Introduction

By the mid-1980s, several advantages of arthroscopy over open surgery had been established, making it the preferred treatment method when appropriate [1-4]. Early research indicated that arthroscopy typically resulted in less pain and postoperative swelling compared to open surgery, and it often lowered the risk of complications such as infection and arthrofibrosis, enabling patients to return to work and normal activities more quickly [5]. It is widely accepted that the optimal management of osteoarthritis involves a combination of nonpharmacologic and pharmacologic treatments, including acetaminophen, nonsteroidal anti-inflammatory drugs, or selective COX2 inhibitors [6,7]. For patients with inadequate response to analgesics and anti-inflammatory drugs, or contraindications to these medications, intra-articular therapy serves as a viable alternative [8]. To enhance pain relief and recovery after arthroscopy, intra-articular injections have been employed [9]. After therapeutic arthroscopic knee surgery, the combined use of intra-articular local anesthetic, morphine, and methylprednisolone has proven rational and effective in reducing pain and inflammation, thereby shortening recovery time following arthroscopic meniscectomy [10,11].

Osteoarthritis (OA) is a common and debilitating joint disease with limited therapeutic options available in clinical practice [12]. Recent research indicates that exosomes derived from Mesenchymal Stem Cells (MSCs) can reduce the severity of OA in animal models, suggesting that MSC-derived exosomes could be a promising treatment strategy for OA [13]. Another study evaluated the safety and feasibility of intra-articular autologous tolerogenic Dendritic Cells (tolDC) in patients with inflammatory arthritis and an inflamed knee, finding that IA tolDC therapy was safe, feasible, and well-accepted by patients [14]. Additionally, a therapeutic case series study assessed the clinical outcomes of intra-articular injection of stem cells combined with arthroscopic lavage for treating knee OA in elderly patients. The results showed that adipose-derived stem cell therapy was effective in promoting cartilage healing, reducing pain, and improving function in elderly patients with knee OA [15,16].

Shoulder stiffness, commonly known as frozen shoulder, can result from various factors. While conservative treatment is typically the first line of action, arthroscopic capsular release may be necessary for cases of refractory stiffness. Postoperative rehabilitation is essential for achieving satisfactory outcomes [17-19]. A network meta-analysis was conducted to determine the most effective treatment for arteriovenous Temporomandibular Disorders (TMDs) [20,21]. The results indicated that minimally invasive procedures, especially those combined with intra-articular injection of adjuvant pharmacological agents, were significantly more effective than conservative treatments in reducing pain and improving mouth opening in TMD patients [22,23].

Bibliometrics is a valuable tool for evaluating published articles using mathematical and statistical methods, and it has been widely applied across various medical disciplines [24]. This method allows beginners to gain an intuitive, systematic, and comprehensive understanding of the development and hot trends in a specific field [25]. CiteSpace and Vosviewer are software programs that visualize information to identify and present emerging trends [26]. These tools are easy to obtain, operate, and interpret, making them popular for bibliometric analysis and other research areas [27]. Currently, research on intra-articular injection in arthroscopic treatment primarily focuses on mechanisms and clinical observations. However, there is a lack of clear analysis regarding hotspot trends and intuitive structural displays in this field. This study aims to analyze the application of intra-articular injection in arthroscopic treatment over the past 23 years using bibliometric analysis. By presenting authors, publishing institutions, keywords, and other elements in the form of knowledge maps, the study seeks to provide a comprehensive understanding of the research background, predict future development trends and hotspots, and offer references for further related research.

Methods

Data collection and search strategy

Given that the Web of Science (WoS) is a prominent academic database widely used for bibliometric analysis, we selected the WoS core collection as our literature source [28]. The search covered the period from 2000 to 2024. Our search strategy was as follows: TS = (Joint injection OR intra-articular therapy OR intra-articular injection or intra-synovial injection) and TS= (Arthroscopic or Arthroscopy or Arthroscope). This search yielded 1106 studies, of which 1007 articles were exported for records and cited references in plain text format. As all data utilized in this study were obtained from public databases, ethics committee approval or informed consent was not required. The detailed retrieval strategy is outlined in Table 1.

Table 1: Data sources and fl ow of retrieval strategy.

Statistical analysis

Information on annual publications and journal distributions was obtained from the WoS database, and the chart of annual publications was generated using Origin Pro 2023. Vosviewer 1.6.18 software was selected to batch import Chinese and English literature data, dynamically adjusting the author’s publication value for optimal display [29]. We utilized Overlay Visualization and Network Visualization for visualization and analysis. Association Strength was chosen as the parameter in the Method functional area, with dynamic adjustments to the Attraction and Repulsion parameters to achieve the best display effect [30]. In the Clustering functional area, we set the Resolution and Min. cluster size parameters to 1.00 and 1, respectively, while also adjusting the Scale, Labels, Lines, and Colors parameters in the Visualization Display functional area to enhance clarity and aesthetics [31].

For the bibliometric analysis using CiteSpace 6.2R7, we selected the “Full Record with Cited References” option, exporting the fully documented and cited reference data from the WoS database to a “plain text” file for import into CiteSpace [32]. Parameters were set to split time slices by one year, using the cosine algorithm to calculate network uniform strength and extract the top 10% of targets in each time slice [33]. Node type selection and keyword threshold (Top N) were set to 50, with the g metric (k=10) used for extraction node thresholds, while default values were applied to all other parameters [34]. Pathfinder and pruned slice networks were employed to crop each slice and merge the networks, highlighting significant network structures. The LSI algorithm was utilized to cluster literature keywords, identifying the top-ranked title words as cluster labels [35].

