Tibia vara. A critical review.

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Abstract

[Indexed for MEDLINE] 7. J Pediatr Orthop B. 2022 Mar 1;31(2):114-119. doi: 10.1097/BPB.0000000000000834. Langenskiöld classification of tibia vara: a multicenter study on interrater reliability. Vosoughi F(1), Nabian MH(1), Simon AL(2), Aghaghazvini L(3), Zargarbashi R(4), Yekaninejad MS(5). Author information: (1)Department of Orthopaedic Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. (2)Pediatric Orthopedic Department, Robert Debré University Hospital, Paris, France. (3)Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences. (4)Children's Medical Center, Tehran University of Medical Sciences. (5)Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Since 1952, when Langenskiöld introduced his six-stage classification on roentgenographic morphologies of tibia vara, this method has been used extensively in Orthopaedic studies. Different studies have tried to determine the reliability of this method. Although there are scarce reports of major variability in using Langenskiöld classification, but the question still remains, as to whether using expert subspecialists and MRI would improve its reliability. The aim of this study is to evaluate inter-rater reliability of Langenskiöld classification using simple radiograph and MRI, by expert raters. This is a cross-sectional multicenter study, involving patients from 4 tertiary pediatric orthopedic centers in France and Iran. Radiograph and MRI (T1, T2, fat saturation) of the affected knees were independently classified by 12 academy members from France and Iran: six pediatric fellowship orthopedic surgeons and six musculoskeletal radiologists. All data were analyzed afterwards by an independent researcher. Mean weighted kappa for agreement based on radiograph and MRI was 0.47 and 0.45, respectively. Mean percent of total agreement was 46.6 and 40.8% in the same order. Kappa statistics for the new grouping were 0.53 and 0.46 for roentgenograms and MRIs, respectively. The new regrouping was proposed so that each group would need a different treatment strategy. Fleiss kappa statistics for group B (stages 2 and 3), rose from (0.33 and 0.09) to 0.44. These values for group C (stages 4 and 5) rose from (0.42 and 0.11) to 0.54. This study concludes that Langenskiöld's classification when used by experts, still has a moderate inter-rater reliability at best. This variability is most at stages 2, 3, and 4; and can cause different treatment approaches. Use of MRI does not have a significant effect on its reliability. Regrouping the stages improved the inter-rater reliability. Level of evidence: III. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BPB.0000000000000834