• Eric J Wall, Matthew D Milewski, James L Carey, Kevin G Shea, Theodore J Ganley, John D Polousky, Nathan L Grimm, Emily A Eismann, Jake C Jacobs, Lucas Murnaghan, Carl W Nissen, Gregory D Myer, Research in Osteochondritis of the Knee (ROCK) Group, Jennifer Weiss, Eric W Edmonds, Allen F Anderson, Roger M Lyon, Benton E Heyworth, Peter D Fabricant, and Andy Zbojniewicz.
• Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
• Am J Sports Med. 2017 May 1; 45 (6): 1370-1375.

BackgroundThe reliability of assessing healing on plain radiographs has not been well-established for knee osteochondritis dissecans (OCD).PurposeTo determine the inter- and intrarater reliability of specific radiographic criteria in judging healing of femoral condyle OCD.Study DesignCohort study (Diagnosis); Level of evidence, 3.MethodsTen 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.ResultsOverall 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.ConclusionInterrater 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.

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