Waciakowski D, Kohout A, Brožík J, Šponer P
Lékařská fakulta Plzeň, Univerzita Karlova Praha.
Fingerlandův ústav patologie, Fakultní nemocnice a Lékařská fakulta Hradec Králové, Univerzita Karlova Praha.
Acta Chir Orthop Traumatol Cech. 2024;91(2):88-95. doi: 10.55095/ACHOT2024/013.
Our study aims to compare the results of preoperative radiography and intraoperative visual assessment of the cartilage with histological assessment of joint surfaces of the medial and lateral compartments resected in patients during the total knee replacement.
The cohort included 20 patients (9 men and 11 women) with the mean age of 66.6 (±7.0) years who met the inclusion criteria of the study. Degenerative changes of the knee joint seen on a preoperative weight-bearing anteroposterior X-ray were evaluated according to the Kellgren-Lawrence grading system separately for the medial and lateral compartment. Based on the visual appearance, the condition of articular surfaces was assessed using the International Cartilage Repair Society Score (ICRS Grade). The histological assessment of degenerative changes was conducted by a pathologist with the use of the Osteoarthritis Research Society International Osteoarthritis Cartilage Histopathology Assessment System based on six grades of articular cartilage degeneration.
The mean degree of degenerative changes based on the radiological classification was assessed as 3.5 (±0.6) for the medial compartment and 2.1 (±0.4) for the lateral compartment. The visually assessed chondropathy according to the ICRS Grade was 3.7 (±0.6) for the medial femoral condyle and 1.8 (±1.0) for the lateral femoral condyle. The histological score obtained using the Osteoarthritis Research Society International Osteoarthritis Cartilage Histopathology Assessment was 4.9 (±1.1) for the medial femoral condyle and 2.4 (±0.7) for the lateral femoral condyle. In respect of the medial compartment, there was no statistically significant parametric correlation between the intraoperative visual assessment of the cartilage degeneration and the preoperative radiological grade r = 0.45. The histological assessment showed a statistically significant concordance both with the degree of chondropathy r = 0.76 and the radiological grade r = 0.64. In the lateral compartment, the parametric test showed a statistically significant concordance only between the radiological grade and the histological score r = 0.72. The correlation between the visual assessment of chondropathy and the radiological grade r = 0.27 as well as the histological score r = 0.24 was very low.
In our cohort assessing the early degenerative changes of the lateral compartment as well as the more advanced degenerative changes of the medial compartment, the correlation between the intraoperative assessment of cartilage degeneration as a diagnostic method to examine the lateral compartment and the preoperative radiological grade was not confirmed. Our results failed to confirm a better reporting value of the visual cartilage degeneration assessment of the lateral compartment as against the preoperative X-ray. The space width without narrowing on an X-ray has no reporting value for this compartment in case of varus deformity.
The results clearly indicate that the assessment of macroscopic appearance of the cartilage degeneration during arthroscopy does not necessarily guarantee good long-term clinical outcomes after high tibial osteotomy. The respective degrees of cartilage degeneration identified during the intraoperative visual assessment and the radiological grading of osteoarthritic changes did not correlate in either compartment. In the lateral compartment, the initial radiological and histological findings preceded the visually detectable cartilage changes.
knee, cartilage, osteoarthritis, radiology, histology, arthroscopy, osteotomy.
本研究旨在比较全膝关节置换患者术中对软骨的视觉评估及术前影像学评估结果与切除的内侧和外侧间室关节面组织学评估结果。
该队列包括20例符合研究纳入标准的患者（9例男性和11例女性），平均年龄66.6（±7.0）岁。根据Kellgren-Lawrence分级系统，分别对术前负重前后位X线片上所见的膝关节退变情况进行内侧和外侧间室评估。基于视觉外观，使用国际软骨修复协会评分（ICRS分级）评估关节面状况。由病理学家使用国际骨关节炎研究学会骨关节炎软骨组织病理学评估系统，基于关节软骨退变的六个等级对退变情况进行组织学评估。
基于放射学分类，内侧间室退变的平均程度评估为3.5（±0.6），外侧间室为2.1（±0.4）。根据ICRS分级，肉眼评估的内侧股骨髁软骨病为3.7（±0.6），外侧股骨髁为1.8（±1.0）。使用国际骨关节炎研究学会骨关节炎软骨组织病理学评估得到的组织学评分，内侧股骨髁为4.9（±1.1），外侧股骨髁为2.4（±0.7）。在内侧间室，软骨退变的术中视觉评估与术前放射学分级之间无统计学显著参数相关性，r = 0.45。组织学评估显示与软骨病程度（r = 0.76）和放射学分级（r = 0.64）均有统计学显著一致性。在外侧间室，参数检验显示仅放射学分级与组织学评分之间有统计学显著一致性，r = 0.72。软骨病视觉评估与放射学分级（r = 0.27）以及组织学评分（r = 0.24）之间的相关性非常低。
在我们评估外侧间室早期退变及内侧间室更严重退变的队列中，未证实将术中软骨退变评估作为检查外侧间室的诊断方法与术前放射学分级之间的相关性。我们的结果未能证实外侧间室软骨退变视觉评估相对于术前X线有更好的报告价值。对于内翻畸形情况，X线片上无狭窄的间隙宽度对该间室无报告价值。
结果清楚表明，关节镜检查时对软骨退变宏观外观的评估不一定能保证高位胫骨截骨术后良好的长期临床结果。术中视觉评估确定的软骨退变程度与骨关节炎改变的放射学分级在任何一个间室均无相关性。在外侧间室，最初的放射学和组织学发现先于肉眼可检测到的软骨变化。
膝关节；软骨；骨关节炎；放射学；组织学；关节镜检查；截骨术
