Many Radiographic and Magnetic Resonance Imaging Assessments for Surgical Decision Making in Pediatric Patellofemoral Instability Patients Demonstrate Poor Interrater Reliability

JUPITER Study Group

doi:10.1016/j.arthro.2022.03.033

Many Radiographic and Magnetic Resonance Imaging Assessments for Surgical Decision Making in Pediatric Patellofemoral Instability Patients Demonstrate Poor Interrater Reliability

JUPITER Study Group

Orthopaedic Surgery

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

PURPOSE: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.

LEVEL OF EVIDENCE: II, prospective diagnostic study.

Original language	English (US)
Pages (from-to)	2702-2713
Number of pages	12
Journal	Arthroscopy - Journal of Arthroscopic and Related Surgery
Volume	38
Issue number	9
DOIs	https://doi.org/10.1016/j.arthro.2022.03.033
State	Published - Sep 2022

Bibliographical note

Funding Information:
The authors report the following potential conflicts of interest or sources of funding: P.D.F. reports editorial or governing board for Clinical Orthopaedics and Related Research, J.F. reports royalties or licences from Arthrex, Biopoly, Springer, and Thieme Medical Publishers; paid consultant for Aesculap/B.Braun, CartiHeal, Cook Biotech, MoxiMed, Organogenesis, Samumed, and ZKR Orthopedics; paid presenter or speaker for Arthrex, MoxiMed, Organogenesis, and Vericel; editorial or governing board of American Journal of Orthopedics and Cartilage; stock or stock Options from MedShape and Ortho Regenerative Tech; and research support from Active Implants, Episurf, JRF Ortho, MoxiMed, Organogenesis, Samumed, Springer, Thieme Medical Publishers, and Vericel. D.W.G. reports IP royalties from Arthrex and Pega Medical; publishing royalties from Current Opinion in Pediatrics and Wolters Kluwer Health-Lippincott Williams & Wilkins; consulting fees from Arthrex; paid presenter or speaker for Arthrex and AO Trauma International; compensation for serving as faculty or as a speaker for an accredited or certified continuing education program for Synthes GMBH; travel and lodging from Synthes GMBH; board or committee member of AAOS, Research in Osteochondritis of the Knee (ROCK), Current Opinion in Pediatrics, New York County Medical Society, New York State Society of Orthopedic Surgeons, PatelloFemoral Foundation, Pediatric Research in Sport Medicine, and Pediatric Orthopaedic Society of North America; and financial or material support from Current Opinion in Pediatrics and Wolters Kluwer Health-Lippincott Williams & Wilkins. B.E.H. reports publishing royalties from Springer; board or committee member of Pediatric Orthopaedic Society of North America and Pediatric Research in Sports Medicine (PRISM); stock or stock options from Imagen Technologies; and other financial or material support from AlloSource, Springers, and Vericel. J.M.B. reports consulting fees from Smith & Nephew; and paid presenter or speaker, education, for Orthopedics Today. J.K. reports paid consultant of Flexion Therapeutics, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Medwest Associates; board or committee member of AAOS, ACL Study Group, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, Herodicus Society, Illinois Association of Orthopaedic Surgeons, International Patellofemoral Study Group, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, and Patellofemoral Foundation; committee member of the American Orthopaedic Association; editorial or governing board of Orthopaedic Journal of Sports Medicine/AOSSM; stock or stock Options from Acuitive; employee; stock or stock options from Marrow Access Technologies; and other from Flexion Therapeutics. D.K. reports consulting fees from Miach and J&J; and other from Arthrex. R.M. reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex and CDC Medical; board or committee member of ACL Study Group, American Orthopaedic Society for Sports Medicine, and International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine; editorial or governing board of Journal of the American Academy of Orthopaedic Surgeons and Orthopaedic Journal of Sports Medicine; and other from Arthrex, Smith & Nephew, and Zimmer. S.P. reports publishing royalties from Wolters Kluwer Health-Lippincott Williams & Wilkins; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Synthes GMB; food, traveling, and lodging from Synthes GMB; board or committee member of AAOS, and Pediatric Orthopaedic Society of North America; editorial or governing board of Orthopedics Today; and other from Wolters Kluwer Health-Lippincott Williams & Wilkins and CDC Medical. L.R. reports paid consultant for GLG Consulting and Relief Health; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex and Gotham Surgical; board or committee member of Pediatric Research in Sports Medicine (PRiSM) Society; and stock or stock options from Relief Health. S.S. reports IP royalties from ConMed; consulting fees from Arthrex, BioVentus, Joint Restoration Foundation, Kinamed, NewClip, ConMed, Smith & Nephew, and Vericel; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex, Kinamed, ConMed, and Smith & Nephew; board or committee member of ACL Study Group, American Orthopaedic Society for Sports Medicine, AAOS, Arthroscopy Association of North America, Biologics Alliance, Epic Bio, International Cartilage Regeneration & Joint Preservation Society, International Sports Medicine Fellows Conference, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, Joint Restoration Foundation, Patellofemoral Foundation, Sarcio, Sparta Biomedical, and Vericel; editorial or governing board of the American Journal of Orthopedics, Video Journal of Sports Medicine, Journal of Clinical Orthopaedics and Traumatology, Current Reviews in Musculoskeletal Medicine, and Arthroscopy; and stock or stock options from Vivorte, Reparel, Sarcio, and Epic Bio. B.S.S. reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events, royalties, and consulting fees from Arthrex; editorial or governing board of Orthopedics Today, S.S. reports consulting fees from Smith & Nephew, Vericel, MoxiMed, and JRF; and other from Engage, Vericel, Organogenesis, Aastrom Biosciences, Aesculap biologics, Fidia Pharma, Flexion Therapeutics, Lifenet Health, Stryker, and ZimmerBiomet. M.A.T. reports grants from DJO; committee member, AAOS; editorial board of American Journal of Sports Medicine; editorial or governing board of Knee Surgery, Sports Traumatology, Arthroscopy and Sports Health; board or committee member of American Orthopaedic Society for Sports Medicine, Pediatric Research in Sports Medicine Society, and Research in Osteochondritis of the Knee (ROCK); and other from AlloSource and Vericel. E.J.W. reports consulting fees from OrthoPediatrics; board or committee member of Cincinnati Children's Physician-Hospital Organization, PRISM, and ROCK group. P.L.W. reports publishing royalties from Elsevier; board or committee member of AAOS, Pediatric Orthopaedic Society of North America; editorial or governing board of the Journal of Pediatric Orthopedics; and other from AlloSource, Elsevier, Ossur, and Pylant Medical. H.B.E. reports compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program for Smith & Nephew; education, compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program for Pylant Medical; compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program for Synthes GMBH; travel and lodging from Smith & Nephew, Pylant Medical and Arthrex; board or committee member for Pediatric Orthopaedic Society of North America and Pediatric Research in Sports Medicine; and other from Smith & Nephew and Pylant Medical. ICMJE author disclosure forms are available for this article online, as supplementary material.

