Interrater and Intrarater Reliability of Arthroscopic Measurements of Articular Cartilage Defects in the Knee
Interrater and Intrarater Reliability of Arthroscopic Measurements of Articular Cartilage Defects in the Knee
复制标题
DOI：
10.2106/jbjs.16.01132
复制
发表时间：
2017-06-21
影响因子：
5.3
通讯作者：
Lattermann, Christian
中科院分区：
文献类型：
--
作者：
Flanigan, David C.;Carey, James L.;Lattermann, Christian
背景：膝关节软骨损伤很难治疗。病灶大小是治疗算法中的关键因素，准确、可重复的病灶大小非常重要。在本研究中，我们评估了各种关节镜尺寸测量技术的评估者间和评估者内可靠性以及相关性。方法：在 10 个尸膝中每个产生 5 个损伤（国际软骨修复协会 3C 级）。三位骨科医生使用 4 种技术（可视化和使用 3 毫米探针、简单的金属尺和滑动金属尺工具）来估计病变大小。使用混合效应线性模型分析重复测量数据。观察值与金标准（塑料模具）值之间的差异用作响应。计算了评估者内和评估者间可靠性的组内和组间相关系数 (ICC) 值，以及测量值和金标准之间的总体相关系数。 结果：平均病变大小为 2.37 cm(2)（范围为 0.36 至 6.02 cm(2)）。评估者、病变位置和大小以及测量方法都会影响软骨缺损的测量。外科医生低估了病灶的大小，与较小病灶的测量相比，较大病灶的测量误差百分比更高。与病变塑料模具相比，60.5% 的外科医生测量结果低估了病变大小。总体而言，简单金属尺法的测量值与金标准之间的相关性最强，可视化法的相关性最弱。结论：有几个因素可能影响关节镜下软骨病变尺寸的估计：病变位置、测量工具、外科医生和缺损尺寸本身。使用 3 毫米探针、滑动金属尺工具或简单金属尺时，评估者内和评估者间的可靠性为中等至良好，仅使用可视化时为中等至中等。临床相关性：需要更准确的方法来确定关节软骨病变的大小。
Background: Cartilage lesions of the knee are difficult to treat. Lesion size is a critical factor in treatment algorithms, and the accurate, reproducible sizing of lesions is important. In this study, we evaluated the interrater and intrarater reliability of, and correlations in relation to, various arthroscopic sizing techniques.Methods: Five lesions were created in each of 10 cadaveric knees (International Cartilage Repair Society grade 3C). Three orthopaedic surgeons used 4 techniques (visualization and use of a 3-mm probe, a simple metal ruler, and a sliding metallic ruler tool) to estimate lesion size. Repeated-measures data were analyzed using a mixed-effect linear model. The differences between observed and gold-standard (plastic mold) values were used as the response. Intraclass and interclass correlation coefficient (ICC) values for intrarater and interrater reliability were computed, as were overall correlation coefficients between measurements and gold standards.Results: The mean lesion size was 2.37 cm(2) (range, 0.36 to 6.02 cm(2)). Rater, lesion location and size, and measurement method all affected the cartilage defect measurements. Surgeons underestimated lesion size, and measurements of larger lesions had a higher percentage of error compared with those of smaller lesions. When compared with plastic molds of lesions, 60.5% of surgeon measurements underestimated lesion size. Overall, the correlation between measurements and gold standards was strongest for the simple metal ruler method and weakest for the visualization method.Conclusions: Several factors may influence arthroscopic estimation of cartilage lesion size: the lesion location, measurement tool, surgeon, and defect size itself. The intrarater and interrater reliability was moderate to good using a 3-mm probe, sliding metallic ruler tool, or simple metal ruler and was fair to moderate using visualization only. Clinical Relevance: There is a need for more accurate methods of determining the size of articular cartilage lesions.