Research trends of ultrasound in orthopaedics:
In terms of the publication volume of all countries, the United States leads the first (Fig. 2), while China had the fastest growth rate (Fig. 4G). We speculate that the reason for this phenomenon is related to the index of the country's GDP (Fig. 2A). We can also find that the developed countries published more research, such as the United States, England and Japan (Fig. 2A). This shows that countries leading in science and technology are exploring more of the uses of ultrasound. Improvements have emerged in ultrasonic technologies in developed countries, such as the invention of ultrasound and microbubble therapy(19), which can efficiently increase cell membrane permeability, resulting in enhanced tissue distribution and intracellular drug delivery of molecules, the popularity of small probes(20) and the combination of ultrasound, X-ray and MRI(21). these new technologies often appear in developed countries.
Published articles with the highest citation frequency are associated with correlative academic impacts in a certain field. Detailed information regarding the top ten most frequently cited publications on ultrasound in orthopaedics is provided in Table 4. The study published in The Journal of Arthroplasty in 2011 with Kwon, YM as the corresponding author provides the most common combination of ultrasound in orthopaedics, and the research indicates that in metal-on-metal hip resurfacing arthroplasty, ultrasound is essential as a diagnostic tool(22). The ranked second to fourth articles are all from the same journal, the American Journal of Sports Medicine, which describes the application of ultrasound diagnosis for the repair of chronic Achilles tendinopathy, large and massive rotator cuff tears and double-row rotator cuffs, respectively(23-25). For the top 10 cited articles about ultrasound in orthopaedics, their focus was an evaluation of the effectiveness of ultrasound diagnosis in the treatment of a disease. The results were similar to clusters such as diagnosis, treatment and statistics (Fig. 6A).
Table 4. Top 10 most-cited researches related to ultrasound in orthopaedics
Title
|
Corresponding Authors
|
Journal
|
Publication Year
|
Total Citations
|
Corresponding Author‘s Country
|
"Asymptomatic" Pseudotumours After Metal-on-Metal Hip Resurfacing Arthroplasty
|
Kwon, YM
|
JOURNAL OF ARTHROPLASTY
|
2011
|
216
|
USA
|
One-Year Follow-up of Platelet-Rich Plasma Treatment in Chronic Achilles Tendinopathy A Double-Blind Randomized Placebo-Controlled Trial
|
de Jonge, S
|
AMERICAN JOURNAL OF SPORTS MEDICINE
|
2011
|
176
|
Netherlands
|
Factors Affecting Healing Rates After Arthroscopic Double-Row Rotator Cuff Repair
|
Tashjian, RZ
|
AMERICAN JOURNAL OF SPORTS MEDICINE
|
2010
|
171
|
USA
|
When Do Rotator Cuff Repairs Fail? Serial Ultrasound Examination After Arthroscopic Repair of Large and Massive Rotator Cuff Tears
|
Miller, BS
|
AMERICAN JOURNAL OF SPORTS MEDICINE
|
2011
|
138
|
USA
|
Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study
|
Filippucci, E
|
OSTEOARTHRITIS AND CARTILAGE
|
2009
|
138
|
Italy
|
The diagnostic value of ultrasonography-derived edema of the temporal artery wall in giant cell arteritis: a second meta-analysis
|
Sfikakis, PP
|
BMC MUSCULOSKELETAL DISORDERS
|
2010
|
134
|
Greece
|
The Sensitivity and Specificity of Ultrasound for the Diagnosis of Carpal Tunnel Syndrome: A Meta-analysis
|
Fowler, JR
|
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH
|
2011
|
116
|
USA
|
Long-term Survivorship of Rotator Cuff Repairs Using Ultrasound and Magnetic Resonance Imaging Analysis
|
Kluger, R
|
AMERICAN JOURNAL OF SPORTS MEDICINE
|
2011
|
104
|
Austria
|
Prevalence and characteristics of asymptomatic tears of the rotator cuff an Ultrasonographic and Clinical study
|
Moosmayer, S
|
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME
|
2009
|
104
|
Norway
|
