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

• Main Authors: Holzer, Nicolas, Salvo, Davide, Marijnissen, A.C.A, Vincken, K. L., Che Ahmad, Aminudin, Sierra, E., Hoffmeyer, Pierre, Stern, Richard, Lübbeke Wolff, Anne, Assal, Mathieu
• Format: Article
• Language: English
• Published: Elsevier 2015
• Subjects: RD701 Orthopedics
• Online Access: http://irep.iium.edu.my/45501/1/Holzer-2014-Radiographic_evaluation_of_posttra.pdf; http://irep.iium.edu.my/45501/; http://dx.doi.org/10.1016/j.joca.2014.11.010
• Institution: Universiti Islam Antarabangsa Malaysia

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.