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Radiographic parameters with potential prognostic value: a reliability analysis
Author(s):
Vuurberg Gwen (Netherlands)
,
Vuurberg Gwen (Netherlands)
Affiliations:
Tümer Nazli
,
Tümer Nazli
Affiliations:
Sierevelt Inger
,
Sierevelt Inger
Affiliations:
Blankevoort L.
,
Blankevoort L.
Affiliations:
Maas M.
,
Maas M.
Affiliations:
Kerkhoffs G.
,
Kerkhoffs G.
Affiliations:
Tuijthof Gabrielle
Tuijthof Gabrielle
Affiliations:
ESSKA Academy. Vuurberg G. May 9, 2018; 209237; P01-194 Topic: Anatomy
Gwendolyn Vuurberg
Gwendolyn Vuurberg
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Abstract
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Objectives: Multiple radiographic variables have been identified over time as potentially prognostic on the development of chronic ankle instability. To conclude whether these parameters can be used in clinical practise the inter- and intra-observer reliability has to be assessed. Therefore the objective of this study is to determine the reliability by comparing measurements of observers with different levels of experience.

Methods: Based on a sample size calculation an expected agreement of 80% and a relative error of 20%, 39 subsequent patients visiting the emergency department after a lateral ankle sprain were included. A mortise view and lateral radiograph was made to exclude fractuse. These radiographs were scored for 5 different measurements extracted from literature as potential prognostic factors: the medial distal tibial angle (MDTA) for varus/valgus alignment, the fibular position (FP) in relation to the tibia, tibiotalar contact ratio (TTCR), the medial malleolar height angle (MMHA) and the talar curvature angle (TCA). Reliability was assessed by calculating the intraclass correlation coefficient (ICC) and visualized by drawing a Bland-Altman plot.

Results: The inter- and intra-observer reliability of all parameters had a p-value <0.05. The inter-observer reliability of the MDTA (ICC 0.80), FP (ICC 0.95), MMHA (ICC 0.93) and TCA (ICC 0.89) all exceeded the 0.75 meaning substantial to excellent reliability. The TTCR however scored only moderate (0.71) between observers. The intra-observer reliability of the MDTA (ICC 0.81), FP (ICC 0.98), TTCR(ICC 0.80), MMHA (ICC 0.82) and TCA (ICC 0.77)all ranged from substantial to excellent.

Conclusions: All angles could be measured with substantial to excellent reliability, argumenting for implementation in clinical practise and future research. There was one outlier being the tibiotalar contact ratio which scored lower than substantial. To avoid the risk of bias by inconsistent measurements, it may be argued this measurement should not be used in the future, atleast untill further standardization is performed concerning its measurement.

Keywords:
Reliability, Radiographic Parameters, Ankle Instability
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