Confiabilidade das classificações artroscópicas das lesões condrais do quadril

Barros, Antônio Augusto Guimarães; Vassalo, Carlos César; Costa, Luciane Rezende; Gómez-Hoyos, Juan; Paganini, Vinícius de Oliveira; Andrade, Marco Antônio Percope de

doi:10.1016/j.rbo.2018.01.002

Cited by 3 publications

(6 citation statements)

References 20 publications

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“…This indicates a potential advantage for the use of our classification over those of Beck [4] and Konan [10] in terms of intraobserver reliability. In our study, we were unable to reproduce the higher agreement coefficients found by others [1,2,8,10,13] for cartilage and labral lesions (Table 7). A reason for this could be the higher number of raters in our evaluation (six compared with four raters in previous studies), differences in the level of experience of the raters, and the difference in the evaluated cohorts and present lesions.…”

Section: Intraobserver Reliabilitycontrasting

confidence: 80%

“…The angle of the arthroscopic camera and the presence of intraarticular fluid can theoretically alter lesion appearance, for example, through lack of oxygenation compared with open surgery [11]. However, the Beck classification developed for open surgery has subsequently been validated several times arthroscopically [1, 2, 8, 13] (Table 7). This implies that the arthroscopic and the open surgical views are interchangeable in general.…”

Section: Discussionmentioning

confidence: 99%

“…None of these classifications covers the entire range of existing lesions. This makes it impossible to adequately describe and grade labral lesions, which may limit the intraoberserver and interobserver reliability of some classifications [1,2,8,10,13]. The appearance of a labral lesion can in turn give important information about the underlying pathomechanism with direct impact on surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

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The New Bern Chondrolabral Classification Is Reliable and Reproducible

Yamamoto

Zurmühle

Stetzelberger

et al. 2021

Clin Orthop Relat Res

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Background Several classification systems have been used to describe early lesions of hip cartilage and the acetabular labrum in young adults with hip pain. Some of them were introduced before the concept of femoroacetabular impingement was proposed. Others were developed for other joints (such as the patellofemoral joint). However, these often demonstrate inadequate reliability, and they do not characterize all possible lesions. Therefore, we developed a novel classification system. Question/purpose We asked: What is the (1) intraobserver reliability, (2) interobserver reproducibility, and (3) percentage of nonclassifiable lesions of the new classification system for damage to the hip cartilage and labrum compared with six established classification systems for chondral lesions (Beck et al. [4], Konan et al. [10], Outerbridge et al. [14]) and labral lesions (Beck et al. [3], Lage et al. [12], Peters and Erickson [15])? Methods We performed a validation study of a new classification system of early chondrolabral degeneration lesions based on intraoperative video documentation taken during surgical hip dislocations for joint-preserving surgery in 57 hips (56 patients) performed by one surgeon with standard video documentation of intraarticular lesions. The exclusion criteria were low-quality videos, inadequate exposure angles, traumatic lesions, and incomplete radiographic documentation. This left 42 hips (41 patients) for the blinded and randomized analysis of six raters, including those with cam-pincer-type femoroacetabular impingement (FAI) (19 hips in 18 patients), isolated cam-type FAI (10 hips), extraarticular FAI due to femoral anteversion (seven hips), isolated pincer-type FAI (two hips), focal avascular necrosis (two hips), localized pigmented villonodular synovitis (one hip), and acetabular dysplasia as a sequelae of Perthes disease (one hip). The raters had various degrees of experience in hip surgery: Three were board-certified orthopaedic fellows and three were orthopaedic residents, in whom we chose to prove the general usability of the classification systems in less experienced readers. Every rater was given the original publication of all existing classification systems and a visual guide of the new Bern classification system. Every rater classified the lesions according the existing classifications (cartilage: Beck et al. [4], Konan et al. [10], and Outerbridge et al. [14]; labrum: Beck et al. [3], Peters and Erickson [15], and Lage et al. [12]) and our new Bern chondrolabral classification system. The intraclass correlation coefficient with 95% confidence interval was used to assess the intraobserver reliability and interobserver reproducibility. The percentage of nonclassifiable lesions was calculated as an absolute number and percentage. Results The intraobserver intercorrelation coefficients (ICCs) for cartilage lesions were as follows: the Bern classification system (0.68 [95% CI 0.61 to 0.70]), Beck (0.44 [95% CI 0.34 to 0.54]), Konan (0.39 [95% CI 0.29 to 0.49]), and the Outerbridge classification (0.57 [95% CI 0.48 to 0.65]). For labral lesions, the ICCs were as follows: the Bern classification (0.70 [95% CI 0.63 to 0.76]), Peters (0.42 [95% CI 0.31 to 0.51]), Lage (0.26 [95% CI 0.15 to 0.38]), and Beck (0.59 [95% CI 0.51 to 0.67]). The interobserver ICCs for cartilage were as follows: the Bern classification system (0.63 [95% CI 0.51 to 0.75), the Outerbridge (0.14 [95% CI 0.04 to 0.28]), Konan (0.58 [95% CI 0.40 to 0.76]), and Beck (0.52 [95% CI 0.39 to 0.66]). For labral lesions, the ICCs were as follows: the Bern classification (0.61 [95% CI 0.49 to 0.74]), Beck (0.31 [95% CI 0.19 to 0.46]), Peters (0.28 [95% CI 0.16 to 0.44]), and Lage (0.20 [95% CI 0.09 to 0.35]). The percentage of nonclassifiable cartilage lesions was 0% for the Bern, 0.04% for Beck, 17% for Konan, and 25% for the Outerbridge classification. The percentage of nonclassifiable labral lesions was 0% for Bern and Beck, 4% for Peters, and 25% for Lage. Conclusion We have observed some shortcomings with currently used classification systems for hip pathology, and the new classification system we developed seems to have improved the intraobserver reliability compared with the Beck and Konan classifications in cartilage lesions and with the Peters and Lage classifications in labral lesions. The interrater reproducibility of the Bern classification seems to have improved in cartilage lesions compared with the Outerbridge classification and in labral lesions compared with the Beck, Peters, and Lage classifications. The Bern classification identified all present cartilage and labral lesions. It provides a solid clinical basis for accurate descriptions of early degenerative hip lesions independent of etiology, and it is reproducible enough to use in the reporting of clinical research. Further studies need to replicate our findings in the hands of nondevelopers and should focus on the prognostic value of this classification and its utility in guiding surgical indications. Level of Evidence Level II, diagnostic study.

