1. Introduction

Wrist arthroscopy is a novel technique used for diagnosing and treating wrist joint injuries and conditions.[1] In this procedure, a mini high-definition camera through a small incision in the wrist, providing visualization that closely resembles traditional open joint surgery.[2] This technique allows for thorough assessment and examination of intra-articular lesions within the wrist joint. Moreover, repairs of these structures can be performed through several small incisions, thereby minimizing tissue damage compared to conventional open surgery. Wrist arthroscopy offers several advantages over open surgery, such as smaller and more aesthetically pleasing incisions, as well as the avoidance of damage to surrounding ligaments and joint capsule during exposure.[3] Furthermore, it carries a reduced risk of noticeable surgical scars. Consequently, patients experience less postoperative pain, shorter hospital stays, and faster recovery times. Importantly, the minimal disruption to the joint capsule and ligaments during surgery also reduces the formation of postoperative adhesions, facilitating optimal joint function, and recovery.[4]

Initially developed and primarily used for diagnostic purposes, wrist arthroscopy has gradually evolved into a valuable adjunctive treatment modality for various wrist joint injuries and conditions.[5,6] Over the past decade, it has become a standard procedure for certain wrist joint injuries and conditions. In theory, except for a few procedures like wrist joint arthroplasty, most wrist joint injuries and conditions can be treated using minimally invasive techniques with the assistance of wrist arthroscopy.[7] With increasing patient demand for minimally invasive surgery and the ongoing evolution of surgical techniques, the indications for wrist arthroscopy are rapidly expanding. Currently, wrist arthroscopy can be utilized in the clinical treatment of diseases including joint motion injuries, ligament injuries, triangular fibrocartilage complex (TFCC) injuries, dislocations of the distal ulna, scaphoid fractures and nonunions, distal radius fractures, and ulnar impaction syndrome.[8–11] In summary, wrist arthroscopy has revolutionized the diagnosis and treatment of wrist joint pathologies. It offers numerous advantages over traditional open surgery, including smaller incisions, improved aesthetics, reduced postoperative pain, shorter hospital stays, and faster recovery.[12] As indications broaden and advancements continue, wrist arthroscopy continues to reshape the landscape of wrist joint interventions.

Bibliometrics, as a quantitative and visual method of literature analysis, plays a crucial role in scientific research and academia.[13,14] It can examine the output and status of literature in various research topics and is widely used to evaluate research results, identify emerging trends, and evaluate the impact of academic literature. It is now widely used in medical fields, such as orthopedics, autoimmune diseases, etc.[15–17] However, no bibliometric studies on wrist arthroscopy have been found in recent years. Therefore, in this study, we utilized sophisticated bibliometric tools, including CiteSpace,[18] VOSviewer,[19] R package“Bibliometrix,”[20] and an online analysis platform (https://bibliometric.com), to obtain comprehensive data on references related to wrist arthroscopy literature. This encompassed information on countries, authors, institutions, journals, keywords, and research fields. Subsequently, we visualized the data to outline the research hotspots, application trends, and collaborative achievements in the field of wrist arthroscopy. This endeavor aims to enhance our understanding of its role in the management of wrist joint conditions and provide valuable insights and guidance for future research focus.

2. Materials and methods 2.1. Data sources and search strategies

We performed a comprehensive literature search in the Web of Science Core Collection (https://www.webofscience.com/wos/woscc), based on daily updates to the database that may have affected the included studies, the literature search was completed within a single day (July 10, 2023). The search terms is as follows: ([TS = wrist arthroscopy], OR [TS = wrist arthroscope], OR [TS = carpal arthroscope], OR [TS = carpal arthroscopic]), the type of literature was restricted to “articles” and “reviews,” and the publication period in this study was set from January 1, 2013 to July 10, 2023. Language restricted to English. After the initial search, we screened the titles and abstracts to confirm the eligibility of the article based on predefined inclusion and exclusion criteria. The flowchart of the screening process is shown in Figure 1. For this bibliometric analysis, ethical approval was not necessary as it did not involve direct human or animal subjects, relying solely on public data and literature.

Figure 1.:

Flowchart of literature identification and analysis process. CR = cited reference, PY = year published, TS = topic, WOSCC = Web of Science Core Collection.

2.2. Bibliometric analysis

After the completion of data collection, we extracted relevant bibliometric information from the selected publications, including annual publication count, countries, affiliations, journals, authors, citation status, keywords, etc. To conduct quantitative analysis and visualization of the collected data, we utilized 4 tools: CiteSpace (Version 6.2. R4), VOSviewer (Version 1.6.19), R package “Bibliometrix” (Version 4.0.0) (https://www.bibliometrix.org), and an online analysis platform (https://bibliometric.com).

