Stetzelberger Vera Maren, Zurmühle Corinne Andrea, Hanauer Matthieu, Laurençon Jonathan, Marti Darius, Meier Malin Kristin, Popa Vlad, Schwab Joseph Michael, Tannast Moritz
Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Fribourg HFR, University of Fribourg, Fribourg, Switzerland.
Department of Orthopaedic Surgery and Traumatology, Inselspital Bern, University of Bern, Bern, Switzerland.
Orthop J Sports Med. 2022 Jun 9;10(6):23259671221098750. doi: 10.1177/23259671221098750. eCollection 2022 Jun.
Several classification systems based on arthroscopy have been used to describe lesions of the ligamentum teres (LT) in young active patients undergoing hip-preserving surgery. Inspection of the LT and associated lesions of the adjuvant fovea capitis and acetabular fossa is limited when done arthroscopically but is much more thorough during open surgical hip dislocation. Therefore, we propose a novel grading system based on our findings during surgical dislocation comprising the full spectrum of ligamentous-fossa-foveolar complex (LFFC) lesions.
To determine (1) intraobserver reliability and (2) interobserver reproducibility of our new grading system.
Cohort study (diagnosis); Level of evidence, 3.
We performed this validation study on 211 hips (633 images in total) with surgical hip dislocation (2013-2021). We randomly selected 5 images per grade for each LFFC item to achieve an equal representation of all grades (resulting in 75 images). The ligament, fossa, and fovea were subcategorized into normal, inflammation, degeneration, partial, and complete defects. All surgeries were performed in a standardized way by a single surgeon. The femur was disarticulated using a bone hook, the LT was inspected, documented and resected, then the fossa and fovea were documented with the femoral head in full dislocation using a 70° arthroscope. Six observers with different levels of expertise in hip-preserving surgery independently conducted the measurements twice, and intraclass correlation coefficients (ICC) were calculated to determine (1) intraobserver reliability and (2) interobserver reproducibility of the novel grading system.
For intraobserver reliability, excellent ICCs were found in both the junior and the experienced raters for grading the ligament, fossa, fovea, and total LFFC (ICCs ranged from 0.91 to 0.99 for the LFFC score). We found excellent interobserver reproducibility between raters for all items of the LFFC (all interobserver ICCs ≥ 0.76).
Our new grading system for lesions of the LFFC is highly reliable and reproducible. It covers the full spectrum of damage more precisely than arthroscopic classifications do and offers a scientific basis for standardized intraoperative evaluation.
几种基于关节镜检查的分类系统已被用于描述接受保髋手术的年轻活跃患者的圆韧带（LT）损伤。关节镜检查时对LT以及辅助性股骨头凹和髋臼窝相关病变的检查有限，但在开放手术髋关节脱位时则更为全面。因此，我们根据手术脱位过程中的发现提出了一种新的分级系统，涵盖韧带 - 窝 - 小凹复合体（LFFC）病变的全谱。
确定（1）我们新分级系统的观察者内可靠性和（2）观察者间的可重复性。
队列研究（诊断）；证据等级，3级。
我们对211例接受手术髋关节脱位的髋关节（共633张图像）进行了这项验证研究（2013 - 2021年）。我们为每个LFFC项目的每个等级随机选择5张图像，以实现所有等级的均衡代表性（共75张图像）。韧带、窝和小凹被细分为正常、炎症、退变、部分和完全缺损。所有手术均由一名外科医生以标准化方式进行。使用骨钩将股骨脱位，检查、记录并切除LT，然后使用70°关节镜在股骨头完全脱位的情况下记录窝和小凹。六名在保髋手术方面具有不同专业水平的观察者独立进行两次测量，并计算组内相关系数（ICC）以确定（1）新分级系统的观察者内可靠性和（2）观察者间的可重复性。
对于观察者内可靠性，初级和经验丰富的评估者在对韧带、窝、小凹和总LFFC进行分级时均发现了出色的ICC（LFFC评分的ICC范围为0.91至0.99）。我们发现LFFC所有项目的评估者间具有出色的可重复性（所有观察者间ICC≥0.76）。
我们新的LFFC病变分级系统高度可靠且可重复。它比关节镜分类更精确地涵盖了损伤的全谱，并为标准化术中评估提供了科学依据。
