Fabricant Peter D, Heath Madison R, Mintz Douglas N, Emery Kathleen, Veerkamp Matthew, Gruber Simone, Green Daniel W, Strickland Sabrina M, Wall Eric J, Shubin Stein Beth E, Parikh Shital N
Hospital for Special Surgery, New York, New York, U.S.A.
Hospital for Special Surgery, New York, New York, U.S.A.
Arthroscopy. 2022 Sep;38(9):2702-2713. doi: 10.1016/j.arthro.2022.03.033. Epub 2022 Apr 8.
To evaluate the interrater reliability of several common radiologic parameters used for patellofemoral instability and to attempt to improve reliability for measurements demonstrating unacceptable interrater reliability through consensus training.
Fifty patients with patellar instability between the ages of 10 and 19 years were selected from a prospectively enrolled cohort. For measurements demonstrating unacceptable interrater reliability (intraclass correlation coefficient [ICC]: <0.6), raters discussed consensus methods to improve reliability and re-examined a subset of 20 images from the previous set of images. If reliability was still low after the second round of assessment, the measure was considered unreliable.
Of the 50 included subjects, 22 (44%) were male and the mean age at the time of imaging was 14 ± 2 years. With 1 or fewer consensus training sessions, the interrater reliability of the following radiograph indices were found to be reliable: trochlea crossing sign (ICC: 0.625), congruence angle (ICC: 0.768), Caton-Deshamps index (ICC: 0.644), lateral patellofemoral angle (ICC: 0.768), and mechanical axis deviation on hip-to-ankle alignment radiographs (ICC: 0.665-0.777). Reliable magnetic resonance imaging (MRI) indices were trochlear depth (ICC: 0.743), trochlear bump (ICC: 0.861), sulcus angle (ICC: 0.684), patellar tilt (ICC: 0.841), tibial tubercle to trochlear groove distance (ICC: 0.706), effusion (ICC: 0.866), and bone marrow edema (ICC: 0.961).
With 1 or fewer consensus training sessions, the interrater reliability of the following patellofemoral indices were found to be reliable for trochlear morphology: trochlea crossing sign and congruence angle on radiograph and trochlear depth, trochlear bump, and sulcus angle on MRI. Reliable patellar position measurements included: Caton-Deshamps index and lateral patellofemoral angle on radiograph and patellar tilt and tibial tubercle to trochlear groove distance on MRI. Additional global measurements (e.g., mechanical axis deviation on standing radiographs) and MRI assessments demonstrated acceptable reliability.
II, prospective diagnostic study.
评估用于髌股关节不稳的几种常见放射学参数的评分者间可靠性，并尝试通过共识训练提高评分者间可靠性显示不可接受的测量的可靠性。
从一个前瞻性纳入的队列中选取50例年龄在10至19岁之间的髌股关节不稳患者。对于评分者间可靠性显示不可接受的测量（组内相关系数[ICC]：<0.6），评分者讨论了提高可靠性的共识方法，并重新检查了前一组图像中的20幅图像子集。如果第二轮评估后可靠性仍然较低，则该测量被认为不可靠。
在纳入的50名受试者中，22名（44%）为男性，成像时的平均年龄为14±2岁。经过1次或更少次数的共识训练，发现以下X线片指标的评分者间可靠性可靠：滑车交叉征（ICC：0.625）、适合角（ICC：0.768）、卡顿-德尚指数（ICC：0.644）、髌股外侧角（ICC：0.768）以及髋-踝对线X线片上的机械轴偏移（ICC：0.665 - 0.777）。可靠的磁共振成像（MRI）指标包括：滑车深度（ICC：0.743）；滑车隆起（ICC：0.861）；沟角（ICC：0.684）；髌骨倾斜度（ICC：0.841）；胫骨结节至滑车沟距离（ICC：0.706）；积液（ICC：0.866）；以及骨髓水肿（ICC：0.961）。
经过1次或更少次数的共识训练，发现以下髌股指标对于滑车形态的评分者间可靠性可靠：X线片上的滑车交叉征和适合角以及MRI上的滑车深度、滑车隆起和沟角。可靠的髌骨位置测量包括：X线片上的卡顿-德尚指数和髌股外侧角以及MRI上的髌骨倾斜度和胫骨结节至滑车沟距离。其他整体测量（例如站立位X线片上的机械轴偏移）和MRI评估显示出可接受的可靠性。
II级，前瞻性诊断研究。
