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New classification yielded substantial, near perfect agreement for grade, location of UCL tears
Recently published results showed substantial to near perfect agreement among and within fellowship-trained observers with use of a newly proposed six-stage MRI-based classification for grade and location of ulnar collateral ligament tears.
Using a newly proposed six-stage classification system, Mark S. Schickendantz, MD, and colleagues had nine fellowship-trained specialists from seven institutions independently complete four surveys consisting of 60 elbow MRI scans with UCL tears. All surveys contained 60 coronal images, with coronal and axial views presented in a random order included with the second and fourth surveys to evaluate the effect of additional imaging views. Researchers acquired intraobserver and interobserver reliability by calculating weighted kappa values for each of the four surveys. Researchers repeated reliability analysis through a two-group classification analysis for distal and non-distal tears, and compared observer readings with intraoperative UCL findings.
Results showed near perfect and substantial agreement with intraobserver and interobserver reliability, respectively, with the newly proposed six-stage MRI-based classification. When substratified into the two-group distal and non-distal tear classification, researchers found an increase in values. Agreement within and among readers did not statistically improve with the additional axial view, according to results. Researchers noted accurate observer readings for partial and complete tear grade, proximal location and distal location, but not midsubstance tears when compared with intraoperative findings from 30 elbows.
“Recent studies have demonstrated the importance of the location of injury to the ulnar collateral ligament with regard to prognosis and appropriate treatment,” Schickendantz told Healio.com/Orthopedics. “As such, being able to reliably and reproducibly determine the location of the injury on MRI, particularly a proximal injury vs. a distal injury, is of utmost importance in guiding treatment.” – by Casey Tingle
Disclosures: Schickendantz reports he receives education and speaker fees from Arthrex. Please see the full study for a list of all other authors’ relevant financial disclosures.