Results

Annual publication outputs and trends

Research in the field of intra-articular injection in arthroscopic treatment primarily focuses on basic scientific research and clinical studies. As shown in Figure 1, which plots the annual distribution of publications with the year on the x-axis and the number of publications on the y-axis, the continuous exploration of intra-articular injection in arthroscopic treatment is depicted. From 2000 to 2004, the number of publications was the lowest, ranging between 14 and 24 per year. However, since 2005, the number of publications has steadily increased, reaching 61 in 2019 and 74 in 2021. This trend indicates growing interest and attention in the study of intra-articular injections in arthroscopic treatment.

In terms of citation frequency, the period from 2000 to 2004 experienced low citation numbers, ranging from 1 to 120 citations per year. Since 2005, citation frequency has shown a significant upward trend, reaching 2,410 citations in 2019 and 3,144 in 2021. This rise suggests that the research outcomes on intra-articular injections in arthroscopic treatment have gradually gained recognition and are being increasingly cited in both academic and clinical settings.

It is noteworthy that both the number of publications and citation frequency exhibit a slight decline starting from 2022. This may be attributed to progress made in the field leading to a saturation of hot topics or increased competition from other emerging research areas. Nonetheless, research on intra-articular injections in arthroscopic therapy continues to maintain a high level of output and impact.

Analysis of countries

The 1,107 articles in this study originated from 68 different countries or regions. The United States (USA) was the most prolific, contributing 350 articles, followed by China with 93 articles, and England with 63 articles. Italy and Turkey ranked fourth and fifth, with 59 and 56 articles, respectively.

In terms of total citations, the USA led with 10,171 citations, followed by England with 2,218, Italy with 2,145, South Korea with 2,094, and Scotland with 2,033 citations. Figure 2 illustrates that the size of the node circles corresponds to the level of centrality. This visualization suggests possible collaborative networks, with the USA leading in article volume, citation frequency, and link strength.

The USA’s dominance in both the number of publications and citation frequency highlights its significant research activity and impact in the field of intra-articular injections in arthroscopic therapy. The high citation count further underscores the substantial influence of US research on the academic community.

Analysis of institutions

A total of 1,471 institutions have been involved in research on intra-articular injections. The top five institutions in terms of publication volume were Rush University (20 publications), Hospital for Special Surgery (18), Mayo Clinic (17), Stanford University (14), and McMaster University (13). Notably, all but McMaster University are based in the USA.

Figure 3 highlights the intricate and extensive collaboration among these institutions, revealing that Rush University leads in publication count, citation frequency, and link strength, indicating its significant partnerships with other research entities. Despite the strength of these institutions in scientific research, the limited connectivity between nodes suggests relatively weak overall collaboration among institutions. Rush University stands out as the most active and influential institution in this field, showcasing its leadership, substantial research foundation, and strong collaborative efforts in the study of intra-articular injections in arthroscopic treatment.

Analysis of journal

Figure 4 illustrates the collaborative network of journals focused on the application of adjuvant injections in arthroscopic treatment. Journals serve as crucial platforms for disseminating research findings and fostering collaboration, significantly contributing to the advancement of scientific knowledge. Between 2000 and 2024, 323 journals published research on intra-articular injections in arthroscopic therapy. Table 2 lists the top 10 journals in this field, highlighting their impact.

Arthroscopy: The Journal of Arthroscopic & Related Surgery led with 78 publications on intra-articular injections in arthroscopic therapy. Knee Surgery, Sports Traumatology, and Arthroscopy ranked second with 50 publications but was only fourth in citation frequency (1,517). The Impact Factors (IF) of these top 10 journals range from 0.9 to 5.3. Among them, four journals have an IF greater than 4.0, six have an IF between 1.0 and 4.0, and one journal has an IF below 1.0. The Journal of Bone and Joint Surgery-American Volume has the highest IF of 5.3 among the top 10 journals based on the number of publications.

Figure 5 presents the dual-map overlay of the literature, where the left clusters represent the journals where the records were published, and the right clusters indicate the citation sources. The dataset reveals four main citation paths, predominantly covering the following domains: (1) Medicine, Medical, Clinical, and (2) Neurology, Sports, and Ophthalmology. The literature was most influenced by the following domains: (1) Molecular Biology and agents; (2) Health, Nursing, and Medicine; and (3) Psychology, Education, and Social. This multidisciplinary influence underscores the diverse perspectives contributing to the citation landscape.

Table 2: Top 10 Journals with publications related to intra-articular injections in arthroscopic therapy between 2000 and 2024.

Analysis of authors and cooperative relationship

Analyzing the authors of the included literature provides insights into key researchers and the primary contributors to this field. The top three authors with the highest number of publications are Brian J. Cole (9), Brian C. Werner (8), and Jourdan M. Cancienne (7). In terms of citation frequency, the leading authors are Yun-Jin Choi (722 citations), Yong-Gon Koh (722 citations), Elizaveta Kon (507 citations), and Giuseppe Filardo (505 citations).

Brian J. Cole from Rush University, the most prolific author, has concentrated on clinical research, particularly focusing on hyaluronic acid and platelet-rich plasma for managing knee osteoarthritis. Figure 6 presents the collaboration network of prominent authors. It reveals that Brian J. Cole and Brian C. Werner, who rank first and second in publication volume, have a close collaboration. However, overall, there is limited cooperation among authors in this field, indicating a relatively disconnected network. To advance research in this area, enhancing collaboration among scholars is recommended.

Table 3: Top 20 co-occurrence keyword frequency.

