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Journal of Experimental Orthopaedics
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The 100 most impactful articles on the rotator cuff: an altmetric analysis of online media

Journal of Experimental Orthopaedics volume 9, Article number: 92 (2022) Cite this article

Abstract

Purpose

The purpose of our study was to use the Altmetric Attention Score (AAS) to evaluate the 100 most impactful articles in online media pertaining to the rotator cuff and compare their characteristics to the most-cited rotator cuff articles in the scientific literature.

Methods

We performed an article extraction using Altmetric Explorer to identify all published articles pertaining to the rotator cuff. The top 100 articles with the highest AAS were included for analysis. Several data elements were extracted for each included article: title, article type, article topic, year of publication, journal name, authors, institutional affiliations, and online mentions (i.e. the number of times the article was mentioned in news, blog, Twitter, Facebook, and Wikipedia sources). The geographic origin of each article was also determined by the institutional affiliation of the first author, which was categorized as American (originating in the United States), European (originating in Europe), or other.

Results

The 100 articles with the highest AAS were published between 2009 and 2020, with AAS ranging from 47 to 676 (median: 74.5, 25th percentile: 59.5, 75th percentile: 114.5). Of all online media sources, Twitter correlated most strongly with AAS (r = 0.9007, r2 = 0.8112). The selected articles were most frequently published in the American Journal of Sports Medicine (13), the Journal of Shoulder and Elbow Surgery (11), and the Journal of Bone and Joint Surgery (7). The most common article type was Systematic Review/Meta-Analysis (29%), followed by Randomized Controlled Trial (15%). The top 3 AAS articles were all published by authors based in Europe.

Conclusion

The most impactful rotator cuff articles in online media generated substantial online attention. These studies were often performed in Europe and tended to be high level of evidence, focusing on treatment of rotator cuff pathology. The rotator cuff articles that produced the most online attention differed from a previous report of the most-cited rotator cuff articles, suggesting that alternative metrics may be used in concert with conventional bibliometrics to obtain a more complete representation of scientific impact.

Introduction

Rotator cuff disorders — ranging across the spectrum from rotator cuff tendonitis and subacromial bursitis to degenerative and traumatic rotator cuff tears — are common musculoskeletal problems that affect 30–50% of people over 50 years of age [1]. Given the strong prevalence of rotator cuff dysfunction in the general population, it follows that the rotator cuff has been one of the most researched topics in orthopaedic shoulder surgery to date [2]. Previous studies have reported the most-cited articles pertaining to the rotator cuff [3,4,5]. However, citation scoring and other conventional bibliometric indicators do not account for the engagement, such as article viewership that is accessed through social media posting and online media production, or advertisements on YouTube. Critical analysis of literature is important as it helps authors to recognize the amount of viewership and who is accessing their articles. Ultimately, researchers are assessed by the quality and quantity of their work in academia, to help guide promotion to tenured positions, which was traditionally evaluated in part by journal impact factor [6]. There are new or alternative metrics that are now able to assess these alternative modes of engagement.

The Altmetric Attention Score (AAS) provides a quantitative assessment of the impact of scholarly articles online and in various forms of social media. The field of orthopaedic surgery has moved toward the utilization of social media as a means of distributing knowledge and exchanging ideas pertaining to musculoskeletal research [7,8,9,10,11,12]. Previous studies have reported the most impactful articles in online media pertaining to other sports medicine topics such as the anterior cruciate ligament [13]. However, the authors are not aware of any prior study that has used AAS to evaluate the rotator cuff articles that generate the greatest online attention.

The purpose of our study was to evaluate the 100 most engaged articles in online media pertaining to the rotator cuff and compare their characteristics to the most-cited rotator cuff articles in the scientific literature, using the Altmetric Attention Score. Our goal was to achieve a better understanding of the online dissemination of the rotator cuff research as an added dimension of rotator cuff research impact. Secondarily, we compared the predominant features of these articles to previous reports of the most-cited rotator cuff articles in the literature [4, 5]. Our overarching goal was to achieve a more comprehensive understanding of the impact of rotator cuff research that extends beyond the realm of conventional bibliometric analysis. We hypothesized that the 100 most impactful articles in online media pertaining to AAS would not be influenced by bibliometric data.

