Reliability of the Arthroscopic Classifications of Hip Chondral Lesions<sup>*</sup>

Barros, Antônio Augusto Guimarães; Vassalo, Carlos César; Costa, Lincoln Paiva; Gómez-Hoyos, Juan; Paganini, Vinícius de Oliveira; Andrade, Marco Antônio Percope de

doi:10.1016/j.rbo.2018.01.002

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Original Article • Rev. bras. ortop. 54 (04) • Jul-Aug 2019 • https://doi.org/10.1016/j.rbo.2018.01.002 copy

Reliability of the Arthroscopic Classifications of Hip Chondral Lesions^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate the inter- and intraobserver reliability of the Outerbridge, Beck, and Haddad classifications for acetabular joint cartilage lesions through the arthroscopic procedure.

Methods

A total of 60 hip arthroscopy videos were evaluated twice by 4 surgeons at 2 different times to assess the inter- and intraobserver reproducibility of the classifications, and the data was analyzed by means of the weighted Cohen Kappa index.

Results

The mean weighted Kappa values in the interobserver assessment of the Outerbridge, Beck, and Haddad classifications were, respectively, 0.72, 0.78, and 0.68. The three classifications were considered as presenting good interobserver agreement. Regarding the intraobserver assessment of the Outerbridge, Beck, and Haddad classifications, the weighted Kappa values were, respectively, 0.9, 0.9, and 0.93. The three classifications were considered as presenting excellent intraobserver agreement.

Conclusion

In the present series, the Outerbridge, Beck, and Haddad classifications presented good interobserver reproducibility and excellent intraobserver reproducibility when evaluating acetabular chondral lesions by the arthroscopic approach.

Keywords:
arthroscopy; hip; cartilage diseases/ classification; reproducibility of results

Types	Description
Outerbridge
0	No gross cartilaginous alterations
1	Softening or edema
2	Fragmentation/lesion < 1.3 cm
3	Fragmentation/lesion > 1.3 cm
4	Bone exposure
Beck
0	No gross cartilaginous alterations
1	Malacia; superficial rugosity, fibrillation
2	Detachment; Loss of subchondral bone attachment, solid cartilage at gross examination, carpet phenomenon
3	Cleavage; Loss of subchondral bone attachment, effaced borders, cartilage thinning, flap
4	Total thickness defect
Haddad
0	No gross cartilaginous alterations
1	Wave signal; Loss of subchondral bone attachment
2	Cleavage; Obvious separation at the chondrolabral junction, but arthroscopic probing shows the joint cartilage adhered to the underlying bone with no delamination evidence
3	Delamination; Cartilage grossly detached from acetabular bone
4	Bone exposure

Classification system			Observer
	I		II		III		IV
	n	%	n	%	n	%	n	%
Outerbridge
0	8	13.33	8	13.33	5	8.33	19	31.67
1	25	41.67	28	46.67	30	50.00	16	26.67
2	11	18.33	13	21.67	8	13.33	15	25.00
3	8	13.33	7	11.67	11	18.33	2	3.33
4	8	13.33	4	6.67	6	10.00	8	13.33
Beck et al.
0	8	13.33	6	10.00	7	11.67	14	23.33
1	22	36.67	13	21.67	12	20.00	8	13.33
2	11	18.33	19	31.67	21	35.00	15	25.00
3	10	16.67	16	26.67	14	23.33	14	23.33
4	9	15.00	6	10.00	6	10.00	9	15.00
Haddad et al.
0	10	16.67	10	16.67	13	21.67	15	25.00
1	22	36.67	15	25.00	18	30.00	5	8.33
2	10	16.67	13	21.67	9	15.00	17	28.33
3	10	16.67	16	26.67	13	21.67	15	25.00
4	8	13.33	6	10.00	7	11.67	8	13.33

Classification system	Kappa	Kappa classification	95%CI	Agreement rate	95%CI
Outerbridge	0.72	Good
Observer I and II	0.73	Good	0.53–0.94	0.62	0.48–0.74
Observer I and III	0.72	Good	0.52–0.92	0.58	0.45–0.71
Observer I and IV	0.58	Moderate	0.37–0.80	0.43	0.31–0.57
Observer II and III	0.82	Excellent	0.72–0.89	0.63	0.50–0.75
Observer II and IV	0.72	Good	0.60–0.87	0.52	0.39–0.65
Observer III and IV	0.73	Good	0.58–0.83	0.43	0.31–0.57
Beck	0.78	Good
Observer I and II	0.77	Good	0.64–0.90	0.57	0.43–0.69
Observer I and III	0.74	Good	0.59–0.90	0.53	0.40–0.66
Observer I and IV	0.74	Good	0.62–0.86	0.50	0.37–0.63
Observer II and III	0.84	Excellent	0.77–0.91	0.68	0.55–0.79
Observer II and IV	0.78	Good	0.66–0.91	0.62	0.48–0.74
Observer III and IV	0.82	Excellent	0.81–0.84	0.63	0.50–0.75
Haddad	0.68	Good
Observer I and II	0.68	Good	0.48–0.88	0.50	0.37–0.63
Observer I and III	0.78	Good	0.66–0.90	0.60	0.47–0.72
Observer I and IV	0.61	Good	0.39–0.82	0.42	0.29–0.55
Observer II and III	0.75	Good	0.54–0.96	0.67	0.53–0.78
Observer II and IV	0.66	Good	0.45–0.86	0.50	0.37–0.63
Observer III and IV	0.60	Moderate	0.37–0.82	0.43	0.31–0.57

Classification system	Kappa	Kappa classification	95%CI	Agreement rate	95%CI
Outerbridge	0.90	Excellent
Observer I	0.83	Excellent	0.70–0.96	0.72	0.58–0.82
Observer II	0.90	Excellent	0.84–0.94	0.73	0.60–0.84
Observer III	0.94	Excellent	0.89–0.96	0.83	0.71–0.91
Observer IV	0.91	Excellent	0.82–0.96	0.78	0.65–0.88
Beck	0.90	Excellent
Observer I	0.90	Excellent	0.83–0.95	0.77	0.64–0.86
Observer II	0.92	Excellent	0.79–1.00	0.87	0.75–0.94
Observer III	0.87	Excellent	0.70–1.00	0.80	0.67–0.89
Observer IV	0.91	Excellent	0.80–1.00	0.87	0.75–0.94
Haddad	0.93	Excellent
Observer I	0.93	Excellent	0.87–0.97	0.80	0.67–0.89
Observer II	0.89	Excellent	0.75–1.00	0.85	0.73–0.93
Observer III	0.94	Excellent	0.88–0.98	0.85	0.73–0.93
Observer IV	0.97	Excellent	0.94–0.99	0.88	0.77–0.95

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] Address for correspondence
Antônio Augusto Guimarães Barros, Master, Hospital Madre Teresa, Belo Horizonte, MG, Brazil (e-mail: antonioagbarros@gmail.com).

Gender, n (%)
Male	32 (53%)
Female	28 (47%)
Age, mean (standard deviation)	33 years old (±7)
Deformity, n (%)
Combined (CAM and Pincer)	31 (52%)
CAM	27 (45%)
Pincer	2 (3%)

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Reliability of the Arthroscopic Classifications of Hip Chondral Lesions*

Abstract

Objective

Methods

Results

Conclusion

Reliability of the Arthroscopic Classifications of Hip Chondral Lesions^*