Comparison of Clinical and Semiquantitative Cartilage Grading Systems in Predicting Outcomes After Arthroscopic Partial Meniscectomy
Comparison of Clinical and Semiquantitative Cartilage Grading Systems in Predicting Outcomes After Arthroscopic Partial Meniscectomy
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DOI：
10.2214/ajr.19.22285
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发表时间：
2020-08-01
影响因子：
5
通讯作者：
Subhas, Naveen
中科院分区：
文献类型：
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作者：
Colak, Ceylan;Polster, Joshua M.;Subhas, Naveen
目标。术前膝关节MRI软骨丢失是关节镜半月板部分切除术后不良预后的预测指标。本研究的目的是比较关节镜下半月板部分切除术后临床使用改良的Outerbridge系统和半定量MRI骨关节炎膝关节评分系统对软骨损失分级的预测能力。材料和方法。在关节镜半月板部分切除术后6个月内接受术前膝关节MRI检查并在手术时和1年后有结果的患者符合纳入条件。病例由两名放射科医生和一名放射科研究员使用两种分级系统进行评估。采用95% ci的ROC曲线（AUC）估计各系统区分手术成功和失败的准确性。Wald检验用于评估临床分级系统的非劣效性。还比较了解读者对分级系统预测结果准确性的认同。研究共纳入78例患者（38例女性，40例男性，平均年龄56.6岁）。使用临床分级的预测模型（AUC = 0.695; 95% CI, 0.566-0.824）不劣于使用MRI骨关节炎膝关节评分分级模型（AUC = 0.683; 95% CI, 0.539-0.827） （p = 0.047）。两种MRI预测模型均优于仅使用人口统计学特征的模型（AUC = 0.667; 95% CI, 0.522-0.812）。临床评分的一致性（80.8%）高于MRI骨关节炎评分的一致性（65.0%,p = 0.012）。临床使用的MRI软骨损失分级系统与半定量系统一样有效，可以预测关节镜半月板部分切除术后的预后，同时也提供了更好的解读者一致性。
OBJECTIVE. Cartilage loss on preoperative knee MRI is a predictor of poor outcomes after arthroscopic partial meniscectomy. The purpose of this study was to compare the ability to predict outcomes after arthroscopic partial meniscectomy with a clinically used modified Outerbridge system versus a semiquantitative MRI Osteoarthritis Knee Score system for grading cartilage loss.MATERIALS AND METHODS. Patients who underwent preoperative knee MRI within 6 months of arthroscopic partial meniscectomy and who had outcomes available from the time of surgery and 1 year later were eligible for inclusion. Cases were evaluated by two radiologists and one radiology fellow with the use of both grading systems. The accuracy of each system in discriminating between surgical success and failure was estimated using the ROC curve (AUC) with 95% CIs. A Wald test was used to assess noninferiority of the clinical grading system. Interreader agreement regarding the accuracy of the grading systems in predicting outcomes was also compared.RESULTS. A total of 78 patients (38 women and 40 men; mean age, 56.6 years) were included in the study. A prediction model using clinical grading (AUC = 0.695; 95% CI, 0.566-0.824) was noninferior (p = 0.047) to a model using MRI Osteoarthritis Knee Score grading (AUC = 0.683; 95% CI, 0.539-0.827). Both MRI prediction models performed better than a model using demographic characteristics only (AUC = 0.667; 95% CI, 0.522-0.812). Interreader agreement with clinical grading (80.8%) was higher than that with MRI Osteoarthritis Knee Score grading (65.0%; p = 0.012).CONCLUSION. A clinically used system to grade cartilage loss on MRI is as effective as a semiquantitative system for predicting outcomes after arthroscopic partial meniscectomy, while also offering improved interreader agreement.