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

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.

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.

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.

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.