Background: Osteoarthritis of the knee is commonly diagnosed and monitored with radiography. However, the reliability of radiographic classification systems for osteoarthritis and the correlation of these classifications with the actual degree of confirmed degeneration of the articular cartilage of the tibiofemoral joint have not been adequately studied.
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The Journal Of Bone And Joint Surgery - Scientific Articles: 16 July 2014 - Volume 96 - Issue 14 - p. 1145-1151
Knee
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Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation
Wright Rick W., MD; Wright Rick W., MD; Ross James R., MD; Haas Amanda K., MA; Huston Laura J., MS; Garofoli Elizabeth A.; Harris David, BE; Patel Kushal, BA; Pearson David, BA; Schutzman Jake; Tarabichi Majd; Ying David, SB; Albright John P., MD; Allen Christina R., MD; Amendola Annunziato, MD; Anderson Allen F., MD; Andrish Jack T., MD; Annunziata Christopher C., MD; Arciero Robert A., MD; Bach Bernard R., MD; Baker Champ L., MD; Bartolozzi Arthur R., MD; Baumgarten Keith M., MD; Bechler Jeffery R., MD; Berg Jeffrey H., MD; Bernas Geoffrey A., MD; Brockmeier Stephen F., MD; Brophy Robert H., MD; Bush-joseph Charles A., MD; Butler V J. Brad, MD; Campbell John D., MD; Carpenter James E., MD; Cole Brian J., MD; Cooper Daniel E., MD; Cooper Jonathan M., DO; Cox Charles L., MD; Creighton R. Alexander, MD; Dahm Diane L., MD; David Tal S., MD; Deberardino Thomas M., MD; Dunn Warren R., MD, MPH; Flanigan David C., MD; Frederick Robert W., MD; Ganley Theodore J., MD; Gatt Charles J., MD; Gecha Steven R., MD; Giffin James Robert, MD; Hame Sharon L., MD; Hannafin Jo A., MD, PhD; Harner Christopher D., MD; Harris Norman Lindsay, MD; Hechtman Keith S., MD; Hershman Elliott B., MD; Hoellrich Rudolf G., MD; Hosea Timothy M., MD; Johnson David C., MD; Johnson Timothy S., MD; Jones Morgan H., MD; Kaeding Christopher C., MD; Kamath Ganesh V., MD; Klootwyk Thomas E., MD; Lantz Brett A., MD; Levy Bruce A., MD; Ma C. Benjamin, MD; Maiers G. Peter, MD; Mann Barton, PhD; Marx Robert G., MD; Matava Matthew J., MD; Mathien Gregory M., MD; Mcallister David R., MD; Mccarty Eric C., MD; Mccormack Robert G., MD; Miller Bruce S., MD, MS; Nissen Carl W., MD; O’neill Daniel F., MD, EdD; Owens Ltc Brett D., MD; Parker Richard D., MD; Purnell Mark L., MD; Ramappa Arun J., MD; Rauh Michael A., MD; Rettig Arthur, MD; Sekiya Jon K., MD; Shea Kevin G., MD; Sherman Orrin H., MD; Slauterbeck James R., MD; Smith Matthew V., MD; Spang Jeffrey T., MD; Spindler Kurt P., MD; Stuart Michael J., MD; Svoboda Ltc Steven J., MD; Taft Timothy N., MD; Tenuta Col Joachim J., MD; Tingstad Edwin M., MD; Vidal Armando F., MD; Viskontas Darius G., MD; White Richard A., MD; Williams James S., MD; Wolcott Michelle L., MD; Wolf Brian R., MD; York James J., MD; Carey James L., MD, MPHKnee
Methods: As the Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) Group, we conducted a multicenter, prospective longitudinal cohort study of patients undergoing revision surgery after anterior cruciate ligament reconstruction. We followed 632 patients who underwent radiographic evaluation of the knee (an anteroposterior weight-bearing radiograph, a posteroanterior weight-bearing radiograph made with the knee in 45° of flexion [Rosenberg radiograph], or both) and arthroscopic evaluation of the articular surfaces. Three blinded examiners independently graded radiographic findings according to six commonly used systems—the Kellgren-Lawrence, International Knee Documentation Committee, Fairbank, Brandt et al., Ahlbäck, and Jäger-Wirth classifications. Interobserver reliability was assessed with use of the intraclass correlation coefficient. The association between radiographic classification and arthroscopic findings of tibiofemoral chondral disease was assessed with use of the Spearman correlation coefficient.
Results: Overall, 45° posteroanterior flexion weight-bearing radiographs had higher interobserver reliability (intraclass correlation coefficient = 0.63; 95% confidence interval, 0.61 to 0.65) compared with anteroposterior radiographs (intraclass correlation coefficient = 0.55; 95% confidence interval, 0.53 to 0.56). Similarly, the 45° posteroanterior flexion weight-bearing radiographs had higher correlation with arthroscopic findings of chondral disease (Spearman rho = 0.36; 95% confidence interval, 0.32 to 0.39) compared with anteroposterior radiographs (Spearman rho = 0.29; 95% confidence interval, 0.26 to 0.32). With respect to standards for the magnitude of the reliability coefficient and correlation coefficient (Spearman rho), the International Knee Documentation Committee classification demonstrated the best combination of good interobserver reliability and medium correlation with arthroscopic findings.
Conclusions: The overall estimates with the six radiographic classification systems demonstrated moderate (anteroposterior radiographs) to good (45° posteroanterior flexion weight-bearing radiographs) interobserver reliability and medium correlation with arthroscopic findings. The International Knee Documentation Committee classification assessed with use of 45° posteroanterior flexion weight-bearing radiographs had the most favorable combination of reliability and correlation.
Level of Evidence: Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.
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