Bibliometric analysis of the Acta Orthopaedica et Traumatologica Turcica from 2013 to 2022

Abstract

Objective

This study aimed to analyze the original articles published in Acta Orthopaedica et Traumatologica Turcica (AOTT) between 2013 and 2022 using bibliometric methods to identify their characteristics and examine the changing trends over the last 10 years.

Methods

The articles were analyzed in terms of publication year, authors, countries, affiliations, citations, study design, subspecialty of orthopedics, sample size, study outcome, presence of statistical methods, time elapsed from submission date to acceptance date, and presence of funding. Periods (2003-2012 and 2013-2022) were compared for trend analysis in the journal. Advanced bibliometric analysis was done using VOSviewer software (version 1.6.19).

Results

A total of 976 articles were included in the analysis. The journal’s self-citation rate was 2.94%. Retrospective observational studies remained the most frequently published article design, as observed over 2003-2012 (n = 411, 42.1%). No review articles were published in the previous period, while 35 review articles were published in this period. Publications from countries outside Türkiye exhibited a significantly higher number of case reports and reviews (P = .001), whereas articles from Türkiye had a significantly greater number of basic science and cross-sectional studies (P = .007, P = .017, respectively). Trauma (n = 207), general orthopedics (n = 144), and spine (n = 105) were identified as the most prominent subspecialties. Spine surgery and adult reconstruction/arthroplasty publications significantly increased, while hand and microsurgery publications significantly decreased (P < .001). Article types were compared regarding citation counts, revealing that case reports and technical notes had significantly lower citation counts (P = .001). There was a significant increase observed in the number of author affiliations (n = 2.57 ± 1.40) (P < .001). Management” (n = 83), “fixation” (n = 78), and “surgery” (n = 65) were the most occurring keywords. There was a significant increase in articles with 1 or 2 authors in the latter 2017-2022 period compared to 2013-2016 (P = .001). A significant increase was observed in publications from private clinics and other clinical facilities (P < .001).

Conclusion

Acta Orthopaedica et Traumatologica Turcica (AOTT) has emerged as one of the leading journals in orthopedics, with a notable increase in international publications in the last decade. Being in the Science Citation Index Expanded (SCI-Expanded) database, increasing impact factor, and having low self-citation rates highlight its high standards and global impact. Acta Orthopaedica et Traumatologica Turcica (AOTT) is a valuable platform for researchers worldwide to share their work and advance orthopedic knowledge.

Level of Evidence

N/A.

Highlights

• Acta Orthopaedica et Traumatologica Turcica (AOTT), a journal of orthopedics in the SCI-expanded category, has a very low self-citation rate.

• There has been a significant increase in the number of articles from other countries in AOTT in the last 10 years.

• The most published articles in the last 10 years have been related to trauma, general orthopedics, and the spine.

Introduction

The number of publications in the field of orthopedics and traumatology has been on the rise, similar to other scientific disciplines.^1,2 This increase in the number of publications has led to a corresponding rise in the number of bibliometric studies that evaluate these works. Bibliometric studies analyze the literature pertaining to specific topics, within particular journals, across various countries, and within a field of science, all within defined time frames. In doing so, they provide guidance to academics and researchers in that field. Furthermore, when focused on a single journal, bibliometric studies can provide valuable insights and recommendations that benefit both the journal’s editors and its readers.^3,4 Acta Orthopaedica et Traumatologica Turcica (AOTT), the leading scientific orthopedics and traumatology journal in Türkiye, commenced publication in the year 1962. The journal has been indexed in the Science Citation Index Expanded (SCI-expanded) on Web of Science (WoS) since 2008, PubMed Central since 2016, and DOAJ since 2006. Other indexing services include PubMed/Medline (since 2002), Scopus, CNKI (China National Knowledge Infrastructure), EBSCO (Elton B. Stephens Company), and TUBITAK ULAKBIM TR Index. The journal began publishing articles in both English and Turkish languages in full-text format starting from 2004, and English has been the main language since 2010. It is published in English every 2 months as an open-access journal and follows double-blinded peer-review principles. The journal has an impact factor (IF) of 1.0 in 2022 (5-year IF = 1.6), a CiteScore of 2.5 (Scopus, 2022), and an SCImago Journal Rank value of 0.46 (2022), accompanied by an h-index of 34.

