Faculty Collaboration Database

Novel radiographic feature classification of knee osteochondritis dissecans: a multicenter reliability study. Am J Sports Med 2015 Feb;43(2):303-9

Date

01/15/2015

Pubmed ID

25583756

DOI

10.1177/0363546514566600

Scopus ID

2-s2.0-84964311241 (requires institutional sign-in at Scopus site)   51 Citations

Abstract

BACKGROUND: Osteochondritis dissecans (OCD) is a vexing condition for patients, parents, and physicians because of the frequent slow healing and nonhealing that leads to prolonged treatment. Several features on plain radiographs have been identified as predictors of healing, but the reliability of their measurement has not been established.

PURPOSE: To determine the inter- and intrarater reliability of several radiographic features used in the diagnosis, treatment, and prognosis of OCD femoral condyle lesions.

STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 3.

METHODS: Pretreatment anteroposterior, lateral, and notch radiographs of 45 knees containing OCD lesions of the medial or lateral femoral condyle were reviewed in blinded fashion by 7 orthopaedic physician raters from different institutions over a secure web portal at 2 time points over a month apart. Classification variables included lesion location, growth plate maturity, parent bone radiodensity, progeny bone fragmentation, progeny bone displacement, progeny bone contour, lesion boundary, and radiodensity of the lesion center and rim. Condylar width and lesion size were measured on all views. Interrater reliability was assessed using free-marginal kappa and intraclass correlations. Intrarater reliability was assessed using the Cohen kappa, linear-weighted kappa, and intraclass correlations based on measurement type.

RESULTS: Raters had excellent reliability for differentiating medial and lateral lesions and growth plate maturity and for measuring condylar width and lesion size. In the subset of knees with visible bone in the lesion, the fragmentation, displacement, boundary, central radiodensity, and contour (concave/nonconcave) of the lesion bone were classified with moderate to substantial reliability. The radiodensity of the lesion rim and surrounding epiphyseal bone were classified with poor to fair reliability.

CONCLUSION: Many diagnostic features of femoral condyle OCD lesions can be reliably classified on plain radiographs, supporting their future testing in multifactorial classification systems and multicenter research to develop prognostic algorithms. Other radiographic features should be excluded, however, because of poor reliability.

Author List

Wall EJ, Polousky JD, Shea KG, Carey JL, Ganley TJ, Grimm NL, Jacobs JC Jr, Edmonds EW, Eismann EA, Anderson AF, Heyworth BE, Lyon R, Research on OsteoChondritis Dissecans of the Knee (ROCK) Study Group

Author

Roger M. Lyon MD Adjunct Professor in the Orthopaedic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Child
Cohort Studies
Epiphyses
Female
Femur
Growth Plate
Humans
Knee Joint
Male
Orthopedics
Osteochondritis Dissecans
Parents
Radiography
Reproducibility of Results
Young Adult