Research Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
J ISAKOS. 2021 May;6(3):153-160. doi: 10.1136/jisakos-2020-000503. Epub 2020 Dec 10.
To determine the diagnostic reliability of the Schneck grading system for acute ligamentous injuries of (1) the three major ligamentous ankle complexes, (2) the individual ankle ligaments and (3) the Sikka classification for syndesmosis injury.
All acute ankle injuries in adult athletes (≥18 years), presenting to the outpatient department of a specialised Orthopaedic and Sports Medicine Hospital, within 7 days postinjury were screened for inclusion. Ankle injuries were excluded if imaging demonstrated a frank ankle fracture or if the 3 T MRI study could not be acquired within 10 days postinjury. Two radiologists graded the three major ligamentous complexes (lateral ankle complex, deltoid complex and syndesmosis complex) and their comprising individual ligaments according the four-grade Schneck grading system. Syndesmotic injuries were classified according the four-grade Sikka classification for consequent injury of the individual syndesmosis ligaments and the deltoid complex. Agreement and kappa (K) statistics were calculated to determine intrarater and interrater reliability.
Between September 2016 and September 2018, a total of 92 MR scans were obtained (87 patients). Interrater and intrarater reliability of the Schneck grading system was moderate to substantial for the lateral ankle complex (K=0.47-0.76), fair to almost perfect for the syndesmosis complex (K=0.37-0.89) and fair to moderate for the deltoid complex (K=0.14-0.51). For the individual ligaments, kappa values ranged from moderate to substantial for the anterior talofibular ligament (ATFL) (K=0.55-0.73), fair to substantial for the calcaneofibular ligament (K=0.31-0.62) and fair to almost perfect for the anteroinferior tibiofibular ligament (AITFL) (K=0.36-0.89). Diagnostic reliability of the Sikka classification ranged from moderate to almost perfect (K=0.51-0.95).
Grading of the three major ligamentous complexes and of the individual ankle ligaments according the Schneck grading system resulted in limited diagnostic reliability. When dichotomised for the presence of complete discontinuity, the interrater reliability of the Schneck grading system improved to substantial and almost perfect for the ATFL and AITFL, respectively. Classification of syndesmosis injury according the Sikka classification resulted in moderate interrater reliability.
确定 Schneck 分级系统在（1）三个主要踝关节复合体、（2）单个踝关节韧带和（3）Sikka 分类的急性韧带损伤中的诊断可靠性。
筛选在损伤后 7 天内到专门的骨科和运动医学医院门诊就诊的所有成年运动员的急性踝关节损伤。如果影像学显示明显的踝关节骨折，或如果在损伤后 10 天内无法进行 3T MRI 研究，则排除踝关节损伤。两位放射科医生根据四级 Schneck 分级系统对三个主要韧带复合体（外侧踝关节复合体、三角复合体和踝关节联合复合体）及其组成的单个韧带进行分级。根据对单个踝关节联合韧带和三角复合体的连续损伤的四级 Sikka 分类对踝关节联合复合体进行分类。计算一致性和kappa（K）统计数据以确定内部和内部观察者的可靠性。
2016 年 9 月至 2018 年 9 月，共获得 92 个磁共振扫描（87 例患者）。外侧踝关节复合体的 Schneck 分级系统的内部和内部观察者可靠性为中度至高度（K=0.47-0.76），踝关节联合复合体的可靠性为公平至接近完美（K=0.37-0.89），三角复合体的可靠性为公平至中度（K=0.14-0.51）。对于单个韧带，前距腓韧带（ATFL）的kappa 值范围为中度至高度（K=0.55-0.73），跟腓韧带（K=0.31-0.62）的kappa 值范围为公平至中度，内前下胫腓韧带（AITFL）的kappa 值范围为公平至接近完美（K=0.36-0.89）。Sikka 分类的诊断可靠性范围为中度至接近完美（K=0.51-0.95）。
根据 Schneck 分级系统对三个主要韧带复合体和单个踝关节韧带进行分级，诊断可靠性有限。当对完全连续性缺失进行二分法时，Schneck 分级系统的内部观察者可靠性分别提高到 ATFL 和 AITFL 的中度和接近完美。根据 Sikka 分类对踝关节联合损伤进行分类，其内部观察者的可靠性为中度。