A bibliometric analysis of publications from a single journal in the field of orthopedics has been conducted previously.^3,5 Yalçınkaya and Bagatur previously conducted a bibliometric analysis of publications in the AOTT journal for the years 2003-2012.⁶ Assessing the status of a journal within specific time frames is significant in terms of revealing the academic direction the journal is heading. In this study, our goal was to evaluate articles published in AOTT from 2013 to 2022 using bibliometric analysis. We aimed to examine the journal’s trends, inclinations, and changes over the past decade compared to the previous period, building upon the earlier work by Yalçınkaya and Bagatur.⁶

Materials and methods

A bibliometric search was conducted using the WoS database search engine. The IF value of the journal was examined for each year and noted. The publications of AOTT from January 2013 to December 2022, covering a 10-year period, were reviewed on 01 March 2024. All original articles, case reports, technical notes, and reviews were included, while letters to the editor, retracted publications, retractions, editorials, congress papers, corrections, and training articles were excluded. The articles were classified based on their study types and subspecialties within orthopedics. The country of affiliation of the first authors was considered as the original country. Two independent researchers (NT, SB) accessed and evaluated the publications from the journal’s official website and independently reviewed the titles and abstracts of the articles. In cases where the study type or the subspecialty couldn’t be determined through this process, the full texts were also examined.

The articles were categorized into the following study types: retrospective observational, prospective observational, basic science, cross-sectional and survey study, review, case report, and technical note. Retrospective and prospective observational studies were further subdivided into 5 subgroups: surgical treatment, conservative treatment, laboratory, radiological, or epidemiological. Prospective studies were also classified based on whether they were randomized or non-randomized. Within the basic science category, they were further divided into 4 subgroups: animal experiment, cadaver experiment, biomechanical study, and laboratory study. Reviews were divided within 3 subgroups: non-systematic, systematic, and meta-analysis. Case reports were divided into surgical or conservative treatment categories. Additionally, the articles were classified into orthopedic subspecialties, including general orthopedics, pediatric orthopedics, spine surgery, adult reconstruction and arthroplasty, trauma, sports injuries and arthroscopy, shoulder and elbow surgery, hand and microsurgery, orthopedic oncology, foot and ankle surgery, and external fixation. An attempt was made to follow a methodology similar to Yalçınkaya and Bagatur.⁶ For this purpose, fractures other than spinal fractures were categorized under trauma, while spinal fractures were included in the spine subspecialty. Fractures of the hand and wrist that do not require microsurgery were categorized under trauma, while those requiring microsurgery were included in hand and microsurgery. If arthroscopy was related to the joints of the shoulder or elbow, it was accepted as shoulder and elbow surgery. Additionally, even if a biomechanical or laboratory study was conducted in an experiment, if it was done on an animal, it was classified as an animal experiment; if a cadaver was used, it was classified as a cadaver experiment.

Each article was assessed for: (1) the number of authors, (2) the number of institutions of the authors, (3) the institutional affiliation of the first author, (4) the country of the first author, (5) sample size, (6) study outcome (positive, negative or neutral), (7) presence of statistical methods, (8) presence of funding, and (9) time from submission to acceptance. The citation counts in WoS core collection and reference numbers of articles were also evaluated. Additionally, the discipline of the first author of each article was assessed, determining whether the study was multidisciplinary and the number of disciplines contributing to it.

To better assess the trends in AOTT over the last 10 years, 2 separate periods, 2003-2012 and 2013-2022, were compared using the data from the article by Yalçınkaya and Bagatur.⁶ When evaluating the number of authors, a comparison was made between the periods of 2013-2016 and 2017-2022 to assess the impact, considering that the criteria for associate professorship in Türkiye changed in December 2016.

VOSviewer (version 1.6.19) is one of the software programs used for advanced bibliometric analysis.^7,8 The tool facilitates the creation of co-occurrence of keywords. Keyword analysis focused on co-occurrence patterns.

Statistical analysis

The data were analyzed using IBM SPSS 23 (IBM SPSS Corp.; Armonk, NY, USA). Prior to conducting statistical analyses, checks were performed to ensure data entry accuracy and to assess whether the parameters were within the expected range. Normality assumptions of continuous variables were examined using the Kolmogorov–Smirnov test, and homogeneity of variances was assessed using Levene’s test. Descriptive statistics, including mean and standard deviation values, were provided for continuous variables. For non-parametric continuous variable analysis, Kruskal–Wallis H, Mann–Whitney U, and Median tests were applied. The Chi-square test was used for categorical variable analysis. A significance level of P < .05 was accepted for all analyses.

