In Vivo Evaluation of the Potential of High-Frequency Ultrasound for Arthroscopic Examination of the Shoulder Joint

Abstract

Objective. Accurate arthroscopic evaluation of cartilage lesions could significantly improve the outcome of repair surgery. In this study, we investigated for the first time the potential of intra-articular ultrasound as an arthroscopic tool for grading cartilage defects in the human shoulder joint in vivo and compared the outcome to results from arthroscopic evaluation and magnetic resonance imaging findings. Design. A total of 26 sites from 9 patients undergoing routine shoulder arthroscopy were quantitatively evaluated with a clinical intravascular (40MHz) ultrasound imaging system, using the regular arthroscopy portals. Reflection coefficient (R), integrated reflection coefficient (IRC), apparent integrated backscattering (AIB), and ultrasound roughness index (URI) were calculated, and high-resolution ultrasound images were obtained per site. Each site was visually graded according to the International Cartilage Repair Society (ICRS) system. "Ultrasound scores" corresponding to the ICRS system were determined from the ultrasound images. Magnetic resonance imaging was conducted and cartilage integrity at each site was classified into 5 grades (0 = normal, 4 = severely abnormal) by a radiologist. Results. R and IRC were lower at sites with damaged cartilage surface (P = 0.033 and P = 0.043, respectively) and correlated with arthroscopic ICRS grades (r s = −0.444, P = 0.023 and r s = −0.426, P = 0.03, respectively). Arthroscopic ICRS grades and ultrasound scores were significantly correlated (rs = 0.472, P = 0.015), but no significant correlation was found between magnetic resonance imaging data and other parameters. Conclusion. The results suggest that ultrasound arthroscopy could facilitate quantitative clinical appraisal of articular cartilage integrity in the shoulder joint and provide information on cartilage lesion depth and severity for quantitative diagnostics in surgery.

Arthroscopic International Cartilage Repair Society Classification System Has Only Moderate Reliability in a Porcine Cartilage Repair Model

“…As our results suggest, the ICRS score has limitations in reliably assessing repair results, and thus more objective methods should be developed. Several novel arthroscopic methods have been introduced to assess the severity of damage in hyaline cartilage, including mechanical testing of cartilage stiffness, 15,16 high-frequency ultrasound, 10,26 mechanoacoustical testing, 11,12 optical coherence tomography, 20 and electromechanical testing. 2,29,30 These methods could possibly make the arthroscopic assessment of cartilage repair more accurate and reliable.…”

Miniaturized Water-Jet Ultrasound Indentation System for Quantitative Assessment of Articular Cartilage Degeneration: A Validation Study

“…With the advancement of modern ultrasound technology, smaller transducers such as those used in the endoscopic applications [ 46 ] with a high-resolution cartilage imaging is also possible, by which more spatial information of the cartilage can be obtained such as the surface roughness [ 17 ]. Among them, the intravascular ultrasound (IVUS) with a very small profile has been demonstrated to be applicable for the characterization of cartilage degeneration [ 47 – 49 ] and is very potential for this purpose. On the other hand, water-jet was successfully applied as an indentation medium to compress the cartilage in this study.…”

Ultrasound Arthroscopy of Hip in Treatment of Osteochondritis Dissecans

“…Similarly, as in previous studies in which the UA technique has been applied in human knee and shoulder joints, ultrasound evaluation of the articular cartilage was found to be clinically feasible. 12 , 14 Furthermore, visualization of the cartilage inner structures and subchondral bone and determination of quantitative ultrasound parameters reflecting the status of the articular cartilage, as well as measurement of cartilage thickness, were found to be straightforward during a routine arthroscopic examination of the hip joint. Because ultrasound imaging can be conducted in real time during the arthroscopic surgical procedure, the technique might be a valuable tool aiding in the selection of the optimal repair technique based on the status of the joint at the time of surgery.…”

“…To overcome the limitations of current clinical diagnostic methods, an ultrasound arthroscopy (UA) technique was recently introduced for objective assessment of the knee and shoulder joints. 11 , 12 Ultrasound imaging enables evaluation of the integrity of the cartilage surface, subsurface structures, and subchondral bone, as well as accurate measurement of cartilage thickness and depth of cartilage lesions. 13 , 14 In addition, quantitative ultrasound parameters reflecting the integrity of the articular cartilage can be determined.…”