Bibliometric Analysis of the Top 100 Most Cited Articles on Wrist Arthroscopy

Background: Over the past few decades, more articles have been published about wrist arthroscopy. The purpose of this study was to identify and analyze the 100 most cited articles about wrist arthroscopy. Methods: The 100 most cited articles were analyzed using the wrist arthroscopy as a keyword on the Web of Science database. Original articles, reviews, clinical trials, and cadaveric studies were included in the study. We recorded and analyzed the following information: Article title, rst author, year of publication, journal of publication, the total number of citations, level of evidence, article language, country, institution, and the main topic of study. Results: The number of citations ranged from 35 to 180 (mean, 64.74). The total number of citations was 6,474. Among the articles examined, the most prolic country was the United States of America (USA). The Journal of Hand Surgery- American Volume was the journal with the most number of publications and the most cited articles. The main topics that were most analyzed and underlined were the diagnostic comparison of Magnetic resonanas imaging and arthroscopy and the diagnosis and treatment of triangular brocartilage complex. Conclusions: As a result, wrist arthroscopy continues to develop, and it is a subject that is open for new studies. More comprehensive and up-to-date randomised controlled studies comparing the benet of wrist arthroscopy or open surgery for wrist pathologies will demonstrate the importance of arthroscopy in the diagnosis and treatment of problems related to this topic.


Introduction
At the current age, where the limits of computer and internet technologies are challenged, the virtual environment is gradually becoming the main source for researchers to access information. Nonetheless, easy access to the information leads to an increase in incorrect and incomplete information. Hence, academic portals that provide quality information at international standards have become of great importance. Citation analysis helps us make a decision about the quality of an academic publication [1,2]. In the orthopedic literature, there are different studies involving citation analyses on various topics [3][4][5][6]. There is no study involving citation analysis about wrist arthroscopy in the literature. In general, there is one previous publication that scanned all cases of wrist arthroscopy [7]. With the widespread use of arthroscopic procedures involving narrow joints, wrist arthroscopy has been used in the diagnosis and treatment of wrist diseases for 30 years; and its importance is gradually increasing [8,9]. Wrist arthroscopy is frequently used for diagnosis and simultaneous treatment in triangular brocartilage complex (TFCC), ganglion cysts of the wrist, distal radial and carpal bone fractures, intercarpal ligament injuries [10][11][12].
This study aims to perform a bibliometric analysis on the 100 most cited articles about the diagnosis and treatment of wrist arthroscopy.

Methods
The Web of Science Core Collection is recognized as the most suitable online database for bibliometric analysis. The search was performed using the term wrist arthroscopy in the search bar under the title category or the topic category on January 2021 including all articles from 1990 to 2020 using the Web of Science platform. After search the database, all articles were ranked from the most cited to the least cited. Articles not related to the diagnosis and treatment process of wrist arthroscopy were excluded. We recorded and analyzed the following information: article title, rst author, year of publication, journal of publication, total number of citations, level of evidence, article language, country, institution, and main topic of study.

Results
A total of 790 publications related to wrist arthroscopy were identi ed. The 100 highest cited papers according to number of citations can be seen in Table 1 Table 2. Among the articles, 96 were written in English, and 4 were written in German.   (Table 3). In terms of country and region of origin, most articles were from the United States of America (51), which was followed by Germany (9), the United Kingdom (6), Japan (6), Switzerland (5), and Italy (4) ( Table 4).   [13]. The most-cited author was Cooney, WP, who had published 2 articles (2%). The total number of citations associated with Cooney WP was 269. The topic of the most cited article included the diagnosis and treatment of TFCC (13).
Among the 100 most cited articles, 86 were identi ed as original articles, 6 were review articles, 7 were cadaveric studies and 1 was a clinical trial. Based on the criteria on level of evidence, 5 articles were providing Level I evidence, 14 articles providing level II evidence, 36 articles providing level III evidence, 36 articles providing level IV evidence, and 9 articles providing level V evidence.

Discussion
Wrist arthroscopy has been of increasing importance in the arthroscopy branch of orthopedics since the day it was rst de ned. New techniques have constantly been de ned, and new treatment procedures are created [14]. In the present study, our aim was to analyze the most cited articles in this developing eld and to create a basic resource for the orthopedics community.
In the present study, we performed a bibliometric analysis on the articles about wrist arthroscopy, which were published between 1990 and 2020 [15,16]. The earliest article was published by Cerofolini E. et al.
in 1990 [17]. The highest number of publications were made between 2000 and 2010. The interest in arthroscopy increased with the rst publication in, leading to an increase in the need for research on wrist arthroscopy. Accordingly, the number of publications also increased.
Looking at the articles analyzed, the most studied topic was the diagnostic value and comparison of MRI and arthroscopy in wrist pathologies. Other most discussed topics were interventional procedures such as the treatment of TFCC injuries, intercarpal ligament repair, and fracture xation. Of the articles, 44 (44%) were published in the journals of orthopedics, and 26 (26%) were published in the journals of radiology. These results indicate that the basic studies on the wrist are diagnostic, and there is an increasing trend in the use of interventional procedures in wrist arthroscopy. When we looked up the articles concerning comparing the bene t of wrist arthroscopy over either open surgery or non operative management of wrist pathology, arthroscopy is superior to open surgery especially in TFCC repair, intercarpal ligament repair and diagnosis and treatment of joint surface pathologies.
As demonstrated in our results, the USA was the country where most articles were published, similar to the majority of previous bibliometric analyses [18][19][20].  [13]. The Journal of Hand Surgery-American Edition was the journal with the highest number of citations, and the journal that published the highest number of articles. The underlying reason for this high scienti c contribution may be having a higher gross national product, receiving more research support, and having more senior researchers in the USA [16].
Our study has several limitations. First of all, the number of citations alone cannot determine the importance of an article. We may have excluded many quality studies from the analysis due to the low number of citations. Only published articles were included in the study while meeting records, textbooks, academic presentations, and lectures were excluded. We only searched the Web of Science database; we did not search the Pubmed, Medline, or Embase databases. Nonetheless, we believe that Web of Science is more reliable compared to the other databases in terms of content, quality, and transparency. We observe that the most cited articles are the articles with old dates. On the other hand, since the number of citations of newly published articles will be determined over time, they cannot be analyzed at this time. This may have caused us to exclude many high-quality articles in the study.

Conclusions
The present study will shed light on the developmental stages of wrist arthroscopy over a 30-year period.
In conclusion, wrist arthroscopy is a subject that is open to improvement among the wrist pathologies in terms of both diagnosis and treatment, and it requires further research. This study reports the basic information about published articles on wrist arthroscopy and so is of particular relevance to a practicing surgeon and will help with decision making related to the treatment of wrist pathology by arthroscopy of otherwise. Further randomised controlled studies concerning arthroscopic or open surgery for this subject to be conducted on the wrist joint would provide easier and more applicable solutions about the pathologies of this region.