Results

Acta Orthopaedica et Traumatologica Turcica (AOTT) has been published bimonthly since 2009 and has maintained continuity throughout the period we examined. The number of articles published in the journal has varied over the years (Figure 1). The maximum number of articles was published in 2014, with 120 articles, while the fewest number of articles was published in 2022, with 72 articles. Its IF has generally followed an upward trend since 2013, starting at a value of 0.554 in 2013 and reaching its peak at 1.557 in 2021. However, in 2022, the IF value declined to 1 (Figure 1).

Figure 1.

Number of articles distribution and impact factor values by year.

The 976 articles by 3086 authors in this list received a total of 6574 citations, with 6381 of them being without self-citations. The journal’s self-citation rate was 2.94%. The top 5 most cited articles are shown in Table 1. Out of the 976 articles, it was observed that 894 (91.6%) articles received at least 1 citation. The average citation count for a paper was determined to be 6.72 (median = 4, range = 0-65), while the mean number of references in a paper was observed to be 24.70 (median = 24, range = 4-72).

Table 1.

The most cited 5 articles of the 2013-2022 period in the journal

Authors	Article Title	Times Cited in WoS* core collection (n)	Year
Simsek, HH; Balki, S; Keklik, SS; Ozturk, H; Elden, H	Does Kinesio taping in addition to exercise therapy improve the outcomes in subacromial impingement syndrome? A randomized, double- blind, controlled clinical trial	65	2013
Tas, S; Yilmaz, S; Onur, MR; Soylu, AR; Altuntas, O; Korkusuz, F	Patellar tendon mechanical properties change with gender, body mass index, and quadriceps femoris muscle strength	54	2017
Turgut, A; Arli, H; Altundah, U; Hancioglu, S; Egeli, E; Kalenderer, O	Effect of COVID-19 Pandemic on the fracture demographics: data from a tertiary care hospital in Türkiye	45	2020
Pekyavas, NO; Ergun, N	Comparison of virtual reality exergaming and home exercise programs in patients with subacromial impingement syndrome and scapular dyskinesis: dhort term effect	45	2017
Say, F; Gurler, D; Inkaya, E; Bulbul, M	Comparison of platelet-rich plasma and steroid injection in the treatment of plantar fasciitis	38	2014

*WoS: Web of Science.

Retrospective observational articles were the most frequently observed study design (n = 411, 42.1%). The other study designs were observed in the following order: case report (n = 157), basic science (n = 153), prospective observational (n = 110), and cross-sectional and survey studies (n = 98), reviews (n = 35), and technical notes (n = 12) (Table 2). Prospective studies were categorized as randomized (n = 56) and non-randomized (n = 54). Management was carried out with surgical treatment (n = 136) or conservative treatment in case reports (n = 21). It was observed that animal experiments (n = 84) were the most common when basic science studies were further categorized. Human cadaver studies (n = 35), biomechanical studies (n = 26), and laboratory studies (n = 8) were the other types of basic science research. The reviews were classified as non-systematic (n = 5), systematic (n = 12), and meta-analyses (n = 18). No significant difference was detected in terms of the distribution of study designs by years during this period (P = .247). However, a statistically significant difference was observed when compared to the period of 2003-2012 in terms of the distribution of study designs (P < .001). Similar to the previous period, retrospective studies and case reports stood out as the most frequently published study designs. However, comparisons between periods could not be made for review, cross-sectional and survey, and technical note as there were few of them in the previous period. The number of case reports and reviews was significantly higher in publications from countries outside of Türkiye (P < .001), whereas in articles originating from Türkiye, the number of basic science and cross-sectional studies was significantly greater (P = .007, P = .017, respectively). Study designs were compared in terms of citation counts and it was observed that case reports and technical notes had significantly lower citation counts (P < .001).

Table 2.

