The correlation between

MRI and Arthroscopy in knee injuries

Author: Miler GeorgianaCoauthor: Vitalis LorandCoordinator: 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 K Strength of agreement

< 0.20 Poor

0.21 - 0.40 Fair

0.41 - 0.60 Moderate

0.61 - 0.80 Good

0.81 - 1.00 Very good

Age distribution

Gender distribution

ACL on MRI and Arthroscopy

Kappa coefficient=0.90Arthroscopic ACL lesion

Total

absent prezent

MRI ACL lesion

absent

Number 0 3 3

% row 0,00% 100,00% 100,00%

% column 0,00% 8,10% 7,00%

% total 0,00% 7,00% 7,00%

prezent

Number 6 34 40

% row 15,00% 85,00% 100,00%

% column 100,00% 91,90% 93,00%

% total 14,00% 79,10% 93,00%

Total

Number 6 37 43

% row 14,00% 86,00% 100,00%

% column 100,00% 100,00% 100,00%

% total 14,00% 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 lesion prezent

Number 2 2

% row 100,00% 100,00%

% column 100,00% 100,00%

% total 100,00% 100,00%

Total

Number 2 2

% row 100,00% 100,00%

% column 100,00% 100,00%

% total 100,00% 100,00%

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

Number 1 1

% row 100,00% 100,00%

% column 100,00% 100,00%

% total 100,00% 100,00%

Total

Number 1 1

% row 100,00% 100,00%

% column 100,00% 100,00%

% total 100,00% 100,00%

IM lesion on MRI and Arthroscopy

Coeficientul Kappa=0.96Arthroscopic IM lesion

Total

absent prezent

MRI IM lesion

absent

Number 0 1 1

% row 0,00% 100,00% 100,00%

% column 0,00% 2,40% 2,30%

% total 0,00% 2,30% 2,30%

prezent

Number 2 41 43

% row 4,70% 95,30% 100,00%

% column 100,00% 97,60% 97,70%

% total 4,50% 93,20% 97,70%

Total

Number 2 42 44

% row 4,50% 95,50% 100,00%

% column 100,00% 100,00% 100,00%

% total 4,50% 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=0.74Arthroscopic EM lesion

Total

absent prezent

MRI EM lesion

absent

Number 0 5 5

% row 0,00% 100,00% 100,00%

% column 0,00% 23,80% 17,90%

% total 0,00% 17,90% 17,90%

prezent

Number 7 16 23

% row 30,40% 69,60% 100,00%

% column 100,00% 76,20% 82,10%

% total 25,00% 57,10% 82,10%

Total

Number 7 21 28

% row 25,00% 75,00% 100,00%

% column 100,00% 100,00% 100,00%

% total 25,00% 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

Number 4 4

% row 100,00% 100,00%

% column 30,80% 30,80%

% total 30,80% 30,80%

prezent

Number 9 9

% row 100,00% 100,00%

% column 69,20% 69,20%

% total 69,20% 69,20%

Total

Number 13 13

% row 100,00% 100,00%

% column 100,00% 100,00%

% total 100,00% 100,00%

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=0.54Arthroscopic Baker cyst

Total

absent prezent

MRI Baker cyst

absent

Number 1 0 1

% row 100,00% 0,00% 100,00%

% column 16,70% 0,00% 14,30%

% total 14,30% 0,00% 14,30%

prezent

Number 5 1 6

% row 83,30% 16,70% 100,00%

% column 83,30% 100,00% 85,70%

% total 71,40% 14,30% 85,70%

Total

Number 6 1 7

% row 85,70% 14,30% 100,00%

% column 100,00% 100,00% 100,00%

% total 85,70% 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 synovitis absent

Number 51 51

% row 100,00% 100,00%

% column 100,00% 100,00%

% total 100,00% 100,00%

Total

Number 51 51

% row 100,00% 100,00%

% column 100,00% 100,00%

% total 100,00% 100,00%

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

Number 26 26

% row 100,00% 100,00%

% column 70,30% 70,30%

% total 70,30% 70,30%

prezent

Number 11 11

% row 100,00% 100,00%

% column 29,70% 29,70%

% total 29,70% 29,70%

Total

Number 37 37

% row 100,00% 100,00%

% cplumn 100,00% 100,00%

% total 100,00% 100,00%

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.

Thank you!