Skip to main content
SpringerLink
Log in

The relevance of knee arthroscopy photographs in medicolegal proceedings

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Whether photographs included in the operative report of knee arthroscopies can make the surgeon liable in the event of a legal investigation remains unknown. The main objective of this study was to establish inter-observer reliability in determining the presence or absence of lesions of the cartilage, meniscus and anterior cruciate ligament (ACL). Secondary objective was to assess the inter-observer reliability in classifying lesions.

Method

A retrospective observational study was conducted in a continuous serie of 60 patients who underwent knee arthroscopy from the same operator. The photographs of each patient's operative report were presented separately to three experts, blinded to each other. Each expert had to decide on the presence or absence of injuries to the following structures: meniscal, cartilage and ACL and then, classify it. Primary and secondary endpoints were evaluated using the Fleiss' kappa index.

Results

Inter-observer reliability for lesion detection was between 0.4 and 0.61 for all structures with three exceptions: for cartilage, it was low (0.15) at the lateral tibial plateau and poor (-0.01) at the external condyle. On the contrary, the concordance was almost perfect (0.8) for the ACL. For classifying cartilaginous and meniscal lesions, inter-observer reliability was poor (from 0.03 to 0.14), except for at the lateral meniscus (0.65).

Conclusion

Inter-observer reliability of arthroscopic knee diagnoses is poor when photographs alone are used. In the event of a legal investigation following knee arthroscopy, the photographs included in the operative report should not be used alone to hold the surgeon liable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

Not applicable.

Code availability

Not applicable.

References

  1. Brismar BH, Wredmark T, Movin T et al (2002) Observer reliability in the arthroscopic classification of osteoarthritis of the knee. J Bone Joint Surg Br 84:42–47

    Article  CAS  PubMed  Google Scholar 

  2. Friberger Pajalic K, Turkiewicz A, Englund M (2018) Update on the risks of complications after knee arthroscopy. BMC Musculoskelet Disord 19:179

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rougereau G, Kavakelis T, Sailhan F et al (2021) Postoperative pain and infection are the most frequent reasons for legal action after knee arthroscopy: a 5-year review based on two private insurance French companies after arthroscopy. Knee Surg Sports Traumatol Arthrosc 29:3551–3559

    Article  PubMed  Google Scholar 

  4. Kn S, Aem E, S P, et al (2018) Medical Malpractice Litigation Following Arthroscopic Surgery. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 34:7

    Google Scholar 

  5. Lubowitz JH, Brand JC, Rossi MJ (2018) Malpractice Litigation After Arthroscopy. Arthroscopy 34:2009

    Article  PubMed  Google Scholar 

  6. Behairy NH, Dorgham MA, Khaled SA (2009) Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee: comparison with arthroscopy. Int Orthop 33:961–967

    Article  PubMed  Google Scholar 

  7. Hernigou P, Karam S, Khaled I (2023) Scoping out the past: meniscus examination with arthroscopy; the light arrived in the knee before the end of World War I with the cystoscope, Fresnel’s lens, and Edison’s lamp. Int Orthop 47:2601–2614

    Article  PubMed  Google Scholar 

  8. Nickinson R, Darrah C, Donell S (2010) Accuracy of clinical diagnosis in patients undergoing knee arthroscopy. Int Orthop 34:39–44

    Article  PubMed  Google Scholar 

  9. Erivan R, Tardieu A, Villatte G et al (2020) Knee surgery trends and projections in France from 2008 to 2070. Orthop Traumatol Surg Res 106:893–902

    Article  PubMed  Google Scholar 

  10. Kim S, Bosque J, Meehan JP et al (2011) Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 93:994–1000

    Article  PubMed  Google Scholar 

  11. Anderson AF, Irrgang JJ, Dunn W et al (2011) Interobserver reliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears. Am J Sports Med 39:926–932

    Article  PubMed  Google Scholar 

  12. Cameron ML, Briggs KK, Steadman JR (2003) Reproducibility and reliability of the outerbridge classification for grading chondral lesions of the knee arthroscopically. Am J Sports Med 31:83–86

    Article  PubMed  Google Scholar 

  13. Marx RG, Connor J, Lyman S et al (2005) Multirater agreement of arthroscopic grading of knee articular cartilage. Am J Sports Med 33:1654–1657

    Article  PubMed  Google Scholar 

  14. Spahn G, Klinger HM, Baums M et al (2011) Reliability in arthroscopic grading of cartilage lesions: results of a prospective blinded study for evaluation of inter-observer reliability. Arch Orthop Trauma Surg 131:377–381

