Top-Cited Literature in Ankle Arthrodesis: Identifying Trends, Evidence Levels, and Future Directions.

Introduction: Ankle arthrodesis is a key surgical option for end-stage ankle arthritis when total ankle replacement is not feasible. Despite advancements, challenges like non-union and infection persist. While bibliometric analysis has been applied in other orthopaedic fields, no study has focused on ankle arthrodesis.

Methods: This study analysed the 50 most-cited articles to assess their impact and guide future research and clinical practice. A Web of Science search using the terms (("Ankle*" OR "Tibiotalar") AND ("Arthrodesis" OR "Fusion")) identified 533 articles published up to October 2024, including only English-language, peer-reviewed studies on human subjects, while excluding non-peer-reviewed, non-English, or unrelated studies. After screening and data extraction, bibliometric techniques assessed publication trends, citation impact, and key research contributors.

Results: The 50 analysed articles, published between 1948 and 2017, accumulated 12,674 citations (average 678.8 per year), with Ankle Arthrodesis: Long-Term Follow-Up with Gait Analysis by Mazur et al. (1979) as the most cited. The Journal of Bone and Joint Surgery published the most articles (N=26), with the USA leading in research output (N=31). Research activity increased in the 1990s and 2000s, with most studies being observational (92%) and Level IV evidence (34%) prevailing.

Conclusion: This analysis highlights influential studies and research gaps, emphasizing the need for high-quality clinical trials to refine surgical techniques and improve patient outcomes in ankle arthrodesis. Future research should focus on robust methodologies and long-term functional outcomes to advance ankle arthrodesis practice.