3. Results 3.1. Annual publication trends

Based on the search conditions and process shown in Figure 1, we collected a total of 635 relevant publications, including 528 articles and 107 reviews. Figure 2 shows the number of publications released each year. It increased from 32 in 2013 to 69 in 2018, demonstrating a continuous upward trend. However, in 2019, the number of publications suddenly decreased to 44, followed by a gradual increase again, reaching a total of 107 publications by 2022. Since 2023 has not concluded, the publication count for that year is insufficient to portray a comprehensive trend.

Figure 2.:

Annual output of arthroscopy publications.

Regarding the annual number of wrist arthroscopy publications from 2013 to 2023, we consider that it might be influenced by several factors. First, the overall trend of increasing publication numbers from 2013 to 2023 may be attributed to the growing interest of hand surgeons in wrist arthroscopy technology, advancements in wrist arthroscopy, and its expanded clinical applications. During this period, there might have been increased funding opportunities, conferences, and symposiums dedicated to this field, thereby increasing the number of publications annually. For the sudden reduction in the number of publications in 2019, we think there could be several potential reasons. First, academic and research fields often go through cycles of innovation and consolidation. If significant technological advancements were made and published in the years before 2019, researchers might have shifted their focus toward consolidating research results and exploring practical clinical applications instead of producing a large volume of new publications. Therefore, as wrist arthroscopy technology became more widely adopted in clinical practice, the research focus might have shifted from exploratory investigations to more comprehensive and rigorous validation studies. These clinical applications and validation studies often require additional time and effort to collect high-quality patient cohort data, thus potentially leading to a decrease in the number of papers published in 2019. Additionally, the corona virus disease 2019 pandemic that started in 2019 might have had an impact on research output and priorities, such as laboratory closures, reduced funding, and reallocating resources to corona virus disease 2019-related research, could have led to a temporary decline in the number of publications. Nevertheless, based on the overall trend of publication numbers over the years, it is evident that the related publications on wrist arthroscopy are continuously increasing, suggesting significant potential in wrist arthroscopy. Therefore, the research trend of wrist arthroscopy is expected to persist.

3.2. Analysis of countries/regions

We measure the output of countries/regions by calculating the “Corresponding author’s countries.” According to the results shown in Figure 3A and Table 1, among all 635 publications, the USA (N = 149, 23.5%), France (N = 65, 10.2%), and China (N = 62, 9.8%) are the top 3 countries in terms of the number of publications. Their publication count is significantly higher than that of other countries/regions, each having over 60 publications. Following closely are Germany (N = 42, 6.6%), Japan (N = 36, 5.7%), South Korea (N = 35, 5.5%), and the United Kingdom (N = 34, 5.4%), each with more than 30 publications. Multiple country publications (MCP) refers to the number of articles coauthored by authors from different countries/regions, while single country publications refer to the number of articles whose authors all come from the same country/region. The proportion of MCPs can reflect the current state of international cooperation and academic research exchange in this field. From Figure 3A and Table 1, it can be observed that the USA and France, in the field of wrist arthroscopy, have published over 10 articles in collaboration with other countries/regions, indicating more abundant academic exchanges. In contrast, other countries exhibit relatively fewer international collaborations and academic exchanges. From the ranking of countries with the most citations in Figure 3B, it can be seen that the USA is in an absolute leading position with 1353 citations, demonstrating its authority in the field of wrist arthroscopy.

Table 1 - Top 10 corresponding author’s countries. Rank Country Articles SCP MCP Centrality 1 USA 149 125 24 0.43 2 France 65 49 16 0.13 3 China 62 56 6 0.09 4 Germany 42 35 7 0.11 5 Japan 36 32 4 0.06 6 Korea 35 34 1 0 7 United Kingdom 34 29 5 0.22 8 Netherlands 23 17 6 0 9 Australia 20 13 7 0.08 10 Spain 18 14 4 0.3

MCP = multiple country publications, SCP = single country publications.

Figure 3.:

Country distribution of wrist arthroscopy publications. (A) Top 20 countries that produced the largest number of literature. (B) Top 10 most cited countries. (C) The overlay visualization map of country co-authorship analysis. (D) The international cooperation analysis among different countries. (E) The countries’ collaboration world map. MCP = multiple country publications, SCP = single country publications.

From Figure 3C and D, and Table 2 of the countries’ collaboration network, further information about the cooperation between the USA, France, and other countries is revealed. The USA collaborates with Australia and China, while France collaborates with Belgium and Japan, each having coauthored more than 6 papers. Additionally, China, Germany, the United Kingdom, and Spain have also carried out collaborations with different countries/regions, forming 6 clusters. The Countries’ Collaboration World Map in Figure 3E shows that there are some connections between countries, but they are sparse and scattered, corresponding to the fact that single country publications far outnumber multicountry publications. This indicates that the majority of academic research in this field is conducted locally by most countries/regions. Although there is a certain foundation of international cooperation, further strengthening cooperation among countries is still needed.

