Abstract
Introduction and aim
Arthroscopy is a well-established method for grading cartilage lesions. This study was undertaken to evaluate the inter-observer variance of grading cartilage lesions in a real life operation.
Materials and methods
Four experienced arthroscopic surgeons used diagnostic arthroscopy, one after the other, to grade cartilage lesions in a total of 16 patients who had undergone knee arthroscopy.
Results
In summary, a total of 14 cartilage areas in 16 patients were graded (n = 224). The Cohens (Fleiss) Kappa Index for multiple investigators was κ = 0.052 in the medial, κ = 0.300 in the central, and κ = 0.107 in the lateral surface of the patella. The indices were κ = 0.292 in the medial, κ = 0.0.255 in the central, and κ = 0.234 in the lateral surface of the trochlea. The inter-observer variance was κ = 0.193 in the MFC mean bearing zone, κ = 0.116 in the margin of the MFC, κ = 0.168 in the mean bearing zone of the TM, and κ = 0.164 in the TM margin. In the lateral compartment, the κ-Index was 0.309 in the LFC mean bearing zone, 0.111 in the margin of the LFC, 0.020 in the mean bearing zone of the TL, and 0.085 in the TL margin.
Conclusions
The inter-observer reliability of the arthroscopic grading of cartilage lesions is poor. The major problem is the relatively large variability in differentiating between intact cartilage and lesions that consist of the softening of the cartilage and the differentiation between superficial and deep cartilage lesions. In the future, objective measurements should be developed to solve this problem.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- KL-grade:
-
Radiological grade of osteoarthritis according to Kellgren–Lawrence [13]
- MFC:
-
Medial femoral condyle
- TM:
-
Medial tibia plateau
- LFC:
-
Lateral femoral condyle
- TL:
-
Lateral tibia plateau
- Mbz:
-
Mean bearing zone
References
Aroen A, Loken S, Heir S, Alvik E, Ekeland A, Granlund OG, Engebretsen L (2004) Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med 32:211–215
Ayral X, Gueguen A, Ike RW, Bonvarlet JP, Frizziero L, Kalunian K, Moreland LW, Myers S, O’Rourke KS, Roos H, Altman R, Dougados M (1998) Inter-observer reliability of the arthroscopic quantification of chondropathy of the knee. Osteoarthritis Cartilage 6:160–166
Bortz J, Lienert GA (2008) Statistics for clinical investigation. Springer, Heidelberg
Brismar BH, Wredmark T, Movin T, Leandersson J, Svensson O (2002) Observer reliability in the arthroscopic classification of osteoarthritis of the knee. J Bone Joint Surg Br 84:42–47
Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85-A(2):58–69
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
Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG (1997) Cartilage injuries: a review of 31, 516 knee arthroscopies. Arthroscopy 13:456–460
Dougados M, Ayral X, Listrat V, Gueguen A, Bahuaud J, Beaufils P, Beguin JA, Bonvarlet JP, Boyer T, Coudane H (1994) The SFA system for assessing articular cartilage lesions at arthroscopy of the knee. Arthroscopy 10:69–77
Duda GN, Kleemann RU, Bluecher U, Weiler A (2004) A new device to detect early cartilage degeneration. Am J Sports Med 32:693–698
Hjelle K, Solheim E, Strand T, Muri R, Brittberg M (2002) Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 18:730–734
Javed A, Siddique M, Vaghela M, Hui AC (2002) Interobserver variations in intra-articular evaluation during arthroscopy of the knee. J Bone Joint Surg Br 84:48–49
Jerosch J, Castro WH, de Waal Malefijt MC, Busch M, van Kampen A (1997) Interobserver variation in diagnostic arthroscopy of the knee joint. “How really objective are arthroscopic findings?”. Unfallchirurg 100:782–786
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502
Marx RG, Connor J, Lyman S, Amendola A, Andrish JT, Kaeding C, McCarty EC, Parker RD, Wright RW, Spindler KP (2005) Multirater agreement of arthroscopic grading of knee articular cartilage. Am J Sports Med 33:1654–1657
Oakley SP, Lassere MN (2003) A critical appraisal of quantitative arthroscopy as an outcome measure in osteoarthritis of the knee. Semin Arthritis Rheum 33:83–105
Outerbridge RE (1957) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43:752–757
Spahn G, Klinger HM, Hofmann GO (2009) How valid is the arthroscopic diagnosis of cartilage lesions? Results of an opinion survey among highly experienced arthroscopic surgeons. Arch Orthop Trauma Surg 129:1117–1121
Spahn G, Plettenberg H, Kahl E, Klinger HM, Muckley T, Hofmann GO (2007) Near-infrared (NIR) spectroscopy. A new method for arthroscopic evaluation of low grade degenerated cartilage lesions. Results of a pilot study. BMC Musculoskelet Disord 8:47
Uchio Y, Ochi M, Adachi N, Kawasaki K, Iwasa J (2002) Arthroscopic assessment of human cartilage stiffness of the femoral condyles and the patella with a new tactile sensor. Med Eng Phys 24:431–435
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Spahn, G., Klinger, H.M., Baums, M. et al. 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 (2011). https://doi.org/10.1007/s00402-011-1259-8
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-011-1259-8