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Asymptomatic Subjects Cynthia 1. Watson, P7; OCS1 Micah Propps, PT2 Wendy Galt, PT3 Amy Redding, PT4 Debra Dobbs, PT5 Study Desip Test-retest reliability study with blinded testers. O b j To determine the intratester reliability of the McConnell classification system and to determine whether the intertester reliability of this system would be improved by otwmone training of the testers, increasing the variability and numbers of subjects, blinding the testers to the absence or presence of patellofemoral pain syndrome, and adhering to the McConnell classification system as it is taught in the "McConnell Patellofemoral Treatment Plan" continuing education course. Background: The McConnell classification system is currently used by physical therapy clinicians to quantify static patellar orientation. The measurements generated from this system purportedly guide the therapist in the application of patellofemoral tape and in assessment of the efficacy of treatment interventions on changing patellar orientation. Methods and Measures: Fifty-six subjects (age range, 21-65 years) provided a total of 101 knees for assessment. Seventy-six knees did not produce symptoms. A researcher who did not participate in the measuring process determined that 17 subjects had patellofemoral pain syndrome in 25 knees. Two testers concurrently measured static patellar orientation (anteriorlposterior and mediaVlateral tilt, mediablateral glide, and patellar rotation) on subjects, using the McConnell classification system. Repeat measures were performed 3-7 days later. A kappa (K) statistic was used to assess the degree of agreement within each tester and between testers. Results: The K coefficients for intratester reliability varied from-0.06 to 0.35. Intertester reliability ranged from-0.03 to 0.19. Conclusion: The McConnell classification system, in its current form, does not appear to be very reliable. lntratester reliability ranged from poor to fair, and intertester reliability was poor to slight. This system should not be used as a measurement tool or as a basis for treatment decisions.) Orthop Sports Phys Ther 1999;29:378-385,386-393. FIGURE 4. Measurement of the anteriorlposterior component of static pa-tellar orientation is depicted. The tester determines how much of the inferior aspect of the patella is readily palpable. Powers CM, Mortenson S, Nishimoto Dl Simon D. Criterion related validity of a clinical measurement to determine the medialllateral component of patellar orientation. J Orthop Sports Phys Ther. 1999;29:372-377. Watson CJ, Propps M, Galt W, Redding A, Dobbs D. Reliability of McConnellls classification of patellar orientation in symptomatic and asymptomatic subjects. I Orthop Sports Phys Ther. 1 999;29:378-385.

Purpose:To compare signal-to-noise ratios (S/N) and contrast-to-noise ratios (C/N) in various MR sequences, including fat-suppressed three-dimensional spoiled gradient-echo (SPGR) imaging, fat-suppressed fast spin echo (FSE) imaging, and fat-suppressed three-dimensional driven equilibrium Fourier transform (DEFT) imaging, and to determine the diagnostic accuracy of these imaging sequences for detecting cartilage lesions in osteoarthritic knees, as compared with arthroscopy. , sagittal fat-suppressed three-dimensional SPGR images (60/5, 40°flip angle), and sagittal fat-suppressed echo-planar three-dimensional DEFT images (400/21.2) were acquired in 35 knees from 28 patients with osteoarthritis of the knee. The S/N efficiencies (S/Neffs) of cartilage, synovial fluid, muscle, meniscus, bone marrow, and fat tissue, and the C/N efficiencies (C/Neffs) of these structures were calculated. Kappa values, exact agreement, sensitivity, specificity, positive predictive value, and negative predictive value were determined by comparison of MR grading with arthroscopic results. Materials and Methods Results:The synovial fluid S/Neff on fat-suppressed FSE short TE images, fat-suppressed FSE long TE images, and fat-suppressed three-dimensional DEFT images showed similar values. Fat-suppressed three-dimensional DEFT images showed the highest fluid-cartilage C/Neff of all sequences. All images showed fair to good agreement with arthroscopy (kappa, 0.615 in FSE short TE, 0.601 in FSE long TE, 0.583 in three-dimensional SPGR, and 0.561 in three-dimensional DEFT). Although the sensitivity of all sequences was high (100% in FSE short TE, FSE long TE, and DEFT; 96.7% in SPGR), specificity was relatively low (67.6% in FSE short TE and FSE long TE; 85.3% in SPGR; 58.3% in DEFT). The peripheral area of bone marrow edema or whole area of bone marrow edema on fat-suppressed FSE images was demonstrated as low or iso-signal intensity on fat-suppressed three-dimensional DEFT images. Conclusion:Fat-suppressed three-dimensional SPGR imaging and fat-suppressed FSE imaging showed high sensitivity and high negative predictive values, but relatively low specificity. The Kappa value and exact agreement was the highest on fat-suppressed FSE short TE images. Fat-suppressed three-dimensional DEFT images showed results similar to the conventional sequences.

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MR imaging was sensitive, specific, and accurate in revealing cyclops lesions in a subgroup of patients with extension loss after ACL reconstruction.