1. Aglietti, P, Giron, F, Losco, M, Cuomo, P, Ciardullo, A, Mondanelli, N. Comparison between single- and double-bundle anterior cruciate ligament reconstruction: a prospective, randomized, single-blinded clinical trial. Am J Sports Med. 2010;38(1):25–34. doi:10.1177/0363546509347096
Google Scholar | SAGE Journals | ISI2. Ahldén, M, Sernert, N, Karlsson, J, Kartus, J. A prospective randomized study comparing double- and single-bundle techniques for anterior cruciate ligament reconstruction. Am J Sports Med. 2013;41(11):2484–2491. doi:10.1177/0363546513497926
Google Scholar | SAGE Journals | ISI3. Ahmed, W, Fowler, RA, McCredie, VA. Does sample size matter when interpreting the fragility index? Crit Care Med. 2016;44(11):e1142–e1143. doi:10.1097/CCM.0000000000001976
Google Scholar | Crossref | Medline4. Bhandari, M, Guyatt, GH, Lochner, H, Sprague, S, Tornetta, P. Application of the Consolidated Standards of Reporting Trials (CONSORT) in the fracture care literature. J Bone Joint Surg Am. 2002;84(3):485–489. doi:10.2106/00004623-200203000-00023
Google Scholar | Crossref | Medline | ISI5. Bhandari, M, Montori, VM, Schemitsch, EH. The undue influence of significant p-values on the perceived importance of study results. Acta Orthop. 2005;76(3):291–295. doi:10.1080/00016470510030724
Google Scholar | Crossref | Medline | ISI6. Biau, DJ, Jolles, BM, Porcher, R. P value and the theory of hypothesis testing: an explanation for new researchers. Clin Orthop Relat Res. 2010;468(3):885–892. doi:10.1007/s11999-009-1164-4
Google Scholar | Crossref | Medline7. Björnsson, H, Desai, N, Musahl, V, et al. Is double-bundle anterior cruciate ligament reconstruction superior to single-bundle? A comprehensive systematic review. Knee Surg Sports Traumatol Arthrosc. 2015;23(3):696–739. doi:10.1007/s00167-013-2666-x
Google Scholar | Crossref | Medline | ISI8. Chavalarias, D, Wallach, JD, Li, AHT, Ioannidis, JPA. Evolution of reporting P values in the biomedical literature, 1990-2015. JAMA. 2016;315(11):1141–1148. doi:10.1001/jama.2016.1952
Google Scholar | Crossref | Medline9. Checketts, JX, Scott, JT, Meyer, C, Horn, J, Jones, J, Vassar, M. The robustness of trials that guide evidence-based orthopaedic surgery. J Bone Joint Surg Am. 2018;100(12):e85. doi:10.2106/JBJS.17.01039
Google Scholar | Crossref | Medline10. Desai, N, Björnsson, H, Musahl, V, et al. Anatomic single- versus double-bundle ACL reconstruction: a meta-analysis. Knee Surg Sport Traumatol Arthrosc. 2014;22(5):1009–1023. doi:10.1007/s00167-013-2811-6
Google Scholar | Crossref | Medline | ISI11. Evaniew, N, Files, C, Smith, C, et al. The fragility of statistically significant findings from randomized trials in spine surgery: a systematic survey. Spine J. 2015;15(10):2188–2197. doi:10.1016/j.spinee.2015.06.004
Google Scholar | Crossref | Medline12. Feinstein, AR . The unit fragility index: an additional appraisal of “statistical significance” for a contrast of two proportions. J Clin Epidemiol. 1990;43(2):201–209. doi:10.1016/0895-4356(90)90186-S
Google Scholar | Crossref | Medline13. Fujita, N, Kuroda, R, Matsumoto, T, et al. Comparison of the clinical outcome of double-bundle, anteromedial single-bundle, and posterolateral single-bundle anterior cruciate ligament reconstruction using hamstring tendon graft with minimum 2-year follow-up. Arthroscopy. 2011;27(7):906–913. doi:10.1016/j.arthro.2011.02.015
Google Scholar | Crossref | Medline | ISI14. Gifstad, T, Foss, OA, Engebretsen, L, et al. Lower risk of revision with patellar tendon autografts compared with hamstring autografts: a registry study based on 45,998 primary ACL reconstructions in Scandinavia. Am J Sports Med. 2014;42(10):2319–2328. doi:10.1177/0363546514548164
Google Scholar | SAGE Journals | ISI15. Gobbi, A, Mahajan, V, Karnatzikos, G, Nakamura, N. Single- versus double-bundle ACL reconstruction: is there any difference in stability and function at 3-year followup? Clin Orthop Relat Res. 2012;470(3):824–834. doi:10.1007/s11999-011-1940-9
Google Scholar | Crossref | Medline | ISI16. Grassi, A, Carulli, C, Innocenti, M, et al. New trends in anterior cruciate ligament reconstruction: a systematic review of national surveys of the last 5 years. Joints. 2018;6(3):177–187. doi:10.1055/s-0038-1672157
