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Arthroscopic classification of intra-articular hip pathology demonstrates at best moderate interrater reliability

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to report several novel classification systems for intra-articular lesions observed during hip arthroscopy, and to quantify the interrater reliability of both these novel systems and existing classifications of intra-articular lesions when tested by a group of high-volume hip arthroscopists.

Methods

Five hip arthroscopists deliberated over shortcomings in current classification systems and developed several novel grading systems with particular effort made to capture factors important to the treatment and outcomes of hip arthroscopy for labral injury. A video learning module describing the classifications was then developed from the video archive of surgeries performed by the senior author and reviewed by study participants. Following review of the module, a pilot study was completed using five randomly selected videos, after which participating surgeons met once more to discuss points of disagreement and to seek clarification. The final video collection for testing reliability was composed of 29 videos selected with the intent of capturing all sublevels of each classification scheme. Study participants recorded their assessments using each classification scheme, and interrater reliability was calculated by a study participant not involved in grading.

Results

The average kappa coefficients for the classification schemes ranged from 0.38 to 0.54, with the interrater reliability of all classification schemes except labral degeneration qualifying as moderate. The percent of cases with absolute agreement ranged from 17.2% to 51.7% across the classification systems.

Conclusions

Even among a group of high-volume hip arthroscopists who engaged in several discussions about the proposed classification schemes, grades were found to have at best moderate interrater reliability. Moderate interrater reliability is demonstrated for novel grading systems for describing labral tear complexity, labral bruising, labral size, and extent of synovitis, and fair reliability is demonstrated for labral degeneration. Further development and refinement of multifactorial grading systems for describing labral injury are indicated. Evaluating the multifactorial nature of intra-articular lesions in the hip is an important part of intraoperative decision-making and defining reliable classifications for intra-articular lesions is a critical first step towards developing generalizable criteria for guiding treatment type.

Level of evidence

Level III.

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Acknowledgements

We would like to acknowledge Steven Garden, B.S., and Thomas Ueland, B.S., for assistance with manuscript preparation and submission.

Author information

Authors and Affiliations

  1. Peachtree Orthopedics, Atlanta, GA, USA

    Brendan R. Emmons & Dominic S. Carreira

  2. Texas Health Sports Medicine, Allen, TX, USA

    John J. Christoforetti

  3. Allegheny Singer Research Institute, Pittsburgh, PA, USA

    John J. Christoforetti

  4. DISC Sports and Spine Center, Marina Del Rey, CA, USA

    Dean K. Matsuda

  5. Hip Preservation and Sports Medicine, Washington Orthopaedics and Sports Medicine, Washington, DC, USA

    Andrew B. Wolff

  6. Rothman Institute, Hip Arthroscopy Program, The Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA, USA

    John P. Salvo

  7. Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA

    RobRoy Martin

  8. UPMC Center for Sports Medicine, Pittsburgh, PA, USA

    RobRoy Martin

Authors
  1. Brendan R. Emmons
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  2. John J. Christoforetti
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  3. Dean K. Matsuda
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  4. Andrew B. Wolff
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  5. John P. Salvo
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  6. RobRoy Martin
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  7. Dominic S. Carreira
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Contributions

Emmons: conceptualization, formal analysis and writing—original draft; Christoforetti: investigation, and writing—review & editing; Matsuda: investigation, and writing—review & editing; Wolff: investigation, and writing—review & editing; Salvo: investigation, and writing---review and editing; Martin: formal analysis, visualization, and writing—review & editing; Carreira: investigation, supervision, methodology, and writing—review & editing

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Correspondence to Brendan R. Emmons.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or nation research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Emmons, B.R., Christoforetti, J.J., Matsuda, D.K. et al. Arthroscopic classification of intra-articular hip pathology demonstrates at best moderate interrater reliability. Knee Surg Sports Traumatol Arthrosc 29, 1392–1400 (2021). https://doi.org/10.1007/s00167-020-06215-x

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