Publisher Copyright:
© 2022 Arthroscopy Association of North America

Keywords

Adolescent
Adult
Child
Decision Making
Female
Humans
Joint Instability/diagnostic imaging
Magnetic Resonance Imaging/methods
Male
Patellofemoral Joint/diagnostic imaging
Prospective Studies
Reproducibility of Results
Tibia/surgery
Young Adult

PubMed: MeSH publication types

Journal Article

Publisher link

10.1016/j.arthro.2022.03.033

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Cite this

Many Radiographic and Magnetic Resonance Imaging Assessments for Surgical Decision Making in Pediatric Patellofemoral Instability Patients Demonstrate Poor Interrater Reliability. / JUPITER Study Group.
In: Arthroscopy - Journal of Arthroscopic and Related Surgery, Vol. 38, No. 9, 09.2022, p. 2702-2713.

Research output: Contribution to journal › Article › peer-review

@article{044e7b18ff4d42d8b8bd0c8f40a6e1f6,

title = "Many Radiographic and Magnetic Resonance Imaging Assessments for Surgical Decision Making in Pediatric Patellofemoral Instability Patients Demonstrate Poor Interrater Reliability",

abstract = "PURPOSE: 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.METHODS: 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.RESULTS: 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).CONCLUSIONS: 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.LEVEL OF EVIDENCE: II, prospective diagnostic study.",

keywords = "Adolescent, Adult, Child, Decision Making, Female, Humans, Joint Instability/diagnostic imaging, Magnetic Resonance Imaging/methods, Male, Patellofemoral Joint/diagnostic imaging, Prospective Studies, Reproducibility of Results, Tibia/surgery, Young Adult",

author = "{JUPITER Study Group} and Fabricant, {Peter D.} and Heath, {Madison R.} and Mintz, {Douglas N.} and Kathleen Emery and Matthew Veerkamp and Simone Gruber and Green, {Daniel W.} and Strickland, {Sabrina M.} and Wall, {Eric J.} and Brady, {Jacqueline M.} and Chambers, {Caitlin C.} and Ellis, {Henry B.} and Jack Farr and Heyworth, {Benton E.} and Koh, {Jason L.} and Kramer, {Dennis E.} and Magnussen, {Robert A.} and Redler, {Lauren H.} and Sherman, {Seth L.} and Tompkins, {Marc A.} and Wilson, {Philip L.} and {Shubin Stein}, {Beth E.} and Parikh, {Shital N.}",

