scholarly journals Reliability of a Novel Scoring System for MRI Assessment of Severity in Gluteal Tendinopathy: The Melbourne Hip MRI Score

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199838
Author(s):  
Chi Kin Nathan Tso ◽  
Richard O’Sullivan ◽  
Hussain Khan ◽  
Jane Fitzpatrick
Keyword(s):  
Scoring System ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Future Research ◽  
Level Of Evidence ◽  
Trochanteric Bursitis ◽  
Gluteal Tendinopathy ◽  
Cortical Irregularity ◽  
Tendon Pathology ◽  
Hip Mri

Background: Gluteal tendinopathy is commonly reported in the literature, but there is a need for a validated magnetic resonance imaging (MRI)-based scoring system to grade the severity of the tendinopathy. Purpose: To use intra- and interobserver reliability to validate a new scoring system, the Melbourne Hip MRI (MHIP) score, for assessing the severity of gluteal tendinopathy. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The MHIP score assesses gluteal tendinopathy according to each 1 of 5 categories: (1) extent of tendon pathology (maximum 5 points); (2) muscle atrophy (maximum 4 points); (3) trochanteric bursitis (maximum 4 points); (4) cortical irregularity (maximum 3 points); and (5) bone marrow edema (maximum 1 point), with an overall range of 0 to 17 (most severe). A total of 41 deidentified MRI scans from 40 patients diagnosed with gluteal tendinopathy (mean baseline age, 57.44 ± 25.26 years; 4 male, 36 female) were read and graded according to MHIP criteria by 2 experienced musculoskeletal radiologists. The radiologists were blinded to previous reports, and the scans were read twice within a 2-month period. Statistical analysis using the intraclass correlation coefficient (ICC) was used to determine intra- and interobserver reliability and mean/range for the MHIP scores. Results: Of a total of 123 readings, the mean MHIP score (±SD) was 3.93 ± 2.24 (range, 0-17 points). The MHIP score demonstrated excellent reliability for determining the severity of gluteal tendinopathy on MRI. The ICC for intra- and interobserver reliability was 0.81 (95% CI, 0.67-0.89) and 0.78 (95% CI, 0.62-0.87), respectively. Conclusion: The MHIP score had excellent intra- and interobserver reliability in scoring gluteal tendinopathy. This score allows gluteal tendon pathology to be graded prior to treatment and to be used for standardized comparisons between results in future research undertaking radiological review of gluteal tendinopathy.

Novel Arthroscopic Classification of Osteochondritis Dissecans of the Knee

2016 ◽  
Vol 44 (7) ◽  
pp. 1694-1698 ◽  
Author(s):  
James L. Carey ◽  
Eric J. Wall ◽  
Nathan L. Grimm ◽  
Theodore J. Ganley ◽  
Eric W. Edmonds ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Classification System ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Intraobserver Reliability ◽  
Classification Systems ◽  
Future Research ◽  
Multicenter Studies ◽  
Level Of Evidence ◽  
Surgical Evaluation

Background: Several systems have been proposed for classifying osteochondritis dissecans (OCD) of the knee during surgical evaluation. No single classification includes mutually exclusive categories that capture all of the salient features of stability, chondral fissuring, and fragment detachment. Furthermore, no study has assessed the reliability of these classification systems. Purpose: To determine the intra- and interobserver reliability of a novel, comprehensive arthroscopic classification system with mutually exclusive OCD lesion types. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The Research in OsteoChondritis of the Knee (ROCK) study group developed a classification system for arthroscopic evaluation of OCD of the knee that includes 6 arthroscopic categories—3 immobile types and 3 mobile types. To optimize comprehensibility and applicability, each was developed with a memorable name, a brief description, a line diagram corresponding to the archetypal arthroscopic appearance, and an arthroscopic photograph depicting this archetype. Thirty representative arthroscopic videos were evaluated by 10 orthopaedic surgeon raters, who classified each lesion. After 4 weeks, the raters again classified the OCD lesions depicted in the 30 videos in a new, randomly selected order. Reliability was assessed via the intraclass correlation coefficient (ICC). Results: The interobserver reliability of this novel arthroscopy classification was estimated by an ICC of 0.94 (95% CI, 0.91-0.97) for the first round and 0.95 (95% CI, 0.93-0.98) for the second round. According to the standards for the magnitude of the reliability coefficient of Altman, these ICCs indicate that interobserver reliability was very good. The intraobserver reliability was estimated by an ICC of 0.96 (95% CI, 0.95-0.97), which indicates that the intraobserver reliability was similarly very good. Conclusion: The ROCK OCD knee arthroscopy classification system demonstrated excellent intra- and interobserver reliability. In light of this reliability, this classification system may be used clinically and to facilitate future research, including multicenter studies for OCD.

