Dataset Information

Good Interrater Reliability for Standardized MRI Assessment of Tendon Discontinuity and Tendon Retraction in Acute Proximal Full-Thickness Hamstring Tendon Injury.

ABSTRACT:

Background

Proximal full-thickness free hamstring tendon injury (ie, tendon avulsion or rupture) is a severe injury. Treatment decision making relies on clinical factors and magnetic resonance imaging (MRI) variables; it specifically relies on which tendons are injured as well as the extent of tendon retraction. According to a worldwide evaluation of current practice, discontinuity of both proximal tendons and retraction of >2 cm are used as surgical indications. However, both the diagnosis and the use of MRI variables in decision making may be fraught with uncertainty in clinical practice. A reliable standardized MRI assessment is required.

Purpose

To propose an MRI assessment for acute proximal full-thickness free hamstring tendon injury and to evaluate its interater reliability.

Study design

Cohort study (diagnosis); Level of evidence, 2.

Methods

We included 40 MRI scans of patients with acute (≤4 weeks of injury) proximal full-thickness free hamstring tendon injury. Three musculoskeletal radiologists assessed proximal full-thickness free hamstring tendon discontinuity using the novel "dropped ice cream sign" and tendon retraction (in mm). Quantification of tendon retraction (in mm) was performed using 2 different methods: (1) a direct (ie, shortest distance between the center of the hamstring origin and the tendon stump) method and (2) a combined craniocaudal/mediolateral measurement method. Absolute and relative interrater reliability were calculated.

Results

We found an almost perfect interrater agreement (kappa = 0.87) for assessment of full-thickness tendon discontinuity using the dropped ice cream sign. Interrater agreement for the direct and craniocaudal retraction measurements was good for both the conjoint (intraclass correlation coefficient [ICC], 0.88 and 0.83) and the semimembranosus tendons (ICC, 0.81 and 0.79). The mediolateral retraction measurement yielded only moderate to poor reliability for the conjoint (ICC, 0.53) and semimembranosus tendons (ICC, 0.41).

Conclusion

The standardized MRI assessment to identify proximal hamstring tendon discontinuity and quantify tendon retraction is reliable. We recommend using the novel dropped ice cream sign and the direct retraction measurement in clinical practice and research.

SUBMITTER: van der Made AD

PROVIDER: S-EPMC8283186 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BackgroundInterrater reliability, aka intercoder reliability, is defined as true agreement between raters, aka coders, without chance agreement. It is used across many disciplines including medical and health research to measure the quality of ratings, coding, diagnoses, or other observations and judgements. While numerous indices of interrater reliability are available, experts disagree on which ones are legitimate or more appropriate. Almost all agree that percent agreement (ao), the oldest and the simplest index, is also the most flawed because it fails to estimate and remove chance agreement, which is produced by raters' random rating. The experts, however, disagree on which chance estimators are legitimate or better. The experts also disagree on which of the three factors, rating category, distribution skew, or task difficulty, an index should rely on to estimate chance agreement, or which factors the known indices in fact rely on. The most popular chance-adjusted indices, according to a functionalist view of mathematical statistics, assume that all raters conduct intentional and maximum random rating while typical raters conduct involuntary and reluctant random rating. The mismatches between the assumed and the actual rater behaviors cause the indices to rely on mistaken factors to estimate chance agreement, leading to the numerous paradoxes, abnormalities, and other misbehaviors of the indices identified by prior studies.MethodsWe conducted a 4 × 8 × 3 between-subject controlled experiment with 4 subjects per cell. Each subject was a rating session with 100 pairs of rating by two raters, totaling 384 rating sessions as the experimental subjects. The experiment tested seven best-known indices of interrater reliability against the observed reliabilities and chance agreements. Impacts of the three factors, i.e., rating category, distribution skew, and task difficulty, on the indices were tested.ResultsThe most criticized index, percent agreement (ao), showed as the most accurate predictor of reliability, reporting directional r2 = .84. It was also the third best approximator, overestimating observed reliability by 13 percentage points on average. The three most acclaimed and most popular indices, Scott's π, Cohen's κ and Krippendorff's α, underperformed all other indices, reporting directional r2 = .312 and underestimated reliability by 31.4 ~ 31.8 points. The newest index, Gwet's AC1, emerged as the second-best predictor and the most accurate approximator. Bennett et al's S ranked behind AC1, and Perreault and Leigh's Ir ranked the fourth both for prediction and approximation. The reliance on category and skew and failure to rely on difficulty explain why the six chance-adjusted indices often underperformed ao, which they were created to outperform. The evidence corroborated the notion that the chance-adjusted indices assume intentional and maximum random rating while the raters instead exhibited involuntary and reluctant random rating.ConclusionThe authors call for more empirical studies and especially more controlled experiments to falsify or qualify this study. If the main findings are replicated and the underlying theories supported, new thinking and new indices may be needed. Index designers may need to refrain from assuming intentional and maximum random rating, and instead assume involuntary and reluctant random rating. Accordingly, the new indices may need to rely on task difficulty, rather than distribution skew or rating category, to estimate chance agreement.

Project description:The popliteus tendon plays a critical role in restraining the tibia against external rotation. It is often injured in the setting of posterolateral corner injuries. However, it is rarely injured in isolation from other structures of the posterolateral corner. This Technical Note describes an open anatomic reconstruction of the popliteus tendon. Although several techniques exist, this technique has been biomechanically validated and shown to have good outcomes. An early rehabilitation protocol focused on protected range of motion, edema control, quadriceps strengthening, and pain control is essential for maximizing patient outcomes. Technique Video Video 1 A standard lateral hockey-stick incision is made over the inferior border of the iliotibial band and carried distally bisecting Gerdy’s tubercle and the anterior border of the fibular head. A 6-cm long CPN neurolysis is performed with extreme care to minimize the risk of footdrop postoperatively due to swelling. Attention is then turned to the tibia for creation of the tibial tunnel. A Chandler retractor is then placed in the developed interval along the posterior tibia to protect the neurovascular structures, and an ACUFEX guide is used to drill a guide wire from anterior to posterior. The surgeon then splits the iliotibial band and enters the lateral capsule to identify the injured popliteus tendon. A pin is placed through the center of the femoral attachment of the popliteus, and the guide pin is angled to exit the thigh anteromedially. This is then over-reamed using a 6-mm reamer and is followed with a 7-mm tap. The semitendinosus tendon is then obtained using an open hamstring harvester tool. The graft is prepared by an assistant on the back table by whipstitching each end with #2 nonabsorbable sutures The popliteus tendon graft is then shuttled into the femoral tunnel and held in place with a 7 × 20-mm bioabsorbable screw. The graft is then fixed within the tibia using a 7 × 20-mm bioabsorbable screw with the knee at 60° of flexion and the foot in neutral rotation and traction on the graft The dial test and posterolateral corner test now return to normal. (CPN, common peroneal nerve.)