Near-infrared spectroscopy for arthroscopic evaluation of cartilage lesions: results of a blinded, prospective, interobserver study.

BACKGROUND

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/

HYPOTHESIS

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.

STUDY DESIGN

Cohort study (diagnosis); Level of evidence, 2.

METHODS

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.

RESULTS

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).

CONCLUSION

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.