Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRIs of Children and Adolescents with Patellofemoral Instability

ACKNOWLEDGEMENTS: The authors would like to acknowledge Drs. Matthew Milewski, Yi-Meng Yen, and Adam Yanke for their contributions. BACKGROUND: Surgical decision-making and pre-operative planning for children and adolescents with patellofemoral instability relies heavily on skeletal maturity status....

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Autores principales: Fabricant, Peter D., Heath, Madison R., Veerkamp, Matthew, Gruber, Simone, Green, Daniel W., Strickland, Sabrina, Wall, Eric, Mintz, Douglas N., Emery, Kathleen H., Stein, Beth Shubin, Parikh, Shital N., Brady, Jacqueline, Ellis, Henry B., Farr, Jack, Heyworth, Benton E., Koh, Jason L., Kramer, Dennis, Magnussen, Robert, Redler, Lauren, Sherman, Seth, Tompkins, Marc, Wilson, Philip
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283068/
http://dx.doi.org/10.1177/2325967121S00150
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author Fabricant, Peter D.
Heath, Madison R.
Veerkamp, Matthew
Gruber, Simone
Green, Daniel W.
Strickland, Sabrina
Wall, Eric
Mintz, Douglas N.
Emery, Kathleen H.
Stein, Beth Shubin
Parikh, Shital N.
Brady, Jacqueline
Ellis, Henry B.
Farr, Jack
Heyworth, Benton E.
Koh, Jason L.
Kramer, Dennis
Magnussen, Robert
Redler, Lauren
Sherman, Seth
Tompkins, Marc
Wilson, Philip
author_facet Fabricant, Peter D.
Heath, Madison R.
Veerkamp, Matthew
Gruber, Simone
Green, Daniel W.
Strickland, Sabrina
Wall, Eric
Mintz, Douglas N.
Emery, Kathleen H.
Stein, Beth Shubin
Parikh, Shital N.
Brady, Jacqueline
Ellis, Henry B.
Farr, Jack
Heyworth, Benton E.
Koh, Jason L.
Kramer, Dennis
Magnussen, Robert
Redler, Lauren
Sherman, Seth
Tompkins, Marc
Wilson, Philip
author_sort Fabricant, Peter D.
collection PubMed
description ACKNOWLEDGEMENTS: The authors would like to acknowledge Drs. Matthew Milewski, Yi-Meng Yen, and Adam Yanke for their contributions. BACKGROUND: Surgical decision-making and pre-operative planning for children and adolescents with patellofemoral instability relies heavily on skeletal maturity status. In order to be clinically useful, radiologic assessments of skeletal maturity must demonstrate acceptable interrater reliability and accuracy. PURPOSE: The purpose of this study was to evaluate the interrater reliability among surgeons of varying experience levels and specialty training backgrounds when evaluating skeletal maturity in the distal femur and proximal tibia of children and adolescents with patellofemoral instability. STUDY DESIGN: Cross-sectional study METHODS: Six fellowship-trained orthopedic surgeons (4 pediatric orthopedic, 2 sports medicine) who perform a high volume of patellofemoral instability surgery examined 20 blinded and randomized knee radiographs and MR images. They assessed these images for clinically relevant growth (open physis) or clinically insignificant growth (closing/closed physis) remaining in the distal femoral and proximal tibial physes. Fleiss’s kappa was calculated for each measurement. After initial ratings, raters discussed consensus methods to improve reliability and assessed the images again in order to determine if training and new criteria improved interrater reliability. RESULTS: Reliability for initial assessments of distal femoral and proximal tibial physeal status was poor (Kappa range: 0.01 – 0.58). After consensus building, all assessments demonstrated almost perfect interrater reliability (Kappa = 0.99 for all measurements). CONCLUSION: Surgical decision-making and pre-operative planning for children and adolescents with patellofemoral instability relies heavily on radiologic assessment of skeletal maturity. This study found that initial interrater reliability of physeal status and clinical decision making was unacceptably low. However, with the addition of new criteria, a consensus-building process, and training, these variables became highly reliable. CLINICAL RELEVANCE: Lack of assessment reliability can jeopardize patient care, both when determining surgical indications as well as choosing an appropriate procedure based upon skeletal maturity. Surgeons should focus on using reliable imaging metrics in children and adolescents with patellofemoral instability, and measurements that remain unreliable after consensus building and training should be removed from clinical decision-making algorithms. WHAT IS KNOWN ABOUT THE SUBJECT: Treatment of patellofemoral instability heavily relies on skeletal maturity status. Physeal assessments of the knee must be reliable and clinically relevant to ensure optimal patient care. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE: Physeal assessment of the knee without training can be unreliable among fellowship trained orthopedic surgeons. With consensus building and training in the use of the methods described in this manuscript, physeal assessments can demonstrate almost perfect reliability.