3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography

2019 ◽  
Vol 40 (6) ◽  
pp. 720-726 ◽  
Author(s):  
Jian Zhong Zhang ◽  
François Lintz ◽  
Alessio Bernasconi ◽  
Shu Zhang ◽  
Keyword(s):  
Computed Tomography ◽  
Comparative Study ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Mean Values ◽  
Intraclass Correlation Coefficients ◽  
Prospective Comparative Study

Background: Weightbearing computed tomography (WBCT) is a useful tool for the assessment of hindfoot alignment (HA). Foot ankle offset (FAO) is a recently introduced parameter, determined from WBCT images using semiautomatic software. The aim of this study was to determine the clinical relevance and reproducibility of FAO for the evaluation of HA. Methods: A prospective comparative study was performed on consecutive patients requiring bilateral WBCT between September 2017 and April 2018. Based on the clinical assessment of HA, patients were divided into 3 groups: (1) normal alignment group (G1), (2) valgus (G2), and (3) varus (G3). FAO and long axial view (HACT) were measured on WBCT images, and the groups were compared. The reproducibility of FAO and HACT was determined through intraclass correlation coefficients (ICCs). Regression analysis was performed to investigate the correlation between the 2 methods. Overall, 249 feet (126 patients) were included (G1 = 115, G2 = 78, and G3 = 56 feet). Results: The mean values for FAO and HACT were 1.2% ± 2.8% and 3.9 ± 3.1, respectively, in G1; 8.1% ± 3.7% and 9.7 ± 4.9 in G2; and −6.6% ± 4.8% and −8.2 ± 6.6 in G3. Intra- and interobserver reliability was 0.987 and 0.988 for FAO and 0.949 and 0.949 for HACT, respectively. There was a good linear correlation between HACT and FAO ( R2 = 0.744), with a regression slope of 1.064. Conclusions: WBCT was a useful method for the characterization of HA. FAO was reproducible and correlated well with physical examination. Level of Evidence: Level II, prospective comparative study.

scholarly journals Scoring System for Identifying Impending Complete Fractures in Incomplete Atypical Femoral Fractures

2016 ◽  
Vol 102 (2) ◽  
pp. 545-550 ◽  
Author(s):  
Byung-Woo Min ◽  
Kyung-Hoi Koo ◽  
Youn-Soo Park ◽  
Chang-Wug Oh ◽  
Seung-Jae Lim ◽  
...  
Keyword(s):  
Roc Curve ◽  
Scoring System ◽  
Interobserver Reliability ◽  
Radiolucent Line ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
Femoral Fractures ◽  
Atypical Femoral Fractures ◽  
Pain Status ◽  
Complete Fracture

Abstract Context: Although impending incomplete atypical femoral fractures (AFFs) require prophylactic fixation, there is still a lack of study on predicting complete fracture among the incomplete AFFs. Objective: Our purposes are to develop a scoring system to predict progression into complete fracture and to evaluate its reliability and validity. Design, Setting, and Patients: We reviewed 46 incomplete AFFs in 44 patients who did not undergo prophylactic fixation. A weighted scoring system, including four identified risk factors (the site, severity of pain, status of the contralateral femur, and the extent of radiolucent line), was developed. We evaluated its interobserver reliability by using intraclass correlation coefficiency (ICC) and its accuracy using receiver operator characteristic (ROC) curve. The validity of the scoring system was tested in a different cohort. Intervention: Observational study. Main Outcome Measure: Progression to complete fracture within 6 months. Results: Among 46 incomplete fractures, 13 developed a complete fracture within 6 months. The probability of complete fracture increased abruptly when the score was 8 points or more. The proposed scoring system showed an almost perfect reliability (ICC, 0.997; 95% confidence interval, 0.995 to 0.998) and higher accuracy than any single risk factor in ROC curve. In the different series, the positive predictive value was 100% and the sensitivity was 75%, when cutoff value was 8 points. Conclusion: The progression to complete fracture could be predicted by using our scoring system. Incomplete AFF with scores <8 points can be treated conservatively, whereas lesions with scores ≥8 require prophylactic fixation.