Discussion on research hotspots and trends

Discussion on disciplinary hotspots

Based on the results generated by Cite Space, an analysis of the frequency, centrality, and temporal development of relevant disciplines provides insight into the application of adjuvant injections in arthroscopic treatment. Figure 7 illustrates the interdisciplinary co-occurrence diagram, with the following observations:

Orthopedics (485 occurrences, centrality 0.16): Orthopedics is a primary discipline investigating the use of intra-articular injections in arthroscopic treatment. High research activity in this field was observed in 2000, indicating early and substantial interest. The sustained high centrality of Orthopedics suggests its fundamental role in the study of arthroscopic procedures involving intra-articular injections.

Surgery (288 occurrences, centrality 0.36): As a central discipline in arthroscopic surgery and associated treatments, Surgery exhibited significant research activity in 2000. The elevated centrality underscores its pivotal role in developing and applying intra-articular injections within arthroscopic treatments.

Sport Sciences (275 occurrences, centrality 0.17) Sport Sciences, focusing on sports and related injuries, saw a relatively high research frequency in 2000. This reflects the relevance of intra-articular injections in managing sports injuries. Despite a decline in research frequency over time, sports sciences continue to maintain notable centrality.

Rheumatology (86 occurrences, centrality 0.05): This discipline, which explores arthritis and rheumatic diseases, had a lower frequency of research in 2000 but demonstrated some centrality. This indicates an emerging recognition of the role of intra-articular injections in treating rheumatic conditions.

Medicine, General & Internal (73 occurrences, centrality 0.23): Encompassing a broad range of internal medicine research, this discipline showed increased activity from 2003 onward. This trend reflects growing attention to the clinical applications and efficacy of intra-articular injections in broader medical contexts.

The analysis indicates that Orthopedics, Surgery, and Sport Sciences play significant roles in the research on intra-articular injections in arthroscopic treatment. The temporal emergence and centrality of these disciplines align with key research trends and hotspots. Initially focused on surgical applications and efficacy evaluations, research has progressively shifted toward clinical applications and evaluations.

Overall, research on intra-articular injections in arthroscopic treatment has evolved from a focus on surgical aspects to a broader clinical perspective. Future investigations may further delve into these disciplines to enhance the understanding and application of intra-articular injections in arthroscopic therapy.

Analysis of keyword

Keywords serve as the fundamental topics of published research articles, and their co-occurrence analysis provides insights into the relationships between different research topics within a field [38]. The co-occurrence network of keywords, depicted in Figure 8, consists of 457 nodes and 1,537 lines, where the lines represent co-occurrence relationships between keywords, with line thickness indicating the frequency of co-occurrences. The analysis reveals that high-frequency keywords include “mesenchymal stem cell” (649), “in vitro” (304), “differentiation” (295), “stem cell” (234), “bone marrow” (213), “expression” (211), “stromal cell” (208), “repair” (176), “bone” (136), and “marrow stromal cell” (134). Keywords with the highest centrality are “tissue engineering” (0.09), “collagen” (0.08), “transplantation” (0.07), “defect” (0.07), “marrow” (0.07), “bone marrow” (0.06), “cell” (0.06), “bone morphogenetic protein 2” (0.06), “injury” (0.06), and “expression” (0.05).

Keyword clustering analysis further simplifies these keywords into clusters based on their co-occurrence network, as shown in Figure 9. The clusters, each containing more than 15 nodes and with silhouettes greater than 0.8, represent distinct research topics. The structural features between clusters highlight key nodes and reflect the primary research hotspots and trends in the field.

In the context of intra-articular injections for knee Osteoarthritis (OA), a systematic review assessed the long-term safety of common treatments. Findings indicated that lifestyle modifications, including weight loss and exercise, presented a low risk of harm and offered beneficial long-term outcomes [39]. Intra-articular hyaluronic acid and corticosteroids also demonstrated low risk and positive long-term outcomes [40], whereas nonsteroidal anti-inflammatory drugs were associated with an increased risk of medical complications [41].

For postoperative pain management following shoulder arthroscopy, a systematic review identified interscalene nerve blocks as the most effective method for controlling pain, and enhancing patient recovery and satisfaction [42]. Adjuvants such as dexamethasone and clonidine were found to improve the efficacy and duration of nerve blocks [43,44].

Research topic clustering

Citespace’s clustering analysis organizes extensive literature data by keywords, authors, institutions, and citation relationships, resulting in a structured knowledge graph [47]. This visualization approach allows researchers to better comprehend the relationships and research hotspots within the literature, thereby enhancing understanding of development trends and knowledge structures in the academic field. The clustering analysis of adjuvant injection in arthroscopic treatment identified 10 clusters, each characterized by unique keywords, silhouette scores, and cluster years, as illustrated in Figure 10.

Cluster 0: This cluster focuses on pain management and drug application in arthroscopic treatment, with keywords such as “bupivacaine,” “intra-articular,” “pain,” “perioperative,” and “topical pain.” The high frequency of these keywords around 2005 indicates that pain management post-arthroscopic surgery was a significant research focus, highlighting its importance for patient recovery and satisfaction.

Cluster 1: Concentrated in 2010, this cluster includes keywords related to rheumatoid arthritis, synovial tissue hyperplasia, and magnetic resonance imaging. This suggests a notable connection between intra-articular injections in arthroscopic treatment and the treatment of these diseases, underlining the role of arthroscopic surgery in managing such conditions.

Cluster 2: Focusing on 2008, this cluster involves keywords related to platelet-rich plasma, osteochondral lesions, and temporomandibular joint osteoarthritis. The presence of these keywords indicates the relevance of intra-articular injections in treating these conditions, emphasizing the potential and prospects of arthroscopic surgery in these areas.

