scholarly journals Assessment of the reliability of a non-invasive elbow valgus laxity measurement device

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Kenneth Seiber ◽  
Chris Bales ◽  
Elisabeth Wörner ◽  
Thay Lee ◽  
Marc R. Safran
Keyword(s):  
Mixed Model ◽  
Interobserver Reliability ◽  
Research Question ◽  
Intraclass Correlation ◽  
Ulnar Collateral Ligament ◽  
Daily Practice ◽  
Intraobserver Reliability ◽  
Measurement Tool ◽  
Collateral Ligament ◽  
Valgus Stress

Abstract Purpose The purpose of this study was to assess the reliability of a new objective measurement tool to measure the valgus stress laxity of the ulnar collateral ligament (UCL) of the elbow, the “Elbow Tester”. The anterior oblique portion of the ulnar collateral ligament (UCL) of the elbow is the primary static restraint to valgus stress during the overhead throwing motion. The main research question was if the “Elbow Tester” that we have developed was reliable and reproducible for further use in research and daily practice. Methods Three different examiners tested both elbows of 11 volunteers for UCL laxity. Each elbow was tested 5 times using a standard 2 Nm valgus load, and 3 times using a manual maximum valgus load. One examiner tested the volunteers again 1 week later. The outcomes of elbow valgus laxity were compared between examiners. The intraobserver reliability was assessed using an intraclass correlation coefficient (ICC) and interobserver reliability was also assessed with a mixed model repeated ANOVA test. Results The device demonstrated a high level of intraobserver reliability with both the 2 Nm valgus force and manual maximum valgus force, using a minimum of three trials as determined by an ICC > 0.9 for all examiners. The interobserver reliability was moderate using the 2 Nm valgus load with an ICC value of 0.72 and significant different outcomes of elbow valgus laxity amongst examiners (p < 0.01). A high interobserver reliability (ICC value of 0.90) was observed using manual maximum valgus force and no differences between outcomes (p > 0.53). Conclusion The noninvasive valgus elbow tester demonstrates high interobserver and intraobserver reliability using manual maximum valgus force and can be used for further research and daily practice.

scholarly journals High Reproducibility of an Automated Measurement of Mobility for Patients with Axial Spondyloarthritis

2018 ◽  
Vol 45 (10) ◽  
pp. 1383-1388 ◽  
Author(s):  
Juan L. Garrido-Castro ◽  
Rafael Curbelo ◽  
Ramón Mazzucchelli ◽  
María E. Domínguez-González ◽  
Cristina Gonzalez-Navas ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Repeated Measures ◽  
Axial Spondyloarthritis ◽  
Activity Index ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Disease Activity Index ◽  
Intraobserver Reliability ◽  
Spinal Mobility ◽  
Video Capture

Objective.Conventional measures of spinal mobility used in the assessment of patients with axial spondyloarthritis (axSpA), such as the Bath Ankylosing Spondylitis Metrology Index and its components, are subject to interobserver variability. The University of Córdoba Ankylosing Spondylitis Metrology Index (UCOASMI) is a validated composite index based on a motion video-capture system, UCOTrack. Our objective was to assess its reproducibility in clinical practice settings.Methods.We carried out an observational study of repeated measures in 3 centers. Video-capture systems were installed and adapted to clinical rooms. Patients with axSpA and stable disease were selected by consecutive stratified sampling [disease duration, sex, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)]. Intraobserver reliability of the UCOASMI and of conventional measures was tested 3–5 days apart. For interobserver reliability, 3 patients from each center were evaluated in the other centers, within 3–7 days. The intraclass correlation coefficients (ICC) were calculated.Results.Thirty patients were included (73% men, mean age 53 yrs, mean BASDAI 3.0). Interobserver and intraobserver ICC of the UCOASMI was 0.98. Conventional measurements showed lower but adequate reproducibility as well, except for interobserver reliability of lateral flexion (0.41), cervical rotation (0.61), and Schöber test (0.07), and intraobserver reliability of tragus-to-wall distance (0.30).Conclusion.Reproducibility of the UCOASMI seems very high, and apparently more reliable than conventional measures of mobility.

