Correlations between radiological classification systems and confirmed cartilage loss in severe knee osteoarthritis

2020 ◽  
Vol 102-B (3) ◽  
pp. 301-309 ◽  
Author(s):  
Oisin J. F. Keenan ◽  
George Holland ◽  
Julian F. Maempel ◽  
John F. Keating ◽  
Chloe E. H. Scott
Keyword(s):  
Knee Osteoarthritis ◽  
Correlation Coefficient ◽  
Interobserver Reliability ◽  
Severe Disease ◽  
Intraclass Correlation ◽  
Lateral Compartment ◽  
Classification Systems ◽  
Medial Compartment ◽  
Cartilage Loss ◽  
Radiological Classification

Aims Although knee osteoarthritis (OA) is diagnosed and monitored radiologically, actual full-thickness cartilage loss (FTCL) has rarely been correlated with radiological classification. This study aims to analyze which classification system correlates best with FTCL and to assess their reliability. Methods A prospective study of 300 consecutive patients undergoing unilateral total knee arthroplasty (TKA) for OA (mean age 69 years (44 to 91; standard deviation (SD) 9.5), 178 (59%) female). Two blinded examiners independently graded preoperative radiographs using five common systems: Kellgren-Lawrence (KL); International Knee Documentation Committee (IKDC); Fairbank; Brandt; and Ahlbäck. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC). Intraoperatively, anterior cruciate ligament (ACL) status and the presence of FTCL in 16 regions of interest were recorded. Radiological classification and FTCL were correlated using the Spearman correlation coefficient. Results Knees had a mean of 6.8 regions of FTCL (SD 3.1), most common medially. The commonest patterns of FTCL were medial ± patellofemoral (143/300, 48%) and tricompartmental (89/300, 30%). ACL status was associated with pattern of FTCL (p = 0.023). All radiological classification systems demonstrated moderate ICC, but this was highest for the IKDC: whole knee 0.68 (95% confidence interval (CI) 0.60 to 0.74); medial compartment 0.84 (95% CI 0.80 to 0.87); and lateral compartment 0.79 (95% CI 0.73 to 0.83). Correlation with actual FTCL was strongest for Ahlbäck (Spearman rho 0.27 to 0.39) and KL (0.30 to 0.33) systems, although all systems demonstrated medium correlation. The Ahlbäck score was the most discriminating in severe knee OA. Osteophyte presence in the medial compartment had high positive predictive value (PPV) for FTCL, but not in the lateral compartment. Conclusion The Ahlbäck and KL systems had the highest correlation with confirmed cartilage loss at TKA. However, the IKDC system displayed the best interobserver reliability, with favourable correlation with FTCL in medial and lateral compartments, although it was less discriminating in more severe disease. Cite this article: Bone Joint J 2020;102-B(3):301–309

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.

scholarly journals Radiographic vs. MRI vs. arthroscopic assessment and grading of knee osteoarthritis - are we using appropriate imaging?

2022 ◽  
Vol 9 (1) ◽  
Author(s):  
Samuel Newman ◽  
Huzefah Ahmed ◽  
Nader Rehmatullah
Keyword(s):  
Knee Joint ◽  
Knee Osteoarthritis ◽  
Imaging Techniques ◽  
Lateral Compartment ◽  
Medial Compartment ◽  
Actual Condition ◽  
Tertiary Centre ◽  
Arthroscopic Findings ◽  
Mri Scans ◽  
Outerbridge Grade

