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.

中文翻译：

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关节内髋关节病理的关节镜分类显示出最佳的中位间可靠性。

目的

这项研究的目的是报告髋关节镜检查中观察到的几种关节内病变的新颖分类系统，并量化这些新颖系统和现有的关节内病变分类的间质可靠性（通过一组高容量测试）髋关节关节科医生。

方法

五名髋关节镜专家讨论了当前分类系统中的缺点，并开发了几种新颖的分级系统，特别努力地捕获了对髋关节镜检查对劳损的治疗和结果很重要的因素。然后，由资深作者进行手术并由研究参与者进行审查的外科手术视频档案库开发了描述分类的视频学习模块。在对该模块进行审查之后，使用五个随机选择的视频完成了一项试点研究，之后与会的外科医生再次会面，讨论分歧点并寻求澄清。用于测试可靠性的最终视频集合由29个视频组成，旨在捕获每个分类方案的所有子级别。

结果

分类方案的平均卡伯系数范围为0.38至0.54，除唇部退化为中度以外，所有分类方案的均值可靠度。在分类系统中，具有绝对一致性的案例的百分比范围从17.2％到51.7％。

结论

即使在一群对拟议的分类方案进行了多次讨论的大批量髋关节关节镜专家中，也发现坡度至多具有中等的坡度间信度。对于描述唇裂的复杂性，唇部淤青，唇裂的大小和滑膜炎程度的新型分级系统，其间信度的可靠性得到了证明，而对于唇肌退化的可靠性也得到了证明。指出了用于描述唇部损伤的多因素分级系统的进一步发展和完善。评估髋关节内病变的多因素性质是术中决策的重要组成部分，定义关节内病变的可靠分类是制定可指导治疗类型通用标准的关键的第一步。

证据水平

第三级。