Singh Gurbinder, Alexeev Sergei O, Haugh Patrick, Halvorson Ryan T, Wang Dean, Pandya Nirav K, Feeley Brian T
Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA.
University of South Carolina School of Medicine, Columbia, South Carolina, USA.
Orthop J Sports Med. 2025 Feb 6;13(2):23259671241313472. doi: 10.1177/23259671241313472. eCollection 2025 Feb.
The literature presents conflicting findings regarding outcomes after pediatric anterior cruciate ligament reconstruction (ACLR) with various autograft options, reflecting a lack of consensus on the standard of practice. Fragility analyses may assist in evaluating the statistical robustness of these studies.
To evaluate the statistical fragility of comparative studies in pediatric ACLR through the fragility index (FI) and fragility quotient (FQ), as well as qualitative factors such as outcome type, outcome significance, and patients lost to follow-up.
Systematic review; Level of evidence, 4.
A systematic review conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines identified 1139 studies in the PubMed and Embase databases that met the search criteria; ultimately, 6 studies were selected for inclusion. A total of 32 comparative outcomes were assessed for fragility across the 6 studies. Descriptive statistics were employed to summarize the fragility data and generate subgroup comparisons.
The mean FI was 1.5, and the mean reverse FI was 3.19 ( < .01); the mean FQ was 0.0064, and the mean reverse FQ was 0.028 (≤ .0001). No significant difference was found in the FIs between objective outcomes and patient-reported outcomes ( = .418). These findings suggested that a comparable number of patients would need to transition from a nonevent to an event to alter a statistically significant result to a nonsignificant one. The FI was lower than the estimated number of patients lost to follow-up for 30 of the 32 outcomes (93.7%).
Comparative studies on pediatric ACLR autograft outcomes displayed vulnerability when assessed using fragility metrics, indicating a lack of statistically robust data. The findings revealed that many reported outcomes are fragile and may require further investigation. Future research should incorporate fragility analyses-especially in studies with long-term follow-ups-to enhance the reliability of conclusions regarding optimal graft selection in pediatric ACLR.
关于小儿前交叉韧带重建（ACLR）采用各种自体移植物后的结果，文献报道的结果相互矛盾，这反映出在实践标准上缺乏共识。脆弱性分析可能有助于评估这些研究的统计稳健性。
通过脆弱性指数（FI）和脆弱性商数（FQ），以及诸如结果类型、结果显著性和失访患者等定性因素，评估小儿ACLR比较研究的统计脆弱性。
系统评价；证据等级，4级。
按照PRISMA（系统评价和Meta分析的首选报告项目）指南进行的系统评价在PubMed和Embase数据库中确定了1139项符合检索标准的研究；最终，选择6项研究纳入。对这6项研究中的32个比较结果进行了脆弱性评估。采用描述性统计来汇总脆弱性数据并进行亚组比较。
平均FI为1.5，平均反向FI为3.19（P<0.01）；平均FQ为0.0064，平均反向FQ为0.028（P≤0.0001）。客观结果与患者报告结果之间的FI无显著差异（P=0.418）。这些发现表明，需要相当数量的患者从无事件转变为有事件，才能将具有统计学意义的结果改变为无统计学意义的结果。32个结果中有30个（93.7%）的FI低于估计的失访患者数量。
使用脆弱性指标评估时，小儿ACLR自体移植物结果的比较研究显示出脆弱性，表明缺乏统计稳健的数据。研究结果表明，许多报告的结果是脆弱的，可能需要进一步研究。未来的研究应纳入脆弱性分析，尤其是在长期随访研究中，以提高关于小儿ACLR最佳移植物选择结论的可靠性。