Abstract Purpose Radiographs and MRI scans are commonly used imaging techniques in the assessment of knee osteoarthritis. However, it currently remains uncertain how good a representation of the actual condition of the knee joint these investigations provide. By comparing them against arthroscopic findings the aim of our study was to conclude how accurate these imaging techniques are at grading knee osteoarthritis. Methods This was a retrospective study looking at knee arthroscopies performed at a tertiary centre over a 5 year period. The Outerbridge grade given at arthroscopy was correlated with pre-operative radiograph and MRI scores, so as to assess the reliability of these imaging techniques at predicting the actual severity of knee osteoarthritis seen. Results Kellgren-Lawrence (KL) grading of radiographs was moderately correlated with Outerbridge grades from arthroscopy for the medial compartment of the knee (Spearman’s rho (SR) 0.483, p < 0.001), with a milder correlation in the lateral compartment (SR 0.218, p = 0.003). MRI reporting of knee osteoarthritis was moderately correlated with Outerbridge grades in the medial compartment (SR 0.451, p < 0.001), mildly correlated for both the lateral (SR 0.299, p < 0.001) and patellofemoral joint compartments (SR 0.142, p = 0.054). KL and MRI grading was moderately correlated for the medial compartment (SR 0.475, p < 0.001) and mildly correlated for the lateral compartment (SR 0.277, p < 0.001). Conclusion The ability of radiographs to represent the actual condition of knee osteoarthritis is underestimated. KL grading especially best represents the disease seen in the medial compartment of the knee joint, with a moderate correlation to Outerbridge scores given on arthroscopic assessment. We suggest that whilst MRI is a useful tool in the investigation of knee symptoms, it is often unnecessarily used in patients with OA, when in fact, radiographs alone would be sufficient. Evidence level III

scholarly journals Feasibility and reliability of a German guideline for farm’s self-monitoring in sows and piglets

2020 ◽  
Vol 98 (10) ◽  
Author(s):  
Lena Friedrich ◽  
Joachim Krieter ◽  
Nicole Kemper ◽  
Irena Czycholl
Keyword(s):  
Animal Welfare ◽  
Correlation Coefficient ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Reliability Study ◽  
Self Monitoring ◽  
Retest Reliability ◽  
Welfare Assessment ◽  
Animal Welfare Assessment ◽  
Test Retest Reliability

Abstract The present study’s aim was to test a German guideline for farm’s self-monitoring in sows and piglets for its feasibility as well as its interobserver and test–retest reliability. The study was performed between September 2016 and April 2018 on 13 farrowing farms in Northern Germany. Contrary to the guideline, the testing was not carried out by the farmers themselves but by 2 observers with experience in pigs representing common farmers. For the interobserver reliability study, the observers performed 20 joint farm visits independently assessing the same animals. For the test–retest reliability study, each farm was visited 5 times by 1 observer (day 0, day 3, week 7, month 5, month 10). Farm visit 1 (day 0) was used as reference and compared with the remaining farm visits. The reliability was evaluated using Spearman’s rank correlation coefficient (RS), intraclass correlation coefficient (ICC), and limits of agreement (LoA). As results, the guideline’s feasibility was limited. The indicators’ reliability also presented divergent results: All indicators in piglets revealed acceptable to good interobserver reliability (RS 0.64 to 0.77 ICC 0.33 to 0.48 LoA between the intervals −0.02 to 0.13 and −0.02 to 0.00). Contrarily, interobserver reliability was low for indicators in sows (e.g., claw alterations: RS −0.41 ICC 0.00 LoA −0.97 to 0.68). Overall acceptable test–retest reliability could be assigned to all indicators although no exact agreement existed but only the pursuit of trends is indicated. On the basis of the present results, the guideline in its present form cannot be recommended for farms’ self-monitoring. Given the restricted applicability, it should be reconsidered whether it might not be more appropriate to use scientifically tested and generally accepted animal welfare assessment systems such as the Welfare Quality animal welfare assessment protocols, although their application is also time-consuming.

scholarly journals The reliability of Cavalier’s principle of stereological method in determining volumes of enchondromas using the computerized tomography tools

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668450
Author(s):  
Nihat Acar ◽  
Ahmet Karakasli ◽  
Ahmet Karaarslan ◽  
Nermin NG Mas ◽  
Onur Hapa
Keyword(s):  
Correlation Coefficient ◽  
Computerized Tomography ◽  
Intraclass Correlation Coefficient ◽  
Measurement Technique ◽  
Interobserver Reliability ◽  
Statistical Significance ◽  
Intraclass Correlation ◽  
Benign Tumors ◽  
Volumetric Measurement

