Critical Evaluation of the Methodologic Quality of the Top 50 Cited Articles Relating to Knee Dislocation and Multiligamentous Knee Injury

Abstract

Background: Many studies have evaluated the management of knee dislocations (KDs) and multiligamentous knee injuries (MLKIs). However, no study to date has analyzed the quality of the most cited articles in this literature. Hypothesis: There is a positive correlation between the number of article citations in the KD and MLKI literature and their methodologic quality. Study Design: Systematic review. Methods: The Web of Science online database was searched to identify the top 50 cited articles in KD and MLKI care. Demographic data were recorded for each study. The Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-randomized Studies (MINORS) were used to analyze the methodological quality of each article. Spearman correlation coefficients ( r s) were then calculated. Results: The articles identified were published between 1958 and 2015 in a wide variety of peer-reviewed journals (n = 16). The majority of study level of evidence (LOE) was of low quality (level 5, 16%; level 4, 54%; level 3, 16%; level 2, 14%). There were no studies of level 1 evidence. The mean MCMS and MINORS scores were 29.0 (SD, 19.1; range, 3-72) and 6.1 (SD, 3.7; range, 0-14), respectively. No significant correlation was identified between the number of citations and the publication year, LOE, MCMS, or MINORS ( r s = 0.123 [ P = .396]; r s = 0.125 [ P = .389]; r s = 0.182 [ P = .204]; and r s = 0.175 [ P = .224], respectively). Positive correlations were observed between improved MCMS and MINORS scores and more recent year of publication ( r s = 0.43 [ P = .002]; r s = 0.32 [ P = .022]) as well as improved study LOE ( r s = 0.65 [ P < .001]; r s = 0.67 [ P < .001]). Conclusion: The top 50 cited articles on KD and MLKI care consisted of low LOE and methodological quality, with no existing level 1 articles. There was no significant correlation between the number of citations and publication year, LOE, or study methodological quality. Positive correlations were observed between later publication date and improved methodological quality.