Peer review practices in academic medicine: how the example of orthopaedic surgery may help shift the paradigm?

The rules of the "game" are unclear/not disclosed in a significant number of cases, and the SBPR system, along with the ASR (mandatory sometimes) and NPR, is still extensively used with questionable integrity and fairness. Several recommendations are provided to mitigate potentially compromising practices, along with future directions to address the scarcity of research in this critical aspect of science.