scholarly journals Comparison of Reliability of Norberg Angle and Distraction Index as Measurements for Hip Laxity in Dogs

2020 ◽  
Vol 33 (04) ◽  
pp. 274-278
Author(s):  
Julius Klever ◽  
Andreas Brühschwein ◽  
Silvia Wagner ◽  
Sven Reese ◽  
Andrea Meyer-Lindenberg
Keyword(s):  
Correlation Coefficient ◽  
Clinical Significance ◽  
Intraclass Correlation Coefficient ◽  
Hip Joint ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Joint Laxity ◽  
Intraobserver Reliability ◽  
Level Of Experience ◽  
Norberg Angle

Abstract Objective The main purpose of the study was to compare reliability of measurements for the evaluation of hip joint laxity in 59 dogs. Materials and Methods Measurement of the distraction index (DI) of the PennHIP method and the Norberg angle (NA) of the Fédération Cynologique Internationale (FCI) scoring scheme as well as scoring according to the FCI scheme and the Swiss scoring scheme were performed by three observers at different level of experience. For each dog, two radiographs were acquired with each method by the same operator to evaluate intraoperator-reliability. Results Intraoperator-reliability was slightly better for the NA compared with the DI with an intraclass correlation coefficient (ICC) of 0.962 and 0.892 respectively. The ICC showed excellent results in intraobserver-reliability and interobserver-reliability for both the NA (ICC 0.975; 0.969) and the DI (ICC 0.986; 0.972). Thus, the NA as well as the DI can be considered as reliable measurements. The FCI scheme and the Swiss scoring scheme provide similar reliability. While the FCI scheme seems to be slightly more reliable in experienced observers (Kappa FCI 0.687; Kappa Swiss 0.681), the Swiss scoring scheme had a noticeable better reliability for the unexperienced observer (Kappa FCI 0.465; Kappa Swiss 0.514). Clinical Significance The Swiss scoring scheme provides a structured guideline for the interpretation of hip radiographs and can thus be recommended to unexperienced observers.

scholarly journals The Evaluation of Trochlear Osseous Morphology: An Epidemiologic Study

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0044
Author(s):  
Sercan Yalçin ◽  
Gabriel Onor ◽  
Scott Kaar ◽  
lee Pace ◽  
Paolo Ferrua ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Normal Population ◽  
Trochlear Dysplasia ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Epidemiologic Study ◽  
Intraobserver Reliability ◽  
Severe Dysplasia ◽  
Mild Dysplasia ◽  
Study Population

Objectives: The purpose of this study is to investigate the prevalence of the trochlear dysplasia in our study population. Methods: We obtained 692 skeletally mature femoral specimens from the [Blinded Institution], [Blinded Collection]. Five observers were asked to evaluate each specimen for trochlear dysplasia on a scale between 0 and 3 (0 – normal/no dysplasia; 1 – mild dysplasia; 2 – moderate dysplasia; 3 – severe dysplasia). Each observer made initial evaluations for interobserver reliability. Each observer then re-evaluated each specimen one month later to determine intraobserver reliability. We evaluated inter and intraobserver reliability utilizing intraclass correlation coefficient (ICC). All statistics were performed with SPSS v.25 (IBM, USA). Results: The interobserver ICC of first and second evaluation of all observers were found to be 0.906 [0.894-0,916] and 0.904 [0.892-0.915], respectively. The intraobserver ICC of observers were as follows: Reviewer1: 0.799 [0.771-0.825]; Reviewer2: 0.686 [0.645-0.724]; Reviewer3: 0.808 [0.781-0.832]; Reviewer4: 0.787 [0.757-0.814]; Reviewer5: 0.778 [0.747-0.806]. These results show intra and interobserver correlation was good to excellent. The percentages of normal trochlea, mild dysplasia, moderate dysplasia and severe dysplasia for first evaluation, by reviewer, are as follows: Reviewer 1: 82.7%, 12.1%, 4.0%, 1.2%; Reviewer 2: 37.3%, 26.2%, 27.5%, 9.1%; Reviewer 3: 57.9%, 28.0%, 12.1%, 1.9%; Reviewer 4: 64.2%, 25.6%, 7.7%, 2.6%; Reviewer 5: 65.6%, 14.9%, 12.3%, 7.2%. The percentages of normal trochlea, mild dysplasia, moderate dysplasia and severe dysplasia for second evaluation, by reviewer, are as follows: Reviewer 1: 78.8%, 16.6%, 3.6%, 1.0%; Reviewer 2: 40.3%, 26.4%, 23.3%, 10.0%; Reviewer 3: 42.2%,35.1%, 18.8%, 3.9%; Reviewer 4: 57.4%, 31.9%, 8.2%, 2.5%; Reviewer 5: 73.7%, 8.2%, 9.7%, 8.4%. In total, the percentages of normal trochlea, mild dysplasia, moderate dysplasia and severe dysplasia were 60.00%, 22.51%, 12.72%, 4.77%; respectively. Conclusions: This study shows that although there was no absolute criteria to grade trochlear dysplasia, observers had similar opinions on the degree of dysplasia. Also, our cohort shows that moderate to severe dysplasia is not uncommon as it is present in around 17% of knees in our cohort. This is the first epidemiologic study evaluating the prevalence of trochlear dysplasia in the normal population.

