The Open Versus Closed Access Publication Advantage in Orthopaedic Surgery

Background: As scientific publishing has shifted to digital platforms, two primary article-publishing modalities have emerged: open access and closed access. Open access is freely accessible with an article processing charge (APC) paid by authors, whereas closed access lies behind paywalls, with low to no APC for authors. As the academic community increasingly relies on digital dissemination, it is critical to evaluate how these models influence research visibility and impact. This study compared open versus closed access randomized control trials (RCTs) across five prevalent orthopaedic conditions by analyzing attention scores, social media metrics, readership, and citations. The study hypothesis was that open access publications would have higher attention and readership, whereas closed access articles would yield more citations. Methods: A PubMed search was conducted in May 2025 to identify RCTs on rotator cuff tears, carpal tunnel syndrome, hip fractures, anterior cruciate ligament tears, and Achilles tendon ruptures. Altmetric Attention Scores, X mentions, Facebook mentions, news mentions, Mendeley readers, and Dimensions citations were collected for each article using the Altmetric Explorer database. A negative binomial regression, adjusted for time since publication, was used to compare metrics between open and closed access publications. Results: Of 1,223 articles studied, 53.8% of the articles were open access and 46.2% were closed access. Open access articles had significantly higher Altmetric Attention Scores (44.1 ± 197 vs 17.2 ± 52.0), X mentions (32.2 ± 27.1 vs 17.4 ± 38.4), Facebook mentions (1.2 ± 4.3 vs 1 ± 2.5), news mentions (4.1 ± 25.2 vs 1.0 ± 7.2), number of Mendeley readers (136.6 ± 127.9 vs 113.4 ± 108), and, notably, number of Dimensions citations (36.8 ± 88.9 vs 30.1 ± 45.6) compared with closed access articles ( P < 0.05). Conclusion: Contrary to our initial hypothesis, open access articles had higher attention metrics and citation numbers when compared with closed access publications. These findings suggest that open access publishing not only enhances visibility and engagement but also may increase academic impact across multiple orthopaedic subspecialties.