Radiographic assessment of the subtalar joint: An evaluation of the Kellgren-Lawrence scale and proposal of a novel scale

To evaluate the reliability of grading subtalar (ST) arthrosis on lateral weightbearing radiographs in a heterogenous patient population using the Kellgren-Lawrence (KL) scale, correlate these findings to advanced imaging (CT and/or MRI), and to validate a novel scale. A random collection of 40 late...

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Bibliographic Details
Published in:Clinical imaging 2020-03, Vol.60 (1), p.62-66
Main Authors: Vier, David, Louis, Thomas, Fuchs, Daniel, Royer, Christian T., Zide, Jacob R., Jaffe, David E.
Format: Article
Language:English
Subjects:
Ankle
Arthritis
Arthrosis
Computed tomography
Correlation analysis
Evaluation
Fractures
Joints (anatomy)
Magnetic resonance imaging
Medical imaging
Patients
Quality
Radiographic classification
Radiographs
Radiography
Reliability analysis
Subtalar joint
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Summary:To evaluate the reliability of grading subtalar (ST) arthrosis on lateral weightbearing radiographs in a heterogenous patient population using the Kellgren-Lawrence (KL) scale, correlate these findings to advanced imaging (CT and/or MRI), and to validate a novel scale. A random collection of 40 lateral weightbearing radiographs presenting to a foot and ankle clinic were reviewed by nine multi-disciplinary independent reviewers. Interobserver reliability was assessed for KL scores. A musculoskeletal radiologist graded available advanced imaging on all 40 radiographs and the advanced imaging scores were correlated to the radiographic scores. A novel scoring system was created and tested for interobserver reliability. There was overall fair reliability amongst reviewers with the traditional KL score, kappa = 0.26. The best agreement was seen amongst those deemed to have a grade 0, with only moderate agreement (k = 0.50). There was only fair interobserver reliability with severe, Grade 4 scores (k = 0.28). Radiographic scores did have moderate correlation with advanced imaging (r = 0.56). A new, simple grading system was proposed and its interobserver reliability was improved substantially (kappa =0.68). The KL scoring system is not applicable to the subtalar joint. The new NSS grading system has improved reliability. Radiographs only had moderate correlation to advanced imaging. Further studies are warranted to correlate clinically. •The Kellgren-Lawrence scale is not reliable for the subtalar joint•Radiographic subtalar arthrosis had moderate correlation with advanced imaging•The new NSS scale has improved reliability for the severity of subtalar arthrosis
ISSN:0899-7071
1873-4499
DOI:10.1016/j.clinimag.2019.08.009