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Comparison of Knee Articular Cartilage Defect Size Between Measurements Obtained on Preoperative MRI Versus During Arthrotomy

Perry, Jade; Kuiper, Jan Herman; McCarthy, Helen S.; Jermin, Paul; Gallacher, Peter D.; Tins, Bernhard; Roberts, Sally

Authors

Paul Jermin

Peter D. Gallacher

Bernhard Tins

Sally Roberts



Abstract

Background:
Treatment decisions for cartilage defects are often based on lesion size. Magnetic resonance imaging (MRI) is widely used to diagnose cartilage defects noninvasively; however, their size estimated from MRI may differ from defect sizes measured during arthrotomy, especially after debridement to healthy cartilage if undergoing autologous chondrocyte implantation.

Purpose/Hypothesis:
The purpose of this study was to evaluate the reliability of 2 methods to assess knee cartilage defect size on preoperative MRI and determine their accuracy in predicting postdebridement defect sizes recorded during arthrotomy. It was hypothesized that defect size would be predicted more accurately by the total area of abnormal articular cartilage rather than the area of full-thickness cartilage loss as identified on MRI.

Study Design:
Cohort study (diagnosis); Level of evidence, 3.

Methods:
This study included 64 patients (mean age, 41.8 ± 9.6 years) who underwent autologous cell therapy. Each patient received a 3-T MRI at 6.1 ± 3.0 weeks before cell implantation. Three raters, a radiologist, a surgeon, and a scientist, measured (1) the full-thickness cartilage defect area and (2) the total predicted abnormal cartilage area, identified by an abnormal signal on MRI. Interrater reliability was assessed using the intraclass correlation coefficient (ICC). Actual pre- and postdebridement defect sizes were obtained from intraoperative surgical notes. Postdebridement surgical measurements were considered the clinical reference standard and were compared with the radiologist’s MRI measurements.

Results:
Eighty-seven defects were assessed, located on the lateral (n = 8) and medial (n = 26) femoral condyle, trochlea (n = 17), and patella (n = 36). The interrater reliability of the cartilage defect measurements on MRI was good to excellent for the full-thickness cartilage defect area (ICC = 0.74) and the total predicted abnormal cartilage area (ICC = 0.78). The median full-thickness cartilage defect area on MRI underestimated the median postdebridement defect area by 78.3%, whereas the total predicted abnormal cartilage area measurement underestimated the postdebridement defect area by 14.3%.

Conclusion:
Measuring the full-thickness cartilage defect area on MRI underestimated the area to treat, whereas measuring the total abnormal area provided a better estimate of the actual defect size for treatment.

Journal Article Type Article
Acceptance Date Apr 13, 2023
Online Publication Date Sep 6, 2023
Publication Date Sep 6, 2023
Deposit Date Jul 28, 2023
Journal Orthopaedic Journal of Sports Medicine
Electronic ISSN 2325-9671
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 11
Issue 9
Article Number 23259671231193380
DOI https://doi.org/10.1177/23259671231193380
Keywords defect size, osteoarthritis, autologous cell therapy, magnetic resonance imaging, articular cartilage, knee
Publisher URL https://journals.sagepub.com/doi/full/10.1177/23259671231193380

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Comparison of Knee Articular Cartilage Defect Size Between Measurements Obtained on Preoperative MRI Versus During Arthrotomy (668 Kb)
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Licence
https://creativecommons.org/licenses/by/4.0/

Publisher Licence URL
https://creativecommons.org/licenses/by/4.0/

Copyright Statement
This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).





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