膝关节关节软骨缺损关节镜测量的评分者间和评分者内信度
Interrater and Intrarater Reliability of Arthroscopic Measurements of Articular Cartilage Defects in the Knee.
作者信息
Flanigan David C, Carey James L, Brophy Robert H, Graham William C, DiBartola Alex C, Hamilton David, Nagaraja Haikady N, Lattermann Christian
机构信息
1Division of Sports Medicine Cartilage Repair Center, Department of Orthopaedics (D.C.F., W.C.G., and A.C.D.), Division of Biostatistics, College of Public Health (H.N.N.), and Wexner Medical Center (D.C.F. and A.C.D.), The Ohio State University, Columbus, Ohio 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 3Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri 4OrthoCarolina, Pineville, North Carolina 5University of Kentucky, Lexington, Kentucky.
出版信息
J Bone Joint Surg Am. 2017 Jun 21;99(12):979-988. doi: 10.2106/JBJS.16.01132.
BACKGROUND
Cartilage lesions of the knee are difficult to treat. Lesion size is a critical factor in treatment algorithms, and the accurate, reproducible sizing of lesions is important. In this study, we evaluated the interrater and intrarater reliability of, and correlations in relation to, various arthroscopic sizing techniques.
METHODS
Five lesions were created in each of 10 cadaveric knees (International Cartilage Repair Society grade 3C). Three orthopaedic surgeons used 4 techniques (visualization and use of a 3-mm probe, a simple metal ruler, and a sliding metallic ruler tool) to estimate lesion size. Repeated-measures data were analyzed using a mixed-effect linear model. The differences between observed and gold-standard (plastic mold) values were used as the response. Intraclass and interclass correlation coefficient (ICC) values for intrarater and interrater reliability were computed, as were overall correlation coefficients between measurements and gold standards.
RESULTS
The mean lesion size was 2.37 cm (range, 0.36 to 6.02 cm). Rater, lesion location and size, and measurement method all affected the cartilage defect measurements. Surgeons underestimated lesion size, and measurements of larger lesions had a higher percentage of error compared with those of smaller lesions. When compared with plastic molds of lesions, 60.5% of surgeon measurements underestimated lesion size. Overall, the correlation between measurements and gold standards was strongest for the simple metal ruler method and weakest for the visualization method.
CONCLUSIONS
Several factors may influence arthroscopic estimation of cartilage lesion size: the lesion location, measurement tool, surgeon, and defect size itself. The intrarater and interrater reliability was moderate to good using a 3-mm probe, sliding metallic ruler tool, or simple metal ruler and was fair to moderate using visualization only.
CLINICAL RELEVANCE
There is a need for more accurate methods of determining the size of articular cartilage lesions.
背景
膝关节软骨损伤难以治疗。损伤大小是治疗方案中的关键因素，准确、可重复地测量损伤大小很重要。在本研究中，我们评估了各种关节镜测量技术的评分者间和评分者内信度以及相关性。
方法
在10具尸体膝关节（国际软骨修复协会3C级）中，每具膝关节制造5处损伤。三名骨科医生使用4种技术（可视化并使用3毫米探针、简单金属尺、滑动金属尺工具）估计损伤大小。使用混合效应线性模型分析重复测量数据。观察值与金标准（塑料模具）值之间的差异用作反应变量。计算评分者内和评分者间信度的组内和组间相关系数（ICC）值，以及测量值与金标准之间的总体相关系数。
结果
平均损伤大小为2.37厘米（范围为0.36至6.02厘米）。评分者、损伤位置和大小以及测量方法均影响软骨缺损测量结果。外科医生低估了损伤大小，与较小损伤相比，较大损伤测量的误差百分比更高。与损伤的塑料模具相比，60.5%的外科医生测量值低估了损伤大小。总体而言，简单金属尺测量方法与金标准之间的相关性最强，可视化方法最弱。
结论
有几个因素可能影响关节镜下对软骨损伤大小的估计：损伤位置、测量工具、外科医生和缺损大小本身。使用3毫米探针、滑动金属尺工具或简单金属尺时，评分者内和评分者间信度为中度至良好，仅使用可视化时为一般至中度。
临床意义
需要更准确的方法来确定关节软骨损伤的大小。
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