note = "Funding Information: The authors report the following potential conflicts of interest or sources of funding: P.D.F. reports editorial or governing board for Clinical Orthopaedics and Related Research, J.F. reports royalties or licences from Arthrex, Biopoly, Springer, and Thieme Medical Publishers; paid consultant for Aesculap/B.Braun, CartiHeal, Cook Biotech, MoxiMed, Organogenesis, Samumed, and ZKR Orthopedics; paid presenter or speaker for Arthrex, MoxiMed, Organogenesis, and Vericel; editorial or governing board of American Journal of Orthopedics and Cartilage; stock or stock Options from MedShape and Ortho Regenerative Tech; and research support from Active Implants, Episurf, JRF Ortho, MoxiMed, Organogenesis, Samumed, Springer, Thieme Medical Publishers, and Vericel. D.W.G. reports IP royalties from Arthrex and Pega Medical; publishing royalties from Current Opinion in Pediatrics and Wolters Kluwer Health-Lippincott Williams & Wilkins; consulting fees from Arthrex; paid presenter or speaker for Arthrex and AO Trauma International; compensation for serving as faculty or as a speaker for an accredited or certified continuing education program for Synthes GMBH; travel and lodging from Synthes GMBH; board or committee member of AAOS, Research in Osteochondritis of the Knee (ROCK), Current Opinion in Pediatrics, New York County Medical Society, New York State Society of Orthopedic Surgeons, PatelloFemoral Foundation, Pediatric Research in Sport Medicine, and Pediatric Orthopaedic Society of North America; and financial or material support from Current Opinion in Pediatrics and Wolters Kluwer Health-Lippincott Williams & Wilkins. B.E.H. reports publishing royalties from Springer; board or committee member of Pediatric Orthopaedic Society of North America and Pediatric Research in Sports Medicine (PRISM); stock or stock options from Imagen Technologies; and other financial or material support from AlloSource, Springers, and Vericel. J.M.B. reports consulting fees from Smith & Nephew; and paid presenter or speaker, education, for Orthopedics Today. J.K. reports paid consultant of Flexion Therapeutics, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Medwest Associates; board or committee member of AAOS, ACL Study Group, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, Herodicus Society, Illinois Association of Orthopaedic Surgeons, International Patellofemoral Study Group, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, and Patellofemoral Foundation; committee member of the American Orthopaedic Association; editorial or governing board of Orthopaedic Journal of Sports Medicine/AOSSM; stock or stock Options from Acuitive; employee; stock or stock options from Marrow Access Technologies; and other from Flexion Therapeutics. D.K. reports consulting fees from Miach and J&J; and other from Arthrex. R.M. reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex and CDC Medical; board or committee member of ACL Study Group, American Orthopaedic Society for Sports Medicine, and International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine; editorial or governing board of Journal of the American Academy of Orthopaedic Surgeons and Orthopaedic Journal of Sports Medicine; and other from Arthrex, Smith & Nephew, and Zimmer. S.P. reports publishing royalties from Wolters Kluwer Health-Lippincott Williams & Wilkins; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Synthes GMB; food, traveling, and lodging from Synthes GMB; board or committee member of AAOS, and Pediatric Orthopaedic Society of North America; editorial or governing board of Orthopedics Today; and other from Wolters Kluwer Health-Lippincott Williams & Wilkins and CDC Medical. L.R. reports paid consultant for GLG Consulting and Relief Health; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex