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28 May 2023: Database Analysis  

Global Research Trends and Hotspots in Lateral Epicondylitis During the Past 30 Years: A Bibliometric and Visualization Study

Jie Xu ORCID logo1ADE, Meng Chen2B, Xiali Xue3C, Wenqi Zhou1DF, Xiaobing Luo1DG*

DOI: 10.12659/MSM.939309

Med Sci Monit 2023; 29:e939309

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Abstract

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BACKGROUND: Lateral epicondylitis is a common clinical disease characterized by lateral elbow pain, seriously affecting patients’ daily life and work. There is a lack of comprehensive and systematic visual analysis of the literature in this field. Therefore, we analyzed the literature on lateral epicondylitis in the past 30 years and summarized the hot spots and frontiers of research in this field to provide ideas and references for subsequent researchers.

MATERIAL AND METHODS: CiteSpace, VOSviewer, and R-Bibliometrix tools were primarily used to collect, visualize, and analyze data from the literature on lateral epicondylitis in the Web of Science database’s core dataset from 1990 to 2022.

RESULTS: There were altogether 1556 items in the literature. Recent years have seen a noticeable development trend in the volume of pertinent literature that is published annually. The United States took first place with 447 papers. Univ Queensland ranked first with 42 papers. Vicenzino B, an academic at the University of Queensland, Australia, ranked first, with 48 papers.

CONCLUSIONS: Yearly volumes and forecasts suggest the USA will continue to lead the world in publications on lateral epicondylitis, with extensive collaboration among authors. More collaboration is still needed in various nations and organizations, according to an analysis of the research literature from the previous 30 years. The mechanism of action of different injectable preparations, such as corticosteroids for the treatment of LE is still unclear, as well as the cellular transduction pathways through which PRP affects LE.

Keywords: Bibliometrics, Elbow Tendinopathy, tennis elbow, Humans, Arthralgia, Australia, Pain

Background

Lateral epicondylitis (LE), also known as tennis elbow, is a common orthopedic disease and is frequently seen in professional athletes, such as tennis players and badminton players. The prevalence of LE is as high as 1% to 3% [1], and is most prevalent in people aged 35 to 50 years [2]. The prevalence of LE in professional athletes is 7% [3]. There is no significant gender difference. Patients usually present with unilateral and, less commonly, bilateral epicondylitis, with the dominant arm being the most commonly affected [4]. It is usually self-limiting, but in a small number of individuals, symptoms can last for 18 months to 2 years [5]. It is a chronic injury of the extensor carpi radialis brevis, with the main clinical manifestation being pain over the elbow joint and, in some cases, impaired movement of the elbow joint, particularly during hand shaking or professional sports [6]. The pathology is based on the degeneration of the tendon tissue. In recent years, with the spread of information technology and electronic products, the age of onset of the disease is becoming younger, its prevalence is increasing year by year, and the disease is prone to recurrence [7]. It has a significant negative impact on patients’ physical and mental health as well as their quality of life [8]. We found no relevant bibliometric studies based on visual analytics software in this area at present. Therefore, this article aims to map the scientific knowledge of the study of LE using visualization tools, with the aim of analyzing the hotspots, frontiers, and evolutionary pathways and gaining insight into the state of research in this field to provide a reference for researchers.

Material and Methods

METHODOLOGICAL DATA SOURCES AND RETRIEVAL METHODS:

Co-citation networks are produced utilizing reference citations in the VOSviewer program, developed by Professors Waltman and Van Eck, and the CiteSpace software, developed by Professor Chen C. These networks highlight the organization of certain study topics [9]. The relevant literature over the past 30 years was examined in terms of high-impact nations or regions, organizations, authors, journals, keywords, and co-cited literature using the visualization applications CiteSpace 6.1, R-Bibliometrix 4.6.1, and VOSviewer 1.6.18. The search term “TS=(Lateral Humeral Epicondylitis OR Lateral Epicondylitis OR Tennis Elbow)” was searched for the period 1990-01-01 to 2022-12-04. A total of 1638 relevant articles were retrieved by selecting “Article” and “Review” as the document type and “English” as the language. After excluding the abstracts of conferences, announcements, news, conference papers, and retraction notices, a total of 1556 relevant papers were finally included. The articles screened were all peer-reviewed journal articles, which have good authority and representativeness. Consider importing data into the CiteSpace visual analysis software as an example. The output “plain text” format for the obtained literature records includes “complete records and references”; with every 500 documents, a file is produced. The file is then renamed in “download” form, imported into the CiteSpace software input folder, and visual analysis is then started. In Figure 1, the workflow diagram is displayed.

SELECTION OF LITERATURE:

Two reviewers read the literature independently. Title and abstract screening were done on articles before inclusion and exclusion criteria were used. In the event of a disagreement during screening, a third reviewer was tasked with reading the full manuscript and rendering a judgment.

DATA ANALYSIS:

CiteSpace 6.1 analyzes important information from publications, such as information about the author, keywords, research institution, and other factors, to identify the information relationships in the literature. The settings for CiteSpace 6.1’s visualization software include 1990–2022, 1 year as the time interval, “Top N” as the threshold object with a value of 50, and “Pathfinder” as the cut connection to disassemble the network model and highlight key elements. Author, institution, keyword, cited literature, nation (region), cited author, and author were chosen for co-occurrence analysis and visual charting for node kinds [10]. Co-occurrence (characteristic words or keywords) mapping is more useful for analyzing the evolution of research hotspots and hotspots, especially with the use of burst term; the most popular method is co-citation mapping, which facilitates the analysis of a research topic’s development through the use of important nodes, clusters, and colors in the mapping, for example, co-citation analysis of literature refers to the phenomenon of 2 or more references being cited by the same publication [11].

Results

TRENDS IN QUANTITY OF PUBLISHED ARTICLES:

The Web of Science database is one of the largest citation databases in the world. There were 1556 recovered LE-related papers, and Figure 2A displays the yearly publishing output in various nations. From 1990 to 2022, the quantity of research articles on LE usually increased with time, with the number of publications increased by nearly 44% in 2019 compared to the previous year and maintained at around 110 thereafter, reaching an all-time high in 2021. The most publications are published each year in the United States, and the share of publications from Turkey and China has been increasing in recent years. We discovered significant correlations using a polynomial fit analysis between the year of publication and the total number of publications (coefficients of determination (R2) for total papers, articles, reviews, and there were 0.9197, 0.9347, 0.7831, and 0.8807 randomized controlled trials (RCTs), respectively). As shown in Figure 2, we anticipated that 138 publications, consisting of approximately 101 articles, 37 reviews, and 40 RCTs, will be published in 2025 based on the polynomial fit research Figure 2B. Generally, the growth of orthopedics and sports medicine has resulted in more in-depth research. However, it is clear that there are still relatively few high-caliber RCT studies, despite the fact that the number of publications grows each year.