Table 2 - Top 10 countries in terms of cooperation quantity. Rank From To Frequency 1 USA Australia 7 2 France Belgium 7 3 France Japan 6 4 USA China 6 5 USA France 6 6 China United Kingdom 5 7 USA Germany 5 8 USA Japan 5 9 USA Netherlands 5 10 France Netherlands 4
3.3. Analysis of institutions

Figure 4 and Table 3 depict the publishing landscape of institutions engaged in wrist arthroscopy research. Notably, among the top 10 institutions publishing the most on wrist arthroscopy, the Mayo Clinic leads with the highest number of publications (N = 34), trailed by the Chinese University of Hong Kong (N = 22), and the University of Amsterdam (N = 18). It’s worth mentioning that each institution within this top 10 list has published more than 10 publications. Specifically, the details of the publication counts and rankings of these institutions are displayed in Figure 4B.

Table 3 - Top 10 institutions for wrist arthroscopy research. Rank Affiliation Articles Citations 1 Mayo Clin 34 106 2 Chinese Univ Hong Kong 22 213 3 Univ Amsterdam 18 69 4 Stanford Univ 14 60 5 Sahlgrens Univ Hosp 13 110 6 Univ Gothenburg 13 139 7 Korea Univ 12 59 8 Heidelberg Univ 11 145 9 Lund Univ 11 50 10 Maasstad Hosp 11 37
Figure 4.:

Institutional status of wrist arthroscopy publications. (A) The visualization of institutions cooperation networks. (B) Top 10 institutions by the number of publications. (C) Top 5 institutions production over time (Sahlgrens Univ Hosp and Univ Gothenburg are tied for fifth place).

The “Affiliations’ Production over Time” for the top 6 publishing institutions is illustrated in Figure 4C. Here, the Mayo Clinic stands out, having experienced the fastest growth rate. This institution started its explosive growth in 2020 and managed to surpass the Chinese University of Hong Kong by 2021 to clinch the top spot. Meanwhile, the Chinese University of Hong Kong kick-started its rapid increase in publications from 2016 and has since sustained high output levels.

Figure 4A provides a visualization of the institution collaboration network. The publishing institutions in the field of wrist arthroscopy are primarily divided into 4 clusters. The collaboration hub among these institutions orbits around the Mayo Clinic and the Chinese University of Hong Kong, which indicates that the above 2 agencies have a core position in the field of wrist joint. Despite the University of Amsterdam’s notable third place ranking in terms of academic output in this field, it does not frequently collaborate with other affiliated institutions, resulting in its exclusion from the depicted network.

3.4. Analysis of journals 3.4.1. Volume of journal publications.

As illustrated in Figure 5A, the top 10 journals are listed in terms of the total number of publications. The 5 leading journals are Journal of Wrist Surgery (N = 83), Journal of Hand Surgery-American Volume (N = 43), Journal of Hand Surgery-European Volume (N = 42), Hand Clinics (N = 38), and Hand Surgery & Rehabilitation (N = 23). Collectively, these 5 journals account for approximately 36.06% of the total publications. This information, based on Bradford’s law, identifies these 5 journals as core sources. Nevertheless, considering the journal citation reports (JCR) partitions and impact factors, all these 5 journals are categorized into the 3rd or 4th quartiles, with impact factors ranging between 0.7 and 2.2, indicating that there is substantial room for improvement in the overall standard of journals publishing wrist arthroscopy-related works.

Figure 5.:

Journal status of wrist arthroscopy publications. (A) Top 10 journals by the number of publications. (B) Top 5 journals production over time. (C) Top 10 most local cited journals. (D) Network map of journals that were cited in more than 10 citations. (E) The dual-map overlay of journals related to wrist arthroscopy. (F) Network map of journals that were co-cited in more than 100 citations.

Figure 5B illustrates the “Sources’ Production over Time” trend for these top 5 publishing journals. Journal of Wrist Surgery, despite having a late start in 2017, has demonstrated an impressive trajectory. With explosive growth, it became the leading journal in publication volume by 2020, a position it continues to hold. Journal of Hand Surgery-American Volume and Journal of Hand Surgery-European Volume, as pioneers in wrist arthroscopy publications, have consistently maintained high publishing standards. Hand Clinics saw a sharp rise in its publication volume in 2016 and has been stable since. Importantly, from 2017 onward, there has been a noticeable annual increase in the volume of wrist arthroscopy-related publications in each of these journals, signaling a growing interest in this field.