Google Scholar | Crossref | Medline17. Grolleau, F, Collins, GS, Smarandache, A, et al. The fragility and reliability of conclusions of anesthesia and critical care randomized trials with statistically significant findings: a systematic review. Crit Care Med. 2019;47(3):456–462. doi:10.1097/CCM.0000000000003527
Google Scholar | Crossref | Medline18. Ioannidis, JPA . Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005;294(2):218. doi:10.1001/jama.294.2.218
Google Scholar | Crossref | Medline | ISI19. Järvelä, T . Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective, randomize clinical study. Knee Surg Sport Traumatol Arthrosc. 2007;15(5):500–507. doi:10.1007/s00167-006-0254-z
Google Scholar | Crossref | Medline | ISI20. Karikis, I, Ahldén, M, Casut, A, Sernert, N, Kartus, J. Comparison of outcome after anatomic double-bundle and antero-medial portal non-anatomic single-bundle reconstruction in ACL-injured patients. Knee Surg Sport Traumatol Arthrosc. 2017;25(4):1307–1315. doi:10.1007/s00167-016-4132-z
Google Scholar | Crossref | Medline21. Karikis, I, Desai, N, Sernert, N, Rostgard-Christensen, L, Kartus, J. Comparison of anatomic double- and single-bundle techniques for anterior cruciate ligament reconstruction using hamstring tendon autografts: a prospective randomized study with 5-year clinical and radiographic follow-up. Am J Sports Med. 2015;44(5):1225–1236. doi:10.1177/0363546515626543
Google Scholar | SAGE Journals22. Khan, M, Evaniew, N, Gichuru, M, et al. The fragility of statistically significant findings from randomized trials in sports surgery: a systematic survey. Am J Sports Med. 2017;45(9):2164–2170. doi:10.1177/0363546516674469
Google Scholar | SAGE Journals | ISI23. Khormaee, S, Choe, J, Ruzbarsky, JJ, et al. The fragility of statistically significant results in pediatric orthopaedic randomized controlled trials as quantified by the fragility index: a systematic review. J Pediatr Orthop. 2018;38(8):e418–e423. doi:10.1097/BPO.0000000000001201
Google Scholar | Crossref | Medline24. Kim, SJ, Chang, JH, Kim, TW, Jo, SB, Oh, KS. Anterior cruciate ligament reconstruction with use of a single or double-bundle technique in patients with generalized ligamentous laxity. J Bone Jt Surg Ser A. 2009;91(2):257–262. doi:10.2106/JBJS.H.00009
Google Scholar | Crossref | Medline | ISI25. Kongtharvonskul, J, Attia, J, Thamakaison, S, Kijkunasathian, C, Woratanarat, P, Thakkinstian, A. Clinical outcomes of double- vs single-bundle anterior cruciate ligament reconstruction: a systematic review of randomized control trials. Scand J Med Sci Sports. 2013;23(1):1–14. doi:10.1111/j.1600-0838.2011.01439.x
Google Scholar | Crossref | Medline | ISI26. Lao, ML, Chen, JH, Wang, CJ, Siu, KK. Functional outcomes of y-graft double-bundle and single-bundle anterior cruciate ligament reconstruction of the knee. Arthroscopy. 2013;29(9):1525–1532. doi:10.1016/j.arthro.2013.06.005
Google Scholar | Crossref | Medline27. Li, YL, Ning, GZ, Wu, Q, et al. Single-bundle or double-bundle for anterior cruciate ligament reconstruction: a meta-analysis. Knee. 2014. doi:10.1016/j.knee.2012.12.004
Google Scholar | Crossref28. Liu, Y, Cui, G, Yan, H, Yang, Y, Ao, Y. Comparison between single- and double-bundle anterior cruciate ligament reconstruction with 6- to 8-stranded hamstring autograft: a prospective, randomized clinical trial. Am J Sports Med. 2016;44(9):2314–2322. doi:10.1177/0363546516650876
Google Scholar | SAGE Journals | ISI29. Mascarenhas, R, Cvetanovich, GL, Sayegh, ET, et al. Does double-bundle anterior cruciate ligament reconstruction improve postoperative knee stability compared with single-bundle techniques? A systematic review of overlapping meta-analyses. Arthroscopy. 2015;31(6):1185–1196. doi:10.1016/j.arthro.2014.11.014
Google Scholar | Crossref | Medline | ISI30. Matics, TJ, Khan, N, Jani, P, Kane, JM. The fragility of statistically significant findings in pediatric critical care randomized controlled trials. Pediatr Crit Care Med. 2019;20(6):e258–e262. doi:10.1097/PCC.0000000000001922
Google Scholar | Crossref | Medline31. Mayr, HO, Benecke, P, Hoell, A, et al. Single-bundle versus double-bundle anterior cruciate ligament reconstruction: a comparative 2-year follow-up. Arthroscopy. 2016;32(1):34–42. doi:10.1016/j.arthro.2015.06.029
Google Scholar | Crossref | Medline32. Mayr, HO, Bruder, S, Hube, R, Bernstein, A, Suedkamp, NP, Stoehr, A. Single-bundle versus double-bundle anterior cruciate ligament reconstruction—5-year results. Arthroscopy. 2018;34(9):2647–2653. doi:10.1016/j.arthro.2018.03.034.