COOPERATION NETWORKS ACROSS NATIONS OR REGIONS:

The visualization covered a total of 65 nations or areas, of which 20 had fewer than 20 articles. The USA had the most articles, with 447, followed by the UK with 141 and Australia with 122. According to the analysis of the countries, the USA (0.53), Australia (0.30), and Italy (0.25) are the top 3 countries in terms of centrality and have strong ties to other nations, as shown in Figure 2C and Table 1.

NETWORKS OF COLLABORATION AND RESEARCH INSTITUTES:

A topological density of 0.002 and a total of 1997 nodes and 3989 connections were produced. There were 1997 universities publishing research on LE, of which 21 produced ≥10 papers. The University of Queensland was the most active, publishing 42 articles, followed by Griffith University with 27 articles and University of Wisconsin with 19. According to the visualization of research institutions, the top 3 institutions in terms of centrality were McMaster Univ (0.1), the University of Milan (0.08), and the Mayo Clinic (0.08). Research partnerships between these 3 universities and other institutions are widely established, as shown in Table 1 and Figure 2D.

NETWORKS OF COLLABORATORS AND HIGH-IMPACT AUTHORS:

A total of 4831 authors were included in the visualization chart, of which 22 had ≥10 publications, the most prominent being Vicenzino B (38) from the University of Queensland, Australia, the second most frequent being Bisset L (24) from the University of Queensland, Australia; the third most frequent being Lee SY (20) from Chung-Ang University, South Korea. The highest document centrality was with Bisset L from the University of Queensland, Australia and Maffulli N from Queen Mary University of London, UK, both with a centrality of 0.05. The most highly cited author was Nirschl of Georgetown University (511 times), followed by Smidt N of the University of Amsterdam (34 times). The top cited author was Nirschl RP (511) from Georgetown University (USA), followed by Smidt N (348) from the University of Amsterdam (Netherlands) and Rompe JD (262) from Johannes Gutenberg University (Germany). The research team from the University of Queensland, Australia, represented by professors Vicenzino B, Bisset L, and Coombes BK, collaborate closely and constitute a densely clustered research group, and they produce many articles. The results of this team regarding this study focus on the clinical efficacy study of physiotherapy using elbow tui na (Chinese therapeutic massage) and exercise interventions combined with corticosteroid injections for LE and the use of hypersensitivity responses to hot and cold pain thresholds to differentiate the severity of patients with LE; a research team led by Korean academics Lee SY and Lee JH, who study the cellular molecular biology of platelet-rich plasma (PRP) release for tendon healing and mesenchymal stem cell therapy for the safety and efficacy of MSCs in the treatment of epicondylitis; a team centered on the Dutch academics Smidt N, Assendelft WJ and Van der Windt DA, whose areas of research were the clinical efficacy and meta-analysis of corticosteroids in the treatment of LE; and a team centered on the German academics Rompe JD and Maffulli N from the UK, whose area of expertise was the extracorporeal shock wave therapy’s analgesic effects on chronic tennis elbow. The figure shows that there was some collaboration between the author teams and was more evident among the high-yielding authors, with a lack of highly centered authors in the literature. See Figure 3A–3C and Table 2.

LITERATURE RESEARCH HOT TOPICS:

Of the 1556 articles retrieved, the literature was divided into 25 categories based on analysis of the distribution of the literature’s research hotspots. Of these, 617 were in the category of orthopedics, 436 in sports science, 346 in surgery, and 252 in rehabilitation disciplines. The information shows that LE has been the subject of substantial study and development in the areas of orthopedics, sports science, surgery, and rehabilitation (Figure 3D).

RELATIONSHIPS BETWEEN CITATIONS AND HIGH-IMPACT JOURNALS:

The top 3 journals in terms of quantity of articles were the Journal of Shoulder and Elbow Surgery (64 articles with 1380 citations and an average of 21.56 citations), the American Journal of Sports Medicine (47 articles with 4012 citations and an average of 85.36 citations), and the Journal of Hand Surgery-American Volume (36 articles with 1095 citations and an average of 30.42 citations). The top 3 journals with a high H index for the study of LE were the American Journal of Sports Medicine (32), the British Journal of Sports Medicine (22), and the Journal of Shoulder and Elbow Surgery (22). The top 3 journals in this field in terms of co-citation frequency were the Journal of Bone and Joint Surgery-American Volume (899 times), the American Journal of Sports Medicine (873 times), and the Journal of Hand Surgery-American Volume (601 times), according to the co-citation analysis of journals done by VOSviewer (Figures 4, 5 and Table 3).

KEYWORD CO-OCCURRENCE CLUSTERING ANALYSIS OF RESEARCH HOTSPOTS: To summarize research hotspots and identify research trends, keyword analysis is crucial [12]. As shown in Figure 6A, 6B, and Table 4, a total of 1168 nodes and 6799 connections were created and a there was strong co-occurrence of keywords. Keywords with a greater centrality and frequency signify the research hotspots at that period. Analysis of the top keywords revealed that research in this area focused on tennis elbow, lateral epicondyle, corticosteroid injections, randomized controlled trials, pain, double-blind, PRP, management, prevalence, tendinopathy, elbow, surgical treatment, treatment, epicondylitis, injections, medial epicondylar tendon, musculoskeletal disorders, follow-up, shoulder, shockwave therapy and physiotherapy. The keyword co-occurrence clustering map for this domain is shown in Figure 6C. The typical LLR approach produced a total of 16 clusters, and the keyword clustering analysis revealed that the degree of aggregation enhanced the homogeneity of the research [13]. Greater homogeneity of research is associated with a higher degree of aggregation. The cluster size is inversely correlated with the cluster number, with #0 being the largest cluster. The keyword clusters from #0 to #15 are prevalence, PRP, lateral epicondylitis, tennis elbow, grip strength, extracorporeal shock wave therapy (ESWT), surgical treatment, extensor carpi radialis brevis, substance p, low-power laser, visual analog score (VAS), local corticosteroid injection, randomized trial, plasma-mediated, work-related musculoskeletal disorder, and Chinese acupuncture. The 16 clusters formed were all very closely linked to each other. Tennis elbow, prevalence, corticosteroid injections, randomized controlled trials, PRP, surgical treatment, work-related musculoskeletal diseases, shockwave therapy, and physiotherapy were current study hotspots in this domain based on keyword co-occurrence and cluster analysis.

