骨科医生之间使用MRI对前交叉韧带可修复性的观察者间和观察者内可靠性
Inter- and Intraobserver Reliability Between Orthopaedic Surgeons for Reparability of the Anterior Cruciate Ligament Using MRI.
作者信息
Anderson Forrest L, Wright Margaret L, Anderson Matthew J, Alexander Frank J, Popa George, Ahmad Christopher S
机构信息
Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA.
出版信息
Orthop J Sports Med. 2020 Nov 19;8(11):2325967120964608. doi: 10.1177/2325967120964608. eCollection 2020 Nov.
BACKGROUND
Anterior cruciate ligament (ACL) reconstruction is the standard of care for patients after an ACL tear, as poor historical outcomes were observed after primary ACL repair. Certain subgroups of patients, however, have been shown to have outcomes equivalent to reconstruction after undergoing ACL repair and therefore may benefit from the potential advantages offered by avoiding reconstruction. It is important to accurately and consistently identify and indicate these candidates for ACL repair.
PURPOSE/HYPOTHESIS: The purpose of this study was to determine the inter- and intraobserver reliability of magnetic resonance imaging (MRI) evaluation for the reparability of ACL tears and to identify imaging factors that may lead to surgeon uncertainty or disagreement in decision making. Our hypothesis was that the orthopaedic surgeons surveyed would not be able to reliably agree on the reparability of an ACL using MRI scans alone.
STUDY DESIGN
Cohort study (diagnosis); Level of evidence, 3.
METHODS
We administered 2 surveys to 6 fellowship-trained orthopaedic sports medicine surgeons. Each surgeon reviewed preoperative MRI scans for 20 patients and answered a series of questions, ultimately determining whether they would choose an ACL reconstruction or repair for the patient based on the imaging alone. The same survey was repeated 6 weeks later. Kappa values for inter- and intraobserver reliability of their decision making were then calculated.
RESULTS
The average kappa for interobserver reliability in the 2 surveys was 0.22, and the average kappa for intraobserver reliability was 0.34. Interobserver reliability among the surgeons in this group was poor to moderate; intraobserver reliability was slightly better. The choice for ACL repair was significantly correlated with proximal tear locations ( = 0.854; < .001), good-quality ACL tissue remnant ( = 0.929; < .001), and how many surgeons believed that the tear only involved a single bundle ( = 0.590; = .006).
CONCLUSION
The surgeons surveyed in this study did not consistently agree on candidates for ACL repair using MRI alone.
背景
前交叉韧带（ACL）重建是ACL撕裂患者的标准治疗方法，因为既往观察到初次ACL修复后的效果不佳。然而，某些亚组患者在接受ACL修复后已显示出与重建相当的效果，因此可能会从避免重建所带来的潜在优势中获益。准确且一致地识别并指出这些适合ACL修复的患者很重要。
目的/假设：本研究的目的是确定磁共振成像（MRI）评估ACL撕裂可修复性的观察者间和观察者内可靠性，并识别可能导致外科医生在决策时存在不确定性或分歧的影像因素。我们的假设是，仅使用MRI扫描，接受调查的骨科医生无法就ACL的可修复性达成可靠的共识。
研究设计
队列研究（诊断）；证据等级，3级。
方法
我们对6名接受过专科培训的骨科运动医学外科医生进行了2次调查。每位外科医生查看了20例患者的术前MRI扫描，并回答一系列问题，最终仅根据影像确定他们会为患者选择ACL重建还是修复。6周后重复相同的调查。然后计算他们决策的观察者间和观察者内可靠性的Kappa值。
结果
两次调查中观察者间可靠性的平均Kappa值为0.22，观察者内可靠性的平均Kappa值为0.34。该组外科医生之间的观察者间可靠性较差至中等；观察者内可靠性稍好。选择ACL修复与近端撕裂部位显著相关（ = 0.854； <.001）、高质量的ACL组织残端（ = 0.929； <.001）以及认为撕裂仅累及单束的外科医生数量（ = 0.590； = 0.006）有关。
结论
本研究中接受调查的外科医生仅使用MRI对ACL修复的候选患者未能达成一致意见。
Zotero 插件