Materials and methods

The Altmetric database was queried on July 20, 2020, to identify articles pertaining to the rotator cuff. The search was performed using the PubMed MeSH terms “rotator cuff” or “supraspinatus” or “infraspinatus” or subscapularis or “teres major” or “teres minor” and yielded 6,183 articles published between 1931 and 2020. These articles were stratified by highest to lowest AAS and the 100 articles with the highest scores were included for analysis. The Altmetric Attention Score is a weighted, automated algorithm that takes into account the quantity of a post’s output and the quality of the post’s source, such as newspaper articles, Twitter posts, blogs, policy documents [14]. These scores can be accessed via the Altmetric Database. All articles that focused on other orthopaedic topics were sequentially excluded until 100 articles were gathered that were directly pertinent to the rotator cuff.

Collected data included title, authors, year of publication, journal name, institutional affiliations, article type, article topic, and online mentions (for example, the number of times the article was mentioned in news, blogs, Twitter, Facebook, and Wikipedia). Article type was identified from the article abstract and classified as original research (subclassified as randomized controlled trial, prospective cohort, retrospective cohort, case–control, case series, case report, or laboratory study), descriptive epidemiology, systematic review/meta-analysis, review, editorial/expert opinion, clinical commentary, or other. Article topics were anatomy, basic science, biomechanics, cost, diagnostics, treatment, epidemiology/risk factors, injury prevention, rehabilitation/return to play, patient satisfaction/quality of life, and other. The geographic origin of the paper was determined by the institutional affiliation of the first author, categorized as American (originating in the United States), European (originating in Europe), or other. The number of citations were provided by Google Scholar (Alphabet, Mountain View, CA), which lists the number of citations for each article.

STATA 15.1 (STATACorp) was used for calculations and statistical analysis. Median and quartiles were calculated for AAS. Spearman correlation and logarithmic regression were used to determine the relationship between online mentions and AAS, and analysis of variance (ANOVA) was used to determine whether article type, topic, or geographic origin were associated with AAS.

Results

The 100 articles with the highest AAS were published between 2009 and 2020, with AAS ranging from 47 to 676 (median: 74.5, 25th percentile: 59.5, 75th percentile: 114.5) (Table 1). The selected articles were most frequently published in the American Journal of Sports Medicine (13), the Journal of Shoulder and Elbow Surgery (11), and the Journal of Bone and Joint Surgery (8) (Fig. 1). The most common article type was Systematic Review/Meta-Analysis (29%), followed by Randomized Control Trial (15%). The most common article topics were Treatment (38%), Epidemiology (19%), and Patient Satisfaction/Quality of Life (10%). Nearly half of the selected articles (44/100, 44%), including the top 3 AAS articles, were published by authors located in Europe. One-quarter of the selected articles (25/100, 25%) were published by authors in the United States, while the remaining articles (31/100, 31%) were published by other.

Table 1 Top 25 rotator cuff articles ranked by altmetric attention score
Full size table
Fig. 1
figure 1

Most frequently published journals for the 100 articles with the top altmetric attention score when searching for “rotator cuff”

Full size image

Among all 100 articles, there were a total of 16,581 Twitter mentions (mean: 165.81), 1077 Facebook mentions (mean: 10.77), and 212 mentions in mainstream online news outlets (mean: 2.12). The online media source that correlated most strongly with AAS was Twitter mentions (r = 0.9007, r2 2 = 0.8112), whereas the other online media sources demonstrated weak correlations with AAS.

Discussion

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].

Conclusion

The most impactful rotator cuff articles in online media generated substantial online attention. These studies were often performed in Europe and tended to be high level of evidence, focusing on treatment of rotator cuff pathology. The rotator cuff articles that produced the most online attention differed from a previous report of the most-cited rotator cuff articles, suggesting that alternative metrics may be used in concert with conventional bibliometrics to obtain a more complete representation of scientific impact. Future use of the Altmetric Attention Score may improve authors’ understanding of their readership demographics by considering online dissemination and the timing of article publication, which are unique to AAS.