RESEARCH HORIZONS TREND ANALYSIS BASED ON KEYWORD TIMELINE VIEWS: The literature filtering of the Web of Science database displays the temporal dynamics of the grouped keywords in a timeline [14] (Figure 7). A strong cluster is indicated by the mean profile value (Silhouette: S value) of 0.8221 >0.5. From 1990 to 1995, prevalence, musculoskeletal disorder, population, laser, placebo, conservative treatment, exercise, lateral epicondylitis, tennis elbow, surgical treatment, low-level laser, and acupuncture were widely followed. From 1995 to 2000, upper-limb disorder, risk factor, physical therapy, clinical trial, randomized controlled trial, management, ultrasound, efficacy, grip strength, corticosteroid injection, reliability, and medial epicondylitis were the keywords that began to receive attention. From 2000 to 2005, double-blind, follow-up, shock wave therapy, disability, carpi radialis brevi, chronic tennis elbow, and expression were the keywords that received attention. From 2005 to 2010, arthroscopic treatment, validation, and 830 nm laser received the most attention. From 2010 to 2015, PRP, autologous blood, growth factor, and autologous conditioned plasma received the most attention. From 2015 to 2022, musculoskeletal manipulation, quality of life, mesenchymal stem cell, prognosis, hyaluronic acid, network meta-analysis, therapeutic ultrasound, cyriax physiotherapy, radiation therapy, VAS score, and clinical application began to be followed as keywords. It is predicted that the in-depth study of LE will continue to focus on musculoskeletal-based physiotherapy (cyriax physiotherapy), physical factor therapy (laser, ultrasound, shockwave), clinical application of combined PRP therapy, prognosis and quality of life, and network meta-analysis.

STUDY OF MODERN RESEARCH TRENDS VIA EMERGENT WORD EMERGENCE: The 20 most commonly referenced terms in the Web of Science database are made up of keywords that have been used often throughout time, highlighting hotspots and trends. The strongest mutation was “platelet-rich plasma” (22.49), followed by “management” (18.21), and in the third ranking was “efficacy” (14.48). The keywords with higher mutation intensity in the last 5 years include: “management” (2018–2022), “injection” (2018–2020), “efficacy” (2019–2022), and “reliability” (2018 to 2020) (Figure 8A). The phrases “platelet-rich plasma,” “management,” “efficacy,” and “epicondylitis” have remained to date and are anticipated to continue to be widely investigated, which allows one to create a broad picture of the evolution of research and future research trends in the field of LE.

KEY LITERATURE ANALYSIS OF RESEARCH HOTSPOTS: The overall number of articles found in this region was 1556, with a total citation frequency of 7260. The research literature’s co-citation graph produced 2271 nodes and 7779 connections. Figure 8B and Tables 5 and 6 display the top 10 publications with a high citation frequency and high centrality. Citation status and centrality are important indicators reflecting the hotspots of research. Review and analysis of the highly cited and central literature is needed to comprehend some of the study findings with a high level of interest and to identify research topics of interest.

The main nodes are often those that propose important theories or ground-breaking ideas in the discipline and are more likely to spark new areas of research. We can identify the research hotspots and the development of the field of LE by examining the co-citation status of the literature at key nodes and the literature most often referenced. These 20 papers can serve as a good representation of the most significant classic literature in the discipline and the main research topics in the area. Clinical studies, reviews, and epidemiological studies are the 3 categories into which research can be classified. Center degree 1st, 3rd, 4th, 6th, 7th, 8th, 9th, and 10th and citation frequency 1st, 2nd, 4th, 5th, 6th, 7th, and 8th are clinical studies. Center degrees 2nd and 5th and citation frequencies 3rd and 9th are review studies and citation frequency 10th is epidemiological studies. The highly cited literature in clinical studies relates to injectable treatments (center degree 3rd and citation frequency 1st, 2nd, 4th, 5th, 6th, 7th, and 8th studies), physical factor treatments (center degree 1st, 4th, 6th studies), surgical treatments (center degree 9th and 10th studies), and acupuncture treatments (center degree 7th studies). The double-blind randomized controlled method (cited frequency 1st, 2nd, 4th, and 6th studies) and experimental method are the techniques employed in the literature (center degree 3rd, 6th, and 7th studies and cited frequency 5th, 7th, and 8th studies). For the assessment of treatment outcome, most of the visual analog rating scales (VAS, DASH, PRTEE) are used as the test indicators. The visual analog rating scales are compared through a certain time of follow-up changes in the values of these scales and are compared over a certain period of time to illustrate the effectiveness of the treatment of LE. In the treatment of LE with different injections, the 6th centrality and 1st and 5th cited frequency studies showed a short-term pain reduction with glucocorticoid injections at 1 month, with a significant difference in the VAS values before and after treatment. However, in the 7th most cited study in the literature, the authors found worse clinical outcomes at 1 year with corticosteroid injections compared to placebo injections. The 3rd centrality and 2nd, 4th, 6th, and 8th cited frequency studies showed that injections of PRP or autologous blood were also better at reducing pain and increasing function at 2-year follow-up, but in the 1st cited study in the literature, the authors found that none of the PRP injections was superior to saline in reducing pain at the 3-month endpoint. The study suggests that PRP injections may have a slower onset of action in the treatment of LE. The effectiveness of extracorporeal shockwave treatment for LE was demonstrated in studies 1st and 4th of the Central Degree by using different physical factors to treat epicondylitis. The 6th study at the center showed that pulsed electromagnetic fields appear to be effective in the treatment of LE, but lacked a significant difference. In the surgical treatment of LE, centrality studies 9th and 10th showed that excision of granulation foci with high T2 signal at the origin of the wrist extensor tendon was effective in improving pain and that arthroscopic release was effective and minimally invasive for recovery. Centrality studies 7th, which used acupuncture to treat LE, revealed a considerable increase in arm function and a decrease in discomfort, especially early on.

