{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T17:23:32Z","timestamp":1786987412006,"version":"build-2736575974"},"reference-count":17,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2021,7,13]],"date-time":"2021-07-13T00:00:00Z","timestamp":1626134400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100007307","name":"arthrex","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007307","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009026","name":"smith and nephew","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>An anteroposterior (AP) radiograph of the elbow in 45\u00b0 of flexion has been suggested to increase the diagnostic accuracy of capitellum osteochondritis dissecans (OCD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To assess the diagnostic performance, inter- and intraobserver reliability, and confidence level for identifying capitellum OCD using plain radiographs (AP, lateral, and 45\u00b0 flexion AP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study (Diagnosis); Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This was a retrospective study of pediatric and adolescent patients with capitellum OCD and a control group. Six independent clinicians who were blinded to the official radiologists\u2019 reports reviewed images on 2 separate occasions, 1 week apart. A 5-point Likert scale was used to assess the clinicians\u2019 level of confidence. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for individual and combinations of radiographic views. Inter- and intraobserver reliability was determined using Cohen kappa (\u03ba) coefficients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 28 elbows (mean age, 12.5 \u00b1 2 years) were included. There were no differences in age ( P = .18), sex ( P = .62), or laterality ( P &gt; .999) between groups. There were marked variations in the diagnostic accuracy between views: sensitivity (AP, 85.1; lateral, 73.2; 45\u00b0 flexion AP, 91.7), specificity (AP, 89.3; lateral, 91.7; 45\u00b0 flexion AP, 91.1), PPV (AP, 88.8; lateral, 89.8; 45\u00b0 flexion AP, 91.1), NPV (AP, 85.7; lateral, 77.4; 45\u00b0 flexion AP, 91.6), and accuracy (AP, 87.2; lateral, 82.4; 45\u00b0 flexion AP, 91.4). Standard radiographs (AP and lateral views) failed to diagnose capitellum OCD in 4.8% of cases. The sensitivity of the 3 combined views was 100%. Confidence intervals in the clinicians\u2019 diagnostic assessments were similar for each view (AP, 4.0; lateral, 4.0; and 45\u00b0 flexion AP, 4.1). Interobserver reliability was substantial for AP and lateral views (\u03ba = 0.65 and \u03ba = 0.60, respectively) but highest for the 45\u00b0 flexion AP radiographs (\u03ba = 0.72). Intraobserver reliability for the 45\u00b0 flexion AP view was moderate to almost perfect (\u03ba = 0.45 to 0.93).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The 45\u00b0 flexion AP view can detect capitellum OCD with excellent accuracy, a high level of confidence, and substantial interobserver agreement. When added to standard AP and lateral radiographs, the 45\u00b0 flexion AP view aids in the identification of capitellum OCD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465211027178","type":"journal-article","created":{"date-parts":[[2021,7,13]],"date-time":"2021-07-13T16:13:06Z","timestamp":1626192786000},"page":"2778-2782","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["Association Between 45\u00b0 Flexion Anteroposterior Elbow Radiographs and Diagnostic Accuracy of Capitellum Osteochondritis Dissecans"],"prefix":"10.1177","volume":"49","author":[{"given":"Michael G.","family":"Saper","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Sports Medicine, Seattle Children\u2019s, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviana","family":"Bompadre","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Sports Medicine, Seattle Children\u2019s, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory A.","family":"Schmale","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Sports Medicine, Seattle Children\u2019s, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Menashe","sequence":"additional","affiliation":[{"name":"Department of Radiology, Seattle Children\u2019s, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Sports Medicine, Seattle Children\u2019s, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Nagle","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Sports Medicine, Seattle Children\u2019s, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahesh","family":"Thapa","sequence":"additional","affiliation":[{"name":"Department of Radiology, Seattle Children\u2019s, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,7,13]]},"reference":[{"key":"bibr1-03635465211027178","unstructured":"2018-2019 High School Athletics Participation Survey. 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