Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026 · 系統性回顧（依標題推測）
High continuous fragility index values for randomised controlled trials investigating medial patellofemoral ligament reconstruction for patellar instability: A systematic review
膝 · 髕骨不穩定
中文閱讀摘要
系統性回顧評估髕骨不穩MPFLR重建RCT，發現FI中位數僅1.0但CFI達11.7，顯示統計脆弱性高，評估時應納入考量。
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原始摘要
Purpose
To evaluate the statistical fragility of randomised controlled trials (RCTs) investigating medial patellofemoral ligament reconstruction (MPFLR) of patients with patellar instability.
Methods
A search of PubMed, MEDLINE, and EMBASE databases for RCTs investigating surgical management of patients with patellar instability from inception to 25 April 2024. Studies that reported over one significant dichotomous outcome, significant continuous outcome, and/or nonsignificant dichotomous outcome were included for analysis. The fragility index (FI), continuous fragility index (CFI) and reverse fragility index (RFI) were calculated for significant dichotomous outcomes, significant continuous outcomes, and non-significant dichotomous outcomes, respectively.
Results
Thirteen RCTs were included which reported on a total of 929 patients (64.1% female, mean age of 24.4 years [range: 10-47 years] before any patients were lost to follow-up. The median FI was 1.0 (interquartile range [IQR], 1; 95% confidence interval [CI], 0.725-2.275; range, 0-4). The number of patients lost to follow-up at the final time point was greater than the study-specific FI in 7 out of 8 outcomes from four studies (87.5%). The overall median CFI for included RCTs amongst 31 outcomes from nine studies was 11.7 (IQR, 12.9-95% CI, 8.9-13.9; range 0-30.3). The number of patients lost to follow-up at the final time point was greater than the study-specific CFI in thirteen outcomes from six studies (41.9%). The median RFI was 7.0 (IQR, 1.0; 95% CI, 6.5-7.5). The number of participants lost to follow-up was greater than the study-specific RFI in a single outcome from one study (16.7%).
Conclusion
This systematic review shows that while FI was low at a median of 1.0, consistent with RCTs in sports medicine, the other indicators of statistical fragility were relatively high, especially CFI (11.7). The level of fragility should be taken into account when assessing practical applicability of RCTs on patellar instability, in combination with other indicators of study rigour.
Level of evidence
Level I.
至 Europe PMC 閱讀完整來源 ↗ · 擷取日期 2026-10-19
書目、來源與全文狀態
- DOI
- 10.1002/ksa.12701
- PMID／PMCID
- 40387213 / PMC12850585
- 作者
- Dhillon D, Balakumar P, Vivekanantha P, Meena A, Malik S, de Sa D
- 首次發表日期
- 2025-05-19Europe PMC 提供，部分日期可能依年份或月份推定。
- 卷／期／頁碼或文章編號
- 34 ／ 2 ／ 494-508
- 書目來源與查核日期
- Europe PMC · 2026-10-19僅核對書目欄位與來源連結；不代表已評讀研究品質。
- 全文與授權
- 來源列有免費全文（查核 2026-10-19），未逐篇測試 PDF 下載。 來源授權標示：cc by。
可回溯引用
Dhillon D, Balakumar P, Vivekanantha P, Meena A, Malik S, de Sa D. High continuous fragility index values for randomised controlled trials investigating medial patellofemoral ligament reconstruction for patellar instability: A systematic review. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2026;34(2):494-508. PMID: 40387213. PMCID: PMC12850585. doi:10.1002/ksa.12701
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