The 50 most cited articles on patellofemoral instability: A bibliometric and network analysis of research trends and impact.

Background: Patellofemoral instability remains a complex clinical challenge, especially among adolescents and young adults. While research in this area has expanded considerably, few studies have comprehensively examined the most influential literature shaping current knowledge and guiding clinical practice. Methods: The top 50 most cited articles related to patellofemoral instability were identified using Publish or Perish software (Version 8, Harzing.com) to access data from Google Scholar. Citation metrics, study characteristics (e.g. design, level of evidence, origin, journal), and thematic foci were extracted. Keyword network mapping was conducted using Gephi to identify dominant research themes. Results: Citation counts ranged from 179 to 2,295, with a median of 276. Most studies were published after 2005 and were predominantly Level IV and V evidence. Surgical reconstruction, especially medial patellofemoral ligament (MPFL) procedures, was the prevailing research focus. Geographically, 40 % of studies originated from the United States of America (USA), followed by France and the United Kingdom (UK). Thematic clustering revealed three main domains: surgical reconstruction, anatomical diagnostics, and clinical outcomes. Non-operative treatment modalities and rehabilitation were notably under investigated. Conclusion: This study provides an up-to-date and comprehensive analysis of the most influential literature regarding patellofemoral instability. It highlights persistent gaps in high-level evidence, conservative treatment approaches, and global representation. These findings offer a strategic direction for future research, emphasizing the need for high-level evidence that is both inclusive and patient-focused to better guide clinical practice.