scholarly journals Assessment of the ankle joint in clubfeet and normal feet to the age of four years by ultrasonography

2018 ◽  
Vol 12 (3) ◽  
pp. 262-272 ◽  
Author(s):  
A. Johansson ◽  
Y. Aurell ◽  
B. Romanus
Keyword(s):  
Ankle Joint ◽  
Interobserver Reliability ◽  
Plantar Flexion ◽  
Intraclass Correlation ◽  
Neutral Position ◽  
Healthy Children ◽  
Level Of Evidence ◽  
Posterior Aspect ◽  
Talocrural Joint ◽  
Interexaminer Reliability

Purpose To establish reproducible posterior ultrasonographic projections for evaluation of the movement in the talocrural joint in clubfeet and normal feet from the perinatal period up to the age of four years. Methods The feet in 105 healthy children and 46 patients (71 clubfeet and 21 normal feet) were examined. In all, 14 feet in seven patients were examined twice by two examiners independently to evaluate the repeatability of the ultrasonography scans. A posterior sagittal projection was used. The distance from the posterior aspect of the tibial physis to the posterior border of the talocalcaneal joint (Tib. phys – TCJ) was measured with the foot in neutral position and dorsiflexion. In plantar flexion the shortest distance between the tibial physis and the calcaneus was measured. The distance from the skin to the tibial epiphyses and the talus was measured in neutral position. The intraclass correlation coefficient (ICC) was calculated to evaluate the repeatability of the measurements. Results The interexaminer reliability was 0.71 to 0.89 ICC. The intra- and interobserver reliability measured as ICC was 0.68 to 0.99 for all measurements. The correlation between Tib. phys. – TCJ and clinical dorsiflexion varied much between the age groups. Conclusion Ultrasonography of the posterior aspect of the ankle joint can be done with high interexaminer reliability. The repeatability of image evaluation was high. Correlation to clinical measurements varied, therefore dynamic ultrasound in real time is clinically more useful than single measurements on frozen ultrasound images. Level of Evidence III

scholarly journals Three-Dimensional Quantification of Glenoid Bone Loss in Anterior Shoulder Instability: The Anatomic Concave Surface Area Method

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110110
Author(s):  
Marine Launay ◽  
Muhammad Naghman Choudhry ◽  
Nicholas Green ◽  
Jashint Maharaj ◽  
Kenneth Cutbush ◽  
...  
Keyword(s):  
Bone Loss ◽  
Surface Area ◽  
Shoulder Instability ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Glenoid Bone Loss ◽  
Concave Surface ◽  
Anterior Shoulder Instability ◽  
Level Of Evidence ◽  
Best Fit

Background: Recurrent shoulder instability may be associated with glenoid erosion and bone loss. Accurate quantification of bone loss significantly influences the contemplation of surgical procedure. In addition, assessment of bone loss is crucial for surgical planning and accurate graft placement during surgery. Purpose: To quantify the concave surface area of glenoid bone loss by using 3-dimensional (3D) segmented models of the scapula and to compare this method with the best-fit circle and glenoid height/width methods, which use the glenoid rim for bone loss estimations. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 36 consecutive preoperative bilateral computed tomography scans of patients eligible for a primary Latarjet procedure were selected from our institutional surgical database (mean patient age, 29 ± 9 years; 31 men and 5 women). The 3D models of both scapulae were generated using medical segmentation software and were used to map the anatomic concave surface area (ACSA) of the inferior glenoid using the diameter of the best-fit circle of the healthy glenoid. Bone loss was calculated as a ratio of the difference between surface areas of both glenoids (healthy and pathological) against the anatomic circular surface area of the healthy glenoid (the ACSA method). These results were compared with bone loss calculations using the best-fit circle and glenoid height/width methods. Inter- and intraobserver reliability were also calculated. Results: The mean (± SD) bone loss calculated using the ACSA, the best-fit circle, and glenoid height/width methods was 9.4% ± 6.7%, 14.3% ± 6.8%, and 17.6% ± 7.3%, respectively. The ACSA method showed excellent interobserver reliability, with an intraclass correlation coefficient (ICC) of 0.95 versus those for the best-fit circle (ICC, 0.71) and glenoid height/width (ICC, 0.79) methods. Conclusion: Quantification of instability-related glenoid bone loss is reliable using the 3D ACSA method.

scholarly journals Development and reliability of a novel ultrasonographic joint-specific scoring system for synovitis with reference atlas for patients with juvenile idiopathic arthritis