Cluster 3: Highlighting 2012, this cluster includes keywords related to temporomandibular joint disease, intra-articular injection, and synovitis. This reflects the importance of intra-articular injections in managing temporomandibular joint diseases and synovitis during this period.

Cluster 4: Focusing on 2009, this cluster involves keywords related to femoral acetabular impingement, iliac spur, and intra-articular bouncing. The connection of these keywords with intra-articular injections in arthroscopic treatment indicates the potential applications in treating these conditions.

Cluster 5: Concentrated in 2012, this cluster includes keywords related to mucinous synovitis, physical therapy, arthroscopic release, and shoulder stiffness. This highlights the role of intra-articular injections in treating these conditions, emphasizing their importance in managing mucinous synovitis and shoulder stiffness.

Cluster 6: Focusing on 2008, this cluster involves keywords related to intra-articular injection, local anesthesia, arthroscopic partial meniscectomy, and toxicity. The association of these keywords with intra-articular injections underscores their potential applications in these areas.

Cluster 7: Concentrated in 2016, this cluster includes keywords related to mesenchymal stem cells, regenerative medicine, cell therapy, amniotic tissue, and tissue matrix. The presence of these keywords indicates the significance of intra-articular injections in regenerative medicine and related fields.

Cluster 8: Highlighting 2013, this cluster involves keywords related to mesenchymal stem cells, hyaluronic acid, articular cartilage, arthroscopic drilling, and hyaline cartilage. The connection of these keywords with intra-articular injections suggests their importance in cartilage repair and related treatments.

Cluster 9: Focusing on 2011, this cluster includes keywords related to pain management, hip arthroscopic surgery, peri-iliac injection, preoperative analgesia, and intra-articular analgesia. The presence of these keywords indicates the critical role of intra-articular injections in pain management for hip arthroscopic surgery.

Cluster 10: Concentrated in 2008, this cluster involves keywords related to joint activity, anesthesia, primary frozen shoulder, corticosteroid injection, and double-blind. The association of these keywords with intra-articular injections underscores their significance in treating primary frozen shoulder and similar conditions.

Cluster 11: Highlighting 2013, this cluster includes keywords related to the rotator cuff, knee, joint pain, and nonsteroidal anti-inflammatory drugs. The presence of these keywords indicates the importance of intra-articular injections in managing these conditions.

Cluster 12: Focusing on 2005, this cluster involves keywords related to intra-articular injection, magnesium sulfate, anti-inflammatory effects, hyaluronic acid, and analgesic effects. The connection of these keywords with intra-articular injections underscores their potential in managing inflammation and pain.

Cluster 13: Concentrated in 2002, this cluster includes keywords related to the knee, radio assimilation, synovectomy, and arthroscopic synovectomy. The association of these keywords with intra-articular injections highlights their relevance in treating these conditions.

Through the analysis of these clusters, it is evident that research on intra-articular injections in arthroscopic treatment primarily focuses on pain management, osteoarthritis, cartilage repair, and regeneration. These research directions are crucial for improving the effectiveness of arthroscopic treatments and enhancing patient quality of life. Continued research on intra-articular injections in arthroscopic treatment is essential to advance this field further.

Evolutionary trends in hot topic research

The keyword timeline visualization map is pivotal in illustrating the relationships between clusters and the historical span of keywords within each cluster [49]. The research timeline for the application of adjuvant injection in arthroscopic treatment, depicted in Figure 11, arranges nodes in the same cluster in chronological order on a horizontal line, with time indicated at the top of the view. Nodes positioned further to the right denote more recent research [50]. This timeline visualization allows for a clear understanding of the historical development and trends in the application of adjuvant injections in arthroscopic treatment.

In 2004, the keyword “Osteoarthritis” appeared 126 times with a high centrality (0.13), highlighting the significant attention given to intra-articular injection research in treating osteoarthritis during that year. Similarly, “Arthroscopy” emerged 112 times in 2001 with high centrality (0.23), indicating that the application of intra-articular injection in arthroscopic surgery began garnering substantial interest in 2001. Additionally, “Pain” demonstrated high centrality in 2003, and “Hyaluronic acid” in 2007, reflecting the focus on pain management and cartilage protection through intra-articular injections during these years.

Between 2000 and 2002, keywords such as “Injection,” “Knee,” “Joint,” and “Bupivacaine” were notably frequent, indicating heightened research interest in injection methods for intra-articular injections, knee joint conditions, joint diseases, and local anesthetics. From 2003 to 2005, keywords like “Double-blind,” “Outcome,” and “Intra-articular injection” became more prominent, signifying attention to double-blind studies, efficacy evaluations, and studies on intra-articular injections in arthroscopic treatment during this period.

From 2000 to 2004, research on intra-articular injections in arthroscopic treatment primarily focused on osteoarthritis, arthroscopic surgery, pain management, and cartilage protection. These research directions are crucial for enhancing the effectiveness of arthroscopic treatments and improving patients’ quality of life. Future research should continue to delve into these areas and foster collaboration among different themes to further advance the field of intra-articular injections in arthroscopic treatment.

Research hotspots and emerging topics

Citespace’s keyword emergence analysis is a powerful method for identifying the frequency and correlation of keyword appearances in literature, revealing hotspots and trends in the research field of adjuvant injection in arthroscopic treatment [52]. Through this analysis, researchers can discern which keywords appear more frequently, indicating the areas of greatest interest and activity within the field. Figure 12 highlights the key research keywords for adjuvant injection in arthroscopic treatment, showing the year and intensity of their emergence, as well as their importance to the research topic.