Notably, in the second-most frequently cited study, the researchers assessed the effectiveness of PRP versus corticosteroids in the treatment of chronic LE and for the first time compared autologous PRP with corticosteroid injections as a treatment option for patients whose non-surgical treatment for LE failed. Before the study’s publication, corticosteroid injections for tendinopathy demonstrated good short-term effectiveness as the criterion standard for treating LE, but unsatisfactory results were frequently observed beyond 12 weeks of follow-up [15]. Compared to corticosteroid injections, a single PRP injection produced longer-lasting benefits in pain and functioning. Additionally, in the 6th most frequently cited study, researchers assessed the effectiveness of leukocyte-rich PRP injections in treating chronic LE in patients who had previously failed physiotherapy, which for the most part did not distinguish between different leukocyte levels. In the study, there was a 71.5% increase in pain scores at 24 weeks after therapy, which treated 230 patients with chronic LE who had failed conservative treatment with leukocyte-rich PRP. For lateral epicondylitis, leukocyte-rich PRP provided longer-lasting symptomatic relief than corticosteroid injections and had a longer-lasting therapeutic benefit.

In studies addressing methods of assessing and diagnosing LE, the common tendon’s outward curvature, the presence of hypoechoic fluid close to the tendon, thickness, decreased echogenicity, and ill-defined tendon borders were identified to be sonographic characteristics of epicondylitis by the 8th Center Degree Study. The range of sensitivity for epicondylitis was 64–82% for ultrasound and 90–100% for MRI. The specificity range for ultrasound was 67–100%, and for MRI it was 83–100%. Thus, ultrasound has the same specificity as MRI but is less sensitive than MRI in the assessment of epicondylitis. As an initial imaging tool, many patients may only need an ultrasound to diagnose this issue, thus allowing MRI to be reserved for patients who have normal ultrasound findings but are still symptomatic.

CO-OCCURRENCE CLUSTERING OF IMPORTANT LITERATURE IS USED TO ANALYZE RESEARCH HOTSPOTS: Cluster analysis can reveal subfields that serve as significant research hotspots based on literature that has been cited together [33]. The average cluster profile value (Silhouette: S)=0.8627 >0.5, indicating a convincing cluster, and the clustering module value (Modularity, Q)=0.8938 >0.5, demonstrating a strong cluster structure [14]. A total of 15 clusters were created using the traditional LLR technique. The homogeneity of research is better the greater the level of aggregation, Figure 8C. The cluster size and number are inversely associated, with #0 designating the largest clusters and so on. The clustering of the literature exposes the sub-thematic directions of the most-cited study on the subject. Keyword clusters from #0 to #14 in order of PRP were chiropractic, ultrasound, magnetic resonance imaging, ESWT, eccentric training, regional sympathetic block, low-intensity laser therapy, lateral epicondylalgia, common extensor tendon, review, manual therapy, occupational disease, pain syndrome, and pressure pain thresholds. In terms of the clustering order, the hotspots of research in this area are PRP, American chiropractic, ultrasound, magnetic resonance imaging (MRI), ESWT and eccentric training. In terms of the lighter-colored clusters, the trends in this area are PRP, ultrasound, lateral epicondylar pain, and American chiropractic.

RESEARCH FRONTIER TRENDS BASED ON THE APPEARANCE OF IMPORTANT PUBLICATIONS: Figure 8D shows the 25 citations found in the Web of Science database that received the most citations. The strongest mutation was in Smidt N’s 2002 study, which found that corticosteroid injections for the treatment of LE were effective in the short term at 6 weeks and that 52 weeks of long-term physiotherapy (including ultrasound, deep friction massage, and exercise programs) was better than the waitlisted observation group, but the difference was not significant (24.57) [15]. The second was Peerbooms JC in 2010, who found that PRP had a more sustained reduction in pain and improved function than corticosteroid injections at 1-year follow-up (24.22) [26]. Third-placed Krogh TP in 2013 discovered that glucocorticoid injections for LE decreased color Doppler activity and tendon thickness as well as short-term discomfort after 1 month (23.09) [2]. Four general categories can be used to categorize the literature. The first focuses on MRI imaging, immunological, surgical and histopathological manifestations of LE, and their correlation (1990–2001) [34,35]. The second part is a comparative study of the clinical efficacy of corticosteroid injections, physical factors (laser, ultrasound, shockwave, magnetic therapy) and exercise interventions in the treatment of LE (2001–2010) [15,36–38]. The third part focuses on the effectiveness and safety of different injections in the treatment of LE, especially the clinical efficacy of PRP and autologous blood, as well as longer-term follow-up studies (≥1 year) after treatment with different injections (2010–2015) [1,26,27,30,39]. A meta-analysis and retrospective review of the clinical efficacy of PRP in the treatment of LE from 2015 to the present are the main topics of Part IV [32,40–42]. These studies focus on epidemiological survey and analysis studies of LE based on data from various populations. Based on a detailed evaluation of the good level of citations, the future research frontiers can be predicted, including longer follow-up studies, network meta-analyses based on a substantial amount of research, studies on the efficiency of successive multiple PRP injections for tendon repair, studies on leukocyte-rich plasma and PRP, and studies on the efficacy of PRP over other injectable preparations in LE, as well as consistent dose and composition of PRP and preparations, PRP combination therapy (stem cells, eccentric exercise), and the mechanism of action of PRP and corticosteroids in the treatment of LE.

USING THEMATIC MAPS TO ANALYZE RESEARCH HOTSPOTS AND CUTTING-EDGE TRENDS: The R-Bibliometrix software’s thematic maps are shown in a two-dimensional matrix. The x-axis and y-axis are matrix centrality and density, respectively. Therefore, the motor themes refer to first quadrant, which are both significant and well established; the niche themes to second quadrant, which are significant but not significant to the present field; the emerging or declining themes to third quadrant, which are not significant but have just emerged or may soon disappear; and the basic themes to 4th quadrant, which are important to the sector yet lack sufficient development (Figure 9). There is a keyword bubble for elbow, epicondylitis, and ultrasound within the first quadrant. In the second quadrant there are 2 bubbles for reliability, validity, injection, corticosteroid, and medial epicondylitis. There is 1 bubble for pain, rehabilitation, and corticosteroids in the third quadrant. In the 4th quadrant, there are 2 bubbles for tendinopathy, PRP, ultrasonography, tennis elbow, LE, and lateral epicondylalgia. It may be inferred that LE, ultrasound, reliability, validity, injections, and corticosteroids are the hotspots of study in this field based on the quadrant in which the important bubbles are placed. While the themes of corticosteroids and rehabilitation could be generated or abandoned in the future, the thematic directions of tendinopathy, PRP, and ultrasound will require more in-depth research in the future.

