1. The correlation between MRI and Arthroscopy in knee injuries Author: Miler Georgiana Coauthor: Vitalis Lorand Coordinator: Lecturer Russu Octav, MD, PhD

2. 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;

3.  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.

4. Aim of study  To highlight the correlation between MRI and Arthroscopic knee injuries

5. 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;

6.  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

7.  Statistic study used: correlation coefficient Kappa ( which evaluates the agreement rate between the two techniques ) Value of KStrength of agreement < 0.20Poor 0.21 - 0.40Fair 0.41 - 0.60Moderate 0.61 - 0.80Good 0.81 - 1.00Very good

8. Age distribution

9. Gender distribution

10. 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 ;

11. 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;

12. 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%

13. 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 ;

14. 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;

15. 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 ;

16. 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 ;

17. 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;

18. 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;

19. 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.

20.  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.

21. Thank you!