4. Discussion
Di Martino A, tear disease, KOA
MUSCULOSKELETAL DISORDERS, CAVITY, TUMOR NECROSIS
KOA is a chronic wear and tear disease that is essentially the result of a metabolic imbalance between the synthesis and breakdown of the articular cartilage matrix.The results suggested that the annual output of papers in this field is growing at a rapid rate. This indicates that there has been a growing interest in PRP in recent years because of its promising clinical outcomes in the treatment of KOA treatment. However, this field of research is still in its developmental stage and requires further study. A total of 6 articles in 2010 received the highest average number of citations in the local database. These highly-cited publications deserve the attention of researchers in the field of PRP applied to KOA. Kon et al applied intra-articular PRP injection to treat KOA, which significantly improved the clinical symptoms of KOA and remained stable within 6 months.The visual analysis of authors showed that Filardo G, Kon E, Cole BJ, Marcacci M, and Di Martino A are the top 5 authors in both H-index and number of publications. Therefore, the contribution of these prolific researchers to the field deserves recognition. Among them, Filardo G and Kon E lead 2 different teams in Italy, which include Di Martino A and Marcacci M, respectively. From 2010 to 2022, Filardo G and Kon E published 24 co-existing articles, including a review of the effects of PRP on relevant pathways, in vitro cellular experiments with PRP, compositional analysis and preparation methods of PRP, application of fluoroscopically targeted subchondral bone injections and the exploration of indications and contraindications for PRP.Olivotto et al drew significant attention to the effect of PRP on synoviocytes. Through in vitro experiments on human fibroblast-like synoviocytes, they found a significant increase in the value of synoviocytes after 7 days of PRP injection. In a tumor necrosis factor (TNF)-α stimulation model, they also found that PRP had an anti-inflammatory effect on KOA and significantly reduced vascular epidermal growth factor mRNA expression.By limiting the author name search in local databases, we retrieved posts regarding Cole BJ, a scholar at Rush University, USA. Using in vitro co-culture experiments based on osteoarthritic cartilage and synovial cells, he found that PRP suppresses the expression of inflammatory factors, and nociceptive markers, and also reduces cartilage catabolism and promotes cartilage synthesis. This includes downregulation of TNF-a and metalloproteinase-metalloproteinase-13 expression and increasing HAS2, collagen type I alpha 1, and Anti-ACAN expression.PIUZZI NS from the USA is ranked 10th based on the H-index because he wrote more review-type articles in the field. He has contributed to the call for standardization of the biological components of PRP, which he believes should define the platelet and leukocyte content, GFs profile, and volume in PRP. The presence of a large number of Vascular endothelial growth factor (VEGF) in PRP is thought to enhance the expression of inflammatory factors. In the future, many of these harmful GFs should be eliminated as much as possible, such as through addition of anti-VEGF antibodies to improve the efficacy of PRP.By analyzing the data from journal sources, “American Journal of Sports Medicine” is considered the leading journal in the field of PRP and KOA, followed by “Knee Surgery Sports Traumatology Arthroscopy,” “Arthroscopy-the Journal Of Arthroscopic And Related Surgery” and “BMC Musculoskeletal Disorders.” These journals have been the leading top 4 in terms of the number of articles published and H-index. According to journal citation reports, these 4 journals journal citation reports installments span regions 2 to 4, starting from the most authoritative journals, and researcher can subscribe to these journals to obtain as much information on cutting-edge developments in the field.From a global perspective, global authorship is concentrated in the United States, China, and some European countries. This is due to the large population base in these countries, which translates to a large number of authors. However, what holds greater significance is the value they place on the field and the frequent communication and collaboration. Despite having a smaller population, Italy closely collaborates with nations such as the United States, the Netherlands, Germany, and China, resulting in a substantial number of influential authors in the field. This demonstrates that the quantity and quality of papers can be improved through increased exchange and cooperation between countries, such as South Korea, India, and Turkey, which are among the most cited in the field. Even close exchanges can be made within the Asian region to which they belong, where cooperation is lacking. In addition to the United States, China, and Italy, which have a strong influence on the field, some European countries that play an important role are also priority targets for cooperation. This section provides a comprehensive analysis of national cooperation, which provides reliable targets for national cooperation and facilitates the advancement of research in the field.The number of national high-producing institutions is directly proportional to the influence of the country they belong to in the field. Among the top 10 producing institutions, the US and China have 2/5 each, whereas Italy and Iran have the remaining 1/10 each. However, looking at the author H-index, 4/5 of the top 5 authors work for Rizzoli Orthopedic Institute in Italy. The remaining 1/5 authors work for Rush University in the US. Therefore, China has a high number of highly productive institutions. However, the Chinese authors have a lower impact than the US and Italian authors. Although Italy has only 1 high-producing institution, their institutional authors have a high impact. Based on the author visualization analysis, the US researchers have frequent external communication. At the same time, Italian scholars have frequent external communication and collaborate more closely within their teams. On the other hand, the inter-institutional and intra-institutional collaborative exchanges of Chinese authors are not as frequent as those of American and Italian authors. Notably, Shahid Beheshti University of Medical Sciences in Iran is catching up with the high annual production of articles on research in this field. However, the research is fragmented and without high-impact teams. In addition, as seen from the author map and citation data, there has been almost no collaborative communication. Institutional research offers diverse options for collaboration. Institutions with a strong desire to collaborate can choose among the high-producing institutions and influential authors uncovered in this study.The keywords are fragmented information. Therefore, an integrated analysis of the keywords can provide a knowledge structure of the current research status in the field. In KOA and PRP, the frequency of keywords from highest to lowest indicates the current research hotspots. For example, “HA” is the most frequent keyword in PRP and KOA. “HA” is commonly used in clinical efficacy design as “viscosupplementation.” “Viscosupplementation” is often used as a control group or base therapy in clinical trials.The keyword analysis demonstrates the current state of research in this field. The current field of PRP and KOA is rich in clinical trial studies, including double-blind randomized controlled trials. HA and MSCs are often used for treating the control group. In addition, they have been used in combination with PRP injection therapy. Research has shown that combining drugs improves the efficacy of PRP. However, research on the composition of PRP is currently the mainstay. PRP contains beneficial and harmful substances to KOA, including cells, GFs, and anabolic factors. At the same time, PRP injections are localized using ultrasound and fluoroscopy. The injection sites in the joint capsule, intra-articular cavity, cartilage, subchondral bone, and muscle ultrasound targeting the injury site are chosen.The results of this study have many important implications for future practice: There is a need for standardization of PRP composition. There is a need to remove factors or cells in PRP that are harmful to KOA, such as leukocytes, red blood cells, and VEGF. In addition, there is a need to develop a specific preparation and specific price. Based on this, there is a need for further studies to investigate other less understood or unknown cells, GFs, or metabolic factors in PRP using ex vivo experiments. In this study, no consensus was reached on whether the optimal platelet concentration is 1400 − 1800 × 109/L.This study has several limitations. First, this paper only addresses papers from WoSCC; some article collections may have been missing. Only WoSCC was selected for this study because it is most commonly used as the article data collection for bibliometric analysis. On the other hand, the results of our analysis may differ from the actual situation. For example, high-quality publications that have been recently published may not be noticed due to their low citation count. In this study, we comprehensively assembled recently published articles, seeking to gather extensive and nuanced data for a comprehensive bibliometric analysis. This process entailed carefully selecting recently published articles and extracting their data with meticulous detail. It is noteworthy that, in bibliometric studies, researchers frequently choose to analyze articles with a publication history of over a year to ensure a thorough and robust analysis.