Classification of the articles according to study designs and comparison with the period 2003-2012

Study Design	2003-2012	2013-2022
	n (%)		Mean Citation Counts	P	P
Retrospective	n = 339	n = 411	6.91 ± 6.57		< .001
Retrospective surgical	292 (47.4)	324 (52.6)		.011*
Retrospective conservative	13 (31.7)	28 (68.3)
Retrospective laboratory	1 (12.5)	7 (87.5)
Retrospective radiological	11 (27.5)	29 (72.5)
Retrospective epidemiological	22 (48.9)	23 (51.1)
Prospective	n = 111	n = 110	9.54 ± 10.57
Prospective surgical	40 (40.8)	58 (59.2)		< .001*
Prospective conservative	30 (49.2)	31 (50.8)
Prospective laboratory	5 (38.5)	8 (61.5)
Prospective radiological	3 (21.4)	11 (78.6)
Prospective epidemiological	33 (94.3)	2 (5.7)
Basic science	n = 84	n = 153	6.42 ± 6.32
Basic science cadaver	11 (13.1)	35 (22.9)		.005*
Basic science animal	40 (47.6)	84 (54.9)
Basic science laboratory	15 (17.9)	8 (5.2)
Basic science biomechanical	18 (21.4)	26 (17.0)
Case report	n = 153	n = 157	2.94 ± 2.54
Case report surgical	117 (76.5)	136 (86.6)		.027*
Case report conservative	36 (23.5)	21 (13.4)
Cross-sectional and survey	n = 9	n = 98	8.24 ± 9.58	–
Review	n = 0	n = 35	11.0 ± 10.90	–
Non-systematic review	0	5		–
Systematic review	0	12		–
Meta-analysis	0	18		–
Technical note	3	12	2.75 ± 2.26	–
Total			6.72 ± 7.45

*P < .05, considered statistically significant.

Trauma (n = 207), general orthopedics (n = 144), and spine (n = 105) were the most prominent subspecialties when articles were examined upon categorizing articles into subfields of orthopedics (Table 3). A significant increase in the number of publications was observed, particularly in the fields of spine surgery and adult reconstruction and arthroplasty when compared to the previous period. Conversely, there was a significant decrease in publications related to hand and microsurgery (P < .001). There was no significant difference in the distribution of orthopedic subspecialties over the years (P = .109).

Table 3.

Classification of the articles according to orthopedic subspecialties and comparison with the period 2003-2012

Orthopedic Subspecialty	2003-2012 (n = 699)	2013-2022 (n = 976)
	n (%)		P
General orthopedics	91 (13.0)	144 (14.8)	<.001*
Pediatric orthopedics	47 (6.7)	39 (4.0)
Spine	39 (5.6)	105 (10.8)
Adult reconstruction/arthroplasty	41 (5.9)	104 (10.7)
Orthopedic trauma	128 (18.3)	207 (21.2)
Sports injuries and arthroscopy	78 (11.2)	80 (8.2)
Shoulder and elbow	55 (7.9)	84 (8.6)
Hand and microsurgery	100 (14.3)	51 (5.2)
Orthopedic oncology	70 (10.0)	91 (9.3)
Foot and ankle	33 (4.7)	47 (4.8)
External fixation	17 (2.4)	24 (2.5)

An average of 4.73 ± 1.51 (median = 5) authors per paper was observed. There was no significant difference in the mean number of authors between the periods 2003-2012 and 2013-2022 (P = .681) (Table 4). When comparing articles originating from Türkiye with 1 or 2 authors to those with 3 or more authors, a significant increase was observed in the number of articles with 1-2 authors during the period of 2017-2022 (P < .001). Out of the total studies, 802 had an orthopedic surgeon as the first author, while the remaining 174 had authors from non-orthopedic specialties as the first author. The investigation of the primary specialty of the first author in non-orthopedic surgical publications revealed that physiotherapy and rehabilitation (n = 54), physical medicine and rehabilitation (n = 18), and anesthesiology (n = 17) departments were predominantly at the top of this list. In 81 out of these 174 articles, there was an orthopedic surgeon present despite the first author not being an orthopedic surgeon. If the first author of the article was an orthopedic surgeon, the citation count was determined to be 6.23 ± 6.73, while if someone from a non-orthopedic discipline was the first author, it was 8.96 ± 9.85 (P < .001). In 381 out of 976 (percentage) of the studies, it was observed that there were multiple disciplines. The average number of disciplines in the articles was determined to be 1.54.

Table 4.

