Journal of Evidence-Based Medicine ISSN 1756-5391 ARTICLE Open access of evidence-based publications: the case of the orthopedic and musculoskeletal literature Kaissar Yammine Emirates Hospital, Foot and Hand Clinic, Center for Evidence-based Sports & Orthopedic Research, Dubai, UAE Keywords Evidence-based medicine; orthopedic; meta-analysis; musculoskeletal diseases; systematic review. Correspondence Kaissar Yammine, Emirates Hospital, Foot and Hand Clinic, Center for Evidence-based Sports & Orthopedic Research, Jumeirah Beach Road, P.O. Box 73663, Dubai, UAE. Tel: +971 50 6659300; Email: kayserym@yahoo.com Received 26 April 2014; accepted for publication 21 August 2015. doi: 10.1111/jebm.12178 Abstract The open access model, where researchers can publish their work and make it freely available to the whole medical community, is gaining ground over the traditional type of publication. However, fees are to be paid by either the authors or their institutions. The purpose of this paper is to assess the proportion and type of open access evidence-based articles in the form of systematic reviews and meta-analyses in the field of musculoskeletal disorders and orthopedic surgery. PubMed database was searched and the results showed a maximal number of hits for low back pain and total hip arthroplasty. We demonstrated that despite a 10-fold increase in the number of evidence-based publications in the past 10 years, the rate of free systematic reviews in the general biomedical literature did not change for the last two decades. In addition, the average percentage of free open access systematic reviews and meta- analyses for the commonest painful musculoskeletal conditions and orthopedic procedures was 20% and 18%, respectively. Those results were significantly lower than those of the systematic reviews and meta-analyses in the remaining biomedical research. Such findings could indicate a divergence between the efforts engaged at promoting evidence-based principles and those at disseminating evidence-based findings in the field of musculoskeletal disease and trauma. The high processing fee is thought to be a major limitation when considering open access model for publication. Introduction It is the wish of every researcher to publish his work and make it available for his peers. Until recently, the most com- mon way to publish a research paper was via periodic “tradi- tional” journals made available to individuals and institutions by means of subscription fees. Even after the development of internet, subscription is still required to view the online con- tent of the printed journals. A major step in accessing research is made possible with the emergence of the open access (OA) model where articles are freely available to the scientific and lay communities. However, in this model, processing fees are required from the publisher and are to be paid by the author(s) or their institutions. More, many researchers raised concerns regarding the OA business model because of the potential conflict between financial interests and quality (1). On the other hand, in this era of evidence-based medicine (EBM), the access to high-quality research such as system- atic reviews (SR) should be beneficial not only in gaining factual knowledge but also in implementing evidence-based guidelines to improve the quality of care for the patients. In the case of musculoskeletal diseases and trauma, there is some evidence that free access to peer-reviewed journals could provide clinically and academically relevant resources to surgeons in low-income countries (LIC) (2, 3). The aim of this paper is to assess the access status of the published systematic reviews/meta-analyses (SR/MA) in orthopedic and musculoskeletal literature. To our knowledge, no such assessment was conducted previously. Methods PubMed database was accessed on 23 February 2013 to lo- cate the number of hits generated by the following search strategies. The first part of the study aimed at collecting and JEBM 8 (2015) 181–184 C  2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd 181