and Gotham Surgical; board or committee member of Pediatric Research in Sports Medicine (PRiSM) Society; and stock or stock options from Relief Health. S.S. reports IP royalties from ConMed; consulting fees from Arthrex, BioVentus, Joint Restoration Foundation, Kinamed, NewClip, ConMed, Smith & Nephew, and Vericel; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex, Kinamed, ConMed, and Smith & Nephew; board or committee member of ACL Study Group, American Orthopaedic Society for Sports Medicine, AAOS, Arthroscopy Association of North America, Biologics Alliance, Epic Bio, International Cartilage Regeneration & Joint Preservation Society, International Sports Medicine Fellows Conference, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, Joint Restoration Foundation, Patellofemoral Foundation, Sarcio, Sparta Biomedical, and Vericel; editorial or governing board of the American Journal of Orthopedics, Video Journal of Sports Medicine, Journal of Clinical Orthopaedics and Traumatology, Current Reviews in Musculoskeletal Medicine, and Arthroscopy; and stock or stock options from Vivorte, Reparel, Sarcio, and Epic Bio. B.S.S. reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events, royalties, and consulting fees from Arthrex; editorial or governing board of Orthopedics Today, S.S. reports consulting fees from Smith & Nephew, Vericel, MoxiMed, and JRF; and other from Engage, Vericel, Organogenesis, Aastrom Biosciences, Aesculap biologics, Fidia Pharma, Flexion Therapeutics, Lifenet Health, Stryker, and ZimmerBiomet. M.A.T. reports grants from DJO; committee member, AAOS; editorial board of American Journal of Sports Medicine; editorial or governing board of Knee Surgery, Sports Traumatology, Arthroscopy and Sports Health; board or committee member of American Orthopaedic Society for Sports Medicine, Pediatric Research in Sports Medicine Society, and Research in Osteochondritis of the Knee (ROCK); and other from AlloSource and Vericel. E.J.W. reports consulting fees from OrthoPediatrics; board or committee member of Cincinnati Children's Physician-Hospital Organization, PRISM, and ROCK group. P.L.W. reports publishing royalties from Elsevier; board or committee member of AAOS, Pediatric Orthopaedic Society of North America; editorial or governing board of the Journal of Pediatric Orthopedics; and other from AlloSource, Elsevier, Ossur, and Pylant Medical. H.B.E. reports compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program for Smith & Nephew; education, compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program for Pylant Medical; compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program for Synthes GMBH; travel and lodging from Smith & Nephew, Pylant Medical and Arthrex; board or committee member for Pediatric Orthopaedic Society of North America and Pediatric Research in Sports Medicine; and other from Smith & Nephew and Pylant Medical. ICMJE author disclosure forms are available for this article online, as supplementary material. Publisher Copyright: {\textcopyright} 2022 Arthroscopy Association of North America",

year = "2022",

month = sep,

doi = "10.1016/j.arthro.2022.03.033",

language = "English (US)",

volume = "38",

pages = "2702--2713",

journal = "Arthroscopy - Journal of Arthroscopic and Related Surgery",

issn = "0749-8063",

publisher = "W.B. Saunders Ltd",

number = "9",

}

TY - JOUR

T1 - Many Radiographic and Magnetic Resonance Imaging Assessments for Surgical Decision Making in Pediatric Patellofemoral Instability Patients Demonstrate Poor Interrater Reliability

AU - JUPITER Study Group

AU - Fabricant, Peter D.

AU - Heath, Madison R.

AU - Mintz, Douglas N.

AU - Emery, Kathleen

AU - Veerkamp, Matthew

AU - Gruber, Simone

AU - Green, Daniel W.

AU - Strickland, Sabrina M.

