Blackburn W D, Bernreuter W K, Rominger M, Loose L L
Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham.
J Rheumatol. 1994 Apr;21(4):675-9.
To compare radiographic, magnetic resonance imaging (MRI), and outpatient direct arthroscopic evaluation of cartilage in patients with osteoarthritis (OA) of the knee.
Thirty-three patients with OA of the knee were evaluated by plain weight bearing radiographs and arthroscopy using a 1.9 mm arthroscope under local anesthesia. Sixteen of these patients also had MRI of the knee performed. Knee compartments were evaluated using AP weight bearing and lateral radiographs of the knee. MRI and outpatient arthroscopic grading of cartilage were performed within 2 weeks of the plain radiographs. The MRI and arthroscopic evaluations were performed independently and were graded without knowledge of the other.
In patients in whom plain radiographs, MRI, and arthroscopy were compared, the plain radiographs and MRI significantly underestimated the extent of cartilage abnormalities. There was a moderate correlation between imaged cartilage scores and the arthroscopy scores (Pearson correlation coefficient = 0.40). The arthroscopic scores were reproducible with good intra and inter-observer reliability. The arthroscopic procedure was well tolerated and actually preferred over the MRI by the majority of patients. No significant complications were noted as a result of arthroscopy.
Our results indicate that outpatient arthroscopic evaluation is a useful method in evaluating surface cartilage abnormalities and is more sensitive in detecting these abnormalities than either plain radiographs or MRI. Outpatient arthroscopic evaluation of cartilage appears to be a safe, sensitive, and a well tolerated tool for evaluating patients with OA of the knee and may prove to be particularly useful in evaluating response to therapeutic interventions.
比较骨关节炎（OA）患者膝关节软骨的X线、磁共振成像（MRI）及门诊直接关节镜评估。
33例膝关节OA患者接受了负重位X线平片检查，并在局部麻醉下使用1.9mm关节镜进行关节镜检查。其中16例患者还进行了膝关节MRI检查。通过膝关节前后位负重位和侧位X线片评估膝关节各间室。在X线平片检查后2周内进行MRI和门诊关节镜软骨分级。MRI和关节镜评估独立进行，且在不知道对方结果的情况下进行分级。
在对X线平片、MRI和关节镜检查结果进行比较的患者中，X线平片和MRI显著低估了软骨异常的程度。成像软骨评分与关节镜评分之间存在中度相关性（Pearson相关系数=0.40）。关节镜评分具有可重复性，观察者内和观察者间的可靠性良好。关节镜检查耐受性良好，大多数患者实际上更喜欢关节镜检查而非MRI检查。关节镜检查未发现明显并发症。
我们的结果表明，门诊关节镜评估是评估表面软骨异常的一种有用方法，在检测这些异常方面比X线平片或MRI更敏感。门诊关节镜软骨评估似乎是一种安全、敏感且耐受性良好的工具，可用于评估膝关节OA患者，并且可能在评估对治疗干预的反应方面特别有用。
