Observer reliability in the arthoscopic classification of osteoarthritis of the knee

Abstract

We studied 19 videotaped knee arthroscopies in 19 patients with mild to moderate osteoarthritis (OA) of the knee in order to compare the intraobserver and interobserver reliability and the patterns of disagreement between four orthopaedic surgeons. The classifications of OA of Collins, Outerbridge and the French Society of Arthroscopy were used. Intraobserver and interobserver agreements using kappa measures were 0.42 to 0.66 and 0.43 to 0.49, respectively. Only 6% to 8% of paired intraobserver classifications differed by more than one category. Observer-specific disagreement was evident both within and between observers. A small, but significant, occasional variation was also seen. Although reliability may improve by an analysis of disagreement, it appears that the arthroscopic grading of early osteoarthritic lesions is inexact.

Multirater Agreement of the Causes of Anterior Cruciate Ligament Reconstruction Failure

“…2,4,7,13,29 Marx et al 29 demonstrated good inter-observer reliability with arthroscopic classification of articular cartilage lesions. Six experienced surgeons based on video analysis classified thirty-one different lesions.…”

“…Brismar et al 4 studied both intra-observer and inter-observer reliability of arthroscopic classification of mild to moderate osteoarthritis using video assessment. Four different surgeons reviewed 19 different videotaped knee arthroscopies twice, classifying the observed arthritis using the Outerbridge, Collins, and French Society of Arthroscopy measures.…”

“…The use of video, while consistently used for reliability studies, 2,4,13,29 does have some limitations. The degree of visual assessment is limited by the quality of what is shown on the video, which is dependent upon the arthroscopic skills of the surgeon as well as the quality of the arthroscopic camera and video software.…”

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.…”

How reliable is MRI in diagnosing cartilaginous lesions in patients with first and recurrent lateral patellar dislocations?

“…Furthermore, the use of arthroscopic grading as a reference standard should be regarded with caution. In the literature, inter-observer agreement at arthroscopy demonstrates sufficient reproducibility [33], but poor results for cartilage grading [34]. On the other hand, a study by Bachmann et al [35] yielded an exact agreement between arthroscopic and histopathologic grading in 287 of 300 cases.…”