AU - Wall, Eric J.

AU - Brady, Jacqueline M.

AU - Chambers, Caitlin C.

AU - Ellis, Henry B.

AU - Farr, Jack

AU - Heyworth, Benton E.

AU - Koh, Jason L.

AU - Kramer, Dennis E.

AU - Magnussen, Robert A.

AU - Redler, Lauren H.

AU - Sherman, Seth L.

AU - Tompkins, Marc A.

AU - Wilson, Philip L.

AU - Shubin Stein, Beth E.

AU - Parikh, Shital N.

N1 - Funding Information: The authors report the following potential conflicts of interest or sources of funding: P.D.F. reports editorial or governing board for Clinical Orthopaedics and Related Research, J.F. reports royalties or licences from Arthrex, Biopoly, Springer, and Thieme Medical Publishers; paid consultant for Aesculap/B.Braun, CartiHeal, Cook Biotech, MoxiMed, Organogenesis, Samumed, and ZKR Orthopedics; paid presenter or speaker for Arthrex, MoxiMed, Organogenesis, and Vericel; editorial or governing board of American Journal of Orthopedics and Cartilage; stock or stock Options from MedShape and Ortho Regenerative Tech; and research support from Active Implants, Episurf, JRF Ortho, MoxiMed, Organogenesis, Samumed, Springer, Thieme Medical Publishers, and Vericel. D.W.G. reports IP royalties from Arthrex and Pega Medical; publishing royalties from Current Opinion in Pediatrics and Wolters Kluwer Health-Lippincott Williams & Wilkins; consulting fees from Arthrex; paid presenter or speaker for Arthrex and AO Trauma International; compensation for serving as faculty or as a speaker for an accredited or certified continuing education program for Synthes GMBH; travel and lodging from Synthes GMBH; board or committee member of AAOS, Research in Osteochondritis of the Knee (ROCK), Current Opinion in Pediatrics, New York County Medical Society, New York State Society of Orthopedic Surgeons, PatelloFemoral Foundation, Pediatric Research in Sport Medicine, and Pediatric Orthopaedic Society of North America; and financial or material support from Current Opinion in Pediatrics and Wolters Kluwer Health-Lippincott Williams & Wilkins. B.E.H. reports publishing royalties from Springer; board or committee member of Pediatric Orthopaedic Society of North America and Pediatric Research in Sports Medicine (PRISM); stock or stock options from Imagen Technologies; and other financial or material support from AlloSource, Springers, and Vericel. J.M.B. reports consulting fees from Smith & Nephew; and paid presenter or speaker, education, for Orthopedics Today. J.K. reports paid consultant of Flexion Therapeutics, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Medwest Associates; board or committee member of AAOS, ACL Study Group, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, Herodicus Society, Illinois Association of Orthopaedic Surgeons, International Patellofemoral Study Group, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, and Patellofemoral Foundation; committee member of the American Orthopaedic Association; editorial or governing board of Orthopaedic Journal of Sports Medicine/AOSSM; stock or stock Options from Acuitive; employee; stock or stock options from Marrow Access Technologies; and other from Flexion Therapeutics. D.K. reports consulting fees from Miach and J&J; and other from Arthrex. R.M. reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex and CDC Medical; board or committee member of ACL Study Group, American Orthopaedic Society for Sports Medicine, and International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine; editorial or governing board of Journal of the American Academy of Orthopaedic Surgeons and Orthopaedic Journal of Sports Medicine; and other from Arthrex, Smith & Nephew, and Zimmer. S.P. reports publishing royalties from Wolters Kluwer Health-Lippincott Williams & Wilkins; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Synthes GMB; food, traveling, and lodging from Synthes GMB; board or committee member of AAOS, and Pediatric Orthopaedic Society of North America; editorial or governing board of Orthopedics Today; and other from Wolters Kluwer Health-Lippincott Williams & Wilkins and CDC Medical. L.R. reports paid consultant for GLG Consulting and Relief Health; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex and Gotham Surgical; board or committee member of Pediatric Research in Sports Medicine (PRiSM) Society; and stock or stock options from Relief Health. S.S. reports IP royalties from ConMed; consulting fees from Arthrex, BioVentus, Joint Restoration Foundation, Kinamed, NewClip, ConMed, Smith & Nephew, and Vericel; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex, Kinamed, ConMed, and Smith & Nephew; board or committee member of ACL Study Group, American Orthopaedic Society for Sports Medicine, AAOS, Arthroscopy Association of North America, Biologics Alliance, Epic Bio, International Cartilage Regeneration & Joint Preservation Society, International Sports Medicine Fellows Conference, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, Joint Restoration Foundation, Patellofemoral Foundation, Sarcio, Sparta Biomedical, and Vericel; editorial or governing board of the American Journal of Orthopedics, Video Journal of Sports Medicine, Journal of Clinical Orthopaedics and Traumatology, Current Reviews in Musculoskeletal Medicine, and Arthroscopy; and stock or stock options from Vivorte, Reparel, Sarcio, and Epic Bio. B.S.S. reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events, royalties, and consulting fees from Arthrex; editorial or governing board of Orthopedics Today, S.S. reports consulting fees from Smith & Nephew, Vericel, MoxiMed, and JRF; and other from Engage, Vericel, Organogenesis, Aastrom Biosciences, Aesculap biologics, Fidia Pharma, Flexion Therapeutics, Lifenet Health, Stryker, and ZimmerBiomet. M.A.T. reports grants from DJO; committee member, AAOS; editorial board of American Journal of Sports Medicine; editorial or governing board of Knee Surgery, Sports Traumatology, Arthroscopy and Sports Health; board or committee member of American Orthopaedic Society for Sports Medicine, Pediatric Research in Sports Medicine Society, and Research in Osteochondritis of the Knee (ROCK); and other from AlloSource and Vericel. E.J.W. reports consulting fees from OrthoPediatrics; board or committee member of Cincinnati Children's Physician-Hospital Organization, PRISM, and ROCK group. P.L.W. reports publishing royalties from Elsevier; board or committee member of AAOS, Pediatric Orthopaedic Society of North America; editorial or governing board of the Journal of Pediatric Orthopedics; and other from AlloSource, Elsevier, Ossur, and Pylant Medical. H.B.E. reports compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program for Smith & Nephew; education, compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program for Pylant Medical; compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program for Synthes GMBH; travel and lodging from Smith & Nephew, Pylant Medical and Arthrex; board or committee member for Pediatric Orthopaedic Society of North America and Pediatric Research in Sports Medicine; and other from Smith & Nephew and Pylant Medical. ICMJE author disclosure forms are available for this article online, as supplementary material. Publisher Copyright: © 2022 Arthroscopy Association of North America

