Prevalence of Osteochondral Lesions on Magnetic Resonance Imaging Following Simple Elbow Dislocations

Objective: Literature regarding osteochondral lesions in patients following elbow dislocation is scarce. The aim of this study was to examine osteochondral lesions on MRI in patients following simple elbow dislocations and evaluate inter-rater reliability between radiologists and orthopedic surgeons at different levels of experience. Methods: In this retrospective, single-center study, 72 MRIs of patients following simple elbow dislocations were evaluated. Ligamentous and osteochondral injuries were evaluated by a junior and senior radiologist and a junior and senior orthopedic surgeon. Osteochondral lesions were classified according to the Anderson classification, and their distribution was assessed. Inter-rater reliability was assessed using Cohen's Kappa (95% CI) and Fleiss' Kappa (95% CI). Results: The mean time from injury to MRI was 6.92 ± 4.3 days, and the mean patient age was 42.4 ± 16.0 years. A total of 84.5% of patients had a lateral collateral ligament tear, and 69.0% had a medial collateral ligament tear. Osteochondral lesions were found in 27.8% to 63.9% of cases. According to the senior orthopedic surgeon, 100% were first-grade lesions, whereas the senior radiologist classified 63.2% as first-grade, 26.3% as second-grade, and 5.3% as third- and fourth-grade lesions. Inter-rater reliability was fair to moderate for ligamentous injuries and fair for osteochondral lesions (Fleiss Kappa 0.25 [0.15-0.34]). Localization of the lesions differed depending on the examiner. For all examiners, osteochondral lesions of the lateral column (radial head and capitulum) were most common, with 57.8-66.7% of all lesions. Inter-rater reliability was moderate for lesions in the medial column (Fleiss Kappa 0.51 [0.41-0.6]) and fair for lesions in the lateral column (Fleiss Kappa 0.34 [0.24-0.43]). Conclusions: Osteochondral lesions following simple elbow dislocations are common; however, in contrast to the current literature, high-grade lesions seem to be relatively rare. Overall inter-rater reliability between radiologists and surgeons, as well as within surgeons, was only moderate to fair regarding ligament and osteochondral lesions.