Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRI of Children and Adolescents With Patellofemoral Instability: Data From the JUPITER Cohort ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Fabricant, P. D., Heath, M. R., Veerkamp, M., Gruber, S., Green, D. W., Strickland, S. M., Wall, E. J., Mintz, D. N., Emery, K. H., Shubin Stein, B. E., Parikh, S. N., Brady, J. M., Ellis, H. B., Farr, J., Heyworth, B. E., Koh, J. L., Kramer, D., Magnussen, R. A., Redler, L. H., Sherman, S. L., Tompkins, M., Wilson, P. L., JUPITER Study Grp 2021; 9 (4): 2325967121991110


Surgical decision making and preoperative planning for children and adolescents with patellofemoral instability rely heavily on a patient's skeletal maturity. To be clinically useful, radiologic assessments of skeletal maturity must demonstrate acceptable interrater reliability and accuracy.The purpose of this study was to examine the interrater reliability among surgeons of varying experience levels and specialty training backgrounds when evaluating the skeletal maturity of the distal femur and proximal tibia of children and adolescents with patellofemoral instability.Cohort study (diagnosis); Level of evidence, 3.Six fellowship-trained orthopaedic surgeons (3 pediatric orthopaedic, 2 sports medicine, and 1 with both) who perform a high volume of patellofemoral instability surgery examined 20 blinded knee radiographs and magnetic resonance images in random order. They assessed these images for clinically relevant growth (open physis) or clinically insignificant growth (closing/closed physis) remaining in the distal femoral and proximal tibial physes. Fleiss' kappa was calculated for each measurement. After initial ratings, raters discussed consensus methods to improve reliability and assessed the images again to determine if training and new criteria improved interrater reliability.Reliability for initial assessments of distal femoral and proximal tibial physeal patency was poor (kappa range, 0.01-0.58). After consensus building, all assessments demonstrated almost-perfect interrater reliability (kappa, 0.99 for all measurements).Surgical decision making and preoperative planning for children and adolescents with patellofemoral instability rely heavily on radiologic assessment of skeletal maturity. This study found that initial interrater reliability of physeal patency and clinical decision making was unacceptably low. However, with the addition of new criteria, a consensus-building process, and training, these variables became highly reliable.

View details for DOI 10.1177/2325967121991110

View details for Web of Science ID 000640374300001

View details for PubMedID 33912616

View details for PubMedCentralID PMC8047867