PY - 2022/9

Y1 - 2022/9

N2 - PURPOSE: 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.METHODS: 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.RESULTS: 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).CONCLUSIONS: 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.LEVEL OF EVIDENCE: II, prospective diagnostic study.

AB - PURPOSE: 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.METHODS: 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.RESULTS: 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).CONCLUSIONS: 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.LEVEL OF EVIDENCE: II, prospective diagnostic study.

KW - Adolescent

KW - Adult

KW - Child

KW - Decision Making

KW - Female

KW - Humans

KW - Joint Instability/diagnostic imaging

KW - Magnetic Resonance Imaging/methods

KW - Male

KW - Patellofemoral Joint/diagnostic imaging

KW - Prospective Studies

KW - Reproducibility of Results

KW - Tibia/surgery

KW - Young Adult

UR - http://www.scopus.com/inward/record.url?scp=85132360934&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85132360934&partnerID=8YFLogxK

U2 - 10.1016/j.arthro.2022.03.033

DO - 10.1016/j.arthro.2022.03.033

M3 - Article

C2 - 35398485

AN - SCOPUS:85132360934

SN - 0749-8063

VL - 38

SP - 2702

EP - 2713

JO - Arthroscopy - Journal of Arthroscopic and Related Surgery

JF - Arthroscopy - Journal of Arthroscopic and Related Surgery

IS - 9

ER -

Many Radiographic and Magnetic Resonance Imaging Assessments for Surgical Decision Making in Pediatric Patellofemoral Instability Patients Demonstrate Poor Interrater Reliability

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