Prospective analysis of arthroscopic rotator cuff repair: Prognostic factors affecting clinical and ultrasound outcome
|
Nho, SJ
|
JOURNAL OF SHOULDER AND ELBOW SURGERY
|
2009
|
103
|
USA
|
Although there have been few outstanding articles (Table. 4) and few high IF journals (Table. 3) In this field, RRI displayed a quickly rising trend (Fig. 3). We analysed the reason for the increase in research interest from the special advantages of ultrasound. On the one hand, hospitals are increasingly using ultrasonic devices to reduce exposure to X-ray radiation during examinations with the improvement of people's health awareness(13), and in the diagnosis of some orthopaedic diseases, the diagnostic rate of ultrasound is not inferior to CT. For example, ultrasound is more accurate in assessing the early healing process of fractures(26); the last but not the least, ultrasound as a diagnostic and therapeutic method does have overwhelmingly taken its place in the scientific arena(27), and the use of bedside ultrasound also provides ideas for rapid diagnosis in critical and emergency situations in the future. For example, the advent of portable ultrasound makes rapid diagnosis of soft tissue injury possible in the wild(28). Thus, the acceptance of ultrasound is improving, and the study of ultrasound in orthopaedics is also undergoing a development process.
Regarding the top 10 institutions and top 10 authors, half of the top 10 institutions are from the United States (Table. 2), and three of the top 10 authors are also from the United States (Table. 3). We predicted that these phenomena were related to the cooperation between countries. For example, the map based on WOS data reveals that the United States has connections with many countries in the field (Fig. 3); however, other countries have few connections. Therefore, the quality of articles in other countries is lower than in the United States. This phenomenon has called on scientists from all over the world to break through boundaries and bring about deeper cooperation. Only in this way can we promote the development and application of ultrasound in the orthopaedics field.
Research focused on ultrasound in orthopaedics:
According to the map based on the bibliographic data from the analysis of all keywords (Figs. 6A, B), we found that the key words were divided into three clusters, namely, diagnosis research, treatment research and epidemiology research. The density of the keywords outlined the overall structure of the figure and draw attention to the most important areas of ultrasound in orthopaedics, revealing an even distribution among the three groups that was consistent among the three clusters. However, the clusters of diagnosis and epidemiology studies were relatively new with respect to the publication dates, and the potential reasons for this are as follows.
First, the research over the past decade indicates that the research direction has transitioned towards various aspects of diagnosis rather than just assessing the fracture. For example, doctors can use ultrasound to diagnose arthritis(29), dysplasia of the hip(30), subacromial pain syndrome(31), neuromuscular diseases(32) and so on. Furthermore, scientists from different countries have also tried to analyse ultrasound studies in orthopaedics using statistical methods in recent years. Thus, keywords such as correlation and reliability have emerged within the epidemiology research cluster. According to the results of the pictures (Fig. 6B), the research direction has shifted towards epidemiology research. For example, in the aspects of the prediction of tendon injury risk, assessment of tendon healing and provision of further insight into tendon physiology, the usefulness of ultrasound was confirmed by epidemiology methods(33). However, the application of ultrasound in osteology is in its infancy, and scientists must further strengthen their research efforts (Fig. 6A).