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Section: Intraobserver Reliabilitycontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The New Bern Chondrolabral Classification Is Reliable and Reproducible

Yamamoto

Zurmühle

Stetzelberger

et al. 2021

Clin Orthop Relat Res

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“…The Outerbridge classification of the chondral lesions was also determined through an analysis of the video of the arthroscopic procedure, 18 nd they were classified as grades 1 to 4, with a spectrum of lesions ranging from cartilage edema to subchondral cartilage erosion. 19…”

Section: Methodsmentioning

confidence: 99%

“…As classificação de Outerbridge das lesões condrais também foi determinada por meio da análise do vídeo do procedimento artroscópico, 18 e elas foram classificadas nos graus de 1 a 4, com um espectro de lesões que variavam desde edema da cartilagem até erosão da cartilagem subcondral. 19…”

Section: Métodosunclassified

Correlação entre intensidade da dor e incapacidade com as lesões intra-articulares em pacientes com síndrome do impacto femoroacetabular

Polesello

Rabelo

Garcia

et al. 2022

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Correlacionar alterações radiográficas e lesões de estruturas intra-articulares do acetábulo com a intensidade da dor e a incapacidade de pacientes com diagnóstico de síndrome do impacto femoroacetabular. Métodos Realiou-se uma análise retrospectiva de dados pré-operatórios de 182 pacientes (190 quadris). Foram avaliadas variáveis clínicas como idade, sexo e prática de atividade física, e variáveis radiográficas, como ângulo de Wiberg e o ângulo alfa. Por meio do vídeo intraoperatório, foi avaliada a extensão das lesões condrais e labiais considerando-se o método clock-face, o grau de comprometimento articular pela classificação de Outerbridge, e a presença de lesão em onda. As variáveis foram analisadas por meio de regressão linear, tendo como variáveis dependentes a intensidade da dor, avaliada pela Escala Visual Analógica (EVA), e a incapacidade funcional, mensurada pelo Harris Hip Score modificado (HHSm). Resultados A média de idade dos pacientes foi de 38,5 ± 9,6 anos, a da intensidade da dor, 7,8 ± 1,6, e a do HHSm, 56,3 ± 12,7. No total, 61% da amostra apresentava Outerbridge III ou IV, e 12,6% apresentava lesão em onda. Observou-se correlação do sexo masculino (r = 0,497) com menor intensidade da dor, e correlação da idade (r = −0,27), do sexo masculino (r = 8,419) e da realização de atividade física com maior escore funcional no HHSm (r = 4,729). Conclusão Não houve correlação dos parâmetros radiográficos e artroscópicos deste estudo com a intensidade da dor e a incapacidade dos pacientes. O sexo masculino está relacionado com menor intensidade da dor, e maior capacidade funcional está relacionada com o sexo masculino, menor idade, e a prática de atividade física. Nível de Evidência IV.

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