References

  1. da Rocha Motta G, Amaral MV, Rezende E, Pitta R, dos Santos Vieira TC, Duarte MEL, Vieira AR, Casado PL (2014) Evidence of genetic variations associated with rotator cuff disease. J shoulder Elb Surg 23:227–35. https://doi.org/10.1016/j.jse.2013.07.053

    Article  Google Scholar 

  2. Namdari S, Baldwin K, Kovatch K, Huffman GR, Glaser D (2012) Fifty most cited articles in orthopedic shoulder surgery. J shoulder Elb Surg 21:1796–1802. https://doi.org/10.1016/j.jse.2011.11.040

    Article  Google Scholar 

  3. Familiari F, Castricini R, Galasso O, Gasparini G, Iannò B, Ranuccio F (2021) The 50 highest cited papers on rotator cuff tear. Arthroscopy 37:61–68. https://doi.org/10.1016/j.arthro.2020.07.044

    Article  PubMed  Google Scholar 

  4. Kraeutler MJ, Freedman KB, MacLeod RA, Schrock JB, Tjoumakaris FP, McCarty EC (2016) The 50 most cited articles in rotator cuff repair research. Orthopedics 39:e1045–e1051. https://doi.org/10.3928/01477447-20160714-01

    Article  PubMed  Google Scholar 

  5. Lei L, Zhang C, Sun F-H, Xie Y, Liang B, Wang L, Pang G, Chen R, Jiang W, Ou X, Miyamoto A, Wang J (2021) Research trends on the rotator cuff tendon: a bibliometric analysis of the past 2 decades. Orthop J Sport Med 9:2325967120973688. https://doi.org/10.1177/2325967120973688

    Article  Google Scholar 

  6. McKiernan EC, Schimanski LA, Muñoz Nieves C, Matthias L, Niles MT, Alperin JP (2019) Use of the Journal Impact Factor in academic review, promotion, and tenure evaluations. Elife 8:e47338

    Article  CAS  Google Scholar 

  7. Chien JL, Sabharwal J, Namoglu EC, Ghassibi MP, Yuan M, Gandy C, Wei C, Somohano K, Engelhard SB, Petrakos P, Van Tassel SH, Chien G-F, Belyea DA (2021) The 100 most mentioned glaucoma articles online with highest altmetric attention scores. J Glaucoma 31(1):8–14. https://doi.org/10.1097/IJG.0000000000001939

    Article  Google Scholar 

  8. Earp BE, Kuo K, Shoji MK, Mora AN, Benavent KA, Blazar PE (2020) Evaluating the online presence of orthopaedic surgeons. J Am Acad Orthop Surg 28:e86–e91. https://doi.org/10.5435/JAAOS-D-18-00610

    Article  PubMed  Google Scholar 

  9. Franko OI (2011) Twitter as a communication tool for orthopedic surgery. Orthopedics 34:873–876. https://doi.org/10.3928/01477447-20110922-21

    Article  PubMed  Google Scholar 

  10. Hughes H, Hughes A, Murphy C (2017) The use of twitter by the trauma and orthopaedic surgery journals: twitter activity, impact factor, and alternative metrics. Cureus 9(12):e1931. https://doi.org/10.7759/cureus.1931

    Article  PubMed  PubMed Central  Google Scholar 

  11. Jildeh TR, Okoroha KR, Guthrie ST, Parsons TW (2019) Social media use for orthopaedic surgeons. JBJS Rev 7(3):e7. https://doi.org/10.2106/JBJS.RVW.18.00085

    Article  PubMed  Google Scholar 

  12. McLawhorn AS, De Martino I, Fehring KA, Sculco PK (2016) Social media and your practice: navigating the surgeon-patient relationship. Curr Rev Musculoskelet Med 9:487–495. https://doi.org/10.1007/s12178-016-9376-1

    Article  PubMed  PubMed Central  Google Scholar 

  13. Civilette MD, Rate WR, Haislup BD, Cohen AS, Camire L, Bodendorfer BM, Gould HP (2022) The top 100 most impactful articles on the anterior cruciate ligament: an altmetric analysis of online media. SAGE Open Med 10:20503121221111694. https://doi.org/10.1177/20503121221111694

  14. How is the Altmetric Attention Score Calculated. (2021). Altmetric. https://help.altmetric.com/support/solutions/articles/6000233311-how-is-the-altmetric-attention-score-calculated-

