The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine classification of knee meniscus tears: three-dimensional MRI and arthroscopy correlation

Chhabra, Avneesh; Ashikyan, Oganes; Hlis, Rocco; Cai, Anthony; Planchard, Kyle; Xi, Yin; McCrum, Christopher L.; Shah, Jay P.

doi:10.1007/s00330-019-06220-w

Cited by 23 publications

(26 citation statements)

References 39 publications

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“…Dunn et al [23] also reported moderate to substantial agreement between arthroscopy and MRI findings in classifying the type and location of meniscal tears (kappa: 0.61-0.63). In another previous study that assessed the correlation of meniscal tears arthroscopy and MRI findings using the ISAKOS classification, the kappa values showed moderate agreement [24]. The results of this study were similar to those of previous studies in terms of agreements and diagnostic values, including sensitivity, specificity, and accuracy [14,[21][22][23][24].…”

Section: Discussionsupporting

confidence: 87%

“…In another previous study that assessed the correlation of meniscal tears arthroscopy and MRI findings using the ISAKOS classification, the kappa values showed moderate agreement [24]. The results of this study were similar to those of previous studies in terms of agreements and diagnostic values, including sensitivity, specificity, and accuracy [14,[21][22][23][24]. Moreover, lower diagnostic values and agreements were found in patients with ACL injury than in patients without ACL injury.…”

Section: Discussionsupporting

confidence: 87%

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Diagnostic Accuracy of Magnetic Resonance Imaging in the Detection of Type and Location of Meniscus Tears: Comparison with Arthroscopic Findings

Kim

Lee

Jang

et al. 2021

JCM

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Magnetic resonance imaging (MRI) has been widely used for the diagnosis of meniscal tears, but its diagnostic accuracy, depending on the type and location, has not been well investigated. We aimed to evaluate the diagnostic accuracy of MRI by comparing MRI and arthroscopic findings. Preoperative 3.0-T MRI and arthroscopic findings from 2005 to 2018 were reviewed to determine the presence, type, and location of meniscus tears. In addition, subgroup analysis was performed according to anterior cruciate ligament (ACL) injury. The exclusion criteria were as follows: (1) Inflammatory arthritis, (2) other ligament injuries, (3) inability to classify meniscal tears due to degenerative arthritis, (4) over 90 days from MRI to surgery, and (5) incomplete data. Of the 2998 eligible patients, 544 were finally included. The sensitivity and specificity of MRI in determining medial and lateral meniscus tears were 91.8% and 79.9%, and 80.8% and 85.4%, respectively. The accuracy of MRI in the ACL-injured group was lower than that in the ACL-intact group (medial meniscus: 81.7% vs. 88.1%, p = 0.041; 72.9% vs. lateral meniscus: 88.0%, p < 0.001). MRI accuracy was low for the longitudinal tears of the posterior horn of the medial meniscus in the ACL-injured group. MRI could be a diagnostic tool for meniscus tears, but has limited accuracy in their classification of the type and location. Hence, care should be taken during arthroscopic assessment of ACL-injured patients due to low diagnostic accuracy of preoperative MRI.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

Diagnostic Accuracy of Magnetic Resonance Imaging in the Detection of Type and Location of Meniscus Tears: Comparison with Arthroscopic Findings

Kim

Lee

Jang

et al. 2021

JCM

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“…This is a modest improvement from the prior 3 T ISAKOS classification study that showed fair to good intermethod correlation in most categories of ISAKOS meniscus tear classification. 34 The results of this study validate that ISAKOS classification can be used in both 1.5 and 3.0 T clinical practices during routine MRI readings. Using such a uniform method, which has been previously validated surgically, would ensure a consistent multidisciplinary communication and may improve patient management and longitudinal evaluation for outcomes.…”

Section: Discussionsupporting

confidence: 71%

“…The distance the tear extends into the meniscus explored this topic on 3 T scanners, which found fair to good intermethod agreement among categories. 34 It is essential to validate this classification on both types of field strengths.…”

