Introduction: Investigators aim to publish their work in top journals in an effort to achieve the greatest possible impact. One measure of impact is the number of times a paper is cited after its publication in a journal. We conducted a review of the highest impact clinical orthopedic journal (Journal of Bone and Joint Surgery, American volume [J Bone Joint Surg Am]) to determine factors associated with subsequent citations within 3 years of publication. Methods: We conducted citation counts for all original articles published in J Bone Joint Surg Am 2000 (12 issues). We used regression analysis to identify factors associated with citation counts. Results: We identified 137 original articles in the J Bone Joint Surg Am. There were 749 subsequent citations within 3 years of publication of these articles. Study design was the only variable associated with subsequent citation rate. Meta-analyses, randomized trials and basic science papers received significantly more citations (mean 15.5, 9.3 and 7.6, respectively) than did observational studies (mean retrospective 5.3, prospective 4.2) and case reports (mean 1.5) (p = 0.01). These study designs were also significantly more likely to be cited in the general medical literature (p = 0.02). Conclusion: Our results suggest that basic science articles and clinical articles with greater methodological safeguards against bias (randomized controlled trials and meta-analyses) are cited more frequently than are clinical studies with less rigorous study designs (observational studies and case reports). © 2007 Canadian Medical Association.