Keywords with strong citation bursts were identified using Citespace’s analysis of strong citation bursts to explore the frontier field of Mesenchymal Stem Cells (MSCs) in orthopedic diseases. As shown in Figure 12, the keywords with the strongest citation bursts included “expression” (2002-2003), “culture” (2002-2003), and “progenitor cell” (2008-2012). More recent burst keywords included “knee” (2014-2021), “platelet-rich plasma” (2015-2021), “osteoarthritis” (2015-2021), and “scaffold” (2018-2021). This highlights the evolving focus in the field, with newer research concentrating on advanced therapies and technologies.

Various therapies aim to reduce symptoms of knee Osteoarthritis (OA), but a cure for the disease remains elusive. A review article evaluated current practices for managing knee OA and discussed emerging therapies, underscoring the importance of a multi-faceted treatment approach and the need for continued research to develop new strategies [53]. A systematic review investigating predictors of outcomes after hip arthroscopic surgery for patients with Femoroacetabular Impingement (FAI) found that younger age, male sex, lower body mass index, absence of preoperative pain, and positive response to preoperative intra-articular hip injections were associated with positive outcomes. Conversely, older age, female sex, higher body mass index, osteoarthritic changes, and undergoing labral debridement alone were predictors of negative outcomes [54,55].

Citespace’s analysis calculated the year, intensity, and importance of keyword emergence, offering insights into the development trends and hotspots in intra-articular injection for arthroscopic treatment [56]. Below, we analyze the year and intensity of emergence, the importance of these keywords, and the cooperative relationships between research topics during corresponding years.

The emergence of intra-articular injection in arthroscopic treatment is primarily concentrated between 2000 and 2004. During this period, keywords like “morphine” and “intra-articular morphine” emerged with high intensity, signaling the beginning of explorations into using intra-articular morphine for pain relief in arthroscopic treatment. Concurrently, other related keywords such as “surgery,” “postoperative pain,” and “knee arthroscopy” appeared, reflecting the clinical emphasis on arthroscopic surgery and postoperative pain management at that time. Additionally, “rheumatoid arthritis” began to emerge in 2001, indicating growing research interest in arthroscopic treatment for rheumatoid arthritis.

Hot areas related to intra-articular injection and arthroscopic treatment include “bupivacaine,” “postoperative surgery,” “pain relief,” and “arthroscopic knee surgery,” all of which emerged with high intensity between 2001 and 2004. These keywords indicate that research during this period focused on pain manmanagement, postoperative analgesia, and joint cartilage repair in arthroscopic treatment. Later years saw the emergence of important keywords such as “hyaluronic acid,” “mesenchymal stem cells,” and “platelet-rich plasma,” reflecting the growing interest in these emerging treatment methods.

The development trends and hotspots for intra-articular injection in arthroscopic treatment were predominantly concentrated between 2000 and 2004. The emerging keywords from this period highlight the importance of pain management, postoperative pain, joint cartilage repair, and new treatment methods in arthroscopic treatment. The collaborative relationships between these research fields likely stem from their interrelated roles in clinical practice aimed at improving the effectiveness of arthroscopic treatment and patient quality of life. Future research should continue to explore these areas to further advance the field of intra-articular injection in arthroscopic treatment.

Conclusion

In conclusion, this bibliometric study provides a comprehensive analysis of dynamic structures and emerging trends in major trauma research using the visualization software, CiteSpace. Based on our findings, the leading countries are the United States, Germany, and England, while Asian countries need more investment in the research field. The comprehensive performance of publication volume, citation frequency, and link strength highlights the significant contributions of institutions such as Rush University, which excels in all three aspects. Hospitals such as the Hospital for Special Surgery and the Mayo Clinic also demonstrate importance and contributions in terms of publication volume and citation frequency. Notably, Yonsei Sarang Hospital has a high influence in terms of citation frequency.

In terms of leading researchers, Brian J. Cole leads in publication volume, indicating their high research activity in the field of intra-articular injection. Yun Jin Choi and Yong Gon Koh show outstanding performance in citation frequency, reflecting the high impact of their research. Wei Jie ranks first in link strength, indicating close research collaboration with other authors. Regarding publishing journals, “Arthroscopy: The Journal of Arthroscopy and Related Surgery” ranks first in terms of publication volume, citation frequency, and link strength, underscoring its important position in the field of intra-articular injection. “Knee Surgery, Sports Traumatology, Arthroscopy” also performs well in terms of article volume and link strength.

Key disciplines such as surgery, orthopedics, and sports sciences play crucial roles in the research of intra-articular injection in arthroscopic treatment. The development trends and hotspots in this field primarily focus on arthroscopy, osteoarthritis, pain management, research on drugs and treatment methods, and the repair and protection of articular cartilage.

To enhance care and guide future research in intra-articular injection therapies, the following recommendations are proposed:

Foster Interdisciplinary Collaboration: Encourage cooperation between different medical and scientific disciplines to integrate diverse perspectives and expertise.

Develop Personalized Treatment Strategies: Tailor treatments based on individual patient characteristics to improve outcomes.

Innovate in Biomaterials and Pharmaceuticals: Continue developing new materials and drugs to enhance treatment efficacy and safety.

Conduct Longitudinal Studies: Perform long-term research to understand the lasting effects and potential risks of intra-articular injections.

Update Clinical Guidelines: Regularly revise treatment protocols to reflect the latest research findings and clinical practices.

Enhance Patient Education and Engagement: Inform patients about treatment options and involve them in decision-making processes.

Explore Emerging Technologies: Investigate new technologies, such as regenerative medicine and advanced imaging techniques, to improve treatment outcomes.

Establish Global Research Networks: Create international collaborations to share knowledge, resources, and best practices across different regions.

