Department of Orthopedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Universidad Autónoma. Madrid, Spain.
Centro Ortopédico Panama Clinic, The Panama Clinic, Panama City, Panama.
J ISAKOS. 2022 Apr;7(2):56-61. doi: 10.1016/j.jisako.2021.12.004. Epub 2021 Dec 27.
The ISAKOS Shoulder Committee developed a new comprehensive classification system aimed to describe all rotator cuff tears. The five characteristics of the tears included are pattern (P), extension (E), fatty atrophy (A), retraction (R), and location (L), conforming to the acronym "PEARL." The objective of this study is to assess if the ISAKOS Rotator Cuff Tear Classification System is reliable by measuring the intraobserver and interobserver multirater reliability.
Arthroscopic videos of 36 rotator cuff tears, including tears of varying sizes and configurations, were evaluated twice by four surgeons from different continents blinded to tear type. Intraobserver and interobserver reliability was measured using multirater and intraobserver Kappa coefficients.
Intraobserver reliability: An almost perfect agreement for "location" (κ = 0.98), substantial agreement for "extension" (κ = 0.73) were obtained for mean intrarater kappa, lower κ agreement for "pattern" (κ = 0.58), and relatively high agreement of 0.79 for "retraction." Every characteristic of "location" had an almost perfect agreement among the surgeons (κ = 0.91). Intrarrater reliability: In the partial-thickness posterosuperior tears "location," there was good agreement in tears involving less than 50% of the tendon (κ = 0.74) and moderate in those deeper than 50% of the tendon thickness (κ = 0.58). "Extension" in full-thickness posterosuperior RCT achieved moderate agreement. Within the anterior subscapularis tears, we have a substantial agreement in Lafosse´s Type 1 (κ = 0.73), moderate in Types 2 and 3 (κ = 0.45 and κ = 0.46) and slight agreement in Type 4 (κ = 0.06). The overall kappa summarizing all categories indicated moderate agreement (κ = 0.52). The articular pattern in the partial-thickness posterosuperior RCT "location" had a perfect kappa of 1, while the bursal pattern showed an almost complete agreement (κ = 0.87). In the full-thickness posterosuperior RCTs, we observed fair agreement in C, U, and reverse L configurations and slight agreement in L pattern (κ = 0.18). The overall kappa is 0.44 with a confidence interval of 0.41-0.47. There was substantial agreement in every category and the overall kappa for "retraction" (k = 0.70).
ISAKOS rotator cuff tear classification system provides sufficient interobserver reliability for communicating among surgeons and for pooling of data from clinical studies.
Cohort study (diagnosis); Level of evidence, 2.
ISAKOS 肩关节委员会开发了一种新的综合分类系统，旨在描述所有肩袖撕裂。撕裂的五个特征包括：形态（P）、延伸（E）、脂肪萎缩（A）、回缩（R）和位置（L），符合“PEARL”的缩写。本研究的目的是通过测量观察者内和观察者间多评分者可靠性来评估 ISAKOS 肩袖撕裂分类系统是否可靠。
对 36 例肩袖撕裂的关节镜视频进行评估，包括不同大小和类型的撕裂。来自不同大陆的 4 名外科医生在不知道撕裂类型的情况下对撕裂进行了两次评估。使用多评分者和观察者内 Kappa 系数测量观察者内和观察者间可靠性。
观察者内可靠性：对于“位置”，获得了近乎完美的一致性（κ=0.98）；对于“延伸”，获得了实质性的一致性（κ=0.73）；对于“形态”，获得了较低的 κ 一致性（κ=0.58）；对于“回缩”，则获得了相对较高的 0.79 一致性。“位置”的每个特征在外科医生之间都具有近乎完美的一致性（κ=0.91）。观察者内可靠性：在前上侧部分厚度撕裂的“位置”中，对于累及肌腱小于 50%的撕裂，具有良好的一致性（κ=0.74），对于累及肌腱厚度大于 50%的撕裂，具有中度一致性（κ=0.58）。在前上侧全厚度 RCT 中，“延伸”获得了中度一致性。在前下肩胛下肌撕裂中，Lafosse 1 型（κ=0.73）具有实质性一致性，2 型和 3 型（κ=0.45 和 κ=0.46）具有中度一致性，4 型（κ=0.06）具有轻度一致性。总结所有类别的总体 κ 值表明具有中度一致性（κ=0.52）。在前上侧部分厚度 RCT“位置”的关节形态中，κ 值为 1，具有完美的一致性，而滑囊形态则具有近乎完全的一致性（κ=0.87）。在前上侧全厚度 RCT 中，我们观察到 C、U 和反向 L 形态具有良好的一致性，而 L 形态具有轻度的一致性（κ=0.18）。总体 κ 值为 0.44，置信区间为 0.41-0.47。每个类别的一致性都很好，回缩的总体 κ 值为 0.70。
ISAKOS 肩袖撕裂分类系统为外科医生之间的沟通和临床研究数据的汇总提供了足够的观察者间可靠性。
队列研究（诊断）；证据水平，2 级。