Introduction: Volumetric measurements of benign tumors enable surgeons to trace volume changes during follow-up periods. For a volumetric measurement technique to be applicable, it should be easy, rapid, and inexpensive and should carry a high interobserver reliability. We aimed to assess the interobserver reliability of a volumetric measurement technique using the Cavalier’s principle of stereological methods. Materials and methods: The computerized tomography (CT) of 15 patients with a histopathologically confirmed diagnosis of enchondroma with variant tumor sizes and localizations was retrospectively reviewed for interobserver reliability evaluation of the volumetric stereological measurement with the Cavalier’s principle, V = t × [((SU) × d) /SL]2 × Σ P. Results: The volumes of the 15 tumors collected by the observers are demonstrated in Table 1. There was no statistical significance between the first and second observers ( p = 0.000 and intraclass correlation coefficient = 0.970) and between the first and third observers ( p = 0.000 and intraclass correlation coefficient = 0.981). No statistical significance was detected between the second and third observers ( p = 0.000 and intraclass correlation coefficient = 0.976). Conclusion: The Cavalier’s principle with the stereological technique using the CT scans is an easy, rapid, and inexpensive technique in volumetric evaluation of enchondromas with a trustable interobserver reliability.

scholarly journals Visual versus automatic ultrasound scoring of lung B-lines: reliability and consistency between systems

2019 ◽  
Vol 21 (1) ◽  
pp. 45 ◽  
Author(s):  
Jorge Short ◽  
Carlos Acebes ◽  
Guido Rodriguez-de-Lema ◽  
Giuliana Maria Concetta La Paglia ◽  
Maria Pavón ◽  
...  
Keyword(s):  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Automatic System ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Counting System ◽  
Observer Reliability ◽  
Automatic Counting ◽  
B Lines

Aims. To evaluate the agreement between a visual and an automatic counting system of lung B-lines by ultrasound (US) as well as to test the inter- and intra-observer reliability of both systems in patients with lung diseases.Material and methods. We included four patients with different lung conditions. Four ultrasonographers expert in lung US blindly, independently and consecutively performed, in two rounds, a US B-mode assessment of 8 lung intercostal spaces of each patient. Each US assessment consisted of a visual and an automatic counting of B-lines.Results. Agreement between visual and automatic counting of B-lines was good to excellent [intraclass correlation coefficient (ICC) 0.79-0.84, p<0.001]. Intra-observer reliability was good to excellent [ICC 0.62-0.99, p<0.001] except for one investigator in whom it was close to moderate for the automatic system [ICC 0.49, p<0.05]. Inter-observer reliability was excellent for both systems in both rounds [ICC 0.86-0.90, p<0.001].Conclusions. US automatic counting was consistent with US visual counting of lung B-lines, as performed by experts in the field. Both systems showed a high intra- and interobserver reliability.

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.

scholarly journals Intraobserver and Interobserver Reliability of Three Classification Systems for Hallux Rigidus

2018 ◽  
Vol 110 (3) ◽  
Author(s):  
Peter Pham ◽  
Sarita Dillard ◽  
Christina Schilero ◽  
Sharon Chiang
Keyword(s):  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Plain Radiograph ◽  
Hallux Rigidus ◽  
Classification Systems ◽  
Foot And Ankle ◽  
Intrarater Reliability ◽  
Single Measure ◽  
The Mean ◽  
Prognostic Implications

