关节镜国际软骨修复学会分类系统在猪软骨修复模型中仅有中等可靠性。

Arthroscopic International Cartilage Repair Society Classification System Has Only Moderate Reliability in a Porcine Cartilage Repair Model.

机构信息

Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland.

Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland.

出版信息

Am J Sports Med. 2021 May;49(6):1524-1529. doi: 10.1177/0363546521998006. Epub 2021 Mar 18.

DOI:10.1177/0363546521998006

PMID:33733882

Abstract

BACKGROUND

The International Cartilage Repair Society (ICRS) score was designed for arthroscopic use to evaluate the quality of cartilage repair.

PURPOSE

To evaluate the reliability of the ICRS scoring system using an animal cartilage repair model.

STUDY DESIGN

Controlled laboratory study.

METHODS

A chondral defect with an area of 1.5 cm was made in the medial femoral condyle of 18 domestic pigs. Five weeks later, 9 pigs were treated using a novel recombinant human type III collagen/polylactide scaffold, and 9 were left to heal spontaneously. After 4 months, the pigs were sacrificed, then 3 arthroscopic surgeons evaluated the medial femoral condyles via video-recorded simulated arthroscopy using the ICRS scoring system. The surgeons repeated the evaluation twice within a 9-month period using their recorded arthroscopy.

RESULTS

The porcine cartilage repair model produced cartilage repair tissue of poor to good quality. The mean ICRS total scores for all observations were 6.6 (SD, 2.6) in arthroscopy, 5.9 (SD, 2.7) in the first reevaluation, and 6.2 (SD, 2.8) in the second reevaluation. The interrater reliability with the intraclass correlation coefficient (ICC) for the ICRS total scores (ICC, 0.46-0.60) and for each individual subscore (ICC, 0.26-0.71) showed poor to moderate reliability. The intrarater reliability with the ICC also showed poor to moderate reliability for ICRS total scores (ICC, 0.52-0.59) and for each individual subscore (ICC, 0.29-0.58). A modified Bland-Altman plot for the initial arthroscopy and for the 2 reevaluations showed an evident disagreement among the observers.

CONCLUSION

In an animal cartilage repair model, the ICRS scoring system seems to have poor to moderate reliability.

CLINICAL RELEVANCE

Arthroscopic assessment of cartilage repair using the ICRS scoring method has limited reliability. We need more objective methods with acceptable reliability to evaluate cartilage repair outcomes.

摘要

背景

国际软骨修复学会（ICRS）评分系统专为关节镜使用而设计，用于评估软骨修复质量。

目的

使用动物软骨修复模型评估 ICRS 评分系统的可靠性。

研究设计

对照实验室研究。

方法

在 18 头家猪的股骨内侧髁上造成 1.5cm² 的软骨缺损。5 周后，9 头猪使用新型重组人 III 型胶原/聚乳酸支架治疗，9 头猪自然愈合。4 个月后，处死猪，然后 3 名关节镜外科医生通过视频记录的模拟关节镜检查使用 ICRS 评分系统评估股骨内侧髁。外科医生在 9 个月内使用记录的关节镜重复评估 2 次。

结果

猪软骨修复模型产生了从差到好的软骨修复组织。所有观察结果的 ICRS 总评分平均值为关节镜检查中的 6.6（标准差，2.6），第一次重新评估中的 5.9（标准差，2.7）和第二次重新评估中的 6.2（标准差，2.8）。评分者间的可靠性（ICC）的 ICRS 总分（ICC，0.46-0.60）和每个单独的亚评分（ICC，0.26-0.71）的可靠性为差到中等。ICRS 总分（ICC，0.52-0.59）和每个单独的亚评分（ICC，0.29-0.58）的评分者内可靠性也显示出差到中等的可靠性。初始关节镜检查和 2 次重新评估的改良 Bland-Altman 图显示观察者之间存在明显的不一致。