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001581
Author(s):  
Nina Krafft Sande ◽  
Pernille Bøyesen ◽  
Anna-Birgitte Aga ◽  
Hilde Berner Hammer ◽  
Berit Flatø ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Scoring System ◽  
Image Acquisition ◽  
Intraclass Correlation ◽  
Power Doppler ◽  
Future Research ◽  
Still Image ◽  
Acquisition Protocol ◽  
Scanning Protocol ◽  
Reader Reliability

ObjectiveTo develop an ultrasonographic image acquisition protocol and a joint-specific scoring system for synovitis with reference atlas in patients with juvenile idiopathic arthritis (JIA) and to assess the reliability of the system.MethodsSeven rheumatologists with extensive ultrasound experience developed a scanning protocol and a semiquantitative joint-specific scoring system for B-mode (BM) synovitis for the elbow, wrist, metacarpophalangeal 2–3, proximal interphalangeal 2–3, hip, knee, ankle and metatarsophalangeal 2–3 joints. An ultrasonographic reference atlas for BM synovitis, divided in four age groups (2–4, 5–8, 9–12, 13–18 years), and power Doppler (PD) activity was then developed. Reliability was assessed for all joints on still images and in a live exercise including 10 patients with JIA, calculated by intraclass correlation coefficient (ICC) and weighted kappa.ResultsA scanning protocol and scoring system for multiple joints with reference atlas composed of images with four different score levels for BM and PD were developed. Still image scoring for BM synovitis on joint level showed good to excellent intra-reader reliability (ICC/kappa ranges: 0.75–0.95/0.63–0.91) and moderate to excellent inter-reader reliability (ICC/kappa ranges: 0.89–0.99/0.50–0.91). Still image scoring for PD activity showed excellent intra-reader and inter-reader reliability (ICC/kappa: 0.96/0.91 and ICC/kappa: 0.97/0.80, respectively). In the live scoring, inter-reader reliability (ICC/kappa) was moderate to excellent for BM synovitis (0.94/0.51) and PD activity (0.91/0.60).ConclusionAn ultrasonographic image acquisition protocol and joint-specific scoring system with reference atlas were developed and demonstrated moderate to excellent reliability for scoring of synovitis in patients with JIA. This can be a valuable tool in clinical practice and future research.

scholarly journals REPRODUCIBILITY OF S2-ALAR ILIAC SCREW MORPHOMETRIC ANALYSIS

2021 ◽  
Vol 29 (2) ◽  
pp. 97-100
Author(s):  
MARIANA DEMÉTRIO DE SOUSA PONTES ◽  
LUCAS AMÉRICO FRANCISCO ◽  
LUCAS KLAROSK ISMAEL ◽  
CARLOS FERNANDO PEREIRA DA SILVA HERRERO
Keyword(s):  
Morphometric Analysis ◽  
Sagittal Plane ◽  
Interobserver Reliability ◽  
Statistical Significance ◽  
Intraclass Correlation ◽  
Intraobserver Reliability ◽  
Axial Plane ◽  
Level Of Evidence ◽  
Screw Length ◽  
Trajectory Angle

ABSTRACT Objective: To evaluate the reproducibility of a S2-alar iliac (S2AI) screw parameters measurement method by inter and intraobserver reliability. Methods: Cross-sectional study, considering computed tomography exams. Morphometric analysis was performed by multiplanar reconstructions. Screw length, diameter and trajectory angles were the studied variables. To analyze the measurements reproducibility, intraclass correlation coefficient (ICC) was used. Results: Interobserver reliability was classified as strong for screw shortest length (ICC: 0.742) and diameter (ICC: 0.699). Interobserver reliability was classified as moderate for screw longest length (ICC: 0.553) and for screw trajectory angles in the axial plane for the longest (ICC: 0.478) and for the shortest lengths (ICC: 0.591). Intraobserver reliability was interpreted as excellent for screw shortest (ICC: 0.932) and longest lengths (ICC: 0.962) and diameter (ICC: 0.770) and screw trajectory angles in the axial plane for the screw longest (ICC: 0.773) and shortest lengths (ICC: 0.862). There were weak interobserver and strong intraobserver reliabilities for trajectory angle in sagittal plane, but no statistical significance was found. Conclusion: Inter and intraobserver reliability of S2AI screw morphometric parameters were interpreted from moderate to excellent in almost all studied variables, except for the screw trajectory angle in the sagittal plane measurement. Level of Evidence IV, Diagnostic Studies - Investigating a Diagnostic Test.