Comparisons between time periods

	2003-2012	2013-2022	P
Number of authors	mean = 4.63 ± 1.62 (range = 1-22, median = 5)	mean = 4.73 ± 1.15 (range = 1-15,median = 5)	.084
Country of the first author affiliation - Türkiye	653 (93.4%)	668 (68.4%)	< .001*
Country of the first author affiliation - Foreign Countries	46 (6.6%)	308 (31.6%)
Number of affiliations	mean = 1.72 ± 1.23 (range = 1-21, median = 1)	mean = 2.57 ± 1.40 (range = 1-15, median = 2)	< .001*
Time from submission date to acceptance date (months)	mean = 7.11 ± 3.70 (range = 1-32, median = 7)	mean = 7.98 ± 5.23 (range = 0-39, median = 7)	.707
Sample size	mean = 92.06 ± 488.45 (range = 1-8946, median = 22)	mean = 262.31 ± 3238.3 (range = 1-95484, median = 33)	.281
Statistical methods: present	38 (48.4%)	700 (71.7%)	< .001*
Statistical methods: absent	361 (51.6%)	276 (28.3%)
Study outcome: positive	494 (70.7%)	690 (70.7%)	< .001*
Study outcome: neutral	133 (19%)	233 (23.9%)
Study outcome: negative	72 (10.3%)	53 (5.4%)

The number of author affiliations was calculated as 2.57 ± 1.40 (median = 2). A significant increase in the number of author affiliations was observed compared to the previous period, which was recorded as 1.72 ± 1.23 (P < .001).

Publications originating from Türkiye were categorized according to the affiliations of the first authors, and the distribution is as follows: 382 (57.2%) from universities, 185 (27.7%) from training and research hospitals, 49 (7.3%) from private hospitals, 37 (5.5%) from state hospitals, 1 (0.1%) from military hospitals, and 14 (2.1%) from other types of private clinics (Table 5). During the study period, there was no significant difference in the distribution of the type of affiliations where the first author worked over the years. When examining the affiliations of the first authors, a statistical significance was observed compared to the previous period (P : .018) with a similar rate of publications coming from universities and education research hospitals. However, it was observed that there was a significant increase, particularly in publications from private clinics and other types of clinical facilities (P < .001).

Table 5.

Comparison of time periods for institutional affiliations of the first authors*

Type of First Author Affiliation	2003-2012 (%)	2013-2022 (%)	P
University hospital	394 (56.4)	382 (57.2)	.018*
Training and research hospital	215 (30.8)	185 (27.7)
State	25 (3.6)	37 (5.5)
Private	55 (7.9)	49 (7.3)
Military	6 (0.9)	1 (0.1)
Private clinics and other types of affiliations	4 (0.6)	14 (2.1)

*Publications from Türkiye were included in this comparison.

A significant increase was observed in the number of publications from abroad (P < .001). In the previous period, the number of publications from abroad was n = 46, accounting for 6.6% of the total. It was observed that the number of publications from abroad increased to n = 308 (31.6%). It was observed that authors from Türkiye ranked first with a total of 670 articles (68.4%) when the countries contributing to AOTT publications were examined. China ranked second with 86 articles, while Korea (n = 52), Japan (n = 17), and Italy (n = 13) were observed as the most productive countries in descending order.

The sample size was determined to be 1-95, 484 (median = 33), and there was no significant difference in the distribution over the years. Additionally, there was no significant change observed in this parameter between the two periods (P = .281).

During the period we examined, there were 690 (70.7%) articles with a positive outcome, 233 (23.9%) with a neutral outcome, and 53 (5.4%) with a negative outcome. There was no significant difference in the distribution of articles by outcome over the years (P = .238). A significant difference was observed when compared to the previous period, (P < .001). There was a decrease in the number of negative articles and an increase in the number of articles with neutral outcomes, while the percentage of positive articles remained constant.

The time elapsed between the manuscript submission date and the acceptance date was found to be 7.98 ± 5.23 months (median = 7). When compared to the previous period, no significant change was observed in the time elapsed between the manuscript submission date and the acceptance date (P = .707). Logistic regression analysis was applied to investigate correlation. No correlation was observed between this timeframe and study type, orthopedic subspecialty, number of authors, sample size, and study outcome in the logistic regression analysis. There was a significant increase in the proportion of articles utilizing statistical methods (n = 700, 71.7%, P < .001).

A total of 888 (90.89%) articles did not receive any funding support. The highest level of funding support, with 17 articles, was provided by the National Natural Science Foundation of China (NSFC). Scientific and Technological Research Council of Türkiye (TÜBİTAK) was the second biggest contributor as a funder with just 3 articles listed in the dataset.