Medial Elbow Instability Resulting From Partial Tears of the Ulnar Collateral Ligament: Stress Ultrasound in a Cadaveric Model

2020 ◽  
Vol 48 (11) ◽  
pp. 2613-2620
Author(s):  
Michael C. Ciccotti ◽  
Sommer Hammoud ◽  
Christopher C. Dodson ◽  
Steven B. Cohen ◽  
Levon N. Nazarian ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Nonoperative Treatment ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Diagnostic Modality ◽  
Partial Tear ◽  
Partial Tears ◽  
Early Reconstruction ◽  
Anterior Posterior

Background: There is consensus that most complete ulnar collateral ligament (UCL) injuries in throwers would benefit from surgical intervention. Optimal treatment for partial UCL tears remains controversial. Stress ultrasonography has become a well-accepted diagnostic modality for assessing UCL injury. Hypothesis: Partial UCL tears will result in an intermediate increase in ulnohumeral joint space gapping as compared with that of an intact UCL and a complete UCL tear, but the degree of joint space gapping will vary by anatomic location of the partial tear. Study Design: Controlled laboratory study. Methods: Twenty-one cadaveric elbows were divided into 7 groups representing different anatomic locations of UCL partial tears. Partial tears were simulated by cutting 50% of the measured width of the UCL at 6 locations: distal anterior/posterior, midsubstance anterior/posterior, and proximal anterior/posterior. A seventh partial tear was created by partially elevating the undersurface of the distal UCL to simulate the radiographic “T-sign.” Valgus stress (15 daN) was applied to each cadaveric elbow at 30° of flexion using a standardized device. Each specimen was tested intact, partially torn, and completely torn. At each state, joint space was measured using stress ultrasonography, and the difference in joint space from unstressed to stressed (delta) was recorded. Results: There were 10 right and 11 left upper extremity specimens. The mean delta was 0.58 mm for the intact state and <0.75 mm in all groups. Both distal partial tear groups had mean deltas <0.75 mm, similar to intact elbows. Proximal tears and the T-sign demonstrated intermediate deltas (0.99-1.23 mm). Midsubstance partial tears demonstrated the largest deltas (1.57-2.03 mm), similar to those of the complete tears. All complete tear groups had a mean delta >1.5 mm (1.54-3.03 mm). Conclusion: These findings suggest that partial tears introduce a spectrum of instability from functionally intact to completely torn. As a result, some may be biomechanically amenable to nonoperative treatment, while others would be indicated for early reconstruction. Further research into the biological and biomechanical determinants of nonoperative treatment failure will assist with more precise treatment recommendations. Clinical Relevance: Describing the biomechanical consequences of different, clinically significant partial UCL tears potentially allows more precise recommendations for operative and nonoperative treatment.

