TY - JOUR
T1 - Classifying radiographic changes of the pubic symphysis in male athletes
T2 - Development and reproducibility of a new scoring protocol
AU - Serner, Andreas
AU - Arnaiz, Javier
AU - Mosler, Andrea
AU - Almusa, Emad
AU - Vuckovic, Zarko
AU - Tak, Igor
AU - Maas, Mario
AU - Weir, Adam
AU - Hölmich, Per
N1 - Publisher Copyright:
© 2020 The Authors
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - PURPOSE: To develop a specified radiographic scoring system for the pubic symphysis and adjacent bones, and to examine the intra- and inter-rater reproducibility of this system.METHOD: Development of the scoring protocol was performed in three stages using AP pelvis radiographs of 102 male adult athletes. The final protocol included 5 overall scoring items, which included further specification of locations: 1) bone lucency (erosion-like configuration and cysts), 2) proliferation, 3) fragmentation, 4) sclerosis, and 5) joint space width. Intra- and inter-rater reproducibility were determined using Cohen's kappa statistic (κ) and intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and minimal detectable difference (MDD) were also determined.RESULTS: We present a radiographic scoring protocol with clear definitions and examples to improve clinical usability. Intra-rater reproducibility was: bone lucency (erosion-like configuration or cysts): κ = 0.67 (95 %CI 0.56-0.78), proliferation: κ = 0.54 (95 %CI 0.38-0.70), fragmentation: κ = 0.80 (95 %CI 0.67-0.93), sclerosis: κ = 0.60 (95 %CI 0.49-0.71), and joint space width: ICC(2.1) 0.85 (95 %CI 0.78-0.89), SEM 0.4 mm, MDD 1.2 mm. Inter-rater reproducibility was: bone lucency: κ = 0.61 (95 %CI 0.50-0.72), proliferation: κ = 0.34 (95 %CI 0.20-0.48), fragmentation: κ = 0.67 (95 %CI 0.50-0.84), sclerosis: κ = 0.30 (95 %CI 0.17-0.43), and joint space width: ICC(2.1) 0.72 (95 %CI 0.59-0.81), SEM 0.5 mm., MDD 1.5 mm.CONCLUSIONS: The Aspetar pubic symphysis radiographic scoring protocol contains five overall scoring items, with additional specifications. These five items showed moderate to almost perfect intra-rater reproducibility, and fair to substantial inter-rater reproducibility. This protocol provides the basis for use in clinical practice, and will allow future investigations of the clinical significance of radiographic changes at the pubic symphysis in athletes.
AB - PURPOSE: To develop a specified radiographic scoring system for the pubic symphysis and adjacent bones, and to examine the intra- and inter-rater reproducibility of this system.METHOD: Development of the scoring protocol was performed in three stages using AP pelvis radiographs of 102 male adult athletes. The final protocol included 5 overall scoring items, which included further specification of locations: 1) bone lucency (erosion-like configuration and cysts), 2) proliferation, 3) fragmentation, 4) sclerosis, and 5) joint space width. Intra- and inter-rater reproducibility were determined using Cohen's kappa statistic (κ) and intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and minimal detectable difference (MDD) were also determined.RESULTS: We present a radiographic scoring protocol with clear definitions and examples to improve clinical usability. Intra-rater reproducibility was: bone lucency (erosion-like configuration or cysts): κ = 0.67 (95 %CI 0.56-0.78), proliferation: κ = 0.54 (95 %CI 0.38-0.70), fragmentation: κ = 0.80 (95 %CI 0.67-0.93), sclerosis: κ = 0.60 (95 %CI 0.49-0.71), and joint space width: ICC(2.1) 0.85 (95 %CI 0.78-0.89), SEM 0.4 mm, MDD 1.2 mm. Inter-rater reproducibility was: bone lucency: κ = 0.61 (95 %CI 0.50-0.72), proliferation: κ = 0.34 (95 %CI 0.20-0.48), fragmentation: κ = 0.67 (95 %CI 0.50-0.84), sclerosis: κ = 0.30 (95 %CI 0.17-0.43), and joint space width: ICC(2.1) 0.72 (95 %CI 0.59-0.81), SEM 0.5 mm., MDD 1.5 mm.CONCLUSIONS: The Aspetar pubic symphysis radiographic scoring protocol contains five overall scoring items, with additional specifications. These five items showed moderate to almost perfect intra-rater reproducibility, and fair to substantial inter-rater reproducibility. This protocol provides the basis for use in clinical practice, and will allow future investigations of the clinical significance of radiographic changes at the pubic symphysis in athletes.
KW - Groin pain
KW - Pelvis
KW - Pubic symphysis
KW - Reliability
KW - Sport
KW - X-ray
UR - http://www.scopus.com/inward/record.url?scp=85097478335&partnerID=8YFLogxK
U2 - 10.1016/j.ejrad.2020.109452
DO - 10.1016/j.ejrad.2020.109452
M3 - Journal article
C2 - 33310551
SN - 0720-048X
VL - 134
SP - 1
EP - 7
JO - European Journal of Radiology
JF - European Journal of Radiology
M1 - 109452
ER -