Background: Previous studies of the reliability of classifications for superior labral anterior and posterior (SLAP) lesions suggest that intraobserver/interobserver reliability is poor.
Purpose: The goals were to (1) evaluate intraobserver/interobserver reliability of the Snyder classification of labrum tears among experienced surgeons, (2) determine the effect of simplifying that classification into normal versus abnormal labrums, (3) determine the reliability of subdividing type II SLAP lesions, and (4) evaluate the effect of videotape quality on diagnostic confidence.
Study Design: Cohort study (diagnosis); Level of evidence, 3.
Methods: At 2 separate times, 5 experienced shoulder surgeons (all >10 years of practice) evaluated 90 videotapes of shoulder arthroscopy performed for SLAP lesions to identify lesion type, to grade video quality, and to determine degree of confidence in diagnosis. The results were compared for intraobserver reliability (κ analysis) and interobserver reliability (intraclass correlation coefficients) and effect of video quality on diagnostic confidence. Significance was set at P < .05.
Results: When the choices were normal labrum or the 4 types of SLAP lesions, the intraobserver agreements (mean κ, 0.670) and interobserver agreements (mean correlation, 0.804) were substantial. When the labrums were divided into normal (normal and type I) and abnormal (types II-IV), the intraobserver agreements (mean κ, 0.792) and interobserver agreements (mean correlation, 0.648) were substantial. When the 3 type II SLAP lesion subvariants were evaluated, the intraobserver agreement (mean κ, 0.598) was moderate, and the interobserver agreement (mean correlation, 0.804) was substantial. The confidence of the diagnosis was highly correlated with the perceived video quality (average Pearson correlation, 0.718; P < .01). Repeated measures analysis showed a significant relationship between confidence and quality (parameter estimate, 0.732; standard error, 0.021; P < .01) adjusting for rater and review.
Conclusion: For experienced shoulder surgeons, the Snyder classification is a reliable system for identifying SLAP lesions.
AndrewsJRBroussardTSCarsonWG. Arthroscopy of the shoulder in the management of partial tears of the rotator cuff: a preliminary report. Arthroscopy. 1985;1(2):117-122.
2.
AndrewsJRCarsonWGJrMcLeodWD. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med. 1985;13(5):337-341.
3.
BurkhartSSMorganCDKiblerWB. The disabled throwing shoulder: spectrum of pathology. Part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19(4):404-420.
CohenJ. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37-46.
6.
DavidsonPARivenburghDW. Mobile superior glenoid labrum: a normal variant or pathologic condition?Am J Sports Med. 2004;32(4):962-966.
7.
GobezieRZurakowskiDLaveryKMillettPJColeBJWarnerJJ. Analysis of interobserver and intraobserver variability in the diagnosis and treatment of SLAP tears using the Snyder classification. Am J Sports Med. 2008;36(7):1373-1379.
8.
JiaXJiJHPetersenSAFreehillMTMcFarlandEG. An analysis of shoulder laxity in patients undergoing shoulder surgery. J Bone Joint Surg Am. 2009;91(9):2144-2150.
9.
JonesGLGalluchDB. Clinical assessment of superior glenoid labral lesions: a systematic review. Clin Orthop Relat Res. 2007;455:45-51.
10.
KiblerWB. Specificity and sensitivity of the anterior slide test in throwing athletes with superior glenoid labral tears. Arthroscopy. 1995;11(3):296-300.
11.
KimTKQuealeWSCosgareaAJMcFarlandEG. Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. J Bone Joint Surg Am. 2003;85(1):66-71.
12.
KreitnerKFBotchenKRudeJBittingerFKrummenauerFThelenM. Superior labrum and labral-bicipital complex: MR imaging with pathologic-anatomic and histologic correlation. AJR Am J Roentgenol. 1998;170(3):599-605.
13.
LandisJRKochGG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics. 1977;33(2):363-374.
14.
LandisJRKochGG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-174.
15.
MaffetMWGartsmanGMMoseleyB. Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med. 1995;23(1):93-98.
16.
McFarlandEGKimTKSavinoRM. Clinical assessment of three common tests for superior labral anterior-posterior lesions. Am J Sports Med. 2002;30(6):810-815.
17.
McFarlandEGTanakaMJGarzon-MuvdiJJiaXPetersenSA. Clinical and imaging assessment for superior labrum anterior and posterior lesions. Curr Sports Med Rep. 2009;8(5):234-239.
18.
McGrawKOWongSP. Forming inferences about some intraclass correlation coefficients [published correction appears in Psychol Methods. 1996;31(34):390]. Psychol Methods. 1996;1(1):30-46.
19.
MorganCDBurkhartSSPalmeriMGillespieM. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy. 1998;14(6):553-565.
20.
ParentisMAGlousmanREMohrKSYocumLA. An evaluation of the provocative tests for superior labral anterior posterior lesions. Am J Sports Med. 2006;34(2):265-268.
21.
RaoAGKimTKChronopoulosEMcFarlandEG. Anatomical variants in the anterosuperior aspect of the glenoid labrum: a statistical analysis of seventy-three cases. J Bone Joint Surg Am. 2003;85(4):653-659.
22.
SasyniukTMMohtadiNGHHollinsheadRMRussellMLFickGH. The inter-rater reliability of shoulder arthroscopy. Arthroscopy. 2007;23(9):971-977.
23.
SnyderSJKarzelRPDel PizzoWFerkelRDFriedmanMJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274-279.
24.
WaldtSMetzSBurkartA. Variants of the superior labrum and labro-bicipital complex: a comparative study of shoulder specimens using MR arthrography, multi-slice CT arthrography and anatomical dissection. Eur Radiol. 2006;16(2):451-458.
25.
WaltonDMSadiJ. Identifying SLAP lesions: a meta-analysis of clinical tests and exercise in clinical reasoning. Phys Ther Sport. 2008;9(4):167-176.