Spinal Instability Neoplastic Score: An Analysis of Reliability and Validity From the Spine Oncology Study Group

2011 ◽  
Vol 29 (22) ◽  
pp. 3072-3077 ◽  
Author(s):  
Daryl R. Fourney ◽  
Evan M. Frangou ◽  
Timothy C. Ryken ◽  
Christian P. DiPaola ◽  
Christopher I. Shaffrey ◽  
...  
Keyword(s):  
Predictive Validity ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
Correlation Coefficients ◽  
Intraobserver Reliability ◽  
Spinal Tumors ◽  
Spinal Instability ◽  
Study Group ◽  
Reliable Classification

PurposeStandardized indications for treatment of tumor-related spinal instability are hampered by the lack of a valid and reliable classification system. The objective of this study was to determine the interobserver reliability, intraobserver reliability, and predictive validity of the Spinal Instability Neoplastic Score (SINS).MethodsClinical and radiographic data from 30 patients with spinal tumors were classified as stable, potentially unstable, and unstable by members of the Spine Oncology Study Group. The median category for each patient case (consensus opinion) was used as the gold standard for predictive validity testing. On two occasions at least 6 weeks apart, each rater also scored each patient using SINS. Each total score was converted into a three-category data field, with 0 to 6 as stable, 7 to 12 as potentially unstable, and 13 to 18 as unstable.ResultsThe κ statistics for interobserver reliability were 0.790, 0.841, 0.244, 0.456, 0.462, and 0.492 for the fields of location, pain, bone quality, alignment, vertebral body collapse, and posterolateral involvement, respectively. The κ statistics for intraobserver reliability were 0.806, 0.859, 0.528, 0.614, 0.590, and 0.662 for the same respective fields. Intraclass correlation coefficients for inter- and intraobserver reliability of total SINS score were 0.846 (95% CI, 0.773 to 0.911) and 0.886 (95% CI, 0.868 to 0.902), respectively. The κ statistic for predictive validity was 0.712 (95% CI, 0.676 to 0.766).ConclusionSINS demonstrated near-perfect inter- and intraobserver reliability in determining three clinically relevant categories of stability. The sensitivity and specificity of SINS for potentially unstable or unstable lesions were 95.7% and 79.5%, respectively.

Comparison of the Biomechanical Profile of the Intact Ulnar Collateral Ligament with the Modified Jobe and the Docking Reconstructed Elbow

2009 ◽  
Vol 37 (5) ◽  
pp. 974-981 ◽  
Author(s):  
Michael G. Ciccotti ◽  
Sorin Siegler ◽  
John A. Kuri ◽  
John H. Thinnes ◽  
Daniel J. Murphy
Keyword(s):  
Degrees Of Freedom ◽  
Ulnar Collateral Ligament ◽  
Elbow Flexion ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Anterior Portion ◽  
Reconstructive Procedures ◽  
Kinematic Coupling ◽  
Loading System ◽  
4 Degrees Of Freedom

Background The modified Jobe and Docking techniques are commonly used to reconstruct the elbow's ulnar collateral ligament. Hypothesis Valgus laxity and kinematic coupling after these reconstructive procedures are similar to those of the native ulnar collateral ligament. Study Design Controlled laboratory study. Methods Testing was conducted on 10 pairs of cadaver elbows using a 4 degrees of freedom loading system. Subfailure valgus loads were applied to the native elbows at different flexion angles; motion and ligament elongation were measured. The elbows were then loaded to failure in valgus at 90° of flexion. The reconstructive techniques were then applied and testing was repeated. Results Only the resting length of the anterior portion of the ulnar collateral ligament anterior bundle remained isometric throughout range of motion. Valgus laxity was nearly equal for the native and reconstructed ligaments at flexion angles of 90° or higher. However, both reconstructions provided less valgus stability than the native ulnar collateral ligament at low flexion angles. Kinematic coupling decreased with increased flexion for both native and reconstructed ligaments. Conclusion The modified Jobe and Docking techniques reconstruct restraint of the native ulnar collateral ligament to valgus laxity and kinematic coupling at 90° of flexion and higher angles where peak valgus torque is experienced in the throwing elbow. Clinical Relevance Both reconstructions provide valgus stability comparable to that of the native ulnar collateral ligament at 90° and higher, helping to explain their success in treating throwing athletes. Both reconstructions provide less valgus stability than the native ulnar collateral ligament at low flexion angles, suggesting that patients undergoing ulnar collateral ligament reconstruction should be cautioned against activities that provide valgus stress at low elbow flexion angles, such as side-arm throwing. This study suggests caution against overtightening the reconstructions at the common 30° of flexion.