Background There are more than ten classification systems currently used in the staging of hallux rigidus. This results in confusion and inconsistency with radiographic interpretation and treatment. The reliability of hallux rigidus classification systems has not yet been tested. We sought to evaluate the intraobserver and interobserver reliabilities of three commonly used classifications for hallux rigidus. Methods Twenty-one plain radiograph sets were presented to ten American College of Foot and Ankle Surgeons board-certified foot and ankle surgeons. Each physician classified each radiograph based on clinical experience and knowledge according to the Regnauld, Roukis, and Hattrup and Johnson classification systems. The two-way mixed single-measure consistency intraclass correlation coefficient was used to calculate intrarater and interrater reliabilities. Results The mean ± SD intrarater reliability of individual sets for the Roukis (0.62 ± 0.19) and Hattrup and Johnson (0.62 ± 0.28) classification systems was fair to good and for the Regnauld system bordered between fair to good and poor (0.43 ± 0.24). The interrater reliability of the mean classification was excellent for all three classification systems. Conclusions Reliable and reproducible classification systems are essential for treatment and prognostic implications in hallux rigidus. Herein, the Roukis classification system had the best intrarater reliability. Although there are various classification systems for hallux rigidus, the present results indicate that the three classification systems evaluated show reliability and reproducibility.

Development and Psychometric Testing of a Scale for Evaluating Self-Management Needs of Knee Osteoarthritis (SMNKOA) in Taiwan

2016 ◽  
Vol 26 (3) ◽  
pp. 354-372 ◽  
Author(s):  
Mei-Hua Kao ◽  
Yun-Fang Tsai
Keyword(s):  
Knee Osteoarthritis ◽  
Correlation Coefficient ◽  
Health Care Providers ◽  
Convergent Validity ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
Self Management ◽  
Care Providers ◽  
Knee Oa ◽  
New Instrument

Self-management of osteoarthritis (OA) of the knee is important for treating this chronic disease. This study developed and psychometrically tested a new instrument for measuring adult patients’ self-management needs of knee osteoarthritis (SMNKOA). The theoretical framework of self-care guided the development of the 35-item SMNKOA scale. Participants ( N = 372) were purposively sampled from orthopedic clinics at medical centers in Taiwan. The content validity index was 0.83. Principal components analysis identified a three-factor solution, accounting for 53.19% of the variance. The divergent validity was −0.67; convergent validity was −0.51. Cronbach’s alpha was .95, Pearson’s correlation coefficient was .88, and the intraclass correlation coefficient was .95. The scale’s reliability and validity supports the SMNKOA, as a tool to measure self-management needs of adults with knee OA. Nurses and other health care providers can use this instrument to evaluate knee OA patients and identify strategies for improving health-related outcomes and patient education.

scholarly journals ISAKOS Classification of Meniscal Tears. Intra and Interobserver Reliability.

2014 ◽  
Vol 2 (12_suppl4) ◽  
pp. 2325967114S0023
Author(s):  
Mariano J. Fresneda ◽  
Juan J. Dere ◽  
Carlos H. Yacuzzi ◽  
Matías Costa Paz
Keyword(s):  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Intraobserver Reliability ◽  
Knee Surgery ◽  
Meniscal Tears ◽  
Meniscal Lesions ◽  
Good Agreement

Objectives: To analyze the intra and interobserverreliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears. Methods: Thearthroscopic classification of meniscal lesions created by the ISAKOS was used. Thirty one arthroscopic videos, made between June and December 2013,with different meniscal tear characteristics were analyzedby three orthopedic surgeons (two specialists in knee surgery and a fellowship), twice at an interval of 30 days. The Kappa Coefficients (k) was used to assess the intraobserver reliability and intraclass correlation coefficient (ICC) for interobserverreliability. Results: The averageintraobserver reliability was for the first observer 51%, the second 65% and the third 58%, reaching moderate agreement according to the Kappa coefficient used by Landis and Koch. Regarding interobserver reliability, good agreement (ICC = 0.71) was obtained as the intraclass correlation coefficient. The whole results were significantlystatical (p <0.05). Conclusion: While this classification provides a detailed description of meniscal lesions, the intraobserver reliability did not reach the optimum values obtained despite having on average a moderate agreement. However interobserver reliability results showed on average 70% of agreement (good agreement), which can affirm that the agreement and interobserver reliability is acceptable.

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