Top 50 Most-Cited Articles on Tension Band Wiring for Patellar Fractures: A Bibliometric Analysis and Methodological Quality Assessment.

Abstract

Tension band wiring (TBW) remains the most common operation for displaced transverse patellar fractures, yet the methodological quality of highly cited papers is often questioned. We aimed to identify the 50 most-cited TBW patella papers and appraise their study designs and methodological rigour. We searched Web of Science (1990-2024) using "patella fracture AND tension band"; olecranon studies were excluded. The top 50 cited papers were selected. For each paper, we recorded bibliographic information and total citations. Study type was assigned based on the primary topic. We scored methodological quality using the Modified Coleman Methodology Score (MCMS; 0-100; poor <55, fair 55-69, good 70-84, excellent ≥85) for clinical outcomes studies, the Methodological Index for Non-Randomized Studies (MINORS) (0-16 non-comparative/0-24 comparative) for non-randomised clinical studies, and the Biomechanics Objective Basic Quality Assessment Tool (BOBQAT) (0-100; higher scores indicate better quality) for biomechanical studies. Two reviewers scored independently, with consensus resolution. Associations between citation metrics and quality were tested using correlation and regression analyses, while subgroup comparisons were conducted using non-parametric tests to account for data distribution. Across 50 papers, the mean number of citations was 71.9 (range 29-229). Publications clustered in the late 1990s-2010s; 50% originated from the United States. Study types were biomechanical 25/50 (50%), clinical 20/50 (40%), and mixed/review/technique 5/50 (10%). Only 2/50 (4%) were small single-centre randomised trials; most clinical studies were Level III-IV. Methodological quality was moderate: MCMS mean 49.0 (SD 10.9; n=18); MINORS mean 8.8/24 (SD 2.5; n=15); BOBQAT mean 44.4/100 (SD 21.6; n=25). Citations did not show a significant correlation with methodological quality (Spearman's ρ indicates correlation strength and direction; MCMS ρ=-0.35, p=0.153; MINORS ρ=-0.08, p=0.783; BOBQAT ρ=-0.03, p=0.879). Among the 50 most-cited TBW patella papers, methodological quality is moderate, and citation counts do not track study rigour. The literature is dominated by biomechanical studies and lower-level clinical evidence, with very few randomised trials. Future work should prioritise prospective comparative studies with sufficient sample sizes and statistical power, including multicentre trials, to ensure that influential studies are supported by high-quality clinical evidence.