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The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine classification of knee meniscus tears: three-dimensional MRI and arthroscopy correlation

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To introduce MRI-based International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification system of meniscal tears and correlate it to the surgical findings from arthroscopy. We hypothesized that the ISAKOS classification will provide good inter-modality and inter-rater reliability for use in the routine clinical practice of radiologists and orthopedic surgeons.

Methods

In this HIPAA-compliant cross-sectional study, there were 44 meniscus tears in 39 patients (26 males, 16 females). Consecutive arthroscopy-proven meniscal tears (March 2017 to December 2017) were evaluated by two board-certified musculoskeletal radiologists using isotropic three-dimensional (3D) MRI user-defined reconstructions. The surgically validated ISAKOS classification of meniscal tears was used to describe medial meniscus (MM) and lateral meniscus (LM) tears. Prevalence-adjusted bias-adjusted kappa (PABAK) and conventional kappa, and paired t test and intra-class correlation coefficient (ICC) were calculated for categorical and numerical variables, respectively.

Results

For the MM, the PABAK for location, depth, length (ICC), pattern, quality of meniscus tissue, and zone was 0.7–1, 0.65, 0.57, 0.67, 0.78, and 0.39–0.7, respectively. For the LM, the PABAK for location, depth, length (ICC), pattern, quality of meniscus tissue, zone, and central to popliteus hiatus was 0.57–0.95, 0.57, 0.74, 0.93, 0.38, 0.52–0.67, and 0.48, respectively. The mean tear lengths were larger on MRI than on arthroscopy (mean difference MM 9.74 mm (6.66 mm, 12.81 mm; p < 0.001), mean difference LM 4.04 mm (0.31 mm, 7.76 mm; p = 0.034)).

Conclusions

The ISAKOS classification of meniscal tears on 3D MRI provides mostly moderate agreement, which was similar to the agreement at arthroscopy.

Key Points

• There is a fair to good inter-method correlation in most categories of ISAKOS meniscus tear classification.

• The tear lengths are significantly larger on MRI than on arthroscopy.

• The inter-reader correlation on 3D MRI is moderate to excellent, with the exception of lateral meniscus tear patterns.

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Abbreviations

2D:

Two-dimensional

ISAKOS:

The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine

mm:

Millimeters

MRI:

Magnetic resonance imaging

PABAK:

Prevalence-adjusted bias-adjusted kappa

SD:

Standard deviation

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA

    Avneesh Chhabra, Oganes Ashikyan, Rocco Hlis, Anthony Cai, Kyle Planchard & Yin Xi

  2. Orthopedic Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA

    Avneesh Chhabra, Christopher McCrum & Jay Shah

  3. Musculoskeletal Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA

    Avneesh Chhabra

  4. Johns Hopkins University, Baltimore, USA

    Avneesh Chhabra

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  1. Avneesh Chhabra
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Correspondence to Avneesh Chhabra.

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The scientific guarantor of this publication is Avneesh Chhabra.

Conflict of interest

Avneesh Chhabra declares relationships with the following companies: consultant for ICON Medical and Treace 3D Medical Inc. and receives royalties from Jaypee and Wolters. All other authors have no relationships to declare.

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Yin Xi, PhD (University of Texas Southwestern), is an author and provided statistical expertise.

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• retrospective

• cross-sectional study

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Chhabra, A., Ashikyan, O., Hlis, R. et al. The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine classification of knee meniscus tears: three-dimensional MRI and arthroscopy correlation. Eur Radiol 29, 6372–6384 (2019). https://doi.org/10.1007/s00330-019-06220-w

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