THE INTER-RATER RELIABILITY OF A DIAGNOSTIC SHOULDER ARTHROSCOPY.

Abstract

The standard of reference by which many imaging studies and clinical tests are often measured is arthroscopy. However, the inter-rater reliability of a surgeon’s arthroscopic diagnosis a relatively unexplored area of investigation. The purpose of the study was to determine the inter-rater reliability among a group of experienced orthopaedic shoulder surgeons in evaluating the intra-articular structures involved in a real-time diagnostic shoulder arthroscopy using a videotape model. Given the conditions of this study, the agreement among experienced shoulder surgeons was structure dependent ranging from poor to very good and was influenced by the prevalence of pathology.

To determine the inter-rater reliability among a group of experienced orthopaedic shoulder surgeons in evaluating the intra-articular structures involved in a real-time diagnostic shoulder arthroscopy using a videotape model.

In this patient population, the agreement among experienced shoulder surgeons was structure dependent ranging from poor to very good and was influenced by the prevalence of pathology.

For educational, research and legal reasons, it is important to objectively demonstrate that intra-operative findings can be reproduced. To date, this is a relatively unexplored area of investigation within shoulder arthroscopy.

The video-review surgeon median overall agreements were as follows: anterior labrum=90%, inferior labrum=45%, superior labrum=60%, posterior labrum=65%, superior glenohumeral ligament(GHL)=50%, middleGHL=50%, anterior-inferiorGHL=25%, glenoid surface=35%, detection of Hill Sachs lesion=85%, biceps tendon=70%, supraspinatus tendon=85%, infraspinatus tendon=70%, subscapularis tendon=80%.

Twenty patients (nineteen males, one female) diagnosed with recurrent anterior shoulder instability with an average age of 27.9 years (15–44years) consented to participate. One experienced surgeon performed a standardized diagnostic shoulder arthroscopy following a modified Snyder 15-point protocol. All surgeries were videotaped. The operative protocol, clarity of videotape information and data collection forms were pre-tested to ensure accuracy. The patients’ clinical information, x-rays and videotaped arthroscopy were sent to six experienced shoulder surgeons. The surgeons reviewed the clinical information, assessed the intra-articular structures shown on the videotape and recorded their diagnoses on a standardized data collection form. The primary outcome was the median overall percent agreement for the video-review surgeons. This was calculated for each structure evaluated.