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The Intrarater and Inter-rater Reliability of Radiographic Evaluation of the Posterior Tibial Slope in Pediatric Patients.

Publication ,  Journal Article
Fletcher, AN; Liles, JL; Pereira, GF; Danilkowicz, RM; Amendola, A; Riboh, JC
Published in: J Pediatr Orthop
July 1, 2021

BACKGROUND: In young athletes, an association exists between an increased posterior tibial slope (PTS) and the risk of primary anterior cruciate ligament (ACL) injury, ACL graft rupture, contralateral ACL injury, and inferior patient reported outcomes after ACL reconstruction. In spite of this, there is no consensus on the optimal measurement method for PTS in pediatric patients. The purpose of this study was to evaluate the reliability of previously described radiographic PTS measurement techniques. METHODS: A retrospective review was performed on 130 patients with uninjured knees between the ages of 6 and 18 years. The medial PTS was measured on lateral knee radiographs by four blinded reviewers using three previously described methods: the anterior tibial cortex (ATC), posterior tibial cortex (PTC), and the proximal tibia anatomic axis (PTAA). The radiographs were graded by each reviewer twice, performed 2 weeks apart. The intrarater and inter-rater reliability were assessed using the intraclass correlation coefficient (ICC). Subgroup analyses were then performed stratifying by patient age and sex. RESULTS: The mean PTS were significantly different based on measurement method: 12.5 degrees [confidence interval (CI): 12.2-12.9 degrees] for ATC, 7.6 degrees (CI: 7.3-7.9 degrees) for PTC, and 9.3 degrees (CI: 9.0-9.6 degrees) for PTAA (P<0.0001). Measures of intrarater reliability was excellent among all reviewers across all 3 methods of measuring the PTS with a mean ICC of 0.87 (range: 0.82 to 0.92) for ATC, 0.83 (range: 0.82 to 0.87) for PTC, and 0.88 (range: 0.79 to 0.92) for PTAA. The inter-rater reliability was good with a mean ICC of 0.69 (range: 0.62 to 0.83) for the ATC, 0.63 (range: 0.52 to 0.83) for the PTC, and 0.62 (range: 0.37 to 0.84) for the PTAA. Using PTAA referencing, the PTS was greater for older patients: 9.9 degrees (CI: 7.7-9.4 degrees) vs 8.5 degrees (CI: 9.2-10.7 degrees) (P=0.0157) and unaffected by sex: 9.5 degrees (CI: 8.8-10.1 degrees) for females and 9.0 degrees (CI: 8.0-10.0) for males (P=0.4199). There were no major differences in intrarater or inter-rater reliability based on age or sex. CONCLUSIONS: While the absolute PTS value varies by measurement technique, all methods demonstrated an intrarater reliability of 0.83 to 0.88 and inter-rater reliability of 0.61 to 0.69. However, this study highlights the need to identify PTS metrics in children with increased inter-rater reliability. LEVEL OF EVIDENCE: IV, Case series.

Duke Scholars

Published In

J Pediatr Orthop

DOI

EISSN

1539-2570

Publication Date

July 1, 2021

Volume

41

Issue

6

Start / End Page

e404 / e410

Location

United States

Related Subject Headings

  • Tibia
  • Retrospective Studies
  • Reproducibility of Results
  • Radiography
  • Orthopedics
  • Male
  • Knee Joint
  • Humans
  • Female
  • Child
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Fletcher, A. N., Liles, J. L., Pereira, G. F., Danilkowicz, R. M., Amendola, A., & Riboh, J. C. (2021). The Intrarater and Inter-rater Reliability of Radiographic Evaluation of the Posterior Tibial Slope in Pediatric Patients. J Pediatr Orthop, 41(6), e404–e410. https://doi.org/10.1097/BPO.0000000000001792
Fletcher, Amanda N., Jordan L. Liles, Gregory F. Pereira, Richard M. Danilkowicz, Annunziato Amendola, and Jonathan C. Riboh. “The Intrarater and Inter-rater Reliability of Radiographic Evaluation of the Posterior Tibial Slope in Pediatric Patients.J Pediatr Orthop 41, no. 6 (July 1, 2021): e404–10. https://doi.org/10.1097/BPO.0000000000001792.
Fletcher AN, Liles JL, Pereira GF, Danilkowicz RM, Amendola A, Riboh JC. The Intrarater and Inter-rater Reliability of Radiographic Evaluation of the Posterior Tibial Slope in Pediatric Patients. J Pediatr Orthop. 2021 Jul 1;41(6):e404–10.
Fletcher, Amanda N., et al. “The Intrarater and Inter-rater Reliability of Radiographic Evaluation of the Posterior Tibial Slope in Pediatric Patients.J Pediatr Orthop, vol. 41, no. 6, July 2021, pp. e404–10. Pubmed, doi:10.1097/BPO.0000000000001792.
Fletcher AN, Liles JL, Pereira GF, Danilkowicz RM, Amendola A, Riboh JC. The Intrarater and Inter-rater Reliability of Radiographic Evaluation of the Posterior Tibial Slope in Pediatric Patients. J Pediatr Orthop. 2021 Jul 1;41(6):e404–e410.

Published In

J Pediatr Orthop

DOI

EISSN

1539-2570

Publication Date

July 1, 2021

Volume

41

Issue

6

Start / End Page

e404 / e410

Location

United States

Related Subject Headings

  • Tibia
  • Retrospective Studies
  • Reproducibility of Results
  • Radiography
  • Orthopedics
  • Male
  • Knee Joint
  • Humans
  • Female
  • Child