Low Fragility Index Undermines Confidence in ACL Graft Superiority: A Systematic Review and Fragility Index Analysis.

Am J Sports MedMay 14, 2026 (epub)
Clinical ResearchOrthopedic Surgery

Ronak J Mahatme, Shawn A Moore, Anish Gangavaram et al.

✦ AI-curated · Sources linked

In 30 seconds

This systematic review analyzed the statistical fragility of outcomes in randomized controlled trials comparing various ACL graft types, including hamstring tendon (HT) and bone-patellar tendon-bone (BPTB). Among 29 RCTs, the overall median fragility index was 2.0, indicating that many significant findings were fragile and could change with minor alterations in data. HT showed the highest fragility quotient at 0.034.

Key findings

  • Overall median fragility index (FI) and reverse FI (rFI) were both 2.0.
  • In 89.7% of studies, loss to follow-up equaled or exceeded the FI or rFI.
  • Hamstring tendon (HT) had the highest fragility quotient (FQ) at 0.034 among significant outcomes.
  • All graft comparisons exhibited high fragility with FI ≤2.5.

Why it matters

Understanding the fragility of outcomes in ACL graft studies is crucial for clinicians to assess the reliability of findings. Fragile results may lead to overconfidence in treatment decisions, impacting patient care and outcomes.

Source

PubMed · PMID 42136071

Published in Am J Sports Med. This summary was written by xxcode from the publication's abstract and metadata. It is not peer reviewed and is not a substitute for the original article. For clinical decisions, review the original publication.

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