Section: Length Of Tearmentioning

confidence: 99%

Correlation of meniscus tears on MRI and arthroscopy using the ISAKOS classification provides satisfactory intermethod and inter-rater reliability

et al. 2020

Self Cite

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ObjectiveTo evaluate the inter-rater and intermethod correlation (reliability between MRI and arthroscopy) of knee for findings of meniscus tears using International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification on both 1.5 and 3.0 T images.Methods81 knees were evaluated in 69 patients aged 30.0±12.6 years (mean±SD). Consecutive arthroscopy-proven meniscal tears were evaluated by two board-certified radiologists on MRI and two sports surgeons on arthroscopies. The surgically validated ISAKOS classification of meniscal tears was used to describe medial meniscus (MM) and lateral meniscus (LM) tears on MRI and re-evaluation of images from completed arthroscopies. Prevalence-adjusted bias-adjusted kappa (PABAK), t-tests and intraclass correlation coefficient (ICC) were calculated.ResultsFor LM on 1.5 T, the agreements for location, depth, tear length and pattern were good to excellent in all categories except fair for tissue quality (PABAK=0.35–0.41) and zone 2 (PABAK=0.35) identification. For MM, the agreements were good to excellent in all except moderate for tissue quality (PABAK=0.6) and zone 1 and 3 (PABAK=0.40–0.47), and fair for zone 2 identification (PABAK=0.27). Similar results were seen on 3 T with improved LM zonal identification (PABAK=0.52–0.90) and better correlation of tear lengths, which were different on 1.5 T vs 3.0 T (p=0.01–0.03). For 1.5 T cases, both MM and LM tear lengths were larger on MRI versus arthroscopy (MM, p=0.004; LM, p=0.095). For 3 T, the MM tear lengths were larger on MRI versus arthroscopy (p=0.001).ConclusionISAKOS classification of meniscal tears on both 1.5 and 3.0 T MRI provides satisfactory inter-rater and intermethod reliability for use in clinical practice. Level of evidence: IV.

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“…Knee arthroscopy is a minimally invasive procedure that could reveal possible causes of knee pain and provide surgical repair of structural change in cartilage, ligament, meniscus or bone. Arthroscopic knee surgery [6] is one of the major surgeries in sports medicine and is particularly suitable for repairing torn cartilage [7], torn meniscus [8], or bone spurs [9]. While surgical wound size is smaller and tissue destruction is far less than that in conventional open knee surgeries, a substantial number of patients experience moderate to severe postoperative pain after arthroscopic knee surgeries [10,11] and improper management of postoperative pain may hinder rehabilitation [12] or delay early mobilization.…”

Section: Introductionmentioning

confidence: 99%

Earlier Is Better? Timing of Adductor Canal Block for Arthroscopic Knee Surgery under General Anesthesia: A Retrospective Cohort Study

Hsu

et al. 2021

IJERPH

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The adductor canal block (ACB) is effective for treating postoperative pain during arthroscopic knee surgery, but its impact on anesthesia course and the optimal administration timing are unknown. This retrospective study addressed these questions. The aim of this study was to compare the effects of preoperative ACB and postoperative ACB on anesthesia course and postoperative recovery. We allocated 215 adult patients who underwent arthroscopic knee surgery under sevoflurane anesthesia between January 2019 and December 2019 to three groups. Group A received general anesthesia without ACB, Group B received ACB before general anesthesia induction, and Group C received ACB in the post-anesthesia recovery unit (PACU). Group B consumed significantly less sevoflurane (0.19 mL/kg/h) and milligram morphine equivalents (0.08 MME) intraoperatively than Groups A (0.22 mL/kg/h; 0.10 MME, respectively) and C (0.22 mL/kg/h; 0.09 MME, respectively). Groups B and C had lower visual analogue scale (VAS) scores upon PACU discharge than Group A. Dynamic, but not at-rest VAS scores, were significantly higher in Group A. Opioid consumption was similar in the ward, but Group A requested more intravenous parecoxib for pain relief. Length of hospital stay was similar. Thus, preoperative ACB reduced the amount of volatile anesthetic required and maintained stable hemodynamics intraoperatively. Preoperative or postoperative ACB improved postoperative pain control. Consequently, preoperative ACB is optimal for intraoperative stress suppression and postoperative pain control.

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The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine classification of knee meniscus tears: three-dimensional MRI and arthroscopy correlation

Cited by 23 publications

References 39 publications

Diagnostic Accuracy of Magnetic Resonance Imaging in the Detection of Type and Location of Meniscus Tears: Comparison with Arthroscopic Findings

Diagnostic Accuracy of Magnetic Resonance Imaging in the Detection of Type and Location of Meniscus Tears: Comparison with Arthroscopic Findings

Correlation of meniscus tears on MRI and arthroscopy using the ISAKOS classification provides satisfactory intermethod and inter-rater reliability

Earlier Is Better? Timing of Adductor Canal Block for Arthroscopic Knee Surgery under General Anesthesia: A Retrospective Cohort Study

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