Interobserver variance in diagnostic arthroscopy of the knee

Abstract

The diagnostic interindividual variance of 91 German and Dutch arthroscopists has been assessed by the Kappa Cohen interobserver variation analysis using a videotape with three complete knee arthroscopies with different pathologies. Non-pathological conditions show a moderate to excellent interobserver correlation, whereas pathological changes often show very little correlation, especially the synovial membrane of the suprapatellar recess, the cartilage of the femuropatellar groove, and the posterior cruciate ligament. The patella alignment also shows a high interobserver variability. There are no apparent differences between German and Dutch arthroscopists. When comparing arthroscopic findings with other imaging techniques the above results should be taken into account because the use of arthroscopy as golden standard is challenged. Furthermore, these results will influence the meaningfulness of medical expert witness based only on pictures. Also the medical cost balance based on arthroscopic findings has to take into account that a wrong diagnosis is possible and therefore charged wrong.

Arthroscopy vs. MRI for a detailed assessment of cartilage disease in osteoarthritis: diagnostic value of MRI in clinical practice

“…A poor inter-observer agreement at arthroscopy could also impair the validity of our study, where several orthopedic surgeons were involved. Studies about inter-observer agreement at arthroscopy demonstrate fair and moderate inter-observer agreement, particularly for the patellofemoral cartilage [37,38], but also sufficient reproducibility [39]. In this context, it has to be mentioned that a comparable intra-operative cartilage assessment is an important objective within most orthopedic departments, especially regarding patients with osteoarthritis.…”

Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport

“…However, as all participating surgeons were experienced instructors of the Turkish Society of Knee Surgery Arthroscopy and Sports Traumatology working in tertiary care centers, the risk of a misdiagnosis was minimized. Van Kampen et al [22] reported on the interobserver variance in diagnostic arthroscopy of 3 videotaped examinations, made by 91 experienced arthroscopists, and found little correlation between the examiners in evaluating pathologic changes. However, the diagnoses were made solely by viewing the videotape, thus probing of the pathological lesion, which is an integral part of diagnosis, could not be carried out.…”

The Measurement of Patellar Alignment in Patellofemoral Pain Syndrome: Are We Confusing Assumptions With Evidence?

“…3,4,11,34,61,63,95 Other studies have found no initial medial movement. 31,76,77 Of the former group, the point at which the medial displacement becomes maximal and the lateral movement begins is highly variable and ranges from 15° to 40° of knee flexion.…”

“…3,4,11,23,30,34,61,63,77,95 Most studies agree that this initial medial tilt is then followed by a lateral tilt as knee flexion continues past 30° to 50°, but the amount of this lateral tilt ranges from 0.7° to 8.2°. 11,30 One study, Goh et al, 25 described the opposite pattern of an initial lateral tilt followed by a medial tilt at 60° to 90° of knee flexion, although they did not measure the first 20° of knee flexion.…”