With respect to the latest research hotspots, MRI from the diagnosis research cluster is the most recent (cluster 1), which indicates that ultrasonic diagnosis has been used in combination with other diagnostic tools to improve diagnostic efficiency. For example, the assessment of fracture healing remains challenging due to a lack of consensus on imaging and clinical criteria as well as the lack of a true gold standard(26). However, ultrasound signs of healing can be identified as early as 1-2 weeks post fracture. By attaching a position sensing device to the ultrasound probe, 3D reconstructed images can be generated, which can help in the interpretation of complex fracture pattern healing(34). In clinical practice, Aspelin P et al. also conducted ultrasonic diagnosis on 32 patients with lower limb soft tissue injury and found that the diagnosis of haematoma was good(35). In the diagnosis of deep tissue damage, MRI has been shown to play a significant role, especially in spinal cord injury(36) and disc herniation(37), compared with ultrasound and CT. Thus, investigating the combination of kinds of imaging rather than just ultrasound is likely to be a new hotspot in future research. For example, MRI performed better in the diagnosis of inflammation, but ultrasound was more valuable in the diagnosis of small bone lesions (38). Therefore, in the treatment of rheumatoid joints, the researchers assessed the disease in three ways: synovitis, osteitis, and erosions. They found that the combination of ultrasound and MRI improves the accuracy of diagnosis(38), which is a trend for future diagnosis.
The complication from the treatment research cluster (cluster 2) was among the most recently identified words in the latest research. As an important indicator to evaluate the therapeutic effect, complications have received much attention by clinicians. In the field of orthopaedics, accurate positioning and navigation during surgery are particularly important; otherwise, nerve and blood vessel damage and other postoperative complications will be caused, leading to poor prognosis of patients. For example, in lateral ankle stabilization techniques, ultrasound-guided arthroscopy can make the direct visualization of ankle anatomical landmarks and structures possible and can also effectively reduce surgical time and decrease the incidence of iatrogenic damage to neurovascular and other soft tissue structures(39). Similarly, Yang et al. conducted a randomized controlled study in which ultrasound-mediated anaesthesia was used in 38 patients who needed surgery on the ankle joint and not in another 38; they found that the use of ultrasound results in fewer complications, which points out the direction of the development of ultrasound in treatment.
According to the epidemiology research cluster (cluster 3), key words such as female and male in the latest research appeared more frequently. Therefore, epidemiological factors such as gender and age have gradually drawn attention in a large number of clinical studies, and gender is one of the important influencing factors in the diagnostic models and prognostic analysis models of some diseases. For example, in a study of combined ultrasound and nerve stimulator-guided deep nerve block, the research objects were also grouped by sex(40). Similarly, in a study of risk factors for osteoporosis and associated fractures, females have long been listed as a risk factor, and due to the secretion of female oestrogen, it has also become a point of consideration in the treatment of osteoporosis patients(41).
In Fig. 7, the words that catch people's attention and last the longest included bone, articular cartilage, and the new salient keywords included instability and fracture. Therefore, we speculated that the study of bone joints would be a trend. Over the last two decades, a number of technical advances have improved ultrasound imaging of joints and soft tissues, increasing accuracy in joint disease assessment(42). For example, ultrasound detection of synovial effusion and synovial hypertrophy in knees has obtained good results (43, 44).
Clinical research is a research method to discuss a series of problems such as the diagnosis, treatment, prognosis, prevention of etiology and so on, while ultrasound as a clinical application device, research results can be quickly converted to clinical. Clinical randomized controlled trial is a highly reliable evidence in the field of evidence-based medicine, finally, we searched Clinicaltrials.gov and found 7 documented clinical randomized controlled trial(Table 5), Ultrasound guided knee injections, as a research focus of bone and joint discipline, is also the focus of clinical randomized controlled studies, which is similar to the results in Fig. 7. What is more surprising is that most of the clinical studies we collected are related to nerve block under ultrasound guidance and achieve good therapeutic effect, which provides a direction for the application of ultrasound in treatment to a certain extent. since all the 7 clinical trials were therapeutic, it is reasonable to believe that ultrasound, as a traditional diagnostic tool, has become a trend to be widely used in clinical treatment.
This bibliometric analysis investigated the publications that were extracted from the WOS database. We try to keep the data objective and reliable. However, limitations are inevitable. Due to our inclusion criteria, only English studies have been collected, and some important but non-English studies related to ultrasound have been ignored. In addition, the database is still constantly updated, so our results may be slightly different from the actual results.