Haptic visual and superimposed digital imaging analysis improves the interrater reliability of J-sign assessment in patients with patellofemoral instability: a prospective diagnostic study
Background: J-sign assessment is increasingly important for decision-making in patients with patellar instability. However, the low interrater reliability of the J-sign evaluation has raised concerns. The aim of this study was to investigate whether haptic visual assessment or superimposed digital i...
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| Main Authors: | , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2 December 2025
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| In: |
Journal of Clinical Medicine
Year: 2025, Volume: 14, Issue: 23, Pages: 1-9 |
| ISSN: | 2077-0383 |
| DOI: | 10.3390/jcm14238559 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.3390/jcm14238559 Verlag, lizenzpflichtig, Volltext: https://www.mdpi.com/2077-0383/14/23/8559 
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| Author Notes: | Felix Zimmermann, Eric Mandelka, Jula Gierse, Paul Alfred Grützner, Sven Y. Vetter and Peter Balcarek |
| Summary: | Background: J-sign assessment is increasingly important for decision-making in patients with patellar instability. However, the low interrater reliability of the J-sign evaluation has raised concerns. The aim of this study was to investigate whether haptic visual assessment or superimposed digital imaging analysis might improve interrater reliability. Methods: In 51 patients with ≥ 1 patellar dislocation, J-sign grading was assessed by two experienced observers via three different methods: (i) plain visual evaluation; (ii) combined haptic visual assessment, including palpation of the medial and lateral patellar facets with the thumb and index finger during active knee joint motion; and (iii) a digital photo application tool using superimposed digital imaging analysis obtained at 90° of flexion–knee joint flexion and full extension. Results: For the visual assessment of the J-sign, the interrater reliability was fair, with κ = 0.39 ± 0.11 [0.18–0.6]. The interrater reliability of the haptic visual assessment and the photo application reached a good level of agreement, with κ = 0.89 ± 0.05 [0.8–0.98] and κ = 0.85 ± 0.05 [0.74–0.95], respectively. Conclusions: Plain visual evaluation of the J-sign revealed fair interrater reliability. The haptic visual assessment of the J-sign and the digital photo application tool yielded good interrater reliability. The results indicate that haptic visual assessment of J-sign should be implemented in daily clinical practice and used to communicate findings between and among physicians and studies. |
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| Item Description: | Veröffentlicht: 2. Dezember 2025 Gesehen am 25.02.2026 |
| Physical Description: | Online Resource |
| ISSN: | 2077-0383 |
| DOI: | 10.3390/jcm14238559 |