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Regression toward the mean (“RTM”) is a phenomenon in which extremely high or low values—for example, and individual’s blood pressure at a particular moment—appear closer to a group’s average upon remeasuring. Although this statistical peculiarity is the result of random error and chance, it has been problematic across various medical, scientific, financial and psychological applications. In particular, RTM, if not taken into account, can interfere when...
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Statistical Robustness of Randomized Controlled Trials Comparing Biceps Tenotomy Versus Tenodesis: A Reverse

Eric Y Hu1, Alyssa D Althoff2, Jesus E Cervantes1

  • 1Rush University, Chicago, Illinois, USA.

The American Journal of Sports Medicine
|April 22, 2026
PubMed
Summary
This summary is machine-generated.

The reverse continuous fragility index (rCFI) shows that non-significant findings comparing biceps tenotomy and tenodesis in shoulder arthroscopy are moderately robust. This statistical measure supports the reliability of current clinical outcome data.

Keywords:
biceps tenodesisbiceps tenotomyfragility indexrandomized controlled trialsshoulder arthroscopy

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Area of Science:

  • Orthopedic Surgery
  • Biostatistics
  • Clinical Trial Analysis

Background:

  • The reverse continuous fragility index (rCFI) assesses the statistical robustness of non-significant findings in randomized controlled trials (RCTs).
  • Studies comparing biceps tenotomy and tenodesis for shoulder arthroscopy typically report similar clinical and functional outcomes.

Purpose of the Study:

  • To evaluate the statistical robustness and fragility of non-significant outcomes from high-quality RCTs.
  • To compare clinical outcomes between biceps tenotomy and tenodesis procedures during shoulder arthroscopy using rCFI.

Main Methods:

  • A systematic review and meta-analysis (Level of evidence, 1) searched PubMed, Embase, and Cochrane Library (2004-2025).
  • Included RCTs compared clinical outcomes of biceps tenodesis versus tenotomy in shoulder arthroscopy.
  • Calculated mean rCFI for primary non-significant outcomes, recorded loss to follow-up, and computed the reverse fragility quotient.

Main Results:

  • Seven studies with 622 patients were analyzed; the mean rCFI was 17.7 (SD, 8.6).
  • Applying rCFI revealed statistically significant outcomes in 57.14% of studies, favoring tenodesis.
  • Loss to follow-up (mean 7.8) did not exceed the calculated rCFI in any study; mean reverse fragility quotient was 0.227.

Conclusions:

  • High-quality RCTs indicate statistical noninferiority of clinical outcomes between biceps tenotomy and tenodesis.
  • The rCFI analysis supports the moderate robustness of these conclusions regarding non-significant findings.