These strategies aim to advance the field of intra-articular injection in arthroscopic treatment, ultimately improving patient care and outcomes.

Limitations

This study had the following limitations. According to a study, it is acknowledged that WOSCC is the recommended database for bibliometric analysis. Consequently, data were collected from the WOSCC database, whereas data from other sources such as PubMed, Google Scholar, and Embase were not included. As several newly published and potentially high-impact studies may not have been included in our study, the emerging hotspots and trends in major trauma research may vary with bibliometric data updates.

Declarations

Author contributions: Xu Feng and Kang Wannian: Project design and supervision. Chang Dehai: Literature search and data analysis. Xu Feng and Guo Erpeng: Editors for article writing.

Funding: This study was supported by the Natural Science Foundation of Wuwei City, Gansu Province (Grant/Award Number: WW23A03RPZ002).

Conflict of interest: The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors, and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References

1. F Aïm, J Delambre, T Bauer, P Hardy. Efficacy of arthroscopic treatment for resolving infection in septic arthritis of native joints, Orthopaedics & Traumatology-Surgery & Research. 2015; 101(1): 61-64.
2. EA Al-Moraissi, LM Wolford, E Ellis, A Neff. The hierarchy of different treatments for arthrogenous temporomandibular disorders: A network meta-analysis of randomized clinical trials, Journal of Cranio-Maxillofacial Surgery. 2020; 48(1): 9-23.
3. RD Altman, T Devji, M Bhandari, A Fierlinger, F Niazi, et al. Clinical benefit of intra-articular saline as a comparator in clinical trials of knee osteoarthritis treatments: A systematic review and meta-analysis of randomized trials, Seminars in Arthritis and Rheumatism. 2016; 46(2): 151-159.
4. I Andia, N Maffulli. Biological Therapies in Regenerative Sports Medicine, Sports Medicine. 2017; 47(5): 807-828.
5. GM Bell, AE Anderson, J Diboll, R Reece, O Eltherington, et al. Autologous tolerogenic dendritic cells for rheumatoid and inflammatory arthritis, Annals of the Rheumatic Diseases. 2017; 76(1): 227-234.
6. JM Cancienne, SF Brockmeier, EW Carson, BC Werner. Risk Factors for Infection After Shoulder Arthroscopy in a Large Medicare Population, American Journal of Sports Medicine. 2018; 46(4): 809-814.
7. JM Cancienne, W Gwathmey, BC Werner. Intraoperative Corticosteroid Injection at the Time of Knee Arthroscopy Is Associated With Increased Postoperative Infection Rates in a Large Medicare Population, Arthroscopy-the Journal of Arthroscopic and Related Surgery. 2016; 32(1): 90-95.
8. G Cattaneo, A De Caro, F Napoli, D Chiapale, P Trada, et al. Micro-fragmented adipose tissue injection associated with arthroscopic procedures in patients with symptomatic knee osteoarthritis, Bmc Musculoskeletal Disorders 19 (2018).
9. CJ Centeno, H Al-Sayegh, J Bashir, S Goodyear, MD Freeman. A prospective multi-site registry study of a specific protocol of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears and osteoarthritis, Journal of Pain Research. 2015; 8: 269-276.
10. J Charlesworth, J Fitzpatrick, NKP Perera, J Orchard. Osteoarthritis- a systematic review of long-term safety implications for osteoarthritis of the knee, Bmc Musculoskeletal Disorders. 2019; 20.
11. ER Chiang, KH Chen, ST Wang, HL Ma, MC Chang, et al. Chen, Intra-articular Injection of Tranexamic Acid Reduced Postoperative Hemarthrosis in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study, Arthroscopy-the Journal of Arthroscopic and Related Surgery. 2019; 35(7): 2127-2132.
12. JL Cook, PA Smith, CC Bozynski, K Kuroki, CR Cook, et al. Multiple injections of leukoreduced platelet rich plasma reduce pain and functional impairment in a canine model of ACL and meniscal deficiency, Journal of Orthopaedic Research. 2016; 34: 607-615.
13. GH Cui, YY Wang, CJ Li, CH Shi, WS Wang. Efficacy of mesenchymal stem cells in treating patients with osteoarthritis of the knee: A meta-analysis, Experimental and Therapeutic Medicine. 2016; 12(5): 3390-3400.
14. M Derwich, M Mitus-Kenig, E Pawlowska. Mechanisms of Action and Efficacy of Hyaluronic Acid, Corticosteroids and Platelet-Rich Plasma in the Treatment of Temporomandibular Joint Osteoarthritis-A Systematic Review, International Journal of Molecular Sciences. 2021; 22(14).
15. S Ekhtiari, NS Horner, D de Sa, N Simunovic, MT Hirschmann, et al. Arthrofibrosis after ACL reconstruction is best treated in a step-wise approach with early recognition and intervention: a systematic review, Knee Surgery Sports Traumatology Arthroscopy. 2017; 25(12): 3929-3937.
