Clin Should Elbow.  2021 Jun;24(2):98-105. 10.5397/cise.2021.00115.

Interobserver agreement for detecting Hill-Sachs lesions on magnetic resonance imaging

• Alkaduhimi H
• Saarig A
• Amajjar I
• Linde JAvd
• Wier MFv
• Willigenburg NW
• Bekerom MPvd
• Shoulder and elbow center

• KMID: 2516555
• DOI: http://doi.org/10.5397/cise.2021.00115

Abstract

Background
Our aim is to determine the interobserver reliability for surgeons to detect Hill-Sachs lesions on magnetic resonance imaging (MRI), the certainty of judgement, and the effects of surgeon characteristics on agreement.
Methods
Twenty-nine patients with Hill-Sachs lesions or other lesions with a similar appearance on MRIs were presented to 20 surgeons without any patient characteristics. The surgeons answered questions on the presence of Hill-Sachs lesions and the certainty of diagnosis. Interobserver agreement was assessed using the Fleiss’ kappa (κ) and percentage of agreement. Agreement between surgeons was compared using a technique similar to the pairwise t-test for means, based on large-sample linear approximation of Fleiss' kappa, with Bonferroni correction.
Results
The agreement between surgeons in detecting Hill-Sachs lesions on MRI was fair (69% agreement; κ, 0.304; p<0.001). In 84% of the cases, surgeons were certain or highly certain about the presence of a Hill-Sachs lesion.
Conclusions
Although surgeons reported high levels of certainty for their ability to detect Hill-Sachs lesions, there was only a fair amount of agreement between surgeons in detecting Hill-Sachs lesions on MRI. This indicates that clear criteria for defining Hill-Sachs lesions are lacking, which hampers accurate diagnosis and can compromise treatment.

Keyword

Interobserver; Shoulder; Instability; Hill; Sachs; Hill-Sachs