title: The Reliability of Assessing Radiographic Healing of Osteochondritis Dissecans of the Knee.
abstract: BACKGROUND
  The reliability of assessing healing on plain radiographs has not been well-established for knee osteochondritis dissecans (OCD).
  
  
  OBJECTIVE
  To determine the inter- and intrarater reliability of specific radiographic criteria in judging healing of femoral condyle OCD.
  
  
  METHODS
  Cohort study (Diagnosis); Level of evidence, 3.
  
  
  METHODS
  Ten orthopedic sports surgeons rated the radiographic healing of 30 knee OCD lesions at 2 time points, a minimum of 1 month apart. First, raters compared pretreatment and 2-year follow-up radiographs on "overall healing" and on 5 subfeatures of healing, including OCD boundary, sclerosis, size, shape, and ossification using a continuous slider scale. "Overall healing" was also rated using a 7-tier ordinal scale. Raters then compared the same 30 pretreatment knee radiographs in a stepwise progression to the 2-, 4-, 7-, 12-, and 24-month follow-up radiographs on "overall healing" using a continuous slider scale. Interrater and intrarater reliability were assessed using intraclass correlations (ICC) derived from a 2-way mixed effects analysis of variance for absolute agreement.
  
  
  RESULTS
  Overall healing of the OCD lesions from pretreatment to 2-year follow-up radiographs was rated with excellent interrater reliability (ICC = 0.94) and intrarater reliability (ICC = 0.84) when using a continuous scale. The reliability of the 5 subfeatures of healing was also excellent (interrater ICCs of 0.87-0.89; intrarater ICCs of 0.74-0.84). The 7-tier ordinal scale rating of overall healing had lower interrater (ICC = 0.61) and intrarater (ICC = 0.68) reliability. The overall healing of OCD lesions at the 5 time points up to 24 months had interrater ICCs of 0.81-0.88 and intrarater ICCs of 0.65-0.70.
  
  
  CONCLUSIONS
  Interrater reliability was excellent when judging the overall healing of OCD femoral condyle lesions on radiographs as well as on 5 specific features of healing on 2-year follow-up radiographs. Continuous scale rating of OCD radiographic healing yielded higher reliability than the ordinal scale rating. Raters showed substantial to excellent agreement of OCD overall radiographic healing measured on a continuous scale at 2, 4, 7, 12, and 24 months after starting treatment.
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Wall
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Milewski
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Carey
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Shea
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Ganley
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Polousky
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Grimm
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Eismann
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Jake C
authors.initials: JC
authors.lastname: Jacobs
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Lucas
authors.initials: L
authors.lastname: Murnaghan
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Carl W
authors.initials: CW
authors.lastname: Nissen
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Myer
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Weiss
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Edmonds
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Allen F
authors.initials: AF
authors.lastname: Anderson
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Roger M
authors.initials: RM
authors.lastname: Lyon
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Benton E
authors.initials: BE
authors.lastname: Heyworth
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Fabricant
authors.affiliation: Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Andy
authors.initials: A
authors.lastname: Zbojniewicz
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D010008:Osteochondritis Dissecans / Q000000981:diagnostic imaging* / Q000601:surgery*; D011859:Radiography; D015203:Reproducibility of Results
keywords: OCD; adolescent; healing; juvenile; osteochondritis dissecans; pediatric; radiograph; reliability