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Related Experiment Videos

Reliability and interobserver variability in radiological patellar height ratios.

R Seil1, B Müller, T Georg

  • 1Orthopedic University Hospital, Homburg/Saar, Germany. rseil@yahoo.com

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA
|September 7, 2000
PubMed
Summary
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Radiographic measurements for patellar height show good interobserver reliability but vary significantly in classifying patella alta, baja, or norma. The Blackburne-Peel (BP) method is recommended for its moderate results and best discrimination.

Area of Science:

  • Orthopedics
  • Radiology
  • Biomechanics

Background:

  • Patellar height is crucial for diagnosing knee conditions.
  • Existing radiographic ratios for patellar height assessment include Insall-Salvati (IS), modified Insall-Salvati (MIS), Blackburne-Peel (BP), Caton-Deschamps (CD), and Labelle-Laurin (LL).
  • Variability in classification may arise from differing normative data and patient anatomy.

Purpose of the Study:

  • To evaluate the reliability and interobserver variability of five common patellar height ratios.
  • To compare the classification of patellar height (alta, baja, norma) using these different radiographic methods.
  • To recommend the most reliable and discriminatory method for assessing patellar height.

Main Methods:

  • Two examiners measured five patellar height ratios (IS, MIS, BP, CD, LL) on lateral knee radiographs of 22 knees.

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  • Radiographs were taken at specific knee flexion angles (20 degrees for IS, MIS, BP, CD; 90 degrees for LL).
  • Interobserver variability was assessed using correlation coefficients and mean errors.

    • Main Results:

    • All five ratios demonstrated good interobserver reliability with high correlation coefficients (0.81-0.92).
    • However, classification of patellar height (alta, baja, norma) varied significantly across methods in 68% of patients.
    • The Blackburne-Peel (BP) ratio showed intermediate results and the best discrimination between patellar height categories.

    Conclusions:

    • While interobserver reliability is high for common patellar height ratios, the classification of patellar height is highly dependent on the chosen index.
    • The Blackburne-Peel (BP) method is recommended due to its lowest interobserver variability and best ability to discriminate between patellar height groups.
    • Future recommendations suggest using ratios that relate the patellar articular surface to the joint line.