  15. Sanders TL, MaraditKremers H, Bryan AJ, Larson DR, Dahm DL, Levy BA, Stuart MJ, Krych AJ (2016) Incidence of anterior cruciate ligament tears and reconstruction. Am J Sports Med 44:1502–1507. https://doi.org/10.1177/0363546516629944

    Article  PubMed  Google Scholar 

  16. Thelwall M, Haustein S, Larivière V, Sugimoto CR (2013) Do altmetrics work? Twitter and ten other social web services. PLoS One 8:e64841. https://doi.org/10.1371/journal.pone.0064841

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Familiari F, Castricini R, Galasso O, Gasparini G, Iannò B, Ranuccio F (2021) The fifty highest cited papers in rotator cuff tear. Arthrosc J Arthrosc Relat Surg 37(1):61–68. https://doi.org/10.1016/j.arthro.2020.07.044

  18. Patil V, Kosmidis I, Tsekes D (2019) A bibliometric analysis: 200 most cited papers in the field of shoulder surgery. JSES Open Access 3:245–246. https://doi.org/10.1016/j.jses.2019.10.052

    Article  Google Scholar 

  19. Sochacki KR, Jack RA, Nauert R, Harris JD (2018) Correlation between quality of evidence and number of citations in top 50 cited articles in rotator cuff repair surgery. Orthop J Sport Med 6(6):2325967118776635. https://doi.org/10.1177/2325967118776635

    Article  Google Scholar 

  20. Kelly JC, Glynn RW, O’Briain DE, Felle P, McCabe JP (2010) The 100 classic papers of orthopaedic surgery: a bibliometric analysis. J Bone Joint Surg Br 92:1338–1343. https://doi.org/10.1302/0301-620X.92B10.24867

    Article  CAS  PubMed  Google Scholar 

  21. Kunze KN, Polce EM, Vadhera A, Williams BT, Nwachukwu BU, Nho SJ, Chahla J (2020) What Is the Predictive Ability and Academic Impact of the Altmetrics Score and Social Media Attention? Am J Sports Med 48:1056–1062. https://doi.org/10.1177/0363546520903703

    Article  PubMed  Google Scholar 

  22. Kwok R (2013) Research impact: Altmetrics make their mark. Nature 500:491–493. https://doi.org/10.1038/nj7463-491a

    Article  CAS  PubMed  Google Scholar 

  23. Luc JGY, Archer MA, Arora RC, Bender EM, Blitz A, Cooke DT, Hlci TN, Kidane B, Ouzounian M, Varghese TK, Antonoff MB (2020) Social media improves cardiothoracic surgery literature dissemination: results of a randomized trial. Ann Thorac Surg 109:589–595. https://doi.org/10.1016/j.athoracsur.2019.06.062

    Article  PubMed  Google Scholar 

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Funding

No sources of funding were used for this study.

Author information

Authors and Affiliations

  1. MedStar Union Memorial Hospital, Baltimore, MD, USA

    Brett D. Haislup & Heath P. Gould

  2. Georgetown University School of Medicine, Washington, DC, USA

    William R. Rate & Matthew D. Civilette

  3. University of Chicago, Chicago, IL, USA

    Andrew S. Cohen

  4. Miller Orthopedic Specialists, Council Bluffs, IA and Omaha, NE, USA

    Blake M. Bodendorfer

Authors
  1. Brett D. Haislup
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  2. William R. Rate
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  3. Matthew D. Civilette
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  4. Andrew S. Cohen
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  5. Blake M. Bodendorfer
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  6. Heath P. Gould
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Contributions

Brett Haislup: Designed and wrote manuscript. William Rate: Statistical analysis. Matt Civilette: Project development, statistical analysis. Andrew Cohen: Data collection. Blake Bodendorfer: oversight. Heath Gould: Oversight, project design. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Brett D. Haislup.

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This study did not involve human or animal subjects and did not require ethical approval.

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Haislup, B.D., Rate, W.R., Civilette, M.D. et al. The 100 most impactful articles on the rotator cuff: an altmetric analysis of online media. J EXP ORTOP 9, 92 (2022). https://doi.org/10.1186/s40634-022-00530-7

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  • DOI: https://doi.org/10.1186/s40634-022-00530-7