The correlation between MRI and Arthroscopy in knee injuries Author: Miler Georgiana Coauthor: Vitalis Lorand Coordinator: Lecturer Russu Octav, MD, PhD
Knee trauma Injuries of the knee joint occur most often due to trauma at this level; The most commonly affected part is the anterior cruciate ligament,as well as both the internal and external meniscus;
The anterior cruciate ligament and the two menisci are prone to injuries when the knee rotates during a sustained effort; The severity of this type of injuries depends on its location, on the degree of stretching, as well as the physical shape and muscle strength.
Aim of study To highlight the correlation between MRI and Arthroscopic knee injuries
Material and methods: The retrospective study was performed on a group of 60 patients with knee injuries during one year( 2013 ), which received medical care at the clinic of Orthopaedics and Traumatology 2 in Targu-Mures;
Anatomic elements studied : Anterior cruciate ligament Posterior cruciate ligament Internal collateral ligament Internal meniscus External meniscus Persistent vertical septum Baker cyst Reactive synovitis Outerbridge chondropathy
Statistic study used: correlation coefficient Kappa ( which evaluates the agreement rate between the two techniques ) Value of KStrength of agreement < 0.20Poor Fair Moderate Good Very good
Age distribution
Gender distribution
ACL on MRI and Arthroscopy Kappa coefficient=0.90 Arthroscopic ACL lesion Total absentprezent MRI ACL lesion absent Number033 % row0,00%100,00% % column0,00%8,10%7,00% % total0,00%7,00% prezent Number63440 % row15,00%85,00%100,00% % column100,00%91,90%93,00% % total14,00%79,10%93,00% Total Number63743 % row14,00%86,00%100,00% % column100,00% % total14,00%86,00%100,00% 43 patients with ACL injuries, 93% on MRI, 86% on Arthroscopy and both 79.1%; Kappa coefficient is 0.90, which indicates a very good strength of agreement between the two techniques ;
PCL lesion on MRI and Arthroscopy Not enough datas to calculate a Kappa coefficient Arthroscopic PCL lesion Total absent MRI PCL lesionprezent Number22 % row100,00% % column100,00% % total100,00% Total Number22 % row100,00% % column100,00% % total100,00% I have only 2 patients with PCL injuries and both stood out on MRI and Arthroscopy;
Internal collateral ligament lesion on MRI and Arthroscopy Kappa coefficient Arthroscopic Internal collateral ligament lesion Total prezent MRI internal collateral ligament lesion prezentă Number11 % row100,00% % column100,00% % total100,00% Total Number11 % row100,00% % column100,00% % total100,00%
IM lesion on MRI and Arthroscopy Coeficientul Kappa=0.96 Arthroscopic IM lesion Total absentprezent MRI IM lesion absent Number011 % row0,00%100,00% % column0,00%2,40%2,30% % total0,00%2,30% prezent Number24143 % row4,70%95,30%100,00% % column100,00%97,60%97,70% % total4,50%93,20%97,70% Total Number24244 % row4,50%95,50%100,00% % column100,00% % total4,50%95,50%100,00% 44 patients with IM injuries, 97.7% on MRI, 95.5% on Arthroscopy and both 93.2%; Kappa coefficient is 0.96,, which indicates a very good strength of agreement between the two techniques ;
EM lesion on MRI and Arthroscopy Kappa coefficient=0.74 Arthroscopic EM lesion Total absentprezent MRI EM lesion absent Number055 % row0,00%100,00% % column0,00%23,80%17,90% % total0,00%17,90% prezent Number71623 % row30,40%69,60%100,00% % column100,00%76,20%82,10% % total25,00%57,10%82,10% Total Number72128 % row25,00%75,00%100,00% % column100,00% % total25,00%75,00%100,00% 28 patients with EM injuries, 82.1% on MRI, 75% on Arthroscopy and both 57.1%; Kappa coefficient is 0.74, which indicates a good strength of agreement between the two techniques;
Vertical septum persistence on MRI and Arthroscopy Kappa coefficient Arthroscopic vertical septum persistence Total prezent MRI vertical septum persistence absent Number44 % row100,00% % column30,80% % total30,80% prezent Number99 % row100,00% % column69,20% % total69,20% Total Number13 % row100,00% % column100,00% % total100,00% Even though the Kappa coefficient couldn’t be assessed because of a small amount of dates, the injuries stood out at 4 patients on Arthroscopy and at 9 patients on MRI ;
Baker cyst on MRI and Arthroscopy Kappa coefficient=0.54 Arthroscopic Baker cyst Total absentprezent MRI Baker cyst absent Number101 % row100,00%0,00%100,00% % column16,70%0,00%14,30% % total14,30%0,00%14,30% prezent Number516 % row83,30%16,70%100,00% % column83,30%100,00%85,70% % total71,40%14,30%85,70% Total Number617 % row85,70%14,30%100,00% % column100,00% % total85,70%14,30%100,00% 7 patients with Baker cyst, 85.7% on MRI, 14.3% on Arthroscopy and both 14.3%; Kappa coefficient is 0.54, which indicates a moderate strength of agreement ;
Reactive synovitis on MRI and Arthroscopy Kappa coefficient Arthroscopic reactive synovitis Total prezentă MRI reactive synovitisabsent Number51 % row100,00% % column100,00% % total100,00% Total Number51 % row100,00% % column100,00% % total100,00% This kind of lesion stood out only on Arthroscopy at 51 of 60 patients;
Cartilage lesions on MRI and Arthroscopy Kappa coefficient Arthroscopic Cartilage lesions Total prezentă MRI Cartilage lesions absent Number26 % row100,00% % column70,30% % total70,30% prezent Number11 % row100,00% % column29,70% % total29,70% Total Number37 % row100,00% % cplumn100,00% % total100,00% From 37 patients with Cartilage lesions, it stood out on MRI on 11 patients and on Arthroscopy on 26 patients; The Kappa coefficient couldn’t be assessed;
Conclusions : The Kappa coefficient couldn’t be assessed in all types of lesions as it didn’t occur often enough; however, these lesions were highlighted both on MRI and Arthroscopy in a significant percentage; The diagnostic accuracy of arthroscopy and MRI diagnosis of knee lesions is high. Their reliability in diagnosing knee lesions is obvious.
MRI and arthroscopy were compared by using the Kappa coefficient method. The value of the coefficient showed a high agreement between the two techniques. In conclusion, my study proved to be related to the recent academic researches regarding my topic.
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