Abstract
HYPOTHESIS/BACKGROUND: Posterior shoulder instability (PSI) is clinically significant but historically underrecognized, and the most influential studies shaping the field have not been systematically evaluated. The purpose of this study was to identify and analyze the 100 most cited articles on PSI, characterizing trends, contributors, and the frequency of themes within this citation-ranked sample. METHODS: Web of Science Core Collection was searched through June 2025 to identify the 100 most cited PSI articles. Two reviewers independently screened titles, abstracts, and full text. Extracted data included citation count/rate, year, journal, authorship, institution, level of evidence, clinical categorization, and thematic focus. Level of evidence was assigned by 2 reviewers, and journal impact was assessed using the 2023 Journal Citation Reports Impact Factor. Spearman correlation and analysis of variance were performed. Bibliometric visualization descriptively summarized collaboration patterns and keyword trends. RESULTS: The 100 most-cited PSI articles were published from 1978 to 2021; citations ranged 28-160 (mean 60.3 ± 33.1). Most were published in the 2010s (45%) and originated from the United States (65%). The American Journal of Sports Medicine published the most articles (n = 32). Level IV was most common (52%); citation count did not differ by level of evidence, although level II studies more often appeared in higher-impact journals. Clinical entity stratification showed chronic/recurrent PSI predominated (65%), followed by mixed/unclear cohorts (19%) and locked posterior dislocation (12%); acute traumatic posterior dislocation was least represented (4%). Most represented institutions included Steadman Philippon Research Institute, Naval Medical Center San Diego (U.S. Navy), Burke & Bradley Orthopedics, and Sungkyunkwan University. James Bradley, Matthew Provencher, and Justin Arner were the most prolific authors. Most articles addressed surgical treatment and outcomes (67%). Recent trends emphasized glenoid bone loss, revision stabilization, and incidence-based epidemiology in high-demand populations. CONCLUSION: The top-cited PSI literature is dominated by surgical treatment/outcomes, is largely Level IV, and is concentrated in the United States and a small number of high-output institutions and authors. Clinical categorization shows it primarily reflects chronic/recurrent PSI, with locked posterior dislocation represented more than acute traumatic events. Recent highly cited work increasingly focuses on posterior glenoid bone loss, revision stabilization, and incidence-based epidemiology in high-risk populations. Although citation count is an imperfect proxy for influence, lower citation prominence was observed for diagnostic pathways, biomechanics/pathoanatomy, and population-based epidemiology. This pattern may reflect citation behavior or established consensus with incremental follow-on work, but may also indicate domains where additional high-quality prospective and population-based research remains valuable.