16. M Fernández-Ferro, J Fernández-Sanromán, A Blanco-Carrión, A Costas-López, A López-Betancourt, et al. Marinescu, Comparison of intra-articular injection of plasma rich in growth factors versus hyaluronic acid following arthroscopy in the treatment of temporomandibular dysfunction: A randomised prospective study, Journal of Cranio-Maxillofacial Surgery. 2017; 45(4): 449-454.
17. BKK Fields, MR Skalski, DB Patel, EA White, A Tomasian, et al. Matcuk, Adhesive capsulitis: review of imaging findings, pathophysiology, clinical presentation, and treatment options, Skeletal Radiology. 2019; 48(8): 1171-1184.
18. J Freitag, J Ford, D Bates, R Boyd, A Hahne, et al. Adipose derived mesenchymal stem cell therapy in the treatment of isolated knee chondral lesions: design of a randomised controlled pilot study comparing arthroscopic microfracture versus arthroscopic microfracture combined with postoperative mesenchymal stem cell injections, Bmj Open. 2015; 5(12).
19. A Gazendam, S Ekhtiari, A Bozzo, M Phillips, M Bhandari. Intra-articular saline injection is as effective as corticosteroids, platelet-rich plasma and hyaluronic acid for hip osteoarthritis pain: A systematic review and network meta-analysis of randomised controlled trials, British Journal of Sports Medicine. 2021; 55(5): 256-261.
20. G Görmeli, M Karakaplan, CA Görmeli, B Sarikaya, N Elmali, et al. Clinical Effects of Platelet-Rich Plasma and Hyaluronic Acid as an Additional Therapy for Talar Osteochondral Lesions Treated with Microfracture Surgery: A Prospective Randomized Clinical Trial, Foot & Ankle International. 2015; 36(8): 891-900.
21. A Gupta, C Suarez-Ahedo, JM Redmond, MB Gerhardt, B Hanypsiak, et al. Best Practices During Hip Arthroscopy: Aggregate Recommendations of High-Volume Surgeons, Arthroscopy-the Journal of Arthroscopic and Related Surgery. 2015; 31(9): 1722-1727.
22. MC Haigler, E Abdulrehman, S Siddappa, R Kishore, M Padilla, et al. Use of platelet-rich plasma, platelet-rich growth factor with arthrocentesis or arthroscopy to treat temporomandibular joint osteoarthritis Systematic review with meta-analyses, Journal of the American Dental Association. 2018; 149(11): 940.
23. Y Hashimoto, Y Nishida, S Takahashi, H Nakamura, H Mera, et al. Transplantation of autologous bone marrow-derived mesenchymal stem cells under arthroscopic surgery with microfracture versus microfracture alone for articular cartilage lesions in the knee: A multicenter prospective randomized control clinical trial, Regenerative Therapy. 2019; 11: 106-113.
24. MA Akçal, N Öztürk, F Erpala, K Bilsel. The Most Cited Top 100 Articles in Shoulder Arthroscopy, Acta Chirurgiae Orthopaedicae Et Traumatologiae Cechoslovaca. 2022; 89(1): 27-36.
25. M Ge, Y Zhang, YL Li, CC Feng, JL Tian, et al. Publication Trends and Hot Spots in Subacromial Impingement Syndrome Research: A Bibliometric Analysis of the Web of Science Core Collection, Journal of Pain Research. 2022; 15: 837-856.
26. A Gobbur, VK Konkathi, GS Babu, G Chellamuthu, S Muthu, et al. Past, Present and Future of Arthroscopic Research: A Scientometric Analysis of Research Frontiers in Arthroscopy, Indian Journal of Orthopaedics. 2022; 56(4): 521-532.
27. HF Jin, YL Ding, WY Wang, RX Ye, M He, et al. Arthroscopic therapy of rotator cuff diseases: A bibliometric study of the past 2 decades (2002-2021), Frontiers in Surgery. 2022; 9.
28. L Lei, C Zhang, FH Sun, YJ Xie, B Liang, et al. Research Trends on the Rotator Cuff Tendon: A Bibliometric Analysis of the Past 2 Decades, Orthopaedic Journal of Sports Medicine. 2021; 9(1).
29. JF Li, B Rothrauff, SY Chen, SY Zhao, ZX Wu, et al. Trends in Anterior Cruciate Ligament Repair: A Bibliometric and Visualized Analysis, Orthopaedic Journal of Sports Medicine. 2022; 10(10).
30. Y Li, W Wang, DH Chao, JY Chai, LY Kong, et al. Arthroscopic treatment of osteoarthritis: a bibliometric study, Annals of Palliative Medicine. 2021; 10(12): 12575-12588.
31. X Liu, D Liu, M Opoku, WH Lu, LY Pan, et al. A bibliometric and visualized analysis of meniscus suture based on the WOS core collection from 2010 to 2022: A review, Medicine. 2023; 102(46).
32. F Tang, WB Dai, XL Li, D Turghun, H Huang, et al. Publication Trends and Hot Spots in Femoroacetabular Impingement Research: A 20-Year Bibliometric Analysis, Journal of Arthroplasty. 2021; 36(8): 2698-2707.
33. H Wang, Z Yi, HW Zhan, YJ Teng, SF Zhang, et al. A Scientometric Analysis of Studies on Patellar Dislocation, Orthopaedic Journal of Sports Medicine. 2022; 10(11).
34. YF Wang, C Huang, YS Qi, HRC Bao, YS Xu. Global research status and hotspot analysis of meniscal root tears based on the WOS database, Frontiers in Surgery. 2022; 9.
35. WT Wu, JA Lin, LR Chen, WZ Sun, CP Lin, et al. Ultrasound Imaging, Guidance, and Treatment for Shoulder-related Pain Syndrome: A Bibliometric Analysis, Pain Physician. 2022; 25(9): E1433-E1445.
