Osteochondritis Dissecans of the Knee: An Interrater Reliability Study of Magnetic Resonance Imaging Characteristics

Abstract

Background: Imaging characteristics of osteochondritis dissecans (OCD) lesions quantified by magnetic resonance imaging (MRI) are often used to inform treatment and prognosis. However, the interrater reliability of clinician-driven MRI-based assessment of OCD lesions is not well documented. Purpose: To determine the interrater reliability of several historical and novel MRI-derived characteristics of OCD of the knee in children. Study Design: Cohort study (diagnosis); Level of evidence, 3 Methods: A total of 42 OCD lesions were evaluated by 10 fellowship-trained orthopaedic surgeons using 31 different MRI characteristics, characterizing lesion size and location, condylar size, cartilage status, the interface between parent and progeny bone, and features of both the parent and the progeny bone. Interrater reliability was determined via intraclass correlation coefficients (ICCs) with 2-way random modeling, Fleiss kappa, or Krippendorff alpha as appropriate for each variable. Results: Raters were reliable when the lesion was measured in the coronal plane (ICC, 0.77). Almost perfect agreement was achieved for condylar size (ICC, 0.93), substantial agreement for physeal patency (ICC, 0.79), and moderate agreement for joint effusion (ICC, 0.56) and cartilage status (ICC, 0.50). Overall, raters showed significant variability regarding interface characteristics (ICC, 0.25), progeny (ICC range, 0.03 to 0.62), and parent bone measurements and qualities (ICC range, –0.02 to 0.65), with reliability being moderate at best for these measurements. Conclusion: This multicenter study determined the interrater reliability of MRI characteristics of OCD lesions in children. Although several measurements provided acceptable reliability, many MRI features of OCD that inform treatment decisions were unreliable. Further work will be needed to refine the unreliable characteristics and to assess the ability of those reliable characteristics to predict clinical lesion instability and prognosis.

Compositional evaluation of lesion and parent bone in patients with juvenile osteochondritis dissecans of the knee using T2* mapping

“…The progeny lesion, the parent bone and the interface between them are the three distinct JOCD regions, each having specific morphologic features and a unique role during the disease progression. [1][2][3]10,11 The progeny lesion region was segmented to encompass the entire progeny area. The interface region was selected between progeny lesion and adjacent tra- Additionally, region volumes were calculated by multiplying a region's pixel count with the pixel volume of the T 2 *-weighted images.…”

“…10 The majority of previous magnetic resonance imaging (MRI) studies focused on the morphological assessment of JOCD lesions with particular attention to describe status of the underlying articular cartage and the main three JOCD regions: the progeny lesion, the parent bone and the interface between them. [1][2][3]10,11 Clinical, morphological MRI can differentiate between stable and unstable lesions, and help guide JOCD management. 4 The interface between progeny lesions and parent bone plays an important role in the evaluation of lesion stability with the presence of multiple cysts or one large cyst suggesting unstable JOCD lesion.…”

“…The majority of previous magnetic resonance imaging (MRI) studies focused on the morphological assessment of JOCD lesions with particular attention to describe status of the underlying articular cartage and the main three JOCD regions: the progeny lesion, the parent bone and the interface between them 1–3,10,11 . Clinical, morphological MRI can differentiate between stable and unstable lesions, and help guide JOCD management 4 .…”

Arthroscopic Fixation of Knee Femoral Condyle Osteochondritis Dissecans Fragment With Bone Marrow Aspirate Concentrate

“…13,14 MRI generally is the gold standard for evaluation, with the benefit of reliably showing the lesion size and "physeal patency." 15 The cartilage can be evaluated for surgical planning (Fig 2). The findings of MRI can include a high T2 signal rim, adjacent cyst, cartilage fracture, and fluid-filled lesion.…”

Editorial Commentary: Early Operative Management of “Stable” Osteochondritis Dissecans Lesions Confers Greater Value in Skeletally Immature Patients

“…2 Galvanized by the work of the Research in Osteochondritis of the Knee (ROCK) study group, our improved recognition and classification of OCD lesions have allowed us to identify unstabledor potentially unstabledlesions, for earlier treatment. 3,4 Yet, although we have refined a range of options for arthroscopic-assisted or open treatment of unstable lesions and/or secondary cartilage restoration with reproducible clinical outcomes, 2,[5][6][7] there is no consensus for the management of persistently symptomatic, stable OCD lesions.…”