Magnetic resonance imaging provides additional utility in the preoperative cartilage assessment of patients undergoing medial unicompartmental knee arthroplasty.
Mei Lin Tay, Scott M Bolam, Tyler Campbell, Laura Hill, Lydia Lin, Hayley Wong, David Dow, Jacob T Munro, Simon W Young, A Paul Monk
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引用次数: 0
Abstract
Purpose: For unicompartmental knee arthroplasty (UKA), patient selection using correct indications can optimise postsurgical outcomes. The current gold standard for assessing eligibility is with radiographs; however, magnetic resonance imaging (MRI) may allow for more accurate assessments of cartilage damage. This study aimed to evaluate the utility of MRI for preoperative assessment of medial UKA patients by (1) comparing osteoarthritis severity of the medial, lateral and patellofemoral (PF) compartments when assessed using MRI compared with standard radiographs, and (2) investigating associations of these two assessments with postoperative clinical outcomes.
Methods: This study had ethical approval. A retrospective review was performed for 88 primary medial UKA between 1 January 2017 and 31 December 2021. The main outcome measures were preoperative cartilage loss and patient-reported clinical outcomes. Preoperative cartilage loss was recorded using the International Cartilage Repair Society (ICRS) classification using MRI, and Kellgren-Lawrence (K-L) scores from radiographs. Patient-reported clinical outcomes were measured using preop, early (6-week) and late (1- or 2-year) Oxford Knee Score (OKS) change scores.
Results: The use of MRI has improved accuracy over radiographs. In the medial compartment, 37 (44%) patients had less severe radiographic K-L scores (1-3); however, all patients had the most severe MRI ICRS scores (4). For patients with mild K-L scores (0 and 1), 20 (43%) and 7 (78%) patients had more severe ICRS scores (3 and 4) within their lateral and PF compartments, respectively. No associations were found between ICRS or K-L scores and OKS for any compartments.
Conclusions: Assessment of medial cartilage thickness loss using MRI provides additional utility over standard radiographs in preoperative assessments of medial UKA patients. However, evidence of disease in the PF compartment assessed using MRI should not be considered a contraindication for UKA.
Level of evidence: Level III, retrospective cohort study.
期刊介绍：
Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication.
The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance.
Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards.
Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
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