St. Elizabeth's Medical Center, Boston, Massachusetts, U.S.A..
Stanford Medical Center, Stanford, California, U.S.A.
Arthroscopy. 2018 Aug;34(8):2429-2435. doi: 10.1016/j.arthro.2018.03.010. Epub 2018 May 24.
The purpose of this study was to compare the efficacy, accuracy, and safety of in-office diagnostic arthroscopy with magnetic resonance imaging (MRI) and surgical diagnostic arthroscopy.
A prospective, blinded, multicenter, clinical trial was performed on 110 patients, ages 18 to 75 years, who presented with knee pain. The study period was April 2012 to April 2013. Each patient underwent a physical examination, an MRI, in-office diagnostic imaging, and a diagnostic arthroscopic examination in the operating room. The attending physician completed clinical report forms comparing the in-office arthroscopic examination and surgical diagnostic arthroscopy findings on each patient. Two blinded experts, unaffiliated with the clinical care of the study's subjects, reviewed the in-office arthroscopic images and MRI images using the surgical diagnostic arthroscopy images as the "control" group comparison. Patients were consecutive, and no patients were excluded from the study.
In this study, the accuracy, sensitivity, and specificity of in-office arthroscopy was equivalent to surgical diagnostic arthroscopy and more accurate than MRI. When comparing in-office arthroscopy with surgical diagnostic arthroscopy, all kappa statistics were between 0.766 and 0.902. For MRI compared with surgical diagnostic arthroscopy, kappa values ranged from a low of 0.130 (considered "slight" agreement) to a high of 0.535 (considered "moderate" agreement). The comparison of MRI to in-office arthroscopy showed very similar results as the comparison of MRI with surgical diagnostic arthroscopy, ranging from a low kappa of 0.112 (slight agreement) to a high of 0.546 (moderate agreement). There were no patient-related or device-related complications related to the use of in-office arthroscopy.
Needle-based diagnostic imaging that can be used in the office setting is statistically equivalent to surgical diagnostic arthroscopy with regard to the diagnosis of intra-articular, nonligamentous knee joint pathology. In-office diagnostic imaging can provide a more detailed and accurate diagnostic assessment of intra-articular knee pathology than MRI. Based on the study results, in-office diagnostic imaging provides a safe, accurate, real-time, minimally invasive diagnostic modality to evaluate intra-articular pathology without the need for surgical diagnostic arthroscopy or high-cost imaging.
Level II, comparative prospective trial.
本研究旨在比较门诊关节镜检查与磁共振成像（MRI）和手术诊断性关节镜检查的疗效、准确性和安全性。
对 2012 年 4 月至 2013 年 4 月期间出现膝关节疼痛的 110 例 18 至 75 岁患者进行了前瞻性、盲法、多中心临床研究。每位患者均接受了体格检查、MRI、门诊关节镜成像和手术室诊断性关节镜检查。主治医生根据每位患者的情况填写了临床报告，比较了门诊关节镜检查和手术诊断性关节镜检查的结果。两名与研究对象临床护理无关的盲法专家使用手术诊断性关节镜图像作为“对照”组比较，对门诊关节镜图像和 MRI 图像进行了评估。所有患者均为连续纳入，且无患者被排除出研究。
在本研究中，门诊关节镜检查的准确性、灵敏度和特异性与手术诊断性关节镜检查相当，且比 MRI 更准确。当将门诊关节镜检查与手术诊断性关节镜检查进行比较时，所有kappa 统计值均在 0.766 至 0.902 之间。与手术诊断性关节镜检查相比，MRI 的 kappa 值范围从低至 0.130（轻度一致）到高至 0.535（中度一致）。MRI 与门诊关节镜检查的比较结果与 MRI 与手术诊断性关节镜检查的比较结果非常相似，kappa 值范围从低至 0.112（轻度一致）到高至 0.546（中度一致）。与门诊关节镜检查相关的患者或设备相关并发症发生率为零。
在办公室环境中使用的基于针的诊断性成像在诊断关节内、非韧带膝关节病变方面与手术诊断性关节镜检查在统计学上等效。门诊关节镜检查可提供更详细、更准确的关节内膝关节病变诊断评估，优于 MRI。基于研究结果，门诊关节镜检查提供了一种安全、准确、实时、微创的诊断方式，可在无需手术诊断性关节镜检查或高成本成像的情况下评估关节内病变。
II 级，比较性前瞻性试验。