Discussion

LIMITATIONS OF THE STUDY:

The setup of temporal segmentation, thresholding, and cropping techniques in producing visualization atlases is not standardized due to the many algorithms. Only English language literature was included in this study. Additionally, because all current visualization software can only analyze a single database, it is likely that excellent literature on the topic from other databases or from other languages went unrecognized.

Conclusions

This study offers a unique viewpoint for quick comprehension of the subject of LE by offering the first comprehensive bibliometric and visual examination for global research around LE over the past 30 years. The USA will maintain its lead in the number of articles issued, although Turkey’s and China’s volume will increase. High-impact writers are collaborating to some extent, but more collaboration is required in many institutions and nations. Hot keywords were tennis elbow, PRP, corticosteroid injections, shockwave therapy, ultrasound, exercise interventions, manipulative therapy, and randomized controlled trials. Research trend keywords were PRP, musculoskeletal physiotherapy, management, efficacy, ultrasound, lateral epicondyle, physiotherapy, prognosis, and network meta-analysis. Due to the lack of comprehensive basic molecular biology studies, especially with regard to animal models and in vitro experiments, the exact cellular transduction pathways through which PRP affects LE are still unknown, as are the mechanisms of action of various injectable preparations, such as corticosteroids for the treatment of LE. We hope our study will aid in the exploration of new research areas, including the standardization of PRP dosage and preparation composition, time, place, route, and frequency of administration, and PRP combination treatment (stem cells, eccentric exercise).

Figures

Workflow diagram.Figure 1. Workflow diagram. (A) Bibliometric analysis of the WoS core database SCIE output. The number of publications on research on lateral epicondylitis in different countries has changed year by year from 1990 to 2022. (B) Publication trends in the field of lateral epicondylitis research and the corresponding polynomial fit curves. (C). Econometric analysis of national collaborative literature in the field of lateral epicondylitis research, with darker colors representing more publications and connecting lines representing collaborative relationships. (D) Institutional co-occurrence network diagram for lateral epicondylitis. The circles in the chart indicate the volume of articles issued, with larger circles indicating more articles issued by the institution, the thickness of the outer purple circle representing the centrality of the institution, and the connecting lines indicating the existence of a collaborative or co-occurring relationship.Figure 2. (A) Bibliometric analysis of the WoS core database SCIE output. The number of publications on research on lateral epicondylitis in different countries has changed year by year from 1990 to 2022. (B) Publication trends in the field of lateral epicondylitis research and the corresponding polynomial fit curves. (C). Econometric analysis of national collaborative literature in the field of lateral epicondylitis research, with darker colors representing more publications and connecting lines representing collaborative relationships. (D) Institutional co-occurrence network diagram for lateral epicondylitis. The circles in the chart indicate the volume of articles issued, with larger circles indicating more articles issued by the institution, the thickness of the outer purple circle representing the centrality of the institution, and the connecting lines indicating the existence of a collaborative or co-occurring relationship. (A) Author co-occurrence network diagram for lateral epicondylitis. The circles in the chart indicate the volume of posts, with larger circles indicating more posts by the author, the thickness of the outer purple circle indicating author centrality, and the connecting lines indicating the existence of a collaborative or co-occurring relationship. (B) Plot of high-yielding authors of lateral epicondylitis over time. The top 20 most prolific researchers in the field and their publications. The larger the node, the more literature published. The darker the color, the more citations. Dark blue represents the number of publications and light blue represents the number of citations per year. (C) The three-field plot showing the knowledge flow of lateral epicondylitis. (D) Distribution of hotspots of research in the literature on lateral epicondylitis by discipline.Figure 3. (A) Author co-occurrence network diagram for lateral epicondylitis. The circles in the chart indicate the volume of posts, with larger circles indicating more posts by the author, the thickness of the outer purple circle indicating author centrality, and the connecting lines indicating the existence of a collaborative or co-occurring relationship. (B) Plot of high-yielding authors of lateral epicondylitis over time. The top 20 most prolific researchers in the field and their publications. The larger the node, the more literature published. The darker the color, the more citations. Dark blue represents the number of publications and light blue represents the number of citations per year. (C) The three-field plot showing the knowledge flow of lateral epicondylitis. (D) Distribution of hotspots of research in the literature on lateral epicondylitis by discipline. H index of high-impact journals for lateral epicondylitis research, 1990–2022.Figure 4. H index of high-impact journals for lateral epicondylitis research, 1990–2022. Cluster visualization of journal co-citation analysis generated based on VOSviewer software. Each node represents a journal, and the size of each circle is determined by the journal’s co-citation, the link is https://tinyurl.com/2no7dorc.Figure 5. Cluster visualization of journal co-citation analysis generated based on VOSviewer software. Each node represents a journal, and the size of each circle is determined by the journal’s co-citation, the link is https://tinyurl.com/2no7dorc. (A) Keyword co-occurrence diagram for lateral epicondylitis. The circles in the diagram represent keywords, the larger the circle the more frequently the keyword appears. Dark to light colors represent years from far to near, connecting lines represent links between keywords, and the thickness of the outer purple circle represents the centrality of the keyword. (B) VOSviewer-based time view of keywords for lateral epicondylitis. (C) Keyword co-occurrence clustering for lateral epicondylitis. The dark to light colors represent the years from far to near and the connecting lines represent the links between keywords.Figure 6. (A) Keyword co-occurrence diagram for lateral epicondylitis. The circles in the diagram represent keywords, the larger the circle the more frequently the keyword appears. Dark to light colors represent years from far to near, connecting lines represent links between keywords, and the thickness of the outer purple circle represents the centrality of the keyword. (B) VOSviewer-based time view of keywords for lateral epicondylitis. (C) Keyword co-occurrence clustering for lateral epicondylitis. The dark to light colors represent the years from far to near and the connecting lines represent the links between keywords. Timeline view of keywords for lateral epicondylitis. The circles in the diagram represent keywords, the larger the circle the more frequently the keyword appears. Dark to light colors represent years from far to near, connecting lines represent links between keywords and the thickness of the outer purple circle represents the centrality of the keyword.Figure 7. Timeline view of keywords for lateral epicondylitis. The circles in the diagram represent keywords, the larger the circle the more frequently the keyword appears. Dark to light colors represent years from far to near, connecting lines represent links between keywords and the thickness of the outer purple circle represents the centrality of the keyword. (A) Keyword emergence diagram for external lateral epicondylitis. In the graph, “” is a 1-year keyword marker and “” is the year of occurrence of the highlighted word. (B) Co-cited literature network for lateral epicondylitis. The circles in the graph represent cited literature (showing the first author’s name), with larger circles indicating more citations. The connecting lines represent co-citations among the literature, and the thickness of the purple outer circle represents the centrality of the literature. (C) Clustering of co-cited literature for lateral epicondylitis. The circles in the diagram represent keywords. The larger the circle, the more frequently the keyword appears. The grey to colored represents the years from far to near, the connecting lines represent the links between keywords, the thickness of the outer purple circle represents the centrality of the keyword. This diagram is arranged in chronological order by clustering colors from light to dark. (D) Key literature on the emergence of lateral epicondylitis. The figure “” shows the year of the appearance of the emergent citation, and the figure “” shows the nodes where the number of citations for the emergent citation suddenly increased, in chronological order from top to bottom.Figure 8. (A) Keyword emergence diagram for external lateral epicondylitis. In the graph, “” is a 1-year keyword marker and “” is the year of occurrence of the highlighted word. (B) Co-cited literature network for lateral epicondylitis. The circles in the graph represent cited literature (showing the first author’s name), with larger circles indicating more citations. The connecting lines represent co-citations among the literature, and the thickness of the purple outer circle represents the centrality of the literature. (C) Clustering of co-cited literature for lateral epicondylitis. The circles in the diagram represent keywords. The larger the circle, the more frequently the keyword appears. The grey to colored represents the years from far to near, the connecting lines represent the links between keywords, the thickness of the outer purple circle represents the centrality of the keyword. This diagram is arranged in chronological order by clustering colors from light to dark. (D) Key literature on the emergence of lateral epicondylitis. The figure “” shows the year of the appearance of the emergent citation, and the figure “” shows the nodes where the number of citations for the emergent citation suddenly increased, in chronological order from top to bottom. Thematic map of the lateral epicondylitis.Figure 9. Thematic map of the lateral epicondylitis.