Bibliometric co-occurrence analysis

An analysis was conducted on the 4759 keywords obtained from these studies. The minimum number of occurrences of a keyword was set at 5. A total of 294 keywords met the threshold. The keywords were analyzed and visualized by VOSviewer software (Figure 2). Each keyword is represented by a circle in the figure. The keywords that co-occur more frequently are displayed with larger circles. “Management” (n = 83), “fixation” (n = 78), “surgery” (n = 65), “complications” (n = 59), “replacement” (n = 55), “fracture” (n = 50), “outcomes” (n = 49), “arthroplasty” (n = 48), “follow-up” (n = 48), and “knee” (n = 47) were the 10 most frequent keywords.

Figure 2.

Co-occurrence of keywords.

Discussion

Bibliometric methods enable the scientific analysis of literature associated with a journal, and research in this direction has also been conducted in the field of orthopedics.^3,4 In this bibliometric study, we aimed to examine the changes and trends of AOTT using the WoS database from 2013 to 2022.

The observed upward trend in the IF over the period we examined can be attributed to several factors. Firstly, we believe that the journal’s decision to adopt English as its primary language in 2010 played the most significant role in this increase. The increase in collaboration with other disciplines may also have contributed, allowing the journal to reach a broader audience. Indeed, when we examine the top 5 most cited articles during this period, we see that 3 of them were authored by departments of physical therapy and rehabilitation. It can also be considered that there has been a general increase in the number of articles and the citation counts of articles worldwide, which may result in an annual inflation of approximately 5% for IF values.⁹ We believe that the increase in indexing services, along with all these factors and many more, has led to the rise in its IF multifactorially. During the coronavirus disease 2019 (COVID-19) pandemic, the IF of journals generally increased due to the boosted publication numbers; however, this increase was observed to be relatively lower in the field of orthopedics.¹⁰ After COVID-19 in 2022, many journals globally experienced a decrease in publication frequency and subsequently saw declines in their IF as normalcy returned. Similarly, AOTT also observed a decrease in its IF in 2022 for the first time since 2015.

The most crucial criterion demonstrating the quality of an academic journal is the IF, which is derived from the published articles. Key factors influencing the IF include the relevance of the subject matter, originality, study design, data quality, and writing style. Additionally, journals can manipulate their IF by self-citing their own articles, creating a bias in the assessment. This phenomenon is referred to as journal self-citation. Nowadays, many scientific journals require that accepted articles include references to other articles in the same journal. The acceptable self-citation rate for a journal ranges from 7% to 20%, with Thomson Reuters considering self-citation rates above 20% as a form of abuse aimed at artificially inflating the journal’s IF.¹¹ However, for AOTT, the self-citation rate has been determined to be only 2.94% over the past decade in this study. Acta Orthopaedica et Traumatologica Turcica (AOTT) adheres to ethical standards by keeping self-citation to a minimum, and its 2022 journal IF remains at 1.0, even when self-citations are excluded. In the field of orthopedics, which includes prestigious journals such as Orthopedics, Journal of Orthopedic Science, Orthopedic Clinics of North America, and AOTT, the IFs of 18 journals in the SCI-expanded category remain unchanged. Medical articles have an uncitedness ratio of 23%, and it is believed that this ratio can vary depending on time, field of medicine, and the journal.¹² It has been determined that 8.4% of articles in this period have not yet received any citations.

Some significant factors that influence a paper’s ability to receive more citations include the number of authors, their affiliations, and the presence of funding for the study.^13,14 In this study, we found that a staggering 90.89% of the articles lacked funding support. Among the articles originating from China, 33.72% (n = 29 out of 86) had funding support, while articles from Türkiye had only 4.93% (n = 33 out of 670) of them with funding support. The funding agency that provided the most support, with 17 articles, was the National Natural Science Foundation of China (NSFC). China has made significant strides in scientific publications, including the field of orthopedics, as it has in many other areas. An investigation into the impact of public funding and the NSFC on the development of Chinese science revealed a significant influence in a recent article.¹⁵ It has been observed that in medical articles, the mention of funding support is available in only 29% of the total articles in the WoS database.¹⁶ Despite this limitation, the scarcity of financial support in studies originating from Türkiye, coupled with a lower number of prospective study designs and the notion that studies are often used primarily for academic advancement, suggest potential reasons for these findings. The advancement of orthopedics and medicine, in general, necessitates various sources of funding, whether from government or industry entities. Conducting sustainable research is not feasible without financial resources. However, the source of the funding is a controversial topic. Leopold et al demonstrated that commercially funded articles are significantly associated with higher positive outcomes.¹⁷ On the other hand, a recent study showed that no significant effects were seen on clinical outcomes after commercial funding.¹⁸ While the use of funding sources in articles may introduce bias into the results, it remains a requirement in many research endeavors to facilitate the conduct of high-quality research.¹⁹ High-income countries tend to publish a greater number of articles and receive more citations than low to middle-income countries. This discrepancy in low to middle-income countries can be attributed to academic, financial, or collaborative deficits.²⁰

