Several assessments for patellofemoral instability yielded poor interrater reliability
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While many radiographic assessments were reliable for surgical decision-making in pediatric patients with patellofemoral instability, results showed five assessments required consensus training to be reliable and five remained unreliable.
“Surgical decision-making for children and adolescents with patellofemoral instability relies heavily on radiographic measurement parameters that can assess for multiple factors that are contributing to patellofemoral instability,” Peter D. Fabricant, MD, MPH, pediatric orthopedic surgeon at Hospital for Special Surgery, told Healio. “This study found that interrater reliability of many currently used patellofemoral instability parameters was unacceptably low.”
Fabricant and colleagues evaluated the interrater reliability of several common radiologic parameters among 50 patients between 10 and 19 years of age who were diagnosed with patellar instability. Raters discussed consensus methods for measurements demonstrating unacceptable interrater reliability to improve reliability and re-examined a subset of 20 images from the previous set of images. Researchers considered the measure unreliable if reliability was still low after the second round of assessment.
Researchers noted three radiographic and seven MRI assessments had acceptable interrater reliability, three radiographic and two MRI assessments had improved interrater reliability after consensus training, and three radiographic and two MRI assessments had unreliable interrater reliability even after consensus training. Before or after consensus training, researchers determined 15 assessments to be reliable.
Results showed trochlea crossing sign, congruence angle, Caton-Deshamps index, lateral patellofemoral angle and mechanical axis deviation on hip-to-ankle alignment radiographs had reliable interrater reliability with one or fewer consensus training sessions. Similarly, researchers found MRI indices of trochlear depth, trochlear bump, sulcus angle, patellar tilt, tibial tubercle-trochlear groove distance, effusion and bone marrow edema to be reliable.
“Lack of measurement reliability can jeopardize patient care both when determining surgical indications, as well as choosing an appropriate procedure based upon skeletal maturity,” Fabricant said. “This study will help surgeons ensure they are using a standardized definition or technique for radiographic measurements in children with patellofemoral instability and to help eliminate unreliable measurements from clinical decision-making algorithms.”
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