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Reliability of Ulnar Collateral Ligament Findings on Magnetic Resonance Imaging.

Reliability of Ulnar Collateral Ligament Findings on Magnetic Resonance Imaging. Journal of shoulder and elbow surgery Bowman, E. N., Sciascia, A., Freehill, M. T., Smith, M. V., Da Silva, A., Chalmers, P. N. 2023

Abstract

Ulnar Collateral Ligament (UCL) tears are common in baseball players. While MRI is the most utilized imaging modality for UCL injuries, the inter-rater reliability of MRI analyzing specific characteristics of UCL pathology has not been defined.The purpose of this study was to define the inter-rater reliability of MRI for evaluating UCL characteristics.Three surgeons analyzed forty-five non-contrast MRIs: 15 without UCL tears, 15 with intra-operatively confirmed partial-thickness tears, and 15 with intra-operatively confirmed full-thickness tears. Findings evaluated included ligament characteristics (peri-ligamentous or osseous edema, ligament hypertrophy, calcifications, partial or full-thickness tearing) and location of the pathology (proximal, mid-substance, or distal). Fleiss' kappa coefficients were utilized to assess inter-observer reliability.There were high rates of agreement for mid-substance (kappa: 0.50) and distal (kappa: 0.69) ligament edema and proximal osseous edema (kappa: 0.48). There were low rates of agreement for proximal ligament edema (kappa:0.08), ligament thickening (kappa: -0.02-0.20), and proximal to mid-substance calcifications (kappa: -0.04-0.10). Mid-substance (kappa: 0.55) and distal full-thickness tears (kappa: 0.63) demonstrated higher agreement than proximal (kappa: 0.29). Proximal partial-thickness tears (kappa: 0.45) had higher agreement than mid-substance (kappa: -0.02) or distal (kappa: -0.02).In our study, there was high inter-rater reliability regarding proximal osseous edema, mid-substance and distal ligament edema and full-thickness tears. There was no agreement for mid-substance and distal partial-thickness UCL tears, but fair agreement for proximal tears. UCL tissue characteristics including ligament thickening and calcifications demonstrated low agreement. Challenges remain in effectively evaluating UCL tissue characteristics on non-contrast MRIs.

View details for DOI 10.1016/j.jse.2023.06.019

View details for PubMedID 37481106