterior cruciate ligament (ACL) injuries and optimal treatment has evolved significantly. Influential articles have been previously evaluated using article citations to determine impact.

Purpose: To identify and characterize the 50 most cited and recent influential articles relating to pediatric and adolescent ACL injuries, to examine trends in publication characteristics, and to evaluate correlations of study citations with quality of evidence.

Study design: Cross-sectional study.

Methods: The top 50 most cited articles on pediatric and adolescent ACL injuries were gathered using the Web of Science and Scopus online databases by averaging the number of citations from each database. Articles from recent years were also aggregated and sorted by citation density (citations/year). Publication and study characteristics were recorded. Level of evidence and methodologic quality were assessed where applicable using the modified Coleman Methodology Score (mCMS), modified Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS). Spearman correlation was used to evaluate the association between citation data and level of evidence or methodologic quality scorings.

Results: The top 50 cited papers had a mean of 117.5 ± 58.8 citations (range, 58.5-288.5 citations), with a mean citation density of 9.4 ± 5.4 citations per year (range, 2.9-25.8 citations/year); 80% were published in 2000 or later, and 6% were considered basic science. Articles were mainly level 4 evidence (27/42; 64.3%), and none was level 1. There were moderate, significant associations between publication year and level of evidence (r _S = -0.45; P = .0030) and citation density and publication year (r _S = 0.59; P < .001). Mean methodologic quality scores were as follows: mCMS, 53 ± 7.2 (range, 39-68); modified Jadad scale, 3.2 ± 1.1 (range, 2-6); and MINORS, 11.2 ± 3.2 (range, 6-20). There was a significant, strong correlation between rank of mean citations and modified Jadad scale (r _S = 0.76; P < .0001), suggesting poorer score associated with more mean citations.

Conclusion: Influential articles on pediatric and adolescent ACL injuries were relatively recent, with a low proportion of basic science-type articles. Most of the studies had a lower evidence level and poor methodologic quality scores. Higher methodologic quality did not correlate positively with citation data.

Keywords: adolescent; anterior cruciate ligament; influential; pediatric sports medicine; quality; skeletally immature.

Figure 1.

Number of 50 most cited articles relating to pediatric and adolescent anterior cruciate ligament reconstruction by decade of publication.

Figure 2.

Number of 50 most cited articles relating to pediatric and adolescent anterior cruciate ligament reconstruction by journal of publication. Journal titles are listed according to PubMed abbreviation. ^a Previously J Bone Joint Surg Am. ^b Previously J Bone Joint Surg Br.

Figure 3.

Number of 50 most cited articles relating to pediatric and adolescent anterior cruciate ligament reconstruction by assigned level of evidence. Articles classified as animal studies, biomechanical/cadaveric studies, or technique/review articles were excluded from level of evidence analysis (n = 8 excluded; total n = 42 included in level of evidence analysis).

Figure 4.

Proportion of 50 most cited articles relating to pediatric and adolescent anterior cruciate ligament reconstruction by study design type.