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Correlation of meniscus tears on MRI and arthroscopy using the ISAKOS classification provides satisfactory intermethod and inter-rater reliability
  1. Jay Shah1,
  2. Rocco Hlis2,
  3. Oganes Ashikyan2,
  4. Anthony Cai2,
  5. Kyle Planchard1,
  6. Christopher McCrum1,
  7. Yin Xi2,
  8. Avneesh Chhabra2
  1. 1 Orthopedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
  2. 2 Musculoskeletal Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
  1. Correspondence to Dr Avneesh Chhabra, Musculoskeletal Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA; avneesh.chhabra{at}utsouthwestern.edu

Abstract

Objective To 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.

Methods 81 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.

Results For 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).

Conclusion ISAKOS 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.

  • knee
  • meniscus
  • tears
  • arthroscopy
  • MRI
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Footnotes

  • Contributors The work in this article is original. AC serves as a consultant for ICON Medical and receives royalties from Jaypee and Wolters. All authors have read and approved of this article and believe that it represents honest work. All authors accept accountability for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JS, OA, CMcC and AC performed conception and design, data acquisition and manuscript writing and editing. RH, AC and KP performed data acquisition, data recording and manuscript writing and editing. YX performed conception and design, statistical analysis, and manuscript writing and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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