Kellgren–Lawrence scoring system underestimates cartilage damage when indicating TKA: preoperative radiograph versus intraoperative photograph

Abdelaziz, Hussein; Balde, Oury M; Citak, Mustafa; Gehrke, Thorsten; Magan, Ahmed; Haasper, Carl

doi:10.1007/s00402-019-03223-6

Cited by 35 publications

(26 citation statements)

References 19 publications

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“…Currently, the grading of osteoarthritic cartilage is based on radiographic images (Kellgren-Lawrence score) or magnetic resonance imaging [4]. However, there likely is a discrepancy between subjective complaints of the patient and the diagnostic finding in those images, potentially underestimating cartilage damages [5]. More reliable classifications, such as the OARSI score [6] histopathological analysis of cartilage samples and thus can only be conducted postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Acoustic sensing of tissue-tool interactions – potential applications in arthroscopic surgery

Sühn

Pandey

Friebe

et al. 2020

Current Directions in Biomedical Engineering

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Arthroscopic surgery is a technically challenging but common minimally invasive procedure with a long learning curve and a high incidence of iatrogenic damage. These damages can occur due to the lack of feedback and supplementary information regarding tissue-instrumentcontact during surgery. Deliberately performed interactions can be used however to obtain clinically relevant information, e.g. when a surgeon uses the tactile feedback to assess the condition of articular cartilage. Yet, the perception of such events is highly subjective. We propose a novel proximally attached sensing concept applied to arthroscopic surgery to allow an objective characterization and utilization of interactions. It is based on acoustic emissions which originate from tissue-instrument-contact, that propagate naturally via the instrument shaft and that can be obtained by a transducer setup outside of the body. The setup was tested on its ability to differentiate various conditions of articular cartilage. A femoral head with varying grades of osteoarthritic cartilage was tapped multiple times ex-vivo with a conventional Veress needle with a sound transducer attached at the outpatient end. A wavelet-based processing of the obtained signals and subsequent analysis of distribution of spectral energy showed the potential of tool-tissue-interactions to characterize different cartilage conditions. The proposed concept needs further evaluation with a dedicated design of the palpation tool and should be tested in realistic arthroscopic scenarios.

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Section: Introductionmentioning

confidence: 99%

Acoustic sensing of tissue-tool interactions – potential applications in arthroscopic surgery

Sühn

Pandey

Friebe

et al. 2020

Current Directions in Biomedical Engineering

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show abstract

“…Over recent years, several diagnostic modalities have been emerged. In spite of more advanced imaging techniques that are available today, traditional radiographs are still the most accessible modality to determine OA severity (15). The plain X-ray of the knee is usually used in diagnosing and monitoring the progression of OA (16).…”

mentioning

confidence: 99%

“…Yet previous articles have reported disagreement between radiological OA severity with functional scores (17). Despite the lack of correlation, guidelines still advocate the use of weight-bearing plain radiography in OA (15). The use of other imaging techniques such as magnetic resonance imaging (MRI), ultrasound, computed tomography (CT), and nuclear medicine in OA evaluation has been extensively studied with each posing its own set of limitations (18).…”

mentioning

confidence: 99%

“…Kellgren-Lawrence grading system has its disadvantages since it suggests a linear radiographic progression of OA and is incapable of quantifying joint space narrowing of the knee joint without osteophyte formation (19). Abdelaziz et al found a significant mismatch between intraoperative and radiological findings with approximately 50% of the patients demonstrating grade 4 degenerative changes intraoperatively, compared to grade 3 radiographically (15). Of note, Kijowski et al demonstrated that the Kellgren-Lawrence scoring system had only a moderately strong correlation with the actual degree of articular cartilage degeneration within the tibiofemoral joint (20).…”

mentioning

confidence: 99%

“…In addition, the scoring system deals with the joint as a whole, not paying attention to each joint compartment separately (15). A weak correlation was found between function and combined space narrowing of tibiofemoral and patellofemoral joints (22) whereas Reichenbach et al revealed that radiographic evidence of bone attrition leads to functional disability (23).…”

mentioning

confidence: 99%

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Hard truths about preoperative knee X-rays

Mak

Razak

2020

Ann Transl Med

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Return‐to‐sport quadriceps strength symmetry impacts 5‐year cartilage integrity after anterior cruciate ligament reconstruction: A preliminary analysis

Brunst

Ithurburn

Zbojniewicz

et al. 2021

Journal Orthopaedic Research

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Quadriceps femoris strength asymmetry at the time of return to sports participation after anterior cruciate ligament (ACL) reconstruction contributes to worse function and asymmetric landing patterns, but the impact on longitudinal outcomes is not known. This study determined if young athletes after ACL reconstruction with quadriceps femoris strength asymmetry at a return to sports clearance would demonstrate markers of knee cartilage degeneration 5 years later compared to those with symmetric quadriceps femoris strength at return to sports. Participants (n = 27) were enrolled at the time of medical clearance for sports participation (baseline testing) and followed for 5 years. At baseline, quadriceps femoris strength was measured bilaterally and a limb symmetry index was used to divide the cohort into two groups: return to sport clearance with high quadriceps femoris strength (RTS‐HQ; limb symmetry index ≥ 90%) and return to sport clearance with low quadriceps femoris strength (RTS‐LQ; limb symmetry index < 85%). At 5 years post‐baseline, quantitative magnetic resonance imaging (T2 relaxation times (ms): involved knee medial/lateral femoral condyle and tibial plateau) data were collected. Group differences were evaluated with independent samples t tests. At 5 years post‐return to sports, the RTS‐LQ strength group (n = 14) demonstrated elevated T2 relaxation times at the anterior region of the lateral femoral condyle compared to the RTS‐HQ strength group (n = 13). Clinical Significance: Just over 50% of this cohort was cleared for sports participation with involved limb quadriceps femoris strength deficits that may contribute to early markers of knee cartilage degeneration within the subsequent 5 years.

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Kellgren–Lawrence scoring system underestimates cartilage damage when indicating TKA: preoperative radiograph versus intraoperative photograph

Cited by 35 publications

References 19 publications

Acoustic sensing of tissue-tool interactions – potential applications in arthroscopic surgery

Acoustic sensing of tissue-tool interactions – potential applications in arthroscopic surgery

Hard truths about preoperative knee X-rays

Return‐to‐sport quadriceps strength symmetry impacts 5‐year cartilage integrity after anterior cruciate ligament reconstruction: A preliminary analysis

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