Van der Wal Robert J P, Ottevanger Jaap W, de Rooij Theo P W, Thomassen Bregje J W, Van Arkel Ewoud R A
Department of Orthopaedic Surgery and Traumatology, Medical Center Haaglanden, The Hague, The Netherlands.
Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands.
J Knee Surg. 2017 Mar;30(3):276-282. doi: 10.1055/s-0036-1584536. Epub 2016 Jul 1.
The objective of the study was the determination of the intra- and interobserver agreement of three magnetic resonance imaging (MRI) criteria for reparability: a peripheral rim smaller than 4 mm, a tear longer than 10 mm, and homogenous aspect of meniscal tissue. In two rounds with an interval of at least 6 weeks, three orthopedic surgeons and three musculoskeletal radiologists studied the preoperative MRI scans of 63 patients with a longitudinal full-thickness medial or lateral meniscal tear. All patients had an arthroscopic meniscal repair. The blinded images were evaluated measuring the tear length and rim width and meniscal aspect was classified. Agreement was calculated using the linear-weighted kappa coefficient () and the intraclass correlation coefficient (ICC). Examiner agreement strength was defined according to the guidelines of Landis and Koch. Intraobserver agreement was poor to good (, 0.12-0.72) for the classification of the meniscal aspect and decreased in lateral meniscal tears. The interobserver agreement for meniscal aspect was mainly poor to fair (, 0.09-0.53). The intraobserver reliability for measurement of the length of the meniscal tear was moderate to excellent (ICC, 0.51-0.80) for all observers in both rounds and moderate to good (ICC, 0.59-0.73) for measurement of the peripheral rim width. The interobserver agreement on tear length and rim width was moderate in both rounds (ICC, 0.58 and 0.50 in round 1; 0.50 and 0.50 in round 2, respectively). Tear length and rim width are the only two measurements with moderate to good agreement. However, these measurements do not predict reparability of longitudinal meniscal tears on MRI images.
本研究的目的是确定用于判断半月板可修复性的三个磁共振成像（MRI）标准在观察者内和观察者间的一致性：外周缘小于4毫米、撕裂长度大于10毫米以及半月板组织的均匀性。在间隔至少6周的两轮研究中，三名骨科医生和三名肌肉骨骼放射科医生对63例患有纵向全层内侧或外侧半月板撕裂的患者的术前MRI扫描图像进行了研究。所有患者均接受了关节镜下半月板修复术。对图像进行盲法评估，测量撕裂长度和边缘宽度，并对半月板外观进行分类。使用线性加权kappa系数（）和组内相关系数（ICC）计算一致性。根据Landis和Koch的指南定义检查者一致性强度。观察者内对半月板外观分类的一致性为差到好（，0.12 - 0.72），在外侧半月板撕裂中有所下降。观察者间对半月板外观的一致性主要为差到一般（，0.09 - 0.53）。在两轮研究中，所有观察者对半月板撕裂长度测量的观察者内可靠性为中等至优秀（ICC，0.51 - 0.80），对外周缘宽度测量的可靠性为中等至良好（ICC，0.59 - 0.73）。两轮研究中观察者间对撕裂长度和边缘宽度的一致性均为中等（第一轮中ICC分别为0.58和0.50；第二轮中ICC分别为0.50和0.50）。撕裂长度和边缘宽度是仅有的两个一致性中等至良好的测量指标。然而，这些测量指标并不能预测MRI图像上纵向半月板撕裂的可修复性。
