The value of high-quality, large-scale, multicenter randomized controlled trials (RCTs) in orthopaedic surgery is becoming well recognized; however, the efforts of investigators participating in RCTs are often underappreciated in areas such as academic merit. Within this manuscript, we discuss how involvement in a large-scale RCT can lead to benefits, such as improvements to clinical practice and decision-making as well as personal incentives. We also examined how investigators’ contributions to large multicenter RCTs are perceived and recognized by academic promotion committees. We found that academic promotion committees undervalue contributions to multicenter RCTs as compared with participation in studies that offer lower levels of evidence. The culture of academic promotion needs to evolve to ensure that participation in large multicenter RCTs is appropriately valued by these committees.