36. Z Yang, ZJ Fan, D Wang, H Li, ZH He, et al. Bibliometric and visualization analysis of stem cell therapy for meniscal regeneration from 2012 to 2022, Front. Bioeng. Biotechnol. 2023; 11: 19.
37. ZP Xiao, WJ Chen, ZH Wei, Q Zhang, GJ Tang. Global trends and hotspots in the application of platelet-rich plasma in knee osteoarthritis: A bibliometric analysis from 2008 to 2022, Medicine. 2023; 102(47): 16.
38. J Zhang, MJ Li, YX Yang, WK Liu, XJ Meng, et al. Bibliometric and visualized analysis of arthroscopic treatment of acromioclavicular joint injury, Journal of Orthopaedic Surgery and Research. 2023; 18(1).
39. N Kamei, M Ochi, N Adachi, M Ishikawa, S Yanada, et al. The safety and efficacy of magnetic targeting using autologous mesenchymal stem cells for cartilage repair, Knee Surgery Sports Traumatology Arthroscopy. 2018; 26(12): 3626-3635.
40. YS Kim, YG Koh. Comparative Matched-Pair Analysis of Open-Wedge High Tibial Osteotomy With Versus Without an Injection of Adipose-Derived Mesenchymal Stem Cells for Varus Knee Osteoarthritis Clinical and Second-Look Arthroscopic Results, American Journal of Sports Medicine. 2018; 46(11): 2669-2677.
41. YG Koh, YJ Choi, SK Kwon, YS Kim, JE Yeo. Clinical results and second-look arthroscopic findings after treatment with adiposederived stem cells for knee osteoarthritis, Knee Surgery Sports Traumatology Arthroscopy. 2015; 23(5): 1308-1316.
42. J Li, YC Huang, J Song, XL Li, XT Zhang, et al. Cartilage regeneration using arthroscopic flushing fluid-derived mesenchymal stem cells encapsulated in a one-step rapid cross-linked hydrogel, Acta Biomaterialia. 2018; 79: 202-215.
43. HC Lim, YB Park, CW Ha, BJ Cole, BK Lee, et al. Cartistem Res, Allogeneic Umbilical Cord Blood-Derived Mesenchymal Stem Cell Implantation Versus Microfracture for Large, Full-Thickness Cartilage Defects in Older Patients: A Multicenter Randomized Clinical Trial and Extended 5-Year Clinical Follow-up, Orthopaedic Journal of Sports Medicine. 2021; 9(1).
44. P Neybecker, C Henrionnet, E Pape, D Mainard, L Galois, et al. In vitro and in vivo potentialities for cartilage repair from human advanced knee osteoarthritis synovial fluid-derived mesenchymal stem cells, Stem Cell Research & Therapy. 2018; 9.
45. BU Nwachukwu, EC Beck, EK Lee, JM Cancienne, BR Waterman, et al. Application of Machine Learning for Predicting Clinically Meaningful Outcome After Arthroscopic Femoroacetabular Impingement Surgery, American Journal of Sports Medicine. 2020; 48(2): 415-423.
46. PD Nguyen, TDX Tran, HTN Nguyen, HT Vu, PTB Le, et al. Comparative Clinical Observation of Arthroscopic Microfracture in the Presence and Absence of a Stromal Vascular Fraction Injection for Osteoarthritis, Stem Cells Translational Medicine. 2017; 6(1): 187-195.
47. MT Zhang, ZT Yang, BR Zhang, T Liu, XD Yun. Treatment of anterior shoulder instability: a bibliometric analysis, Journal of Orthopaedic Surgery and Research. 2022; 17(1).
48. TP Zhou, YH Xu, WD Xu. Emerging research trends and foci of studies on the meniscus: A bibliometric analysis, Journal of Orthopaedic Surgery. 2020; 28(3).
49. JY Gu, F Han, SY Chen, Q Zhang. Bibliometric Analysis of Publications in Clinical Trials on Knee Osteoarthritis Between 2001 and 2022, Journal of Pain Research. 2023; 16: 1961-1977.
50. ZY Lu, LY Xie, WB Liu, ZT Li, YZ Chen, et al. A bibliometric analysis of intra-articular injection therapy for knee osteoarthritis from 2012 to 2022, Medicine. 2023; 102(46): 15.
51. F Tang, CG Jiang, J Chen, LY Wang, FK Zhao. Global hotspots and trends in Myofascial Pain Syndrome research from 1956 to 2022: A bibliometric analysis, Medicine. 2023; 102(12): 9.
52. K. Wang, D. Xing, S.J. Dong, J.H. Lin, The global state of research in nonsurgical treatment of knee osteoarthritis: a bibliometric and visualized study, Bmc Musculoskeletal Disorders. 2019; 20(1): 10.
53. A.S. Panni, M. Vasso, A. Braile, G. Toro, A. De Cicco, D. Viggiano, F. Lepore, Preliminary results of autologous adipose-derived stem cells in early knee osteoarthritis: identification of a subpopulation with greater response, International Orthopaedics. 2019; 43(1): 7-13.
54. KY Saw, A Anz, CSY Jee, RCS Ng, N Mohtarrudin, et al. High Tibial Osteotomy in Combination With Chondrogenesis After Stem Cell Therapy: A Histologic Report of 8 Cases, Arthroscopy-the Journal of Arthroscopic and Related Surgery. 2015; 31(10): 1909-1920.
55. M Ranalletta, LA Rossi, SL Bongiovanni, I Tanoira, CM Elizondo, et al. Corticosteroid Injections Accelerate Pain Relief and Recovery of Function Compared With Oral NSAIDs in Patients With Adhesive Capsulitis: A Randomized Controlled Trial, American Journal of Sports Medicine. 2016; 44(2): 474-481.
56. DM Xia, JH Wu, F Zhou, S Wang, ZT Zhang, et al. Mapping Thematic Trends and Analysing Hotspots Concerning the Use of Stem Cells for Cartilage Regeneration: A Bibliometric Analysis From 2010 to 2020, Front. Pharmacol. 2022; 12: 16.