Peachtree Orthopedics, Atlanta, GA, USA.
Texas Health Sports Medicine, Allen, TX, USA.
Knee Surg Sports Traumatol Arthrosc. 2021 May;29(5):1392-1400. doi: 10.1007/s00167-020-06215-x. Epub 2020 Aug 17.
The purpose of this study was to report several novel classification systems for intra-articular lesions observed during hip arthroscopy, and to quantify the interrater reliability of both these novel systems and existing classifications of intra-articular lesions when tested by a group of high-volume hip arthroscopists.
Five hip arthroscopists deliberated over shortcomings in current classification systems and developed several novel grading systems with particular effort made to capture factors important to the treatment and outcomes of hip arthroscopy for labral injury. A video learning module describing the classifications was then developed from the video archive of surgeries performed by the senior author and reviewed by study participants. Following review of the module, a pilot study was completed using five randomly selected videos, after which participating surgeons met once more to discuss points of disagreement and to seek clarification. The final video collection for testing reliability was composed of 29 videos selected with the intent of capturing all sublevels of each classification scheme. Study participants recorded their assessments using each classification scheme, and interrater reliability was calculated by a study participant not involved in grading.
The average kappa coefficients for the classification schemes ranged from 0.38 to 0.54, with the interrater reliability of all classification schemes except labral degeneration qualifying as moderate. The percent of cases with absolute agreement ranged from 17.2% to 51.7% across the classification systems.
Even among a group of high-volume hip arthroscopists who engaged in several discussions about the proposed classification schemes, grades were found to have at best moderate interrater reliability. Moderate interrater reliability is demonstrated for novel grading systems for describing labral tear complexity, labral bruising, labral size, and extent of synovitis, and fair reliability is demonstrated for labral degeneration. Further development and refinement of multifactorial grading systems for describing labral injury are indicated. Evaluating the multifactorial nature of intra-articular lesions in the hip is an important part of intraoperative decision-making and defining reliable classifications for intra-articular lesions is a critical first step towards developing generalizable criteria for guiding treatment type.
Level III.
本研究旨在报告髋关节镜检查中观察到的关节内病变的几种新分类系统，并通过一组高容量髋关节镜医师测试这些新系统和现有关节内病变分类的组内信度。
5 位髋关节镜医师讨论了当前分类系统的不足之处，并制定了几种新的分级系统，特别努力捕捉到对髋关节镜治疗和结局有重要影响的因素。然后，从高级作者手术的视频档案中开发了一个视频学习模块，并由研究参与者进行了审查。在审查该模块后，使用 5 个随机选择的视频完成了一项试点研究，然后参与的外科医生再次开会讨论分歧点并寻求澄清。用于测试可靠性的最终视频集由 29 个视频组成，旨在捕获每个分类方案的所有亚级。研究参与者使用每个分类方案记录他们的评估，由未参与分级的研究参与者计算组内信度。
分类方案的平均 kappa 系数范围为 0.38 至 0.54，除了髋关节镜检查中半月板退变的分级方案外，所有分类方案的组内信度均为中度。在所有分类系统中，绝对一致的病例百分比范围为 17.2%至 51.7%。
即使在一组参与了关于拟议分类方案的几次讨论的高容量髋关节镜医师中，发现分级方案的组内信度最高也只有中度。描述半月板撕裂复杂性、半月板挫伤、半月板大小和滑膜炎程度的新分级系统显示出中度组内信度，半月板退变显示出适度组内信度。需要进一步开发和完善描述半月板损伤的多因素分级系统。评估髋关节关节内病变的多因素性质是术中决策的重要组成部分，定义可靠的关节内病变分类是朝着制定指导治疗类型的通用标准迈出的关键第一步。
III 级。
