The Journal of Bone and Joint Surgery receives approximately 2000 submissions annually, over half from outside the US, with an acceptance rate of around 10%. The journal uses CrossCheck software to screen for duplicate submissions and plagiarism, finding less than 2% of submissions are declined for duplicating previous uncited work, while around 3% are returned for issues like needing additional citations. Follow-up studies and data mining studies are generally accepted. The findings show the rate of declined manuscripts is relatively low and authors' education on these issues varies, and the journal aims to increase scrutiny as a deterrent while raising awareness to decrease plagiarized publications.