Acta Orthopaedica et Traumatologica Turcica (AOTT) is a journal primarily preferred by Turkish researchers, welcoming authors from all around the world, and aiming to publish high-quality articles in various fields of orthopedics. Yalçınkaya and Bagatur found that between 2003 and 2012, 93.4% of the articles in AOTT listed the first author’s country as Türkiye.⁶ However, this percentage significantly declined to 68.4% in the subsequent 10-year period. The increasing trend in international publications continues, with factors such as the journal’s transition to English, its inclusion in PubMed, and the rise in its IF playing significant roles. We anticipate that this trend will persist in the coming years. We observed that the total number of articles published in the last decade increased from 699 to 976 (97.6 per year). However, it’s worth noting that AOTT’s publication frequency contributed to this increase, as the journal published 5 issues per year until 2009 and subsequently increased to 6 issues per year. The quantitative growth of the journal also signifies its ascent to a higher academic level.

The number of authors per article has been on the rise in recent years across all literature, and specifically in the field of orthopedics.^21,22 The most significant factors contributing to this trend can be attributed to advancements in individual, institutional, and international collaboration networks. However, in the case of AOTT, contrary to the literature, such an increase in trend is not observed. When comparing the 10-year periods, it was observed that the number of authors per article remained similar in both periods.

In Türkiye, associate professorship criteria were revised by the Interuniversity Board (ÜAK) as of December 2016. According to these regulations, in single-author publications, the author receives the entire score per publication; in publications with two authors, the corresponding author receives 80% of the score, and the second author receives 50% of the score. For publications with 3 or more authors, the first author receives 50% of the score, while the other authors share the remaining points. When we examined the impact of this on publications originating solely from Türkiye, we observed that before 2017, there were 13 single-authored or two-authored articles. However, from 2017 onward, there was a significant increase in the number of single or two-author publications, which totaled 40 (P < .001). We believe this trend is related to the criteria set by ÜAK for associate professorship. Based on this scoring system, we anticipate a continued inclination towards fewer author names, particularly in publications originating from Türkiye, in studies that are not multidisciplinary and not multicenter in the future.

We observed that the majority of publications in the last 10 years consisted of retrospective observational studies (n = 411, 42.1%). Yalçınkaya and Bagatur also showed the highest proportion of publications being retrospective observational studies at 48% in the previous period.⁶ It was observed that this trend has persisted, albeit to a lesser extent. Factors contributing to this trend could be attributed to the difficulty in securing financial support for research articles or the challenges associated with conducting prospective studies in the field of orthopedics, which often involves rare conditions.

It is expected that prospective and randomized controlled trial articles would receive a higher number of citations.²³ As Yalçınkaya and Bagatur previously suggested in their articles, it seems necessary for the journal to increase its impact factor and reach more readers by publishing prospective randomized studies and meta-analyses.⁶ While no reviews were published in the previous 10-year period, there have been 35 reviews published in this period, with 18 of them being meta-analyses. In our analysis, we observed the highest citation count per article in prospective observational studies and reviews in the last 10 years of AOTT publications, although statistical significance was not detected.

