THE 50 MOST CITED ARTICLES IN THE BRAZILIAN MEDICAL LITERATURE ON KNEE SURGERYABSTRACT
Objective: To provide an analysis of the 50 most cited articles on knee surgery in the Brazilian medical literature.
Methods: This is a study of systematic review and meta-analysis, level of evidence 3. It was carried out through search in the SCOPUS database to identify scientific articles published in the Brazilian medical literature. Eighty-six Brazilian journals were analyzed, and articles with ten or more citations and which had the word “joelho” or “knee” in the title, abstract or keywords were selected.
Results: All articles were published as of the year 2000 in 14 journals. The Journal Clinics presented the largest number of publications, followed by Acta Ortopédica Brasileira. The main focus of the studies was on anatomy and biomechanics, mainly from Brazilian authors. Most of the authors were Brazilian, from Brazilian and public research institutions.
Conclusion: Biometric analysis has been gaining ground in recent years, but its interpretation must consider various aspects related to the paramount analytical importance.
Keywords: Knee; Systematic Review; Data base
RESUMO
Objetivo: Fornecer uma análise dos cinquenta artigos mais citados sobre cirurgia do joelho na literatura médica brasileira.
Métodos: Foi utilizada a base de dados da SCOPUS para identificar artigos científicos publicados na literatura médica brasileira de 1945 a junho de 2008 com o tema referente ao joelho. Foram analisados 86 periódicos brasileiros e selecionados os artigos com número de citações igual ou superior a dez que possuíam a palavra “joelho” ou knee no título, resumo ou palavras-chave. Foram selecionados aqueles que possuíam a articulação do joelho como foco principal do estudo, chegando ao resultado final de cinquenta artigos mais citados.
Resultados: Todos os artigos foram publicados a partir do ano 2000, em quatorze revistas. A Revista Clinics apresentou maior número de publicações, seguida da Acta Ortopédica Brasileira. A maior parte foi sobre estudos sobre anatomia e biomecânica, preponderamente de autores brasileiros. Instituições de pesquisa brasileiras e públicas foram as responsáveis pela maior parte das pesquisas.
Conclusão: Análise biométrica vem ganhando espaço nos últimos anos, contudo sua interpretação deve considerar variados aspectos relacionados a importância analítica.
Descritores: Joelho; Revisão Sistemática; Bases de Dados
INTRODUCTION
The knee joint is an area of wide interest in medicine, and the subject of intense debate among specialists in Orthopedics and Trauma. Since the first attempts of surgically treating osteoarthritis more than a century and a half ago, the interest in knee surgery has arisen enormously, particularly with milestones in the treatment of degenerative diseases and the introduction of arthroscopic and joint preservation surgery,1 making this articulation the focus of many human body scientific studies.
Society’s growing demand and requirement for results that keep getting closer to perfection, coupled with technological innovations, have helped to drive a greater quest for knowledge. Researchers’ personal ambitions also contribute to the exponential increase of scientific studies in various areas of interest, especially in the medical literature, where authors combine the satisfaction of new discoveries with the increasing demand for scientific publications by universities, employers and societies. (2 Thus, countless researches have emerged in the last decades, contributing to a better understanding of knee aspects, especially in relation to anatomy, biomechanics, treatment, surgical techniques and rehabilitation, among others. (3
In view of this growth in the academic area, the researchers needed methods to efficiently track the most impacting advances and identify the existing challenges. Bibliometric science can accomplish this goal, (4), (5 since it can provide qualitative and quantitative publications analysis, as well as their characteristics, thus providing their academic impact within a field of research. (3
Bibliometric studies fall into the category of systematic reviews, representing an instantaneous analysis that provides a cross-sectional view of the current state of the object studied. They have a limited half-life due to being part of a continuous process in which high quality impact articles are constantly produced. (3
A useful method for determining the impact of an article on the scientific community is by performing a citation analysis. Each article that is referenced by another scientific article is credited as a “citation.” (6 This form of analysis is an important method to determine the influence of an article on scientific progress, as well as to evaluate the Impact Factor (IF) of a scientific journal. (7 The study of citation analysis can help identify articles, research topics, and authors of influence. (8 In the field of international research, several analyses were done to identify the most cited articles about different themes, such as: epilepsy, (9 encephalic brain trauma10, orthodontics, (11 radiology, (12 surgery13 and orthopedics3, among others. However, we need to collect bibliometric data in the context of the Brazilian national literature.
The objective of this study is to provide an analysis of the 50 most cited articles of the Brazilian medical literature on knee surgery, allowing a more accurate comprehension of the qualities of the citation classics, as well as highlighting the main intellectual research marks in this field in Brazil.
