Carey James L, Wall Eric J, Grimm Nathan L, Ganley Theodore J, Edmonds Eric W, Anderson Allen F, Polousky John, Murnaghan M Lucas, Nissen Carl W, Weiss Jennifer, Lyon Roger M, Chambers Henry G
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Am J Sports Med. 2016 Jul;44(7):1694-8. doi: 10.1177/0363546516637175. Epub 2016 Apr 6.
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.
To determine the intra- and interobserver reliability of a novel, comprehensive arthroscopic classification system with mutually exclusive OCD lesion types.
Cohort study (diagnosis); Level of evidence, 3.
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).
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.
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.
在手术评估过程中，已经提出了几种用于对膝关节剥脱性骨软骨炎（OCD）进行分类的系统。没有一种单一的分类包括相互排斥的类别来涵盖稳定性、软骨裂伤和碎片分离的所有显著特征。此外，没有研究评估这些分类系统的可靠性。
确定一种具有相互排斥的OCD病变类型的新型综合关节镜分类系统的观察者间和观察者内可靠性。
队列研究（诊断）；证据等级，3级。
膝关节骨软骨炎研究（ROCK）小组开发了一种用于膝关节OCD关节镜评估的分类系统，该系统包括6个关节镜类别——3种固定型和3种活动型。为了优化可理解性和适用性，每个类别都有一个易记的名称、简短描述、与典型关节镜外观相对应的线图以及描绘该原型的关节镜照片。10名骨科医生评估者对30个代表性关节镜视频进行评估，并对每个病变进行分类。4周后，评估者再次以新的随机选择顺序对30个视频中描绘的OCD病变进行分类。通过组内相关系数（ICC）评估可靠性。
该新型关节镜分类的观察者间可靠性在第一轮评估中通过ICC估计为0.94（95%CI，0.91 - 0.97），第二轮评估中为0.95（95%CI，0.93 - 0.98）。根据阿尔特曼可靠性系数大小的标准，这些ICC表明观察者间可靠性非常好。观察者内可靠性通过ICC估计为0.96（95%CI，0.95 - 0.97），这表明观察者内可靠性同样非常好。
ROCK OCD膝关节关节镜分类系统显示出优异的观察者间和观察者内可靠性。鉴于这种可靠性，该分类系统可用于临床并促进未来的研究，包括OCD的多中心研究。
