Reproducibility assessment of different descriptions of the Kellgren and Lawrence classification for osteoarthritis of the knee

Gonçalves, Felipe Borges; Rocha, Felipe Almeida; Albuquerque, Rodrigo Pires e; Mozella, Alan de Paula; Crespo, Bernardo; Cobra, Hugo

doi:10.1016/j.rboe.2016.10.009

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Revista Brasileira de Ortopedia

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ORIGINAL ARTICLES • Rev. bras. ortop. 51 (06) • Nov-Dec 2016 • https://doi.org/10.1016/j.rboe.2016.10.009 copy

Reproducibility assessment of different descriptions of the Kellgren and Lawrence classification for osteoarthritis of the knee^{^☆} ☆ Study conducted at the Knee Surgery Center, Instituto Nacional de Traumatologia e Ortopedia (Into), Rio de Janeiro, RJ, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To assess the inter- and intraobserver reproducibility of the original version and different descriptions of the Kellgren and Lawrence classification used in epidemiological studies for osteoarthritis of the knee.

METHODS:

The study included 72 patients with osteoarthritis of the knee. Three medical members of the Brazilian Society of Knee Surgery were invited to evaluate the images. An intra- and interobserver analysis was conducted, with an interval of one month. The intraobserver agreement was analyzed using the weighted Cohen's Kappa coefficient. The interobserver agreement was analyzed using the Krippendorff alpha coefficient (a).

RESULTS:

The intraobserver assessment indicated conflicting results. In the interobserver analysis, the level of agreement was superficial.

CONCLUSIONS:

The classification of Kellgren and Lawrence and its variants generated a low reproducibility between observers. The intraobserver analysis showed a lack of uniformity in the use of this classification and its variants, even among experienced observers.

Keywords:
Knee; Radiography; Classification

	Original	Variant 1	Variant 2	Variant 3	Variant 4
Grade 0 (0)	Normal	Normal	Normal	Normal	Normal
Grade I	Doubtful JSN and minute osteophytes on the border	Minute osteophytes	Minimal osteophytes dubious significance	Only minute osteophytes	Minute marginal osteophytes
Grade II	Possible JSN and definite osteophytes	Definite osteophytes	Definite osteophytes without JSN	Definite osteophytes and minute JSN	Definite osteophytes and minute JSN
Grade III	Moderate JSN, multiple osteophytes, a certain degree of subchondral sclerosis and possible deformity of the bone contour	Osteophytes and JSN	Moderate JSN (with osteophytes)	Osteophytes in moderate quantity and/or definite JSN	Multiple osteophytes of moderate size, definite JSN, and possible deformity in the bone contour (bone friction)
Grade IV	Notable JSN, severe subchondral sclerosis, definite deformity of the bone contour, and presence of large osteophytes	Large osteophytes, definite JSN, and deformity	Substantial JSN with subchondral sclerosis	Large osteophytes, severe JSN and/or bone sclerosis	Large osteophytes, considerable JSN, severe sclerosis, definite bone contour deformity (bone friction)

K-value	Concordance rating
-1 to 0.00	None
0.0 to 0.20	Poor
0.21 to 0.40	Superficial
0.41 to 0.60	Reasonable
0.61 to 0.80	Good
0.81 to 0.92	Very good
0.93 to 1.0	Excellent

Observer	Classification
	Original	Variant 1	Variant 2	Variant 3	Variant 4
1	0.35 (0.15; 0.55)	0.34 (0.14; 0.54)	0.34 (0.14; 0.54)	0.34 (0.14; 0.54)	0.34 (0.14; 0.54)
2	0.92 (0.84; 0.99)	0.85 (0.75; 0.95)	0.90 (0.82; 0.98)	0.90 (0.82; 0.98)	0.90 (0.82; 0.98)
3	1.0 (1.0; 1.0)	0.97 (0.92; 1.0)	1.0 (1.0; 1.0)	1.0 (1.0; 1.0)	0.97 (0.92; 1.0)

Classification	First evaluation	Second evaluation
Original	0.25	0.33
Variant 1	0.23	0.28
Variant 2	0.21	0.32
Variant 3	0.22	0.34
Variant 4	0.26	0.35

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] * Corresponding author. E-mail: rodalbuquerque19@gmail.com (R.P. Albuquerque).

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Reproducibility assessment of different descriptions of the Kellgren and Lawrence classification for osteoarthritis of the knee☆ ☆ Study conducted at the Knee Surgery Center, Instituto Nacional de Traumatologia e Ortopedia (Into), Rio de Janeiro, RJ, Brazil.

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Reproducibility assessment of different descriptions of the Kellgren and Lawrence classification for osteoarthritis of the knee^{^☆} ☆ Study conducted at the Knee Surgery Center, Instituto Nacional de Traumatologia e Ortopedia (Into), Rio de Janeiro, RJ, Brazil.