References

1. Gosens T, Peerbooms JC, van Laar W, Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: A double-blind randomized controlled trial with 2-year follow-up: Am J Sport Med, 2011; 39(6); 1200-8

2. Krogh TP, Fredberg U, Stengaard-Pedersen K, Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: A randomized, double-blind, placebo-controlled trial: Am J Sport Med, 2013; 41(3); 625-35

3. Zhou Y, Chen C, Yang Y, Acupuncture therapy for tennis elbow: A protocol for systematic review and meta-analysis: Medicine, 2021; 100(5); e24402

4. Nirschl RP, Pettrone FA, Tennis elbow. The surgical treatment of lateral epicondylitis: J Bone Joint Surg Am, 1979; 61(6A); 832-39

5. Hudak PL, Cole DC, Haines AT, Understanding prognosis to improve rehabilitation: The example of lateral elbow pain: Arch Phys Med Rehab, 1996; 77(6); 586-93

6. Eygendaal D, Rahussen FT, Diercks RL, Biomechanics of the elbow joint in tennis players and relation to pathology: Brit J Sport Med, 2007; 41(11); 820-23

7. Griffiths KL, Mackey MG, Adamson BJ, Prevalence and risk factors for musculoskeletal symptoms with computer-based work across occupations: Work, 2012; 42(4); 533-41

8. Chiarotto A, Gerger H, van Rijn RM, Physical and psychosocial work-related exposures and the occurrence of disorders of the elbow: A systematic review: Appl Ergon, 2023; 108; 103952

9. Chen C, Song M, Visualizing a field of research: A methodology of systematic scientometric reviews: PLoS One, 2019; 14(10); e223994

10. Liu C, Yu R, Zhang J, Research hotspot and trend analysis in the diagnosis of inflammatory bowel disease: A machine learning bibliometric analysis from 2012 to 2021: Front Immunol, 2022; 13; 972079

11. Synnestvedt MB, Chen C, Holmes JH, CiteSpace II: Visualization and knowledge discovery in bibliographic databases: AMIA Annu Symp Proc, 2005; 2005; 724-28

12. Guan C, Gu Y, Cheng Z, Global trends of traditional Chinese exercises for musculoskeletal disorders treatment research from 2000 to 2022: A bibliometric analysis: Front Neurosci-Switz, 2023; 17; 1096789

13. Xu J, Du W, Xue X, Global research trends on platelet-rich plasma for tendon and ligament injuries from the past two decades: A bibliometric and visualized study: Front Surg, 2023; 10; 1113491

14. Xia D, Yao R, Wang S, Mapping trends and hotspots regarding clinical research on COVID-19: A bibliometric analysis of global research: Front Public Health, 2021; 9; 713487

15. Smidt N, van der Windt DA, Assendelft WJ, Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: A randomised controlled trial: Lancet, 2002; 359(9307); 657-62

16. Krischek O, Pompe JD, Hopf C, Extracorporeal shockwave therapy in epicondylitis humeri ulnaris or radialis – a prospective, controlled, comparative study: Z Orthop Ihre Grenzgeb, 1998; 136(1); 3-7

17. Buchbinder R, Green SE, Youd JM, Shock wave therapy for lateral elbow pain: Cochrane Db Syst Rev, 2005; 2005(4); D3524

18. Connell DA, Ali KE, Ahmad M, Ultrasound-guided autologous blood injection for tennis elbow: Skeletal Radiol, 2006; 35(6); 371-77

19. Hammer DS, Rupp S, Ensslin S, Extracorporal shock wave therapy in patients with tennis elbow and painful heel: Arch Orthop Traum Surg, 2000; 120(5–6); 304-7

