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How Long Should my Video Documents Be to Allow Others Reproduce What I Diagnosed During Wrist Arthroscopy
Steffen Löw, MD1; Holger Erne, MD2; Alexander Schütz, MD3; Christoph Eingartner, MD1; Frank Unglaub, MD4; Christian K. Spies, MD4
1Caritas-Krankenhaus, Bad Mergentheim, Germany; 2Klinikum rechts der Isar TUM, Munich; 3Sporthopaedicum, Regensburg, Germany, 4Vulpius Clinic, Bad Rappenau, Germany

Introduction: Arthroscopy has become a cornerstone of diagnosis and treatment of various wrist disorders. Concurrently, adequate documentation of arthroscopic findings is necessary. However, photos as well as videos have to meet specific quality criteria to allow reproducibility of diagnoses based on these documents. As for videos, an adequate length of the sequences was claimed. Therefore, the purpose of this study was to examine the relationship between video length for wrist arthroscopy and interobserver reliability.
Materials and Methods: 100 consecutive wrist arthroscopies were documented by pairs of long and short videos of the radiocarpal and the midcarpal compartments. The long videos were about twice as long as the short videos. During video recording, all joints were examined by the probe in a standardized manner from radial to ulnar. The pairs of videos were presented in a random order to two independent and blinded surgeons. The diagnoses they made according to these reviews were compared to the diagnoses made at the time of the arthroscopies. Kappa coefficients were calculated. We suspected that the cartilage status could be assessed more accurately by viewing the long videos than by viewing the short videos.
Results: Kappa statistics were inconsistent and did not show that the long video provided an obvious advantage over the short video. The two surgeons’ Kappa coefficients for the assessment of the cartilage status were 0.524 and 0.700 for the long videos and 0.465 and 0.639 for the short videos, respectively. Using the short videos, the independent reviewers diagnosed twice as many false-positive cartilage lesions than they did when using the long videos. The assessment of ligament lesions according to long video sequences was more accurate than according to short video sequences.
Conclusions: The results confirmed the hypothesis that the reproducibility of diagnoses based on video documents was influenced by the length of the video sequences. Long video sequences reduced the risk of false-positive cartilage lesions. Furthermore, detection of relevant ligament lesions was more likely when viewing the longer videos. Therefore, it may be advisable for video documentation to be done diligently. Assuming that the median length of the videos in this study adequately displays the findings in a simple wrist, we recommend that a sequence of the radiocarpal joint should last about 60 seconds and that the sequence of a midcarpal joint should last about 45 seconds. Videos of difficult joints should last appropriately longer.


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