scholarly journals Elbow valgus stability of the transverse bundle of the ulnar collateral ligament

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mutsuaki Edama ◽  
Kanta Matsuzawa ◽  
Hirotake Yokota ◽  
Ryo Hirabayashi ◽  
Chie Sekine ◽  
...  
Keyword(s):  
Subcutaneous Tissue ◽  
Load Condition ◽  
Ulnar Collateral Ligament ◽  
Joint Space ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Limb Position ◽  
Intact State ◽  
Significant Difference ◽  
Telos Stress Device

Abstract Background The purpose of this study was to clarify elbow valgus stability of the transverse bundle (TB). We hypothesized that the transverse bundle is involved in elbow valgus stability. Methods Twelve elbows of six Japanese Thiel-embalmed cadavers were evaluated. The skin, subcutaneous tissue and origin of forearm flexors were removed from about 5 cm proximal to the elbow to about 5 cm distal to the elbow, and the ulnar collateral ligament was dissected (intact state). The cut state was defined as the state when the TB was cut in the middle. The joint space of the humeroulnar joint (JS) was measured in the intact state and then in the cut state. With the elbow flexed to 30°, elbow valgus stress was gradually increased to 30, 60 N using the Telos Stress Device, and the JS was measured by ultrasonography under each load condition. Paired t-testing was performed to compare the JS between the intact and cut states under each load. Results No significant difference in JS was identified between the intact and cut state at start limb position. The JS was significantly higher in the cut state than in the intact state at both 30 N and 60 N. Conclusion The findings from this study suggested that the TB may be involved in elbow valgus stability.

Biomechanical Analysis of Thumb Ulnar Collateral Ligament Tear Kinematics

Hand ◽  
2019 ◽  
pp. 155894471986851
Author(s):  
Charles C. Lin ◽  
Nilay A. Patel ◽  
Yasuo Itami ◽  
Michelle H. McGarry ◽  
Steven S. Shin ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Biomechanical Analysis ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Valgus Stress ◽  
Ligament Tear ◽  
Partial Tear ◽  
Complete Tear ◽  
Valgus Instability ◽  
The Stability

Background: Thumb ulnar collateral ligament (UCL) injuries are common, but the kinematics of these injuries have not been comprehensively described, especially regarding kinematic changes with progressive UCL injury. Methods: Eleven cadaveric thumbs underwent kinematic testing under 4 conditions: intact, partial tear (50%) of the proper UCL, full tear of the proper UCL, and complete tear of both the proper and accessory UCL. Kinematic testing parameters included varus/valgus stress, pronation/supination, and volar/dorsal translation at −10 degree, 0 degree, 15 degree, and 30 degree of metacarpophalangeal flexion. Results: Partial tear of the proper UCL did not result in significant increases in laxity in any direction compared with intact ( P ≥ .132). Full tear of the proper UCL resulted in a significant increase in valgus angulation (18.8° ± 1.7° vs 11.5° ± 1.5°; P = .024) and pronation (15.4° ± 2.5° vs 12.6° ± 2.3°; P = .034) at 30 degree of flexion relative to intact. Complete tear of both the proper and accessory collateral ligaments resulted in increased valgus angulation at all degrees of flexion ( P < .001). Complete tear also resulted in a significant volar translation at 0 degree, 15 degree, and 30 degree of flexion ( P ≤ .016). Conclusion: Partial tear of the proper UCL does not significantly affect the stability of the joint, but full tear of the proper UCL increases valgus instability at 30 degree of flexion. Complete tear of the UCL is necessary for increased varus/valgus instability at all degrees of flexion and results in significant increases in pronation/supination and volar translation.

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