    Article  PubMed  Google Scholar 

  15. Dunn WR, Wolf BR, Amendola A et al (2004) Multirater agreement of arthroscopic meniscal lesions. Am J Sports Med 32:1937–1940

    Article  PubMed  Google Scholar 

  16. Javed A, Siddique M, Vaghela M, Hui ACW (2002) Interobserver variations in intra-articular evaluation during arthroscopy of the knee. J Bone Joint Surg Br 84:48–49

    Article  CAS  PubMed  Google Scholar 

  17. Dwyer T, Martin CR, Kendra R et al (2017) Reliability and Validity of the Arthroscopic International Cartilage Repair Society Classification System: Correlation With Histological Assessment of Depth. Arthroscopy 33:1219–1224

    Article  PubMed  Google Scholar 

  18. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  19. Hoshino Y, Rothrauff BB, Hensler D et al (2016) Arthroscopic image distortion-part I: the effect of lens and viewing angles in a 2-dimensional in vitro model. Knee Surg Sports Traumatol Arthrosc 24:2065–2071

    Article  PubMed  Google Scholar 

  20. Hoshino Y, Rothrauff BB, Hensler D et al (2016) Arthroscopic image distortion-part II: the effect of lens angle and portal location in a 3D knee model. Knee Surg Sports Traumatol Arthrosc 24:2072–2078

    Article  PubMed  Google Scholar 

  21. Shakoor D, Guermazi A, Kijowski R et al (2019) Cruciate ligament injuries of the knee: A meta-analysis of the diagnostic performance of 3D MRI. J Magn Reson Imaging 50:1545–1560

    Article  PubMed  Google Scholar 

  22. Randsborg P-H, Bukholm IRK, Jakobsen RB (2018) Compensation after treatment for anterior cruciate ligament injuries: a review of compensation claims in Norway from 2005 to 2015. Knee Surg Sports Traumatol Arthrosc 26:628–633

    Article  PubMed  Google Scholar 

  23. Shah KN, Eltorai AEM, Perera S et al (2018) Medical Malpractice Litigation Following Arthroscopic Surgery. Arthroscopy 34:2236–2244

    Article  PubMed  Google Scholar 

  24. Brown CH (1989) Producing still images in arthroscopy. Arthroscopy 5:87–92

    Article  PubMed  Google Scholar 

  25. Harting MT, DeWees JM, Vela KM, Khirallah RT (2015) Medical photography: current technology, evolving issues and legal perspectives. Int J Clin Pract 69:401–409

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Dr Gabriel Raybaud (data collection). Dr Sonja Murgier (translator)

Funding

The authors declare no funds, grants or other support were received during preparation of this manuscript. Financial interest: CH, TDR, BRD, BG and VM declare they have no financial interest. JB receives consultant honoraria from SBM, Arthrex and MoveUP and royalties from SBM and MoveUP without competing interest with the study. RP receives consultant honoraria from Xnov and Mathys without competing interest with the study.

Author information

Authors and Affiliations

  1. Service de Chirurgie de L’Arthrose Et du Sport, Urgences Traumatiques Des Membres, Hôpital Sud - CHU de Grenoble, 38000, Biarritz, France

    Clément Horteur, Thibault Della Rosa, Benoit Gaulin, Brice Rubens Duval & Johannes Barth

  2. Clinique Aguiléra, 21 Rue de L’Estagnas, Service de Chirurgie Orthopédique, 64200, Biarritz, France

    Vincent Morin

  3. Hôpital Privé Médipole de Savoie, Challes-Les-Eaux, France

    Régis Pailhe

Authors
  1. Clément Horteur
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thibault Della Rosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benoit Gaulin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vincent Morin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brice Rubens Duval
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Johannes Barth
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Régis Pailhe
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CH: writing of the manuscript. TDR: data collection. BG: photograph interpretation. VM: photographs interpretation. BRD: photographs interpretation. JB: proofreading and editing.

Corresponding author

Correspondence to Clément Horteur.

Ethics declarations

Ethics approval

This study was conducted in line with the principles of the Declaration of Helsinki. This is a retrospective observational study of routine healthcare in accordance with the MR004 French legislation, thus does not require ethical approval.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

All authors gave their consent for publication of this work.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Type of study and level of evidence: Single-center descriptive and analytical retrospective observational study. Level IV.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Horteur, C., Della Rosa, T., Gaulin, B. et al. The relevance of knee arthroscopy photographs in medicolegal proceedings. International Orthopaedics (SICOT) 48, 1133–1138 (2024). https://doi.org/10.1007/s00264-024-06129-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-024-06129-0

Keywords

Search

Navigation