20. Coombes BK, Bisset L, Vicenzino B, Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: A systematic review of randomised controlled trials: Lancet, 2010; 376(9754); 1751-67

21. Uzunca K, Birtane M, Taştekin N, Effectiveness of pulsed electromagnetic field therapy in lateral epicondylitis: Clin Rheumatol, 2007; 26(1); 69-74

22. Fink M, Wolkenstein E, Karst M, Acupuncture in chronic epicondylitis: A randomized controlled trial: Rheumatology, 2002; 41(2); 205-9

23. Miller TT, Shapiro MA, Schultz E, Comparison of sonography and MRI for diagnosing epicondylitis: J Clin Ultrasound, 2002; 30(4); 193-202

24. Owens BD, Murphy KP, Kuklo TR, Arthroscopic release for lateral epicondylitis: Arthroscopy, 2001; 17(6); 582-87

25. Aoki M, Wada T, Isogai S, Magnetic resonance imaging findings of refractory tennis elbows and their relationship to surgical treatment: J Shoulder Elb Surg, 2005; 14(2); 172-77

26. Peerbooms JC, Sluimer J, Bruijn DJ, Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: Platelet-rich plasma versus corticosteroid injection with a 1-year follow-up: Am J Sport Med, 2010; 38(2); 255-62

27. Krogh TP, Bartels EM, Ellingsen T, Comparative effectiveness of injection therapies in lateral epicondylitis: A systematic review and network meta-analysis of randomized controlled trials: Am J Sport Med, 2013; 41(6); 1435-46

28. Mishra AK, Skrepnik NV, Edwards SG, Efficacy of platelet-rich plasma for chronic tennis elbow: A double-blind, prospective, multicenter, randomized controlled trial of 230 patients: Am J Sport Med, 2014; 42(2); 463-71

29. Coombes BK, Bisset L, Brooks P, Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: A randomized controlled trial: JAMA, 2013; 309(5); 461-69

30. Thanasas C, Papadimitriou G, Charalambidis C, Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: A randomized controlled clinical trial: Am J Sport Med, 2011; 39(10); 2130-34

31. Vaquero-Picado A, Barco R, Antuña SA, Lateral epicondylitis of the elbow: Efort Open Rev, 2016; 1(11); 391-97

32. Sanders TJ, Maradit KH, Bryan AJ, The epidemiology and health care burden of tennis elbow: A population-based study: Am J Sport Med, 2015; 43(5); 1066-71

33. Rodriguez A, Laio A, Machine learning. Clustering by fast search and find of density peaks: Science, 2014; 344(6191); 1492-96

34. Kraushaar BS, Nirschl RP, Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies: J Bone Joint Surg Am, 1999; 81(2); 259-78

35. Boyer MI, Hastings HN, Lateral tennis elbow: “Is there any science out there?”: J Shoulder Elb Surg, 1999; 8(5); 481-91

36. Haake M, König IR, Decker T, Extracorporeal shock wave therapy in the treatment of lateral epicondylitis: A randomized multicenter trial: J Bone Joint Surg Am, 2002; 84(11); 1982-91

37. Bisset L, Paungmali A, Vicenzino B, A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia: Brit J Sport Med, 2005; 39(7); 411-22

38. Bisset L, Beller E, Jull G, Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: Randomised trial: BMJ, 2006; 333(7575); 939

39. Creaney L, Wallace A, Curtis M, Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: A prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections: Brit J Sport Med, 2011; 45(12); 966-71

40. Walker-Bone K, Palmer KT, Reading I, Occupation and epicondylitis: A population-based study: Rheumatology, 2012; 51(2); 305-10

41. Bisset LM, Vicenzino B, Physiotherapy management of lateral epicondylalgia: J Physiother, 2015; 61(4); 174-81

42. Arirachakaran A, Sukthuayat A, Sisayanarane T, Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: Systematic review and network meta-analysis: J Orthop Traumatol, 2016; 17(2); 101-12

43. Cohen MS, Romeo AA, Hennigan SP, Lateral epicondylitis: Anatomic relationships of the extensor tendon origins and implications for arthroscopic treatment: J Shoulder Elb Surg, 2008; 17(6); 954-60

44. Rubenthaler F, Wiese M, Senge A, Long-term follow-up of open and endoscopic Hohmann procedures for lateral epicondylitis: Arthroscopy, 2005; 21(6); 684-90

45. Petrella RJ, Cogliano A, Decaria J, Management of tennis elbow with sodium hyaluronate periarticular injections: Sports Med Arthrosc Rehabil Ther Technol, 2010; 2; 4

46. Wong SM, Hui AC, Tong PY, Treatment of lateral epicondylitis with botulinum toxin: A randomized, double-blind, placebo-controlled trial: Ann Intern Med, 2005; 143(11); 793-97

47. Scarpone M, Rabago DP, Zgierska A, The efficacy of prolotherapy for lateral epicondylosis: A pilot study: Clin J Sport Med, 2008; 18(3); 248-54

48. Zeisig E, Fahlström M, Ohberg L, Pain relief after intratendinous injections in patients with tennis elbow: Results of a randomised study: Brit J Sport Med, 2008; 42(4); 267-71

49. Brown R, Orchard J, Kinchington M, Aprotinin in the management of Achilles tendinopathy: A randomised controlled trial: Brit J Sport Med, 2006; 40(3); 275-79

50. Dingemanse R, Randsdorp M, Koes BW, Evidence for the effectiveness of electrophysical modalities for treatment of medial and lateral epicondylitis: A systematic review: Brit J Sport Med, 2014; 48(12); 957-65

51. Basford JR, Sheffield CG, Cieslak KR, Laser therapy: A randomized, controlled trial of the effects of low intensity Nd: YAG laser irradiation on lateral epicondylitis: Arch Phys Med Rehab, 2000; 81(11); 1504-10

52. Hansen M, Boesen A, Holm L, Local administration of insulin-like growth factor-I (IGF-I) stimulates tendon collagen synthesis in humans: Scand J Med Sci Spor, 2013; 23(5); 614-19

53. Kjaer M, Langberg H, Heinemeier K, From mechanical loading to collagen synthesis, structural changes and function in human tendon: Scand J Med Sci Spor, 2009; 19(4); 500-10

54. Engebretsen L, Steffen K, Alsousou J, IOC consensus paper on the use of platelet-rich plasma in sports medicine: Brit J Sport Med, 2010; 44(15); 1072-81

