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Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation.

Publication ,  Journal Article
Wright, RW; MARS Group
Published in: J Bone Joint Surg Am
July 16, 2014

BACKGROUND: Osteoarthritis of the knee is commonly diagnosed and monitored with radiography. However, the reliability of radiographic classification systems for osteoarthritis and the correlation of these classifications with the actual degree of confirmed degeneration of the articular cartilage of the tibiofemoral joint have not been adequately studied. METHODS: As the Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) Group, we conducted a multicenter, prospective longitudinal cohort study of patients undergoing revision surgery after anterior cruciate ligament reconstruction. We followed 632 patients who underwent radiographic evaluation of the knee (an anteroposterior weight-bearing radiograph, a posteroanterior weight-bearing radiograph made with the knee in 45° of flexion [Rosenberg radiograph], or both) and arthroscopic evaluation of the articular surfaces. Three blinded examiners independently graded radiographic findings according to six commonly used systems-the Kellgren-Lawrence, International Knee Documentation Committee, Fairbank, Brandt et al., Ahlbäck, and Jäger-Wirth classifications. Interobserver reliability was assessed with use of the intraclass correlation coefficient. The association between radiographic classification and arthroscopic findings of tibiofemoral chondral disease was assessed with use of the Spearman correlation coefficient. RESULTS: Overall, 45° posteroanterior flexion weight-bearing radiographs had higher interobserver reliability (intraclass correlation coefficient = 0.63; 95% confidence interval, 0.61 to 0.65) compared with anteroposterior radiographs (intraclass correlation coefficient = 0.55; 95% confidence interval, 0.53 to 0.56). Similarly, the 45° posteroanterior flexion weight-bearing radiographs had higher correlation with arthroscopic findings of chondral disease (Spearman rho = 0.36; 95% confidence interval, 0.32 to 0.39) compared with anteroposterior radiographs (Spearman rho = 0.29; 95% confidence interval, 0.26 to 0.32). With respect to standards for the magnitude of the reliability coefficient and correlation coefficient (Spearman rho), the International Knee Documentation Committee classification demonstrated the best combination of good interobserver reliability and medium correlation with arthroscopic findings. CONCLUSIONS: The overall estimates with the six radiographic classification systems demonstrated moderate (anteroposterior radiographs) to good (45° posteroanterior flexion weight-bearing radiographs) interobserver reliability and medium correlation with arthroscopic findings. The International Knee Documentation Committee classification assessed with use of 45° posteroanterior flexion weight-bearing radiographs had the most favorable combination of reliability and correlation. LEVEL OF EVIDENCE: Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

July 16, 2014

Volume

96

Issue

14

Start / End Page

1145 / 1151

Location

United States

Related Subject Headings

  • Young Adult
  • Weight-Bearing
  • Reproducibility of Results
  • Prospective Studies
  • Osteoarthritis, Knee
  • Orthopedics
  • Observer Variation
  • Middle Aged
  • Male
  • Longitudinal Studies
 

Citation

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Wright, R. W., & MARS Group. (2014). Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation. J Bone Joint Surg Am, 96(14), 1145–1151. https://doi.org/10.2106/JBJS.M.00929
Wright, Rick W., and MARS Group. “Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation.J Bone Joint Surg Am 96, no. 14 (July 16, 2014): 1145–51. https://doi.org/10.2106/JBJS.M.00929.
Wright RW, MARS Group. Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation. J Bone Joint Surg Am. 2014 Jul 16;96(14):1145–51.
Wright, Rick W., and MARS Group. “Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation.J Bone Joint Surg Am, vol. 96, no. 14, July 2014, pp. 1145–51. Pubmed, doi:10.2106/JBJS.M.00929.
Wright RW, MARS Group. Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation. J Bone Joint Surg Am. 2014 Jul 16;96(14):1145–1151.

Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

July 16, 2014

Volume

96

Issue

14

Start / End Page

1145 / 1151

Location

United States

Related Subject Headings

  • Young Adult
  • Weight-Bearing
  • Reproducibility of Results
  • Prospective Studies
  • Osteoarthritis, Knee
  • Orthopedics
  • Observer Variation
  • Middle Aged
  • Male
  • Longitudinal Studies