MRI Features That Contribute to Decision-Making for Treatment of Capitellar OCD Lesions: An Expert Consensus Using the Delphi Method.

Background: Most healthcare providers utilize magnetic resonance imaging (MRI) to assist in diagnosing and treating osteochondritis dissecans (OCD) of the capitellum. However, consensus on imaging features that portend clinically relevant information in the care of these lesions has not been determined.
Purpose: To conduct a survey on the MRI features of a capitellar OCD that are salient for clinical decision-making using a classic Delphi protocol.
Study Design: A consensus statement.
Methods: Invitations to participate were sent to 33 healthcare providers identified as capitellar OCD experts. A classic 3-round survey method was used to gather agreement and consensus on the level of importance for clinical decision-making on 33 MRI features. A concise list of features that guide decision-making on the stability of an OCD lesion and the ability of an OCD lesion to heal with nonoperative care was also identified. Agreement and consensus were determined a priori as ≥66%.
Results: Of the 33 identified experts, 20 agreed to participate, and 17 (52%) completed all 3 rounds. Of the 33 MRI features evaluated, 17 reached agreement as important for clinical decision-making by the experts. Consensus was reached for a concise list of MRI features that were significant to decision-making (94%), suggestive of a stable lesion (100%), had the potential to heal with nonoperative treatment (94%), were suggestive of an unstable lesion (100%), and had low potential to heal with nonoperative treatment (88%).
Conclusion: This 3-round Delphi process produced consensus on clinically relevant MRI features that contribute to clinical decision-making for capitellar OCD. The results of this study will be used as the basis for an interrater reliability assessment of the identified salient features, creating the foundation for developing a reliable MRI assessment tool rooted in clinical experiences. The development of a standardized assessment of capitellar OCD is intended to improve clinical practice and patient outcomes.
Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: J.A. has received research funds from Smith+ Nephew. J.D.P. has received education payments from Rock Medical Orthopedics and Pylant Medical. D.B. has received royalties from Lippincott Williams & Wilkins. E.E. has received nonconsulting fees from Arthrex. T.G. has received research support from Vericel and AlloSource; education payments from Arthrex; and is a paid associate editor for The American Journal of Sports Medicine. J.L.P. has received consulting fees from Arthrex and JRF Ortho. D.P. has received education payments from Arthrex and has stock ownership in Zimmer Biomet, Medtronic, and Walgreens. P.S. has received speaking fees from Arthrex. M.S. has received grant support from DJO; education payments from Arthrex and Smith+Nephew; and nonconsulting fees from Arthrex. K.S. has received research grants from RCT and Vericel; education payments from Evolution Inc, Arthrex, and Stryker; and hospitality payments from BioMarin Pharmaceutical. E.W. has received education payments from Legacy Ortho. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from Hartford HealthCare (ref No. HHC-2022-0182).
(© The Author(s) 2024.)