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spelling pubmed-82830682021-08-02 Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRIs of Children and Adolescents with Patellofemoral Instability Fabricant, Peter D. Heath, Madison R. Veerkamp, Matthew Gruber, Simone Green, Daniel W. Strickland, Sabrina Wall, Eric Mintz, Douglas N. Emery, Kathleen H. Stein, Beth Shubin Parikh, Shital N. Brady, Jacqueline Ellis, Henry B. Farr, Jack Heyworth, Benton E. Koh, Jason L. Kramer, Dennis Magnussen, Robert Redler, Lauren Sherman, Seth Tompkins, Marc Wilson, Philip Orthop J Sports Med Article ACKNOWLEDGEMENTS: The authors would like to acknowledge Drs. Matthew Milewski, Yi-Meng Yen, and Adam Yanke for their contributions. BACKGROUND: Surgical decision-making and pre-operative planning for children and adolescents with patellofemoral instability relies heavily on skeletal maturity status. In order to be clinically useful, radiologic assessments of skeletal maturity must demonstrate acceptable interrater reliability and accuracy. PURPOSE: The purpose of this study was to evaluate the interrater reliability among surgeons of varying experience levels and specialty training backgrounds when evaluating skeletal maturity in the distal femur and proximal tibia of children and adolescents with patellofemoral instability. STUDY DESIGN: Cross-sectional study METHODS: Six fellowship-trained orthopedic surgeons (4 pediatric orthopedic, 2 sports medicine) who perform a high volume of patellofemoral instability surgery examined 20 blinded and randomized knee radiographs and MR images. They assessed these images for clinically relevant growth (open physis) or clinically insignificant growth (closing/closed physis) remaining in the distal femoral and proximal tibial physes. Fleiss’s kappa was calculated for each measurement. After initial ratings, raters discussed consensus methods to improve reliability and assessed the images again in order to determine if training and new criteria improved interrater reliability. RESULTS: Reliability for initial assessments of distal femoral and proximal tibial physeal status was poor (Kappa range: 0.01 – 0.58). After consensus building, all assessments demonstrated almost perfect interrater reliability (Kappa = 0.99 for all measurements). CONCLUSION: Surgical decision-making and pre-operative planning for children and adolescents with patellofemoral instability relies heavily on radiologic assessment of skeletal maturity. This study found that initial interrater reliability of physeal status and clinical decision making was unacceptably low. However, with the addition of new criteria, a consensus-building process, and training, these variables became highly reliable. CLINICAL RELEVANCE: Lack of assessment reliability can jeopardize patient care, both when determining surgical indications as well as choosing an appropriate procedure based upon skeletal maturity. Surgeons should focus on using reliable imaging metrics in children and adolescents with patellofemoral instability, and measurements that remain unreliable after consensus building and training should be removed from clinical decision-making algorithms. WHAT IS KNOWN ABOUT THE SUBJECT: Treatment of patellofemoral instability heavily relies on skeletal maturity status. Physeal assessments of the knee must be reliable and clinically relevant to ensure optimal patient care. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE: Physeal assessment of the knee without training can be unreliable among fellowship trained orthopedic surgeons. With consensus building and training in the use of the methods described in this manuscript, physeal assessments can demonstrate almost perfect reliability. SAGE Publications 2021-07-14 /pmc/articles/PMC8283068/ http://dx.doi.org/10.1177/2325967121S00150 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc-nd/4.0/This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at http://www.sagepub.com/journals-permissions.
spellingShingle Article
Fabricant, Peter D.
Heath, Madison R.
Veerkamp, Matthew
Gruber, Simone
Green, Daniel W.
Strickland, Sabrina
Wall, Eric
Mintz, Douglas N.
Emery, Kathleen H.
Stein, Beth Shubin
Parikh, Shital N.
Brady, Jacqueline
Ellis, Henry B.
Farr, Jack
Heyworth, Benton E.
Koh, Jason L.
Kramer, Dennis
Magnussen, Robert
Redler, Lauren
Sherman, Seth
Tompkins, Marc
Wilson, Philip
Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRIs of Children and Adolescents with Patellofemoral Instability
title Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRIs of Children and Adolescents with Patellofemoral Instability
title_full Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRIs of Children and Adolescents with Patellofemoral Instability
title_fullStr Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRIs of Children and Adolescents with Patellofemoral Instability
title_full_unstemmed Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRIs of Children and Adolescents with Patellofemoral Instability
title_short Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRIs of Children and Adolescents with Patellofemoral Instability
title_sort reliability of radiologic assessments of clinically relevant growth remaining in knee mris of children and adolescents with patellofemoral instability
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283068/
http://dx.doi.org/10.1177/2325967121S00150
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