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The reliability and validity of radiological assessment for patellar instability. A systematic review and meta-analysis

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Abstract

Objective

To determine the discriminative validity and reliability of the evidence base using meta-analysis.

Materials and Methods

A review of published sources using the databases AMED, CINHAL, EMBASE, MEDLINE, Scopus and the Cochrane Library, and for unpublished material was conducted. All studies assessing the reliability, validity, sensitivity or specificity of magnetic resonance imaging (MRI), computed tomography (CT) or ultrasound (US) of the patellofemoral joint of patients following patellar dislocation, subluxation or instability, were included. A meta-analysis was performed to assess the difference in radiological measurements between healthy controls and subjects with patellar instability in order to assess discrimination validity. A narrative assessment was used to evaluate the inter- and intra-observer reliability as well as the sensitivity and specificity of specific radiological measurements.

Results

A total of 27 studies were reviewed. The findings indicated that there was acceptable inter-observer and intra-observer reliability and validity for different methods of assessing patellar height and the sulcus angle with X-ray, MRI and CT methods, and the tibial tubercle-trochlear groove (TT-TG) assessed using CT. There was poor reliability or validity for the assessment of severity of trochlear dysplasia and the sulcus angle using US.

Conclusion

There is insufficient evidence to determine the reliability, validity, sensitivity or specificity of tests such as the congruence angle, lateral patellar displacement, lateral patellar tilt, trochlear depth, boss height, the crossing sign or Wiberg patellar classification. A critical appraisal of the literature identified a number of recurrent methodological limitations. Further study is recommended to evaluate the reliability and validity of these radiological outcomes using well-designed radiological trials.

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Acknowledgements

We thank the Sir Thomas Browne Library at the Norfolk and Norwich University Hospital for their assistance in gathering the articles used in this paper. We also thank the corresponding authors who reviewed the search results, and in particularly Dr Seppo Koskinen, Helsinki University Hospital, for providing additional data used in the meta-analysis.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Faculty of Health, University of East Anglia, Queens’ Building, Norwich, NR4 7TJ, UK

    Toby O. Smith, Andoni P. Toms & Simon T. Donell

  2. Norfolk and Norwich University Hospital, Norwich, UK

    Leigh Davies, Andoni P. Toms & Simon T. Donell

  3. St George’s Hospital, London, UK

    Caroline B. Hing

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  1. Toby O. Smith
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Correspondence to Toby O. Smith.

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Smith, T.O., Davies, L., Toms, A.P. et al. The reliability and validity of radiological assessment for patellar instability. A systematic review and meta-analysis. Skeletal Radiol 40, 399–414 (2011). https://doi.org/10.1007/s00256-010-0961-x

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  • DOI: https://doi.org/10.1007/s00256-010-0961-x

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