Devitt Brian M, Smith Bjorn, Stapf Robert, Jo Suenghwan, O'Donnell John M
Department of hip arthroscopy, Hip Arthroscopy Australia, 21-23 Erin Street, Melbourne, Victoria 3121, Australia.
J Hip Preserv Surg. 2017 Mar 5;4(2):187-193. doi: 10.1093/jhps/hnx005. eCollection 2017 Jul.
The importance of the ligamentum teres (LT) in the hip is increasingly being recognized. However, the incidence of LT tears in the literature is extremely variable. Although classification systems exist their reliability in classifying LT pathology arthroscopically has not been well defined. To determine the inter- and intra-observer reliability of two existing classifications systems for the diagnosis of LT pathology at hip arthroscopy. Second, to identify key pathological findings currently not included. Four experienced hip-arthroscopists reviewed 40 standardized arthroscopic videos. Arthroscopic findings of the LT were classified using the Gray and Villar (G&V) and descriptive classification (DC). Reviewers were asked to record other relevant pathology encountered. Inter- and intra-observer reliability was defined using Fleiss-Kappa and Cohen-Kappa statistics. Both classifications demonstrated fair inter-observer reliability. The intra-observer reliability for G&V was moderate-to-substantial and for DC was slight-to-moderate. An absolute agreement rate of 10% (G&V) and 37.5% (DC) was found. Differentiation between normal, and partial or low-grade tears was a common source of disagreement. The prevalence of LT pathology was 90%. Synovitis was the most common diagnostic finding that was not included in either classification system used in this study. Arthroscopic classification of LT pathology using the G&V and the DC demonstrated only fair inter-observer reliability. The major discrepancy in interpretation was between normal, and partial or low-grade tears. The presence of synovitis was not in either classification but was considered an important arthroscopic finding. Thorough arthroscopic scrutiny reveals the prevalence of LT pathology is higher than previously reported.
髋臼圆韧带（LT）在髋关节中的重要性日益受到认可。然而，文献中LT撕裂的发生率差异极大。尽管存在分类系统，但它们在关节镜下对LT病变进行分类的可靠性尚未得到明确界定。目的是确定两种现有分类系统在髋关节镜检查中诊断LT病变时的观察者间和观察者内可靠性。其次，识别当前未包括的关键病理发现。四位经验丰富的髋关节镜医师对40个标准化关节镜视频进行了评估。使用格雷和比利亚尔（G&V）分类法和描述性分类法（DC）对LT的关节镜检查结果进行分类。要求评估者记录遇到的其他相关病变。使用Fleiss-Kappa和Cohen-Kappa统计量定义观察者间和观察者内可靠性。两种分类法的观察者间可靠性均为中等。G&V分类法的观察者内可靠性为中等至高度，DC分类法的观察者内可靠性为低度至中等。发现绝对一致率分别为10%（G&V）和37.5%（DC）。正常情况与部分或低度撕裂之间的区分是常见的分歧来源。LT病变的患病率为90%。滑膜炎是本研究中使用的两种分类系统均未包括的最常见诊断发现。使用G&V和DC对LT病变进行关节镜分类，观察者间可靠性仅为中等。解释上的主要差异在于正常情况与部分或低度撕裂之间。滑膜炎未在任何一种分类中出现，但被认为是一项重要的关节镜检查发现。全面的关节镜检查显示，LT病变的患病率高于先前报道。