It is well known that the publication of case reports has a negative impact on a journal’s IF. In their research, Erivan et al evaluated articles published in orthopedic journals in 2015 and 2016 and demonstrated that the IF would have significantly increased from 2.013 to 2.072 if case reports had not been published.²⁴ A similar pattern was observed in AOTT. The mean citation count per article was 6.72, while the citation count per case report was 2.58. Twenty case reports (12.74%) received no citations, whereas in non-case report original articles, this rate was only 7.57%. This suggests that if case reports were not included, AOTT would have a higher IF. However, it’s important to note that case reports are essential for some rare diseases and conditions where randomized controlled trials cannot be conducted. A surgeon may utilize examples from the literature for rare conditions encountered, thereby contributing to diagnosis and treatment. Thus, despite the low citation rate of case reports, their contribution to science cannot be denied.²⁵ However, considering the low citation rate, caution should be exercised when selecting case reports for publication.

The publications that garnered the most interest and were published were found to be primarily focused on trauma, general orthopedics, and the spine. This trend can be attributed to the fact that these areas receive the most attention and experience significant scientific developments. Trauma was the most published subspecialty in the journal as well between 2003-2012 (18.3%).⁶ Although hand and microsurgery was the second most published subspecialty previously, there has been a decrease in the number of articles published in this area. Instead, during this period, general orthopedics publications have gained prominence. When examining the most frequently used keywords (management, fixation, surgery), it is not surprising to find that they are related to these fields. The frequency of publications related to hand surgery and microsurgery remained at 5.2%. Hand surgery was officially recognized as a subspecialty in accordance with the Medical Specialty Regulations in 2009, and fellowship program started in 2014. However, at least in terms of AOTT publications, we did not observe a significant impact of this recognition.

Acta Orthopaedica et Traumatologica Turcica (AOTT), although primarily focused on orthopedics, also attracts the interest of healthcare professionals from outside the field of orthopedics and traumatology. In the past 10 years of articles in the journal, 17.8% of first authors are from other medical specialties. The most frequently cited articles in a journal have been previously investigated.²⁶ In AOTT, among the most cited articles on this list, 3 of them are related to physical therapy and rehabilitation. Additionally, an interesting point to note is that the articles authored by professionals from other medical specialties tend to receive a significantly higher rate of citations. Therefore, journals being open to articles from every medical specialty related to their areas of interest and promoting interdisciplinary collaboration can elevate the quality of journals to higher standards.

The primary centers where science is produced and supported are universities. In AOTT, we have observed that the majority of articles published from Türkiye were conducted in universities. It was observed that this trend continued. With the increasing prevalence of private healthcare in Türkiye, there has been a noticeable increase in other types of institutions outside of public hospitals.

In recent years, some changes have also occurred in the characteristics of orthopedic and traumatology publications, which have also been reflected in AOTT. Especially with the impact of the COVID-19 pandemic, the orthopedic world has been affected, and AOTT has not remained indifferent to the issue in this period.^27-29 During this time, a separate information network has emerged on social media and the internet, leading to studies focusing on the reliability and accuracy of information found there.^30-32 Specifically, due to the launch of the chatbot named ChatGPT on November 30, 2022, which coincided with the end of the period we examined, we did not come across any studies related to chatbots in this field. Over the past decade, articles on patient-specific instrumentation and 3D printing modeling have been published in line with technological advancements.^33-35 During this period, while there has been an increase in articles related to artificial intelligence (AI) in the world, only one article has been published on the use of robotics in orthopedic surgery.³⁶ Two original articles and one technical note on navigation use were also published.^37-39 However, we believe that in the coming decade, we will see greater effectiveness of AI and related applications. This will be coupled with a more pronounced rise in robotic and navigated surgeries and their implications in the orthopedic journals and within AOTT. These developments will also lead to changes in orthopedic education, resulting in an increase in articles related to assistant training and video-assisted training. Consequently, we expect to witness an increase in publications in these areas, reflecting the evolving landscape of orthopedic medicine.

This study has some limitations. The WoS database was used, and citations and citation counts were determined through WoS. Despite being one of the most widely used databases, WoS does not evaluate journals that are not included within its own database, and it primarily assesses English-language journals. Therefore, citations from journals not included in this database were not considered. Like any bibliometric study, this research is retrospective and carries the inherent limitations of retrospective studies.

Acta Orthopaedica et Traumatologica Turcica (AOTT) has gained a more international identity in the last 10 years. It is anticipated that the trend of increased frequency of publications from abroad will continue. To ensure the existence of higher-quality publications, there is a need to increase funding sources. This will lead to an increase in prospective, randomized controlled trials, and basic science studies in the journal.

Funding Statement

The authors declared that this study has received no financial support.

Data availability statement:

The data that support the findings of this study are available on request from the corresponding author.