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Radiographic evaluation of posttraumatic osteoarthritis of the ankle: the Kellgren–Lawrence scale is reliable and correlates with clinical symptoms

Holzer, Nicolas and Salvo, Davide and Marijnissen, A.C.A and Vincken, K. L. and Che Ahmad, Aminudin and Sierra, E. and Hoffmeyer, Pierre and Stern, Richard and Lübbeke Wolff, Anne and Assal, Mathieu (2015) Radiographic evaluation of posttraumatic osteoarthritis of the ankle: the Kellgren–Lawrence scale is reliable and correlates with clinical symptoms. Osteoarthritis and Cartilage, 23 (3). pp. 363-369. ISSN 1063-4584

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Summary Objective To assess reliability and construct validity of the Kellgren–Lawrence (K&L) scale in posttraumatic ankle osteoarthritis (OA); additionally evaluate the validity of including tibiotalar tilting in the scale. Method One-hundred and fifty ankle radiographs (75 patients, unilateral malleolar fractures) evaluated at average of 18 years after surgery. American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot (HF) score and pain (visual analog scale) were recorded. Grading of OA according to K&L criteria and identification of OA features was performed on standardized radiographs by four physicians. Minimal joint space width, sclerosis, and talar tilt angle were quantified by digital measurements. A modified K&L scale including talar tilting is presented. Validity of original and modified scale was evaluated and expressed as ability to (1) Identify those with clinical symptoms of ankle OA; and (2) Distinguish between different degrees of fracture severity. Results Inter- and intra-observer reliability of OA assessment according to K&L were good (ICC 0.61 and 0.75). Original and modified K&L grades significantly increased with decreasing AOFAS ankle-HF scores and greater pain. A talar-tilt angle >2° compared with ≤2° in grade 3 was associated with significantly higher pain levels (VAS pain 4.2 vs1.4, respectively; mean difference 2.8, 95% CI 0.5–5.1). More severe fracture patterns at time of surgery were more often in patients with the highest K&L grades. Conclusions The K&L scale is a valid and reliable radiographic grading system for assessment of ankle OA. Inclusion of the talar tilt angle might allow for better differentiation with respect to clinical outcomes.

Item Type: Article (Journal)
Additional Information: 3516/45501
Uncontrolled Keywords: Ankle; Osteoarthritis; Radiography; Kellgren and Lawrence; Reliability; Validity
Subjects: R Medicine > RD Surgery > RD701 Orthopedics
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button): Kulliyyah of Medicine > Department of Department of Orthopaedics, Traumatology & Rehabilitation
Depositing User: Assoc Prof Dr Aminudin Che Ahmad
Date Deposited: 03 Nov 2015 15:29
Last Modified: 03 Nov 2015 15:29
URI: http://irep.iium.edu.my/id/eprint/45501

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