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Post-traumatic subtalar osteoarthritis: which grading system should we use?

Robert-Jan O de Muinck Keizer1, Manouk Backes2, Siem A Dingemans2

  • 1Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. rjodemuinckkeizer@amc.nl.

International Orthopaedics
|June 26, 2016
PubMed
Summary

The Kellgren and Lawrence Grading Scale (KLGS) and Paley Grading System (PGS) show similar reliability for grading post-traumatic subtalar osteoarthritis. The PGS is simpler for clinical use, while the KLGS is preferred for research.

Keywords:
CalcaneusClassificationHindfootPosttraumatic osteoarthritisSubtalar joint

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Area of Science:

  • Orthopedics
  • Radiology
  • Medical Imaging

Background:

  • Post-traumatic osteoarthritis (PTOA) following calcaneal fractures requires consistent grading.
  • A reliable grading system is crucial for physician communication and research interpretation.
  • Currently, no consensus exists on the optimal grading system for subtalar PTOA.

Purpose of the Study:

  • To determine and compare the inter- and intra-rater reliability of two grading systems for post-traumatic subtalar osteoarthritis.
  • Evaluate the Kellgren and Lawrence Grading Scale (KLGS) and the Paley Grading System (PGS).

Main Methods:

  • Four observers evaluated 50 calcaneal fractures (at least one year post-trauma).
  • Radiographs (oblique lateral, internal/external rotation views) were used for grading.
  • Inter- and intra-rater reliability were calculated for KLGS and PGS.

Main Results:

  • Inter-rater reliability: ICC of 0.54 for KLGS and 0.41 for PGS (not statistically significant).
  • Intra-rater reliability: Mean weighted kappa of 0.62 for both KLGS and PGS.
  • No significant difference in reliability was found between the two systems.

Conclusions:

  • Both KLGS and PGS demonstrate comparable reliability for subtalar PTOA assessment.
  • PGS offers a simpler, two-step approach suitable for clinical practice.
  • KLGS, being more detailed and widely used, is preferable for research applications.