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First published on February 20, 2008, doi:10.1177/0363546507313091
This version was published on June 1, 2008
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The American Journal of Sports Medicine 36:1143-1149 (2008)
© 2008 American Orthopaedic Society for Sports Medicine

Observer Reliability in Ankle and Calcaneocuboid Stress Radiography

Heinz Lohrer, MD*, Tanja Nauck, MA, Sabine Arentz, MD and Jakob Schöll, MD

From the Institute for Sports Medicine, Frankfurt/Main, Germany

* Address correspondence to Heinz Lohrer, MD, Otto-Fleck-Schneise 10, 60528 Frankfurt/Main, Germany (e-mail: lohrer{at}sport.uni-frankfurt.de).

Background: Stress radiographic measurements play an important role in assessing the degree of joint instability in scientific investigations and for decision making in treatment. However, their validity and reliability are still a matter of intensive debate.

Hypothesis: There is no difference regarding interobserver and intraobserver reliability with respect to anterior talar drawer, talar tilt, and calcaneocuboid stress radiographs.

Study Design: Cohort study (diagnosis); Level of evidence, 4.

Methods: Eighty-nine anterior talar drawer, 89 talar tilt, and 76 calcaneocuboid stress radiographs were selected. Analyses for anterior talar drawer (1 measurement technique), talar tilt (1 measurement technique), and lateral calcaneocuboid instability (4 measurement techniques) were performed by 4 independent raters. One rater repeated the measurements after 1 month. Intraclass and interclass correlation coefficients (ICCs) with calculated confidence intervals assessed intratester and intertester reliability of each measure.

Results: Ankle stress radiographic interobserver agreement was ICC = 0.73 to 0.97 for anterior talar drawer test and ICC = 0.78 to 0.97 for talar tilt. Interobserver reliability for calcaneocuboid angle measurement methods was lower (ICC = 0.35–0.91) than for the calcaneocuboid joint-space distance measurements (ICC = 0.81–0.95). Intraobserver ICC varied between 0.78 and 0.97 for ankle stress testing and was 0.67 to 0.94 for calcaneocuboid stress radiography, respectively.

Conclusions: Ankle stress radiographic measurements were proven to be reliable. Insufficient reproducibility was found for angular calcaneocuboid stress radiography measurements, while lateral calcaneocuboid joint-space distances offered accurate reliability.

Clinical Relevance: Measurement errors can be avoided using standardized stress radiography and measurement techniques with proven reliability.

Key Words: ankle instability • calcaneocuboid instability • reliability • stress radiography






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