Google Scholar | Crossref | Medline33. Mohtadi, NG, Chan, DS. Return to sport-specific performance after primary anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med. 2018;46(13):3307–3316. doi:10.1177/0363546517732541
Google Scholar | SAGE Journals | ISI34. Oh, JY, Kim, KT, Park, YJ, et al. Biomechanical comparison of single-bundle versus double-bundle anterior cruciate ligament reconstruction: a meta-analysis. Knee Surg Relat Res. 2020;32(1):14–14. doi:10.1186/s43019-020-00033-8
Google Scholar | Crossref | Medline35. Parisien, RL, Dashe, J, Cronin, PK, Bhandari, M, Tornetta, P. Statistical significance in trauma research: too unstable to trust? J Orthop Trauma. 2019;33(12):e466–e470. doi:10.1097/BOT.0000000000001595
Google Scholar | Crossref | Medline36. Persson, A, Fjeldsgaard, K, Gjertsen, JE, et al. Increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction: a study of 12,643 patients from the Norwegian Cruciate Ligament Registry, 2004-2012. Am J Sports Med. 2014;42(2):285–291. doi:10.1177/0363546513511419
Google Scholar | SAGE Journals | ISI37. Rahr-Wagner, L, Thillemann, TM, Pedersen, AB, Lind, M. Comparison of hamstring tendon and patellar tendon grafts in anterior cruciate ligament reconstruction in a nationwide population-based cohort study: results from the Danish registry of knee ligament reconstruction. Am J Sports Med. 2014;42(2):278–284. doi:10.1177/0363546513509220
Google Scholar | SAGE Journals | ISI38. Renström, PA . Eight clinical conundrums relating to anterior cruciate ligament (ACL) injury in sport: recent evidence and a personal reflection. Br J Sports Med. 2013;47(6):367–372. doi:10.1136/bjsports-2012-091623
Google Scholar | Crossref | Medline | ISI39. Riboh, JC, Hasselblad, V, Godin, JA, Mather, RC. Transtibial versus independent drilling techniques for anterior cruciate ligament reconstruction: a systematic review, meta-analysis, and meta-regression. Am J Sports Med. 2013;41(11):2693–2702. doi:10.1177/0363546513506979
Google Scholar | SAGE Journals | ISI40. Shochet, LR, Kerr, PG, Polkinghorne, KR. The fragility of significant results underscores the need of larger randomized controlled trials in nephrology. Kidney Int. 2017;92(6):1469–1475. doi:10.1016/j.kint.2017.05.011
Google Scholar | Crossref | Medline41. Suomalainen, P, Moisala, AS, Paakkala, A, Kannus, P, Järvelä, T. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: randomized clinical and magnetic resonance imaging study with 2-year follow-up. Am J Sports Med. 2011;39(8):1615–1622. doi:10.1177/0363546511405024
Google Scholar | SAGE Journals | ISI42. Svantesson, E, Hamrin Senorski, E, Danielsson, A, et al. Strength in numbers? The fragility index of studies from the Scandinavian knee ligament registries. Knee Surg Sport Traumatol Arthrosc. 2020;28(2):339–352. doi:10.1007/s00167-019-05551-x
Google Scholar | Crossref | Medline43. Tiamklang, T, Sumanont, S, Foocharoen, T, Laopaiboon, M. Double-bundle versus single-bundle reconstruction for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev. 2012. doi:10.1002/14651858.cd008413.pub2
Google Scholar | Crossref | Medline44. Tignanelli, CJ, Napolitano, LM. The fragility index in randomized clinical trials as a means of optimizing patient care. JAMA Surg. 2019;154(1):74–79. doi:10.1001/jamasurg.2018.4318
Google Scholar | Crossref | Medline45. Walsh, M, Srinathan, SK, McAuley, DF, et al. The statistical significance of randomized controlled trial results is frequently fragile: a case for a fragility index. J Clin Epidemiol. 2014;67(6):622–628. doi:10.1016/j.jclinepi.2013.10.019
Google Scholar |