Spahn Gunter, Klinger H Michael, Hofmann Gunther O
Center of Trauma and Orthopaedic Surgery, Eisenach, Germany.
Arch Orthop Trauma Surg. 2009 Aug;129(8):1117-21. doi: 10.1007/s00402-009-0868-y. Epub 2009 Apr 15.
In general, arthroscopy is considered the "gold standard" for the evaluation of cartilage lesions. In this multicenter survey, we ascertained the general opinion of surgeons regarding arthroscopic cartilage diagnoses.
A total of 301 highly experienced arthroscopists (instructors of the AGA, the German-speaking society of arthroscopy) were contacted in writing with a request to complete the survey.
The data from 105 respondents (34.8% of those contacted) were used for the investigation. In the grading of the cartilage lesions, the Outerbridge classification was most frequently used (n = 87), followed by the ICRS protocol (n = 8) and the Insall score (n = 3). The majority (61%) of the arthroscopic surgeons felt that differentiation between healthy cartilage and low-grade cartilage lesions was simple. For differentiation between grade I and grade II lesions, and for differentiation between grade II and grade III lesions, 41.9 and 51.4%, respectively, thought that there was a "need for improvement". In the case of grade IV lesions, 70.5% of the surgeons thought that the diagnosis was valid. The respondents also judged the utility of incorporating objective measurements (e.g., intraoperative biomechanical tests): 13.3% (n = 14) responded that such measurements would be "very useful" and 61.9% (n = 65) responded that they would be "somewhat useful".
Among surgeons, arthroscopy was not perceived to be as reliable as a "gold standard" for the diagnosis of cartilage lesions. The majority of experienced arthroscopists felt unsure of the results in general, or at least in some cases. A universal and definitive grading system for lesions appears to be needed. For questionable cases, measurement devices are needed for objective cartilage grading.
一般而言，关节镜检查被认为是评估软骨损伤的“金标准”。在这项多中心调查中，我们确定了外科医生对关节镜下软骨诊断的总体看法。
我们书面联系了总共301名经验丰富的关节镜医生（德语区关节镜学会AGA的教员），要求他们完成调查。
105名受访者（占被联系者的34.8%）的数据用于调查。在软骨损伤分级方面，最常使用的是Outerbridge分类法（n = 87），其次是ICRS方案（n = 8）和Insall评分（n = 3）。大多数（61%）关节镜外科医生认为区分健康软骨和低度软骨损伤很简单。对于I级和II级损伤的区分，以及II级和III级损伤的区分，分别有41.9%和51.4%的人认为“需要改进”。对于IV级损伤，70.5%的外科医生认为诊断是有效的。受访者还对纳入客观测量（如术中生物力学测试）的实用性进行了评判：13.3%（n = 14）的受访者表示此类测量“非常有用”，61.9%（n = 65）的受访者表示“有点用”。
在外科医生中，关节镜检查在软骨损伤诊断方面并未被视为像“金标准”那样可靠。大多数经验丰富的关节镜医生总体上或至少在某些情况下对结果感到不确定。似乎需要一个通用且明确的损伤分级系统。对于有疑问的病例，需要测量设备来进行客观的软骨分级。