3.4.2. Journal citations and co-citations.

Figure 5F presents a collaborative network diagram of journals that have published over 10 wrist arthroscopy papers. The network comprises 11 journals in total, featuring Journal of Wrist Surgery, Journal of Hand Surgery-European Volume, and Skeletal Radiology as central nodes. This network is primarily divided into 3 clusters, demonstrating close collaboration among various journals. Within these 11 journals, except for J Hand Surg-Asian-Pa, the remaining 10 journals correspond to the top 10 journals based on citation frequency. The specific citation count ranking can be referred to in Table 4. Leading the pack is J Hand Surg-Am with the highest number of citations (N = 435), followed by J Hand Surg-Eur (N = 428), and Arch Orthop Traum Su (N = 324). Figure 5C and D showcases the collaborative network diagrams of the top 10 co-cited journals and journals with over 100 co-citations. The top 5 journals in this regard are: J Hand Surg-Am (N = 3983), Arthroscopy (N = 1171), Hand Clin (N = 827), J Bone Joint Surg Am (N = 802), and J Hand Surg-Brit Eur (N = 702). A total of 25 journals have been co-cited more than 100 times and are divided into 5 clusters, with J Hand Surg-Am at the core.

Table 4 - Top 10 journals and co-citations journals of wrist arthroscopy. Rank Journals Articles Citations IF Q Rank Journals Co-citations IF Q 1 Journal of Wrist Surgery 83 162 0.7 / 1 J Hand Surg-Am 3983 1.9 3 2 J Hand Surg-Am 43 435 1.9 3 2 Arthroscopy 1171 4.7 1 3 J Hand Surg-Eur 42 428 2.2 3 3 Hand Clin 827 1.1 4 4 Hand Clinics 38 309 1.1 4 4 J Bone Joint Surg Am 802 5.3 1 5 Hand Surgery & Rehabilitation 23 103 1.1 4 5 J Hand Surg-Brit 702 / / 6 Arch Orthop Traum Su 21 324 2.3 3 6 J Wrist Surg 632 0.7 / 7 Arthroscopy 15 180 4.7 1 7 J Hand Surg-Eur 592 2.2 3 8 Orthop Traumatol-Sur 14 122 2.3 2 8 Clin Orthop Relat R 474 4.2 1 9 J Hand Surg-Asian-Pa 11 6 0.5 / 9 Tech Hand Up Extrem Surg 308 / / 10 BMC Musculoskeletal Disorders 10 208 2.3 2 10 J Bone Joint Surg Br 282 / /

CiteSpace was utilized to display a dual map overlay of journals related to wrist arthroscopy, as demonstrated in Figure 5E. The cluster on the left side of the pink line signifies the journals citing the articles, while the cluster on the right side of the pink path represents the journals being cited. It is primarily seen that articles published under the domains of health/nursing/medicine and sports/rehabilitation/sport are most often cited by researchers in medicine/medical/clinical journals. The double map overlay of journals could suggest that the primary focus of current wrist arthroscopy research is clinical rehabilitation, particularly aiming at the restoration of motor function and postoperative care.

3.5. Analysis of authors

Figure 6 and Table 5 display the situation of the authors of wrist arthroscopy publications. Figure 6A depicts the collaboration among authors who have published over 6 papers in the field of wrist arthroscopy research. There are 20 authors in total, primarily segmented into 5 clusters, with Kakar S (USA), Liu B (China), Ho PC (Hong Kong, China), Del Pinal F (Spain), and Mathoulin C (France) being the central figures. Figure 6B illustrates the network of authors whose research related to wrist arthroscopy technology has co-citation more than 80 times. The network consists of 13 authors, with Palmer AK, Geissier WB, and Berger RA, all from the USA, being the core authors.

Table 5 - Top 10 authors and co-citations authors of wrist arthroscopy. Rank Authors Articles H-index Country Institutions Rank Authors Citations Total link strength Country Institutions 1 Ho PC 17 7 HK, China Chinese University of Hong Kong 1 Palmer AK 232 3447 USA SUNY Health Science Center 2 Kakar S 15 4 USA Mayo Clinic 2 Geissler WB 205 3254 USA University of Mississippi Medical Center 3 Del Pinal F 12 7 Spain Hospital Mutua Montañesa 3 Del Pinal F 189 2857 Spain Hospital Mutua Montañesa 4 Mathoulin C 12 6 France Clinique Bizet 4 Nakamura T 162 2735 Japan Keio University 5 Hirata H 10 5 Japan Mie University 5 Atzei A 153 2656 Italy Italy Hand Surgery Unit 6 Liu B 10 4 China Beijing Ji Shui Tan Hospital 6 Berger RA 126 2580 USA Mayo Clinic 7 Liverneaux P 10 4 France University Hospital of Strasbourg 7