title: Osteochondritis dissecans of the humeral capitellum: reliability of four classification systems using radiographs and computed tomography.
abstract: BACKGROUND
  The radiographic appearance of osteochondritis dissecans (OCD) of the humeral capitellum varies according to the stage of the lesion. It is important to evaluate the stage of OCD lesion carefully to guide treatment. We compared the interobserver reliability of currently used classification systems for OCD of the humeral capitellum to identify the most reliable classification system.
  
  
  METHODS
  Thirty-two musculoskeletal radiologists and orthopaedic surgeons specialized in elbow surgery from several countries evaluated anteroposterior and lateral radiographs and corresponding computed tomography (CT) scans of 22 patients to classify the stage of OCD of the humeral capitellum according to the classification systems developed by (1) Minami, (2) Berndt and Harty, (3) Ferkel and Sgaglione, and (4) Anderson on a Web-based study platform including a Digital Imaging and Communications in Medicine viewer. Magnetic resonance imaging was not evaluated as part of this study. We measured agreement among observers using the Siegel and Castellan multirater κ.
  
  
  RESULTS
  All OCD classification systems, except for Berndt and Harty, which had poor agreement among observers (κ = 0.20), had fair interobserver agreement: κ was 0.27 for the Minami, 0.23 for Anderson, and 0.22 for Ferkel and Sgaglione classifications. The Minami Classification was significantly more reliable than the other classifications (P < .001).
  
  
  CONCLUSIONS
  The Minami Classification was the most reliable for classifying different stages of OCD of the humeral capitellum. However, it is unclear whether radiographic evidence of OCD of the humeral capitellum, as categorized by the Minami Classification, guides treatment in clinical practice as a result of this fair agreement.
authors.affiliation: Orthotrauma Research Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands; Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA. Electronic address: fclaessen@mgh.harvard.edu.
authors.forename: Femke M A P
authors.initials: FM
authors.lastname: Claessen
authors.affiliation: Department of Orthopaedic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Kimberly I M
authors.initials: KI
authors.lastname: van den Ende
authors.affiliation: Orthotrauma Research Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Job N
authors.initials: JN
authors.lastname: Doornberg
authors.affiliation: Orthotrauma Research Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Thierry G
authors.initials: TG
authors.lastname: Guitton
authors.affiliation: Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: Denise
authors.initials: D
authors.lastname: Eygendaal
authors.affiliation: Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Michel P J
authors.initials: MP
authors.lastname: van den Bekerom
mesh_terms: D002983:Clinical Competence; D004551:Elbow Joint / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging; D008297:Male; D015588:Observer Variation; D009985:Orthopedics; D010008:Osteochondritis Dissecans / Q000145:classification* / Q000000981:diagnostic imaging*; D011871:Radiology; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed
keywords: Osteochondritis dissecans; arthroscopy; classification; humeral capitellum; interobserver study; sport traumatology