Validation of the Ligamentous-Fossa-Foveolar Complex (LFFC) Grading System With Clinical Correlation for Patients Undergoing Hip Arthroscopy.

IF 2.4 3区 医学 Q2 ORTHOPEDICS
Orthopaedic Journal of Sports Medicine Pub Date : 2025-06-20 eCollection Date: 2025-06-01 DOI:10.1177/23259671251340986
Benjamin D Kuhns, Peter S Chang, Jarrod Brown, Vera M Stezelberger, Joseph J Ruzbarsky, Jonathan Godin, Leslie Vidal, Marc J Philippon
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引用次数: 0

Abstract

Background: Pathology involving the acetabular fossa is often identified during hip arthroscopy, with many of the descriptive classification systems focusing on the ligamentum teres (LT). Recently, a novel grading system for ligamentous-fossa-foveolar complex (LFFC) lesions was introduced for open hip preservation surgery that included evaluation of the cotyloid fossa and perifoveal cartilage.

Purpose: To validate the LFFC grading system for hip arthroscopy and correlate these results with preoperative and intraoperative findings.

Study design: Cohort study (diagnosis); Level of evidence, 3.

Methods: High-resolution arthroscopic images of the central compartment were obtained identifying the LT, cotyloid fossa, and perifoveal cartilage in a prospective series of patients undergoing hip arthroscopy. Each structure was graded according to increasing pathology on a scale of 0 to 4 based on a modified LFFC classification system to include the pulvinar intra-articular adipose tissue. Five surgeons graded the images, which were then randomized and regraded for intraobserver reliability. Agreement was quantified by the intraclass correlation coefficient (ICC) and kappa (κ) statistic to determine inter- and intraobserver reliability. Grading discrepancies were resolved in conference with the senior author, and final LFFC grades were compared with preoperative clinical and radiographic data as well as intraoperative findings.

Results: A total of 93 patients were included in the study. LFFC component intraobserver reliability for 2 rounds of grading resulted in an LT ICC of 0.78 to 0.90, cotyloid fossa ICC of 0.85 to 0.93, and perifoveal cartilage ICC of 0.78 to 0.87 with an LFFC total score ICC of 0.87 to 0.95. Interobserver reliability resulted in an LT ICC of 0.73 to 0.91, cotyloid fossa ICC of 0.84 to 0.95, perifoveal cartilage ICC of 0.83 to 0.91, and LFFC total score ICC of 0.89 to 0.96. Severe central compartment pathology (LFFC total score >6) was significantly associated with age (48.2 vs 34.4; P = .0002), preoperative Tönnis grade 1 (43% vs 4%; P < .0001), preoperative Tönnis angle (8.7 vs 5.2; P = .002), and intraoperative femoral head weightbearing chondral lesions (14% vs 0%; P = .02) when compared to patients with an LFFC score <6.

Conclusion: The modified LFFC grading system demonstrated satisfactory intraobserver and interobserver reliability for patients undergoing hip arthroscopy that compares favorably with existing arthroscopic classification systems for the acetabular fossa. The addition of a descriptive classification system for the pulvinar intra-articular adipose tissue did not decrease the reliability of the grading system. Increasing LFFC scores were found to be associated with known risk factors for inferior outcomes after hip arthroscopy providing enhanced clinical utility for this grading system.

韧带-窝-小凹复合体(LFFC)分级系统与髋关节镜患者临床相关性的验证。
背景:涉及髋臼窝的病理通常在髋关节镜检查中发现,许多描述性分类系统都集中在圆韧带(LT)上。最近,一种新的韧带-窝-凹窝复合体(LFFC)病变分级系统被引入开放式髋关节保存手术,包括评估子叶窝和凹窝周围软骨。目的:验证髋关节镜LFFC分级系统,并将这些结果与术前和术中发现相关联。研究设计:队列研究(诊断);证据水平,3。方法:在一系列接受髋关节镜检查的前瞻性患者中,获得中央腔室的高分辨率关节镜图像,识别LT,尾状窝和窝周软骨。每个结构根据增加的病理在0到4的范围内分级,基于改进的LFFC分类系统,包括枕后关节内脂肪组织。五名外科医生对图像进行评分,然后随机进行评分,并根据观察者的可靠性进行重新评分。一致性通过类内相关系数(ICC)和kappa (κ)统计量来量化,以确定观察者之间和观察者内部的信度。在与资深作者的会议中解决了分级差异,并将最终的LFFC分级与术前临床和放射学资料以及术中发现进行了比较。结果:共纳入93例患者。LFFC成分在2轮评分的观察者内信度结果显示,LFFC评分为0.78 - 0.90,子叶窝评分为0.85 - 0.93,凹周软骨评分为0.78 - 0.87,LFFC总分为0.87 - 0.95。观察者间信度的结果是:LT ICC为0.73 ~ 0.91,子叶窝ICC为0.84 ~ 0.95,窝周软骨ICC为0.83 ~ 0.91,LFFC总分ICC为0.89 ~ 0.96。严重的中央室病理(LFFC总分>.6)与年龄显著相关(48.2 vs 34.4;P = 0.0002),术前Tönnis 1级(43% vs 4%;P < 0.0001),术前Tönnis角度(8.7 vs 5.2;P = 0.002),术中股骨头负重软骨病变(14% vs 0%;结论:与现有的髋臼窝关节镜分类系统相比,改进的LFFC分级系统在髋关节镜患者中显示出令人满意的观察者内和观察者间的可靠性。增加一个描述性分类系统对枕后关节内脂肪组织并没有降低分级系统的可靠性。增加的LFFC评分被发现与髋关节镜术后不良预后的已知危险因素相关,为该评分系统提供了增强的临床效用。
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来源期刊
Orthopaedic Journal of Sports Medicine
Orthopaedic Journal of Sports Medicine Medicine-Orthopedics and Sports Medicine
CiteScore
4.30
自引率
7.70%
发文量
876
审稿时长
12 weeks
期刊介绍: The Orthopaedic Journal of Sports Medicine (OJSM), developed by the American Orthopaedic Society for Sports Medicine (AOSSM), is a global, peer-reviewed, open access journal that combines the interests of researchers and clinical practitioners across orthopaedic sports medicine, arthroscopy, and knee arthroplasty. Topics include original research in the areas of: -Orthopaedic Sports Medicine, including surgical and nonsurgical treatment of orthopaedic sports injuries -Arthroscopic Surgery (Shoulder/Elbow/Wrist/Hip/Knee/Ankle/Foot) -Relevant translational research -Sports traumatology/epidemiology -Knee and shoulder arthroplasty The OJSM also publishes relevant systematic reviews and meta-analyses. This journal is a member of the Committee on Publication Ethics (COPE).
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