The impact of randomized controlled trials on the management of anterior shoulder instability: A bibliometric and altmetrics analysis

To perform a bibliometric and altmetric analysis of randomized controlled trials (RCTs) in anterior shoulder instability (ASI) management through a citation and altmetrics analysis. A complete search of MEDLINE, EMBASE and CENTRAL databases was conducted from inception to 17 July 2025 for RCTs assessing surgical management of ASI. Citation metrics were obtained from Clarivate Web of Science Database on 16 August 2025, and Altmetrics data were extracted from Altmetrics.com on 5 September 2025. Univariate regression models and a one-way analysis of variance were used to explore correlations between scholarly impact and various study characteristics. A total of 24 studies consisting of 1559 participants were included. Studies were published between 1999 and 2024. Eleven countries were represented, with most studies originating from Canada (n = 5). The average impact factor was 4.3 (range 0.3-5.4), and the median citation density was 4.90 citations per year (range 1.0-19.3). The average altmetrics attention score was 10.8 (range 1-25). The median scholarly composite score density (SCSD) was 6.75 mentions per year (range 0.05-24). Regression analysis demonstrated fair and significant correlation to the first author's H-index for both citation density (r = 0.44, p = 0.030) and SCSD (r = 0.41, p = 0.047). All other variables were non-significant but had high effect sizes. Risk of bias (RoB) scores were found to be fairly correlated with citation density (r = 0.43, p = 0.036). The bibliometric and altmetric impact of RCTs assessing surgical management of ASI is wide and varied across many journals of variable impact factors. Despite high effect size, only the first author's H-index was correlated with higher citation and SCSD, while RoB score was fairly correlated with a higher citation density, posing the question of whether an author's preestablished reputation or the robustness of an RCTs' design to control for bias can have an impact on the dissemination of academic information. Level V, expert opinion.