The inter-rater reliability of shoulder arthroscopy

Area of Science:

• Orthopaedic surgery
• Sports medicine
• Diagnostic imaging

Background:

• Recurrent anterior shoulder instability is a common condition requiring accurate arthroscopic evaluation.
• Diagnostic shoulder arthroscopy is crucial for identifying intra-articular pathology.
• Inter-rater reliability in surgical assessments is vital for consistent patient care.

Purpose of the Study:

• To assess the inter-rater reliability of orthopaedic shoulder surgeons in evaluating intra-articular shoulder structures.
• To determine reliability using a videotape model of diagnostic shoulder arthroscopy.
• To identify specific structures with high and low agreement among surgeons.

Main Methods:

• Six experienced shoulder surgeons reviewed videotaped arthroscopies of 20 patients with anterior shoulder instability.
• Surgeons assessed intra-articular structures including labrum, ligaments, tendons, and bone surfaces.
• Diagnoses were recorded, and median overall percent agreement was calculated for each structure.

Main Results:

• High agreement (>80%) was found for the anterior labrum (90%) and supraspinatus tendon (85%), and detecting Hill-Sachs lesions (85%).
• Poor agreement (<40%) was observed for the glenoid surface (35%) and anterior inferior glenohumeral ligament (25%).
• Intermediate agreement (50-75%) was noted for other structures like the inferior and superior labrum, and various glenohumeral ligaments.

Conclusions:

• Inter-rater reliability varies significantly among orthopaedic surgeons when arthroscopically evaluating intra-articular shoulder anatomy.
• Reliability is excellent for certain structures like the anterior labrum and supraspinatus tendon.
• Structures such as the glenoid and anterior inferior glenohumeral ligament require further standardization for reliable arthroscopic assessment.