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Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation
Journal article   Open access   Peer reviewed

Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation

Rick W Wright and MARS Group (Multicenter ACL Revision Study)
Journal of bone and joint surgery. American volume, Vol.96(14), pp.1145-1151
07/16/2014
DOI: 10.2106/JBJS.M.00929
PMCID: PMC4083772
PMID: 25031368
url
https://doi.org/10.2106/JBJS.M.00929View
Published (Version of record) Open Access

Abstract

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. 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. 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. 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. Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.
 Reproducibility of Results Prospective Studies Humans Middle Aged Male Osteoarthritis, Knee - diagnostic imaging Young Adult Arthroscopy Arthrography Osteoarthritis, Knee - pathology Adolescent Adult Female Weight-Bearing Osteoarthritis, Knee - physiopathology Child Longitudinal Studies Observer Variation Osteoarthritis, Knee - classification

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