MATERIALS AND METHODS
This is a systematic, quantitative, observational and analytical cross-sectional review study. Articles were identified by a bibliometric analysis in July 2018 using SCOPUS database search tools. We chose this index because it contains the largest number of Brazilian journals. We selected 86 journals with affiliation to Brazil with “area of interest in medicine” (Table 1 and Figure 1), obtained from official information from SCOPUS. The study population consisted of a sample of scientific articles published in the Brazilian medical literature from 1946 to June 2018, regardless of the language. Each of these journals was individually examined, and the articles analyzed according to the flowchart presented below (Figure 1). Initially, the articles were arranged in descending order of citation and the ones with ten or more citations were selected. From this selection, a new search was performed with the identification of all articles that presented the word “joelho” or “knee” in the title, abstract or keywords, excluding those that did not refer to the knee joint. They were arranged in alphabetical order (Table 2) to identify duplicates and later analyzed by two independent observers who, reading the abstract, selected the articles that presented the knee as the main focus of the study. In cases of divergence in the selection process, the analysis was submitted to a third observer. This new sample was placed in the descending order, according to the number of citations and the first fifty were selected (Table 2). All authors of this research signed the Informed Consent Form and the work was submitted to the Ethics and Research Committee of Unifesp - Hospital São Paulo.
List of journals of the Brazilian medical literature with area of interest in “Medicine” searched in the SCOPUS database.
RESULTS
Each of these articles was analyzed individually according to the authors’ most relevant information, such as academic affiliation of the main author, year of publication, main focus of the study, number of citations, and the journal of publication.
Among the 89 journals, Clinics was the main medium of publication, being responsible for 19 indexes from different studies, followed by Acta Ortopédica Brasileira with 7.
The main focus varied considerably among all the fields of research, with a higher prevalence on anatomy and biomechanics, totaling 11 articles, followed by biomolecular studies (9) and studies on prevention and rehabilitation8.
Although we identified a total of 211 different authors, only twenty of them were published more than once. In the specific analysis about the first author, only four were published at least twice from a total of 46 different first authors, all Brazilian.
Finally, we analyzed the institutions related to the articles considering only the first author’s academic affiliation. The Universidade de São Paulo (USP), with 18 articles, stood out as the most predominant, followed by the Universidade Federal de São Paulo (Unifesp), with 8 articles.
DISCUSSION
The amount of citations has become an important instrument for the assessment of an article and, besides being valuable to measure its own impact in the academic context, it also contributes to the analysis of the publication vehicle and of its authors. However, its data should not be analyzed in isolation and the social and temporal context in which it is inserted should be considered.
In this study, it is important to highlight that all the fifty most cited articles were published after the year 2000, which lets us infer that studies with higher quality and importance began to arise from then on. This was the moment of intense global technological transformations, with changes in the form of communication, driven by the spread of ever faster and more effective communication networks, such as the internet. This event contributed to the greater access to knowledge, reflecting the increase of research done in the scientific world. This pattern of publication dates found in our study resembles the findings of the international literature, except for the so-called “classic articles” that correspond to the ones that became important milestones in the medical literature on the subject studied, which have had a fundamental relevance since its production, being more present in international studies than in our country.
Although there are a large number of different authors, totaling 211, it is noted that only twenty of them (9.47%) were present in more than one occasion, which may indicate difficulties on the part of Brazilian authors in the production of works or, more likely, they have directly chosen to publish in international journals. Thus their research is not found in the national literature.
All articles were present in 14 of the 86 journals surveyed (16.27%), reflecting the greater searching tendency, with a specific focus on surgical, genetic and musculoskeletal system subjects. Although not only linked to orthopedics and traumatology, the journal Clinics was predominant in this study, which shows its high capacity of scientific production in the national territory, occupying the fourth position in the biometric analysis of citations in the CiteScore ranking. Acta Ortopédica Brasileira appears as the second most prevalent in publications, possibly because it is specifically devoted to studies with an interest in orthopedics and traumatology.
Interestingly, 34 articles (68%) are from research institutions located in the state of São Paulo, highlighting their academic importance in the national territory. USP and Unifesp, both public educational institutions, stood out as the most prevalent academic institution.
All three articles published in the journal Genetics and Molecular Research had as their main focus the study classified as “biomolecular” and, differently from the pattern found in this study, there were no Brazilian first authors, two of them were Chinese and one was Thai. Although they are all foreigners, the superficial analysis may bring misinterpretations. In recent years studies of this nature have been widely developed all over the world, due to the interest in new discoveries abounding intensively, even in Brazil, although through eventual investment restrictions that we face constantly. The absence of articles by Brazilian authors with this focus leads us to infer that such articles are probably intended for publication in the international literature, rather than their nonexistence.
Still under this perspective, it is possible to observe that all foreign works were published after 2011 and focused almost exclusively on biomolecular research. These data suggest that researchers from other countries find opportunities in Brazil for publication that they sometimes do not find around the world, either because our journals actually have academic value or because they simply did not find space in international journals, which are very demanding.
CONCLUSION
We conclude that the biometric analysis has been gaining ground in recent years, as a means of evaluating scientific studies; however, this study did not aim to analyze the quality of articles and first authors, since many relevant articles are probably published in the international literature, an issue not addressed by this study.
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Publication Dates
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Publication in this collection
20 Jan 2020 -
Date of issue
Jan-Feb 2020
History
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Received
25 May 2019 -
Accepted
29 July 2019
