腘绳肌腱与股四头肌腱自体移植物用于ACL重建的短期结果相当是否具有统计稳健性？随机对照试验的反向连续性脆性指数分析
简介
该研究对8项RCT（562例）行反向连续脆弱指数（rCFI）分析，评估腘绳肌腱与股四头肌腱自体移植物前交叉韧带重建中非显著性连续结局的统计稳健性。平均rCFI为17.4±7.3，均大于失访例数，提示HT与QT短期连续结局相当的随机证据稳定。临床决策可间接参考，但无新结局数据。
英文摘要
BACKGROUND: Randomized controlled trials (RCTs) and meta-analyses have generally reported comparable short-term outcomes between hamstring tendon (HT) and quadriceps tendon (QT) autografts for anterior cruciate ligament reconstruction (ACLR). However, the statistical robustness of these nonsignificant continuous outcomes remains unclear. PURPOSE/HYPOTHESIS: To evaluate the robustness of nonsignificant continuous outcomes in RCTs comparing HT and QT autografts for ACLR using the reverse continuous fragility index (rCFI). It was hypothesized that these outcomes would demonstrate statistical robustness. STUDY DESIGN: Systematic review; Level of evidence, 1. METHODS: A systematic search of PubMed, Embase, and the Cochrane Library was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines from database inception to April 2026. Level 1 RCTs comparing HT and QT autografts for primary adult ACLR were included if they reported ≥1 nonsignificant continuous outcome with sufficient summary statistics for rCFI calculation. The primary analysis evaluated nonsignificant primary continuous outcomes at the longest available follow-up. rCFI values were calculated using pseudoindividual data sets generated from published summary statistics and were compared with loss to follow-up. Reverse continuous fragility quotients were also calculated. Sensitivity analysis using 20 simulation seeds assessed estimate stability. RESULTS: Eight RCTs including 562 allocated patients were included. At the follow-up time point used for primary analysis, 482 patients were available, with an overall loss to follow-up of 80 patients. Six studies reported nonsignificant primary continuous outcomes eligible for rCFI analysis. The mean rCFI was 17.4 ± 7.3, and the mean reverse continuous fragility quotient was 0.296 ± 0.069. All eligible primary outcomes had rCFI values greater than the corresponding loss to follow-up, and sensitivity analysis showed stable findings. Among 21 eligible secondary outcomes, 19 had rCFI values greater than loss to follow-up. CONCLUSION: Nonsignificant primary continuous outcomes in RCTs comparing HT and QT autografts for ACLR demonstrated statistical robustness. These findings support the stability of randomized evidence showing comparable short-term continuous outcomes between HT and QT autografts.