Interrater and Intrarater Reliability of Arthroscopic Measurements of Articular Cartilage Defects in the Knee

Bayam

Arthroscopy, Sports Medicine, and Rehabilitation

et al. 2021

Purpose To assess the results of a technique for pie crusting of the medial collateral ligament (MCL) and inside-out medial meniscal repair and perform a comparison with the literature. Methods This retrospective study consisted of electronic data collection between 2012 and 2017 with a minimum of 2 years’ follow-up. The inclusion criteria were the presence of difficult medial meniscal tears with joint tightness requiring pie crusting and the presence of acute or chronic tears of zone I or II with or without anterior cruciate ligament reconstruction (ACLR) using hamstring autograft during the same session. The primary outcome of the study was the achievement of good results with the aforementioned technique. There was no control group. All patients underwent assessments at 1, 2, and 6 months in outpatient clinics. At 6 months, the Lysholm knee score was calculated. For statistical analysis, the Social Science Statistics online program was used to perform descriptive analysis and assess any associations between the variables. Results This study included 53 patients from a single surgeon’s practice; of these patients, 31 underwent additional ACLR using hamstring autograft during the same session. The mean age was 29.43 years (range, 14-49 years), and the mean increase in the medial joint space width was 3.21 mm (range, 2-5 mm) with pie crusting. At 6 months, the average Lysholm score was 93 (range, 67-100) and the average visual analog scale score was 0.8 (range, 0-4). There was no meaningful association between age, tear pattern, chronicity of tear, joint space width obtained after pie crusting, and associated anterior cruciate ligament tear. Patients returned to their daily activity level at 4.5 months on average and returned to sporting activities at 7.4 months on average. Saphenous nerve symptoms were observed in 5 patients, but no infection or instability was documented in the follow-up period. Conclusions In this study, we obtained good outcomes using arthroscopic inside-out medial meniscal repair combined with pie crusting for the release of the MCL, with or without ACLR. Level of Evidence Level IV, therapeutic case series.

Section: Discussionmentioning

confidence: 99%

The Role of the Pie-Crusting Technique of the Medial Collateral Ligament in the Arthroscopic Inside-out Technique for Medial Meniscal Repair With or Without Anterior Cruciate Ligament Reconstruction: A Satisfactory Repair Technique

Bayam

Arthroscopy, Sports Medicine, and Rehabilitation

et al. 2021

Magnetic Resonance Imaging

“…The lower sensitivity for the characterization, rather than detection of partial‐thickness cartilage defects in our study may be related to difficulties in differentiating surface irregularities of articular cartilage from low‐grade partial thickness defects on MRI. Similar to the variability of measuring the size of cartilage defects during arthroscopy, the accuracy of assessing the relative depth of a defect may vary in children due to differences in the total thickness of the articular cartilage. Also, during the period between MRI diagnosis and arthroscopic surgery, new cartilage lesions or exacerbation of existing cartilage defects may occur as part of the natural history in unstable knees.…”

Section: Discussionmentioning

confidence: 99%

10‐Min 3D Turbo Spin Echo MRI of the Knee in Children: Arthroscopy‐Validated Accuracy for the Diagnosis of Internal Derangement

Fritz

Ahlawat

Fritz

et al. 2018

Knee Surg Sports Traumatol Arthrosc

“…A previously published procedure was used to determine the actual defect size for use as the reference standard [8, 31]. The cadaveric ankles were disarticulated and the talar surface was carefully prepared.…”

Section: Methodsmentioning

confidence: 99%

Arthroscopic defect size measurement in osteochondral lesions of the talus underestimates the exact defect size and size measurement with arthro-MRI (MR-A) and high-resolution flat-panel CT-arthro imaging (FPCT-A)

Ettinger

Sonnow

Plaaß

et al. 2022

PurposeThe size of osteochondral lesions of the talus (OLTs) is highly relevant for their treatment. In addition to intraoperative measurement of defect size, preoperative planning by means of magnetic resonance imaging (MRI) or computed tomography (CT) is crucial. MethodsFour defects of different sizes and depths were created on the talar joint surface in 14 cadaver feet. All defects were evaluated, both arthroscopically and via arthrotomy with a probe. Arthro‐MRI (MR‐A) and high‐resolution flat‐panel CT arthro scans (FPCT‐A) were acquired. Length, width, and depth were measured for every defect and the defect volume was calculated. To determine the exact defect size, each talar defect was filled with plastic pellets to form a cast and the casts were scanned using FPCT to create a 3D multiplanar reconstruction data set. Finally, the surgically measured values were compared with the radiological values and the exact defect size. ResultsOverall, the surgically measured values (both arthroscopic and open) underestimated the exact defect size (p < 0.05). Arthroscopically determined defect length and width showed the largest deviation (p < 0.05) and underestimated the size in comparison with MR‐A and FPCT‐A. The FPCT‐A measurements demonstrated higher correlation with both the arthroscopic and open surgical measurements than did the MR‐A measurements (p < 0.05). ConclusionThe exact defect size is underestimated on intraoperative measurement, in both arthroscopic and open approaches. Arthroscopic defect size measurement underestimates defect size in comparison with MR‐A and FPCT‐A. FPCT‐A was shown to be a reliable imaging technique that allows free image reconstruction in every plane and could be considered as the new reference standard for preoperative evaluation of defect size in OLT.