The reliability of the patellotrochlear index on magnetic resonance imaging for measuring patellofemoral height.

BACKGROUND: The purpose of this study was to determine the inter- and intra-observer reliability of the patellotrochlear index (PTI) on magnetic resonance images (MRI) in patients with patellofemoral pain. The correlation between the PTI measured on MRI and the modified Insall-Salvati (MIS) ratio measured on radiographs was also assessed. METHODS: The PTI was assessed on MRI images and the MIS ratio on radiographs of 66 knees of 62 patients. Assessment was performed by two orthopaedic surgeons, one orthopaedic surgery registrar, two radiologists and one radiology registrar. Correlation coefficients, standard errors of measurement and limits of agreement were calculated for the PTI. To assess the association between the PTI and the MIS ratio, the Pearson's correlation coefficient was calculated. RESULTS: The PTI showed good interobserver reliability (intraclass correlation coefficient (ICC) 0.79; 95% confidence interval (CI) 0.73-0.85) and excellent intra-observer reliability (ICC 0.90; 95% CI 0.89-0.91). The standard error of measurement was 0.05 and limits of agreement with the mean ± 0.09. A very weak and not significant correlation was found between the PTI and the MIS (r = 0.02; P = 0.77). CONCLUSIONS: The PTI showed good interobserver reliability and excellent intra-observer reliability. In order to conclude which measurement method of assessing patellar height is truly the most reliable, future studies should investigate agreement parameters (standard error of measurement, limits of agreement) besides solely correlation coefficients. We found a very weak correlation between the PTI and the MIS which suggests that at least one index has poor validity. Future validity studies on indices to assess patellar height are necessary.

Impact of time interval between multidisciplinary team meeting and intended pancreatoduodenectomy on oncological outcomes.

BACKGROUND: Dutch guidelines indicate that treatment of pancreatic head and periampullary malignancies should be started within 3 weeks of the multidisciplinary team (MDT) meeting. This study aimed to assess the impact of time to surgery on oncological outcomes. METHODS: This was a retrospective population-based cohort study of patients with pancreatic head and periampullary malignancies included in the Netherlands Cancer Registry. Patients scheduled for pancreatoduodenectomy and who were discussed in an MDT meeting from May 2012 to December 2016 were eligible. Time to surgery was defined as days between the final preoperative MDT meeting and surgery, categorized in tertiles (short interval, 18 days or less; intermediate, 19-32 days; long, 33 days or more). Oncological outcomes included overall survival, resection rate and R0 resection rate. RESULTS: A total of 2027 patients were included, of whom 677, 665 and 685 had a short, intermediate and long time interval to surgery respectively. Median time to surgery was 25 (i.q.r. 14-36) days. Longer time to surgery was not associated with overall survival (hazard ratio 0·99, 95 per cent c.i. 0·87 to 1·13; P = 0·929), resection rate (relative risk (RR) 0·96, 95 per cent c.i. 0·91 to 1·01; P = 0·091) or R0 resection rate (RR 1·01, 0·94 to 1·09; P = 0·733). Patients with pancreatic ductal adenocarcinoma and a long time interval had a lower resection rate (RR 0·92, 0·85 to 0·99; P = 0·029). DISCUSSION: A longer time interval between the last MDT meeting and pancreatoduodenectomy did not decrease overall survival.

ANTECEDENTES: Las guías holandesas señalan que el inicio del tratamiento de los cánceres de cabeza de páncreas o periampulares se realice durante las tres semanas posteriores a la reunión del equipo multidisciplinar. Este estudio tuvo como objetivo evaluar la repercusión del tiempo transcurrido hasta la cirugía en los resultados oncológicos. MÉTODOS: Se trataba de un estudio de cohortes retrospectivo de base poblacional de pacientes con tumores pancreáticos de cabeza y periampulares a partir del registro de cáncer holandés. Se incluyeron los pacientes programados para duodenopancreatectomía cefálica discutidos en una reunión de equipo multidisciplinario entre mayo de 2012 y diciembre de 2016. El tiempo hasta la cirugía se definió como los días transcurridos entre la reunión final del equipo multidisciplinar y la cirugía, clasificándose en terciles (corto ≤ 18 días; intermedio 19-32 días; largo ≥ 33 días). Los resultados oncológicos analizados fueron la supervivencia global, la tasa de resección y la tasa de resección R0. RESULTADOS: Se incluyeron 2.027 pacientes, de los que 677, 665 y 685 correspondieron a los terciles de intervalo corto, intermedio y largo, respectivamente. La mediana del tiempo hasta la cirugía fue de 25 días (rango intercuartílico 14-36). La existencia de un intervalo de tiempo largo hasta la cirugía no se asociaba con la supervivencia global (cociente de riesgos instantáneos, hazard ratio, HR 0,99; i.c. del 95% 0,87-1,13; P = 0,93), la tasa de resección (riesgo relativo, RR 0,96; i.c. del 95% 0,91-1,01; P = 0,09) o la tasa de resección R0 (RR 1,01; i.c. del 95% 0,94-1,09; P = 0,73). Los pacientes con adenocarcinoma ductal pancreático y mayor intervalo tuvieron una tasa de resección más baja (RR 0,92; i.c. del 95%: 0,85-0,99; P = 0,03). CONCLUSIÓN: Un mayor intervalo de tiempo entre la última reunión del equipo multidisciplinar y la duodenopancreatectomía cefálica no disminuyó la supervivencia global.