Reliability of predictive models for non-operative healing potential of stable juvenile osteochondritis dissecans knee lesions.
BACKGROUND
While juvenile osteochondritis dissecans (JOCD) lesions have greater healing potential than equivalent lesions in adults, only 50% of JOCD lesions demonstrate radiographic healing after six months of non-operative treatment. Two previous studies have produced nomograms to predict a patient's probability of healing with non-operative treatment based on patient and lesion characteristics. The purpose of this study was to determine inter- and intra-observer reliability of the predictive nomograms.


METHODS
A consecutive series of 34 skeletally immature patients (40 knees), who underwent non-operative treatment for stable JOCD lesions was retrospectively reviewed. At two time points at least one week apart, two medical students, two orthopaedic surgeons, and a radiologist made measurements of the JOCD lesions. These measurements, along with patient ages and pain type, were used to generate a point value for each lesion based on both nomograms. Intra-class correlations (ICCs) were calculated to determine inter- and intra-rater reliability.


RESULTS
We found near perfect intra-rater correlation (ICC) for all raters' individual OCD measurements, as well as total point score for the two nomograms (ICC range, 0.780-0.929). Additionally, there was near perfect inter-rater reliability among raters for total scores and individual components of each nomogram (ICC range, 0.721-0.974).


CONCLUSIONS
There is high inter- and intra-rater reliability for both point systems for predicting healing of JOCD lesions. Clinicians should be aware of these as tools to help guide decision making in patients with JOCD lesions.
Weill Cornell Medical College, New York, NY 10021, USA. Electronic address: tyler.uppstrom@gmail.com.
Tyler J
TJ
Uppstrom
Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
Jonathan D
JD
Haskel
Hospital for Special Surgery, New York, NY 10021, USA.
Elizabeth B
EB
Gausden
Hospital for Special Surgery, New York, NY 10021, USA.
Russel
R
Meyer
Hospital for Special Surgery, New York, NY 10021, USA.
Yong-Woon
YW
Shin
Hospital for Special Surgery, New York, NY 10021, USA.
Joseph T
JT
Nguyen
Hospital for Special Surgery, New York, NY 10021, USA.
Daniel W
DW
Green
D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D049451:Nomograms; D010008:Osteochondritis Dissecans / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D011379:Prognosis; D015203:Reproducibility of Results; D014945:Wound Healing / Q000502:physiology*
Healing potential; Juvenile osteochondritis dissecans; Nomogram; Non-operative treatment; Reliability