Center of Trauma and Orthopaedic Surgery Eisenach, Germany.
Am J Sports Med. 2010 Dec;38(12):2516-21. doi: 10.1177/0363546510376744. Epub 2010 Sep 16.
Mechanical tests to grade cartilage damage are limited by the instruments used and by the ability to access all areas of cartilage within a joint. Better methods to diagnose cartilage injury or degeneration are needed. Purpose/
To detect the interobserver variance of arthroscopic cartilage grading by subjective judgment using the International Cartilage Repair Society (ICRS) score and by objective measurement using near-infrared (NIR) spectroscopy. We hypothesized that objective measurement of cartilage lesions by NIR spectroscopy will yield more valid results than routine grading using the ICRS score.
Cohort study (diagnosis); Level of evidence, 2.
Fifteen patients undergoing arthroscopic knee operations were evaluated by 4 experienced arthroscopists independently. The cartilage lesions within the medial knee compartment were estimated by each observer using the ICRS grade and by measurements with a special arthroscopic NIR spectroscopy probe.
The ICRS grading had a poor interobserver agreement, with a mean Fleiss kappa index of κ = 0.173. Only in 10% (6 of 60) of judged cartilage areas did all 4 surgeons grade the cartilage areas with the same result. In 17 areas (28.3%), the surgeons had a variance of 2 or more grades. In the remaining cases, the surgeons varied within 1 grade. The objective NIR spectroscopy-obtained measurements of cartilage resulted in a significant correlation within the observers of R = 0.885 ± 0.036 (P < .001).
Our results of interobserver evaluation in real-time arthroscopic cartilage grading suggest that this subjective grading is not satisfactory. This study emphasizes the need for objective measurement techniques for arthroscopic cartilage grading. Near-infrared spectroscopy has a good interobserver correlation. Thus, this method could be developed in the future as a precise method of measuring cartilage lesions.
用于分级软骨损伤的机械测试受到所使用的仪器以及进入关节内所有软骨区域的能力的限制。需要更好的方法来诊断软骨损伤或退变。
目的/假设：通过国际软骨修复学会（ICRS）评分的主观判断和近红外（NIR）光谱的客观测量，检测关节镜下软骨分级的观察者间差异。我们假设 NIR 光谱对软骨病变的客观测量将比使用 ICRS 评分的常规分级产生更有效的结果。
队列研究（诊断）；证据水平，2。
15 名接受关节镜膝关节手术的患者由 4 名经验丰富的关节镜医生独立评估。每位观察者使用 ICRS 分级和特殊关节镜 NIR 光谱探头测量来评估内侧膝关节间隙的软骨病变。
ICRS 分级的观察者间一致性较差，Fleiss kappa 指数平均为κ=0.173。只有在 60 个判断的软骨区域中的 10%（6 个）中，所有 4 名外科医生对软骨区域的分级结果相同。在 17 个区域（28.3%）中，外科医生的分级差异为 2 个或更多等级。在其余情况下，外科医生的分级差异在 1 个等级内。观察者之间的 NIR 光谱获得的软骨测量值具有显著相关性，R=0.885±0.036（P<0.001）。
我们对实时关节镜软骨分级的观察者间评估结果表明，这种主观分级并不令人满意。本研究强调了关节镜软骨分级需要客观测量技术。近红外光谱具有良好的观察者间相关性。因此，这种方法将来可能会发展成为测量软骨病变的精确方法。
