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      Inter- and Intra-Rater Reliability of Predictive Models for the Non-Operative Healing Potential of Stable Juvenile Osteochondritis Dissecans (JOCD) Knee Lesions

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          Abstract

          Objectives:

          While juvenile osteochondritis dissecans (JOCD) lesions have greater healing potential than equivalent lesions in adults, only 50% of JOCD lesions demonstrate radiographic healing after 6 months of non-operative treatment. Krause et al. (2013) and Wall et al. (2008) have described models to predict a patient's probability of healing with non-operative treatment based on patient and lesion characteristics. The Wall et al. nomogram incorporates normalized lesion length, normalized lesion width, and pain type, while the Krause et al. model includes normalized lesion width, patient age, and the size of concurrent cyst-like lesions. The purpose of this study was to determine inter- and intra-observer reliability of the predictive nomograms.

          Methods:

          We retrospectively evaluated a consecutive series of children with open physes, who underwent non-operative treatment for stable JOCD lesions. Thirty-four patients (40 knees) were included in the study. At two time points at least one week apart, two medical students, two orthopaedic surgeons, and a radiologist made measurements of the JOCD lesions as described by Wall and Krause. These measurements, along with patient ages and pain type, were used to generate a point value for each lesion based on both the Krause and Wall models. Intra-class correlations (ICC) were calculated using the point value data obtained from the nomograms to determine inter- and intra-rater reliability.

          Results:

          Based on the Landis & Koch (1977) threshold, we found near perfect intra-rater correlation for all raters in terms of individual OCD measurements, as well as total point score as calculated by both Krause and Wall methods (Table 1). Additionally, amongst the five raters there was near perfect inter-rater reliabilities in total scores, as well as substantial to near perfect reliability in measuring the individual components of the scores (Table 2).

          Conclusion:

          There is high inter- and intra-rater reliability for both the Krause and Wall point systems for predicting healing of JOCD lesions. These models appear to be important tools for helping doctors and patients reliably predict the healing potential of non-operative management of JOCD lesions.

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          Author and article information

          Journal
          Orthop J Sports Med
          Orthop J Sports Med
          OJS
          spojs
          Orthopaedic Journal of Sports Medicine
          SAGE Publications (Sage CA: Los Angeles, CA )
          2325-9671
          17 July 2015
          July 2015
          : 3
          : 7 suppl2 , AOSSM 2015 Annual Meeting Abstracts
          : 2325967115S00066
          Affiliations
          [1 ]Robert Wood Johnson Medical School, Piscataway, NJ, USA
          [2 ]Hospital for Special Surgery, New York, NY, USA
          Article
          10.1177_2325967115S00066
          10.1177/2325967115S00066
          4901623
          ce3dbb2d-54a8-41af-b103-a1da6ef88b85
          © The Author(s) 2015

          This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.

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