Intraobserver and Interobserver Reliability of the Snyder and Expanded SLAP Classification System: A Video Study

Area of Science:

• Orthopaedic Surgery
• Sports Medicine
• Diagnostic Imaging

Background:

• Superior labral anterior and posterior (SLAP) tears are common in overhead athletes.
• Existing SLAP tear classification systems (Snyder and expanded SLAP) have shown inconsistencies in diagnosis and treatment.
• Patient-specific factors like age and sport influence treatment decisions for SLAP tears.

Purpose of the Study:

• To evaluate the interobserver and intraobserver reliability of the Snyder and expanded SLAP (ESLAP) classification systems.
• To determine the consistency of treatment recommendations for SLAP tears across different clinical scenarios.

Main Methods:

• 20 arthroscopic videos and MRIs of SLAP tears were reviewed by 20 orthopaedic sports medicine surgeons.
• Surgeons classified tears using Snyder and ESLAP systems and proposed treatments for 4 patient scenarios.
• Interobserver and intraobserver reliability were assessed using Fleiss kappa coefficient (κ).

Main Results:

• Moderate intraobserver reliability (κ = 0.52) and fair interobserver reliability (Snyder κ = 0.31, ESLAP κ = 0.30) were found for both classification systems.
• Agreement on treatment modalities was fair (κ = 0.30) across reviewers.
• Significant statistical difference (P < .0001) was noted for interobserver reliability.

Conclusions:

• SLAP tears present ongoing diagnostic and treatment challenges for orthopaedic surgeons.
• Preoperative discussions should thoroughly cover all treatment options due to potential impacts on recovery and patient expectations.
• The reliability of current SLAP tear classification systems may necessitate further refinement for improved clinical application.