This study identified the 100 most mentioned articles in online media pertaining to the rotator cuff. The characteristics of these impactful articles in online media were correlated with Twitter and Facebook citations and had a high proportion of European authorship, with publication in frequently cited American journals. AAS provides a unique dimension of article impact that may be used as an adjunct to citation analysis.
The top 100 rotator cuff articles in online media were published in a wide range of journals. Although the American Journal of Sports Medicine, Journal of Shoulder and Elbow Surgery, and Journal of Bone and Joint Surgery were the most common, these three journals only combined for about one-third of all articles in the top 100. AJSM was also the most represented journal among the most impactful articles in online media pertaining to the ACL, but the AJSM-published articles accounted for a much larger proportion of articles in those studies (44% and 34%, respectively) than in the present study examining the rotator cuff (13%) [7]. These findings suggest that a larger number of journals seem to be actively disseminating rotator cuff research in online media, compared to other major research topics in the field of sports medicine. One contributing factor to this trend may be the fact that ACL injuries tend to affect competitive athletes, whereas rotator cuff dysfunction often affects the general non-athlete population [15, 16]. This could conceivably lead to a lower proportion of the most impactful articles on the rotator cuff being published in subspecialty-specific journals that are focused on sports medicine. This trend parallels the findings of prior studies that have reported a high proportion of the most cited rotator cuff articles published in the Journal of Bone and Joint Surgery, [4, 17] a journal that includes all topics related to orthopaedic surgery and is not restrictive to sports medicine or shoulder surgery. Further investigation is needed to improve our collective knowledge of how rotator cuff research can be distributed most effectively, both in the arena of scientific publication as well as in online media.
The most common article types among the top 100 AAS rotator cuff articles were Systematic Review/Meta-Analysis (29%) and Randomized Control Trial (15%), indicating that higher level-of-evidence studies tend to generate the most attention in online media. These findings are consistent with prior studies that have examined the top AAS articles for other sports medicine topics such as the ACL [13]. In contrast, previous studies investigating the most-cited articles on the rotator cuff found that Case Series were the most common article type, [3, 4] likely due to the fact that many of the cited articles are comprised of the early, seminal work on rotator cuff disease, which laid the foundation for the higher level-of-evidence studies that have been conducted more recently and appear to be generating more online attention. This disparity between the most-cited rotator cuff articles and the highest AAS rotator cuff articles with regard to article type and level of evidence underscores the utility of alternative metrics in providing a more current, real-time snapshot of the impact of rotator cuff research, as compared to the long-term assessment of impact that can be gleaned from conventional bibliometrics.
The most common article topics in our study were Treatment (38%), Epidemiology (19%), and Patient Satisfaction/Quality of Life (10%). Studies that focus on treatment and epidemiology are helpful to healthcare providers because they enhance the understanding of which patients are most likely to get injured and how to provide optimal care for them. Patient satisfaction was the third most common topic in regard to rotator cuff, whereas rehabilitation and return to play were more common in ACL reconstruction. These disparate results are likely due to the fact that ACL injuries are more relevant to athletic individuals, whereas rotator cuff injuries commonly occur in non-athletes who would be more concerned with returning to normal life activities rather than returning to sport.
The largest proportion of top 100 AAS rotator cuff articles were published by authors based in Europe (44%), whereas US studies comprised only one-quarter (25%) of the included articles. This finding conflicts with previous studies that have reported a strong predominance of US articles among the most impactful studies in online media pertaining to the ACL (54%) [13]. European authors are widely regarded to be at the forefront of shoulder research, with several of the major developments in the field of shoulder surgery occurring in France (e.g. Goutallier classification, Grammont prosthesis, Latarjet procedure) [18]. Therefore, it is not surprising that much of the online attention surrounding rotator cuff research is derived from European articles. However, it is interesting that our findings regarding geographic origin contrast with previous studies that have reported a majority of US articles (58% and 60%) [4, 19] among the most-cited rotator cuff studies in the literature. The reasons for this disparity are not certain, but it is possible that European authors, journals, and healthcare organizations may be disseminating rotator cuff research more actively in online media compared to their US counterparts. Further investigation is needed to verify this hypothesis, as well as to elucidate any other factors that may be responsible for this finding.
Authors can find their article’s AAS by clicking the Altmetric link on the cite that hosts their publication, which offers a list of platforms that have interacted with their article. The website includes a comparison of engagement with other articles that have been published within the same scientific genre, over a similar timeframe. There is no definitive numerical score that is used as a benchmark to determine if a score is good or bad, since many factors go into calculating these scores. For instance, if a publication is produced this year that publication will be compared to other publications that are produced this year rather than those produced 10 years ago, which would have had greater opportunity to be disseminated through media and a greater opportunity to collect citations [11].
There are several limitations inherent to Altmetric that may have affected the findings of the present study. Altmetric is updated on a daily basis in a semi-continuous fashion; thus, it is possible to identify a different list of top 100 articles depending upon the specific date on which the search was performed. Moreover, Altmetric does not account for context and is solely dependent upon the volume of online mentions. Thus, both negative and positive discussion equally impact AAS, and a high AAS may not necessarily reflect a high quality study [20,21,22,23].