55. Chahla J, Cinque ME, Piuzzi NS, A Call for Standardization in platelet-rich plasma preparation protocols and composition reporting: A systematic review of the clinical orthopaedic literature: J Bone Joint Surg Am, 2017; 99(20); 1769-79

56. DeLong JM, Russell RP, Mazzocca AD, Platelet-rich plasma: The PAW classification system: Arthroscopy, 2012; 28(7); 998-1009

57. Castillo TN, Pouliot MA, Kim HJ, Comparison of growth factor and platelet concentration from commercial platelet-rich plasma separation systems: Am J Sport Med, 2011; 39(2); 266-71

58. Say F, Türkeli E, Bülbül M, Is platelet-rich plasma injection an effective choice in cases of non-union?: Acta Chir Orthop Traumatol Cech, 2014; 81(5); 340-45

59. Abate M, Di Gregorio P, Schiavone C, Platelet rich plasma in tendinopathies: How to explain the failure: Int J Immunopath Ph, 2012; 25(2); 325-34

60. Harrison S, Vavken P, Kevy S, Platelet activation by collagen provides sustained release of anabolic cytokines: Am J Sport Med, 2011; 39(4); 729-34

61. Krogh TP, Ellingsen T, Christensen R, Ultrasound-guided injection therapy of achilles tendinopathy with platelet-rich plasma or saline: A randomized, blinded, placebo-controlled trial: Am J Sport Med, 2016; 44(8); 1990-97

62. Boesen AP, Hansen R, Boesen MI, Effect of high-volume injection, platelet-rich plasma, and sham treatment in chronic midportion Achilles tendinopathy: A randomized double-blinded prospective study: Am J Sport Med, 2017; 45(9); 2034-43

63. Filardo G, Kon E, Della Villa S, Use of platelet-rich plasma for the treatment of refractory jumper’s knee: Int Orthop, 2010; 34(6); 909-15

64. Edwards SG, Calandruccio JH, Autologous blood injections for refractory lateral epicondylitis: J Hand Surg-Am, 2003; 28(2); 272-78

65. Saito M, Takahashi KA, Arai Y, Intraarticular administration of platelet-rich plasma with biodegradable gelatin hydrogel microspheres prevents osteoarthritis progression in the rabbit knee: Clin Exp Rheumatol, 2009; 27(2); 201-7

66. Lu HT, Chang WT, Tsai ML, Development of injectable fucoidan and biological macromolecules hybrid hydrogels for intra-articular delivery of platelet-rich plasma: Mar Drugs, 2019; 17(4); 236

67. Zhao T, Wei Z, Zhu W, Recent developments and current applications of hydrogels in osteoarthritis: Bioengineering (Basel), 2022; 9(4); 132

Figures

Figure 1. Workflow diagram.Figure 2. (A) Bibliometric analysis of the WoS core database SCIE output. The number of publications on research on lateral epicondylitis in different countries has changed year by year from 1990 to 2022. (B) Publication trends in the field of lateral epicondylitis research and the corresponding polynomial fit curves. (C). Econometric analysis of national collaborative literature in the field of lateral epicondylitis research, with darker colors representing more publications and connecting lines representing collaborative relationships. (D) Institutional co-occurrence network diagram for lateral epicondylitis. The circles in the chart indicate the volume of articles issued, with larger circles indicating more articles issued by the institution, the thickness of the outer purple circle representing the centrality of the institution, and the connecting lines indicating the existence of a collaborative or co-occurring relationship.Figure 3. (A) Author co-occurrence network diagram for lateral epicondylitis. The circles in the chart indicate the volume of posts, with larger circles indicating more posts by the author, the thickness of the outer purple circle indicating author centrality, and the connecting lines indicating the existence of a collaborative or co-occurring relationship. (B) Plot of high-yielding authors of lateral epicondylitis over time. The top 20 most prolific researchers in the field and their publications. The larger the node, the more literature published. The darker the color, the more citations. Dark blue represents the number of publications and light blue represents the number of citations per year. (C) The three-field plot showing the knowledge flow of lateral epicondylitis. (D) Distribution of hotspots of research in the literature on lateral epicondylitis by discipline.Figure 4. H index of high-impact journals for lateral epicondylitis research, 1990–2022.Figure 5. Cluster visualization of journal co-citation analysis generated based on VOSviewer software. Each node represents a journal, and the size of each circle is determined by the journal’s co-citation, the link is https://tinyurl.com/2no7dorc.Figure 6. (A) Keyword co-occurrence diagram for lateral epicondylitis. The circles in the diagram represent keywords, the larger the circle the more frequently the keyword appears. Dark to light colors represent years from far to near, connecting lines represent links between keywords, and the thickness of the outer purple circle represents the centrality of the keyword. (B) VOSviewer-based time view of keywords for lateral epicondylitis. (C) Keyword co-occurrence clustering for lateral epicondylitis. The dark to light colors represent the years from far to near and the connecting lines represent the links between keywords.Figure 7. Timeline view of keywords for lateral epicondylitis. The circles in the diagram represent keywords, the larger the circle the more frequently the keyword appears. Dark to light colors represent years from far to near, connecting lines represent links between keywords and the thickness of the outer purple circle represents the centrality of the keyword.Figure 8. (A) Keyword emergence diagram for external lateral epicondylitis. In the graph, “” is a 1-year keyword marker and “” is the year of occurrence of the highlighted word. (B) Co-cited literature network for lateral epicondylitis. The circles in the graph represent cited literature (showing the first author’s name), with larger circles indicating more citations. The connecting lines represent co-citations among the literature, and the thickness of the purple outer circle represents the centrality of the literature. (C) Clustering of co-cited literature for lateral epicondylitis. The circles in the diagram represent keywords. The larger the circle, the more frequently the keyword appears. The grey to colored represents the years from far to near, the connecting lines represent the links between keywords, the thickness of the outer purple circle represents the centrality of the keyword. This diagram is arranged in chronological order by clustering colors from light to dark. (D) Key literature on the emergence of lateral epicondylitis. The figure “” shows the year of the appearance of the emergent citation, and the figure “” shows the nodes where the number of citations for the emergent citation suddenly increased, in chronological order from top to bottom.Figure 9. Thematic map of the lateral epicondylitis.

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