Di Laura Frattura Giorgio, Sangiorgio Alessandro, Poggi Alberto, Busacca Maurizio, Del Grande Filippo, Vincenzo Gabriele, Bordoni Vittorio, Filardo Giuseppe
Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland.
Unità di Ortopedia e Traumatologia, Ospedale di Vignola, Modena, Italy.
Arch Orthop Trauma Surg. 2025 May 16;145(1):300. doi: 10.1007/s00402-025-05858-0.
Bone bruise is a common consequence of trauma. Its presence, size, and shape correlate with articular damage and symptoms evolution. Purpose of this study was to identify, among the most used quantitative and semi-quantitative evaluation strategies, the most reliable method to evaluate bone bruise in knees with anterior cruciate ligament (ACL) injury.
Knee Magnetic Resonance Imaging (MRI) of 100 ACL-injured patients were selected. Bone bruise characteristics were assessed by five different evaluators applying Whole Organ Magnetic Resonance Scoring (WORMS) and MRI Osteoarthritis Knee Score (MOAKS). Bone bruise area was measured freehand using Intellispace PACS Enterprise. A topographic assessment in the coronal view was performed to evaluate reproducibility between different operators. Inter and intra-rater agreement were calculated with Fleiss-k for WORMS, MOAKS, and topographic evaluation, and with intra-class correlation (ICC) for area measurement.
Bone bruise presence was reported in 63-65% of cases in the lateral femoral condyle, 42-48% in the medial femoral condyle, 80-82% in the lateral tibial plateau, 53-61% in the tibial sulcus, and 40-42% in the medial tibial plateau, with a substantial to almost perfect agreement (Fleiss-k 0.67-0.89). Inter-rater agreement was classified as moderate for WORMS and MOAKS (Fleiss-k = 0.46 and 0.45, respectively), while the area measurement resulted in a poor agreement (ICC = 0.44). Intra-rater agreement was classified as almost perfect for WORMS and MOAKS (Fleiss-k = 0.91 and 0.90, respectively), while the area measurement resulted in a good agreement (ICC = 0.79).
Semi-quantitative scores outperformed the quantitative evaluation of bone bruise. WORMS and MOAKS both resulted in a moderate inter-rater agreement, while bone bruise area assessment showed poor reliability. Intra-rater reliability confirmed the advantages of the semi-quantitative approach versus the quantitative one, being good for the area measurement while almost perfect when both WORMS and MOAKS scores were used to assess bone bruise in ACL-injured knees.
骨挫伤是创伤的常见后果。其存在、大小和形状与关节损伤及症状演变相关。本研究的目的是在最常用的定量和半定量评估策略中，确定评估前交叉韧带（ACL）损伤膝关节骨挫伤的最可靠方法。
选取100例ACL损伤患者的膝关节磁共振成像（MRI）。由五名不同的评估者应用全器官磁共振评分（WORMS）和MRI膝关节骨关节炎评分（MOAKS）评估骨挫伤特征。使用Intellispace PACS Enterprise徒手测量骨挫伤面积。在冠状面进行地形评估以评估不同操作者之间的可重复性。使用Fleiss-k计算WORMS、MOAKS和地形评估的评分者间一致性，使用组内相关系数（ICC）计算面积测量的一致性。
外侧股骨髁63%-65%的病例、内侧股骨髁42%-48%的病例、外侧胫骨平台80%-82%的病例、胫骨沟53%-61%的病例以及内侧胫骨平台40%-42%的病例报告有骨挫伤，一致性从中度到几乎完美（Fleiss-k 0.67-0.89）。WORMS和MOAKS的评分者间一致性为中度（Fleiss-k分别为0.46和0.45），而面积测量的一致性较差（ICC = 0.44）。WORMS和MOAKS的评分者内一致性为几乎完美（Fleiss-k分别为0.91和0.90），而面积测量的一致性良好（ICC = 0.79）。
半定量评分在骨挫伤的评估方面优于定量评估。WORMS和MOAKS的评分者间一致性均为中度，而骨挫伤面积评估的可靠性较差。评分者内可靠性证实了半定量方法相对于定量方法的优势，面积测量时一致性良好，而使用WORMS和MOAKS评分评估ACL损伤膝关节的骨挫伤时几乎完美。
