Arthroscopic estimation of the extent of chondropathy.
ABSTRACT Arthroscopy has been used to evaluate articular cartilage (AC) pathology in osteoarthritis (OA) for outcome measurement and validation of non-invasive imaging. However, many fundamental aspects of arthroscopic assessment remain un-validated.
This study evaluated arthroscopic estimates of extent of chondropathy.
Serial arthroscopic assessments were performed in a group of 15 sheep before and after bilateral stifle medial meniscectomy (MMx). Post-mortem assessments were performed in un-MMx sheep and 4 and 16 weeks post-MMx. Arthroscopic assessments of the extent of each grade of chondropathy were compared with a non-arthroscopic hybrid assessment that incorporated biomechanical, thickness and macroscopic assessments.
Arthroscopy evaluated only 36% of AC and missed significant pathological changes, softening and chondro-osteophyte, occurring in peripheral regions. The patterns of change in arthroscopic assessments were similar to those of the non-arthroscopic assessment but there was a very strong tendency to over-estimate the extent of softened AC after MMx. In spite of these limitations arthroscopic assessments were responsive to change. Estimates of the extent of normal and softened AC were most responsive to change over time followed by estimates of superficial and deep fibrillation. Arthroscopy was as an excellent discriminator between normal and OA. Assessments of chondro-osteophyte and exposed bone were not responsive to change.
Arthroscopic estimates of extent of chondropathy are prone to substantial error. While experience and training may reduce these errors other approaches may more effectively improve performance.
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ABSTRACT: Arthroscopic and particularly histopathological assessments have been used to evaluate alterations of knee cartilage in osteoarthritis (OA). The aim of this study was to examine the correlation between an arthroscopic method to grade the severity of chondropathies and the histological/histochemical grading system (HHGS) applied to the corresponding articular cartilage areas in knee OA. The articular cartilage surface was examined by chondroscopy using the Beguin and Locker severity criteria, analysing the lesions in 72 chondroscopic areas. Afterwards, samples were obtained by dividing the cartilage surface of the medial tibiofemoral compartment of three OA knee joints into equal squares and they were evaluated histologically using the HHGS. The correlation between both grading methods was assessed using the weighted Kappa coefficient (K(w)). The results obtained with both scores showed good agreement (K(w): mean+/-standard deviation, 0.619+/-0.071). While the average HHGS scores of the chondral samples showed a better agreement with arthroscopic grades 0, I and II, the arthroscopic evaluation has a tendency to overestimate chondral lesions for histological grades III and IV. The intra- and inter-observer reliability of the HHGS evaluation of chondral lesions was excellent (Intraclass Correlation Coefficient: 0.909 and 0.941, respectively). In this study, we found a good quantitative correlation between established arthroscopic severity and histopathological scoring systems, particularly in less advanced lesions. Our results suggest that the arthroscopic method is a valuable tool in clinical research to score chondropathies in the medial femorotibial compartment of the OA knee, although some limitations should not be overlooked.Osteoarthritis and Cartilage 09/2008; 17(2):205-12. · 4.26 Impact Factor
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ABSTRACT: Purpose: To present a new method of arthroscopic measurement of the surface and location of condylar lesions. Methods: We propose measuring the height of the condylar lesion by using the lesion’s arc (Δ°) obtained from the difference between the angle of flexion at the beginning of the lesion and the angle of flexion at the end of the lesion. The first goal of the study was to determine the intra and inter reliability of the lesion’s arc. Experiment 1: 20 deep lesions were evaluated using the lesional arc by two arthroscopists. Experiment 2: In a second series of 20 lesions, the flexion angles of the knees were recorded using a goniometer. All 10 knees (5 in each series) were then disarticulated and the true lesion arc was checked with a goniometer to assess the validity of the scopic measurements. The second goal was to obtain the height of the lesion from the lesion’s arc. The lesion arc Δ° of the condylar is converted into height (millimeters) on the basis of a table obtained from 5 standard profiles of the lateral X-ray of the knee. Results: Experiment 1: The intra observer reliability was good but the inter observer reliability was poor. Experiment 2: The intra and inter observers’ reliability were good. On the anatomic control after disarticulating the knee, the confidence interval was narrower when using the goniometer. Conclusions: We propose a simple, reliable method to measure the height of a condylar lesion with the lesion’s arc during arthroscopy.Cartilage 01/2011; 2(3):237-245.