scholarly journals Compressed Lateral and anteroposterior Anatomical Systematic Sequences «CLASS»: compressed MRI sequences with assessed anatomical femoral and tibial ACL's footprints, a feasibility study

2022 ◽  
Vol 9 (1) ◽  
Author(s):  
Grégoire Thürig ◽  
Raùl Panadero-Morales ◽  
Luca Giovannelli ◽  
Franziska Kocher ◽  
José Luis Peris ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Tibial Slope ◽  
Lateral View ◽  
Individual Identification ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
X Ray ◽  
Femoral Intercondylar Notch

Abstract Purpose This study's main objective is to assess the feasibility of processing the MRI information with identified ACL-footprints into 2D-images similar to a conventional anteroposterior and lateral X-Ray image of the knee. The secondary aim is to conduct specific measurements to assess the reliability and reproducibility. This study is a proof of concept of this technique. Methods Five anonymised MRIs of a right knee were analysed. A orthopaedic knee surgeon performed the footprints identification. An ad-hoc software allowed a volumetric 3D image projection on a 2D anteroposterior and lateral view. The previously defined anatomical femoral and tibial footprints were precisely identified on these views. Several parameters were measured (e.g. coronal and sagittal ratio of tibial footprint, sagittal ratio of femoral footprint, femoral intercondylar notch roof angle, proximal tibial slope and others). The intraclass correlation coefficient (ICCs), including 95% confidence intervals (CIs), has been calculated to assess intraobserver reproducibility and interobserver reliability. Results Five MRI scans of a right knee have been assessed (three females, two males, mean age of 30.8 years old). Five 2D-"CLASS" have been created. The measured parameters showed a "substantial" to "almost perfect" reproducibility and an "almost perfect" reliability. Conclusion This study confirmed the possibility of generating "CLASS" with the localised centroid of the femoral and tibial ACL footprints from a 3D volumetric model. "CLASS" also showed that these footprints were easily identified on standard anteroposterior and lateral X-Ray views of the same patient, thus allowing an individual identification of the anatomical femoral and tibial ACL's footprints. Level of evidence Level IV diagnostic study

Interobserver Reliability of Neovascularization Score Using Power Doppler Ultrasonography in Midportion Achilles Tendinopathy

2009 ◽  
Vol 37 (8) ◽  
pp. 1627-1631 ◽  
Author(s):  
Pieter M. Sengkerij ◽  
Robert-Jan de Vos ◽  
Adam Weir ◽  
Bert J. G. van Weelde ◽  
Johannes L. Tol
Keyword(s):  
Correlation Coefficient ◽  
Doppler Ultrasonography ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Power Doppler ◽  
Achilles Tendinopathy ◽  
Power Doppler Ultrasonography ◽  
Level Of Evidence ◽  
The Difference ◽  
Control Study

Background Power Doppler ultrasonography is widely used to examine neovascularization in midportion Achilles tendinopathy. The reliability of the grading of the degree of neovascularization has not been examined previously. Hypothesis Power Doppler ultrasonography can be performed with a high interobserver reliability to determine the neovascularization score in patients with midportion Achilles tendinopathy. Study Design Case control study (diagnosis); Level of evidence, 4. Methods Thirty-three symptomatic and 17 asymptomatic Achilles tendons from 25 consecutive patients were included for ultrasound examination. Victorian Institute of Sport Assessment–Achilles score was used to assess the severity of the Achilles tendinopathy. Each tendon was scored twice by different radiologists using the modified Öhberg score for neovascularization. Results The intraclass correlation coefficient for interobserver reliability was 0.85. Neovascularization was observed in 70% (23/33) of the symptomatic tendons and in 29% (5/17) of the asymptomatic tendons. The Spearman correlation coefficient between the Victorian Institute of Sport Assessment–Achilles score and the degree of neovascularization was −0.16 (P =. 10). Conclusion An excellent interobserver reliability was found for determining the degree of neovascularization on power Doppler ultrasonography examination. Neovessels were present in a majority of symptomatic tendons. The severity of symptoms was not correlated with the neovascularization score. Clinical Relevance Power Doppler ultrasonography is widely used to evaluate tendinopathy without knowledge of the difference in observations between several testers. Interobserver reliability of the evaluation of the degree of neovascularization in chronic midportion Achilles tendinopathy is excellent.

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