Osteochondritis Dissecans of the Knee: An Interrater Reliability Study of Magnetic Resonance Imaging Characteristics

The Research in Osteochondritis of the Knee (ROCK) Study Group

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Imaging characteristics of osteochondritis dissecans (OCD) lesions quantified by magnetic resonance imaging (MRI) are often used to inform treatment and prognosis. However, the interrater reliability of clinician-driven MRI-based assessment of OCD lesions is not well documented. Purpose: To determine the interrater reliability of several historical and novel MRI-derived characteristics of OCD of the knee in children. Study Design: Cohort study (diagnosis); Level of evidence, 3 Methods: A total of 42 OCD lesions were evaluated by 10 fellowship-trained orthopaedic surgeons using 31 different MRI characteristics, characterizing lesion size and location, condylar size, cartilage status, the interface between parent and progeny bone, and features of both the parent and the progeny bone. Interrater reliability was determined via intraclass correlation coefficients (ICCs) with 2-way random modeling, Fleiss kappa, or Krippendorff alpha as appropriate for each variable. Results: Raters were reliable when the lesion was measured in the coronal plane (ICC, 0.77). Almost perfect agreement was achieved for condylar size (ICC, 0.93), substantial agreement for physeal patency (ICC, 0.79), and moderate agreement for joint effusion (ICC, 0.56) and cartilage status (ICC, 0.50). Overall, raters showed significant variability regarding interface characteristics (ICC, 0.25), progeny (ICC range, 0.03 to 0.62), and parent bone measurements and qualities (ICC range, –0.02 to 0.65), with reliability being moderate at best for these measurements. Conclusion: This multicenter study determined the interrater reliability of MRI characteristics of OCD lesions in children. Although several measurements provided acceptable reliability, many MRI features of OCD that inform treatment decisions were unreliable. Further work will be needed to refine the unreliable characteristics and to assess the ability of those reliable characteristics to predict clinical lesion instability and prognosis.

Original languageEnglish (US)
Pages (from-to)2221-2229
Number of pages9
JournalAmerican Journal of Sports Medicine
Volume48
Issue number9
DOIs
StatePublished - Jul 1 2020

Bibliographical note

Funding Information:
One or more of the authors has declared the following potential conflict of interest or source of funding: P.D.F. has received education and hospitality payments from Smith & Nephew and DePuy. M.D.M. has received publishing royalties and financial or material support from Saunders/Mosby-Elsevier and education payments from Kairos Surgical Inc. E.J.W. has received consulting fees from OrthoPediatrics. J.C.A. has received education payments from Gemini Medical, Wardlow Enterprises, and Gemini Mountain Medical; hospitality payments from DJO and Arthrex; and research support from Arthrex. K.L.B. holds stock or stock options in ROM3. J.L.C. has received research support from AlloSource, Anika Therapeutics, Ossur, and Vericel Corporation and consulting fees and hospitality payments from Vericel Corporation. H.G.C. has received consulting fees from Roche Molecular Systems and OrthoPediatrics and speaking fees from Allergan Corp. E.W.E. has received speaking fees from Arthrex. H.B.E. has received hospitality payments and speaking fees from Smith & Nephew, Pylant Medical, and Synthes GMBH and hospitality payments from Arthrex. T.J.G. has received research support from Allosource and Vericel Corp and education payments from Liberty Surgical and Arthrex. D.W.G. has received speaking fees from AO Trauma International, Arthrex, and Synthes GMBH; consulting fees from Arthrex; and royalties from Arthrex and Pega Medical. N.L.G. has received education and hospitality payments from Smith & Nephew. B.E.H. has received other financial or material support from Allosource and Vericel Corp and education and hospitality payments from Kairos Surgical and Arthrex and holds stock or stock options in Imagen Technologies. M.S.K. has received consulting fees from Smith & Nephew, Ossur, OrthoPediatrics, and Best Doctors and royalties from OrthoPediatrics. A.J.K. has received consulting fees from JRF Ortho, Arthrex, and Vericel Corp; research support from Aesculap/B.Braun, Arthrex, Ceterix, and Histogenics; royalties from Arthrex; and a grant from Exactech. S.W.M. has received consulting fees from Arthrex and Stryker and education and hospitality payments from Smith & Nephew and Gemini Mountain Medical. J.J.N. has received consulting fees from Responsive Arthroscopy, Smith & Nephew, and Ceterix Orthopaedics; research support from Smith & Nephew and Zimmer; and education and hospitality payments from Elite Orthopedics, Ceterix Orthopaedics, and Arthrex. C.W.N. has received research support from Allosource and Vericel. A.T.P. has stock or stock options in Imagen and has received consulting fees from OrthoPediatrics, speaking fees and hospitality payments from Smith & Nephew, and education and hospitality payments from Sportstek Medical. J.D.P. has received consulting fees from the Joint Restoration Foundation, research support from Ossur and Verical, and hospitality payments from Smith & Nephew. P.S. has received consulting fees from Arthrex and hospitality payments from DJO, Rock Medical Orthopedics, and MTF and holds stock or stock options in Equalizer and Middle Path Innovations. K.G.S. has received education payments from Evolution Surgical and hospitality payments from Arthrex. M.A.T. has received other financial or material support from Allosource and Vericel and a grant from DJO. S.C.W. has received speaking fees from Arthrex and consulting fees from Smith & Nephew. P.L.W. has received research support from AlloSource and Ossur and education and hospitality payments from Pylant Medical. R.W.W. has received royalties from Responsive Arthroscopy. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Keywords

  • OCD
  • adolescent
  • cartilage
  • magnetic resonance imaging
  • pediatric
  • skeletally immature

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