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Classifying radiographic changes of the pubic symphysis in male athletes: development and reproducibility of a new scoring protocol

journal contribution
posted on 11.01.2021, 00:54 by A Serner, J Arnaiz, Andrea MoslerAndrea Mosler, E Almusa, Z Vuckovic, I Tak, M Maas, A Weir, P Hölmich
© 2020 The Authors Purpose: To develop a specified radiographic scoring system for the pubic symphysis and adjacent bones, and to examine the intra- and inter-rater reproducibility of this system. Method: Development of the scoring protocol was performed in three stages using AP pelvis radiographs of 102 male adult athletes. The final protocol included 5 overall scoring items, which included further specification of locations: 1) bone lucency (erosion-like configuration and cysts), 2) proliferation, 3) fragmentation, 4) sclerosis, and 5) joint space width. Intra- and inter-rater reproducibility were determined using Cohen's kappa statistic (κ) and intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and minimal detectable difference (MDD) were also determined. Results: We present a radiographic scoring protocol with clear definitions and examples to improve clinical usability. Intra-rater reproducibility was: bone lucency (erosion-like configuration or cysts): κ = 0.67 (95 %CI 0.56−0.78), proliferation: κ = 0.54 (95 %CI 0.38−0.70), fragmentation: κ = 0.80 (95 %CI 0.67−0.93), sclerosis: κ = 0.60 (95 %CI 0.49−0.71), and joint space width: ICC(2.1) 0.85 (95 %CI 0.78−0.89), SEM 0.4 mm, MDD 1.2 mm. Inter-rater reproducibility was: bone lucency: κ = 0.61 (95 %CI 0.50−0.72), proliferation: κ = 0.34 (95 %CI 0.20−0.48), fragmentation: κ = 0.67 (95 %CI 0.50−0.84), sclerosis: κ = 0.30 (95 %CI 0.17−0.43), and joint space width: ICC(2.1) 0.72 (95 %CI 0.59−0.81), SEM 0.5 mm., MDD 1.5 mm. Conclusions: The Aspetar pubic symphysis radiographic scoring protocol contains five overall scoring items, with additional specifications. These five items showed moderate to almost perfect intra-rater reproducibility, and fair to substantial inter-rater reproducibility. This protocol provides the basis for use in clinical practice, and will allow future investigations of the clinical significance of radiographic changes at the pubic symphysis in athletes.

History

Publication Date

01/01/2021

Journal

European Journal of Radiology

Volume

134

Article Number

109452

Pagination

7p. (p. 1-7)

Publisher

Elsevier

ISSN

0720-048X

Rights Statement

The Author reserves all moral rights over the deposited text and must be credited if any re-use occurs. Documents deposited in OPAL are the Open Access versions of outputs published elsewhere. Changes resulting from the publishing process may therefore not be reflected in this document. The final published version may be obtained via the publisher’s DOI. Please note that additional copyright and access restrictions may apply to the published version.

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