Reliability of the novel MRI-based OCD lesion healing assessment tool for adolescent OCD of the knee

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Abstract

BACKGROUND: One of the most debatable issues in osteochondritis dissecans (OCD) research is bone and cartilage healing assessment during OCD postoperative management. The x-ray scale developed by Wall and colleagues is a commonly used evaluation tool for OCD lesion assessment. This tool has excellent reliability but is associated with radiologic exposure. Also, it provides complete information about bone structure only, even though the articular cartilage is also involved in the pathological process. Lack of cartilage assessment combined with radiation exposure facilitated the development of the novel MRI-based OCD healing assessment tool. It could draw attention to bone and cartilage during healing assessment to improve decision-making in the postoperative period after OCD treatment.

AIM: This study assesses the reliability of a developed novel MRI-based OCD healing assessment tool.

MATERIALS AND METHODS: Ten patients with OCD of the femoral condyle were involved in the current study. A reliability test for the novel MRI-based assessment tool was performed with the expert group comprising six participants to assess 34 MRI studies of 10 patients. From all studies, one study was obligatory for each patient before the operative treatment, and a postoperative MRI study series was performed during the first postoperative year. Each MRI study was examined by each expert twice with a 4-week time lag. The novel MRI-based assessment tool consists of five criteria, of which the common criterion was “general healing,” incorporating all previously described ones. Each criterion was tested, and a two-way mixed-effects intraclass correlation coefficient (ICC) was used to assess intraobserver and interobserver reliability.

RESULTS: The main parameter “general healing” calculations were made first. Two patients achieved full OCD lesion healing with 100 scale points and two patients with 97.5 and 98.5 points, respectively. Other patients reached the cut-off value of 75 points and were defined as “healed with minimally detectable changes on MRI.” Second, a two-way mixed-effects ICC calculation was performed. The “bone marrow extension” parameter reached the value of 0.972, “the extent of the union” – 0.984, “bone structure” – 0.977, and “articular cartilage intensity and structure” – 0.977. The general healing parameter reached the value of 0.993. These values corresponded to the excellent marks according to the guidelines for ICC assessment. The novel MRI-based assessment tool showed excellent intraobserver and interobserver reliability.

CONCLUSIONS: The novel MRI-based assessment tool permits assessing bony and cartilage structures while making decisions about OCD lesion healing in the postoperative period. The novel OCD healing assessment tool has excellent intraobserver and interobserver reliability. Also, it is recommended for use in clinical and research practice since a study revealed a correlation of the MRI healing score with that of the clinical assessment tool.

About the authors

Andrey V. Semenov

Pirogov Russian National Research Medical University

Author for correspondence.
Email: dru4elos@gmail.com
ORCID iD: 0000-0001-6858-4127

MD, PhD student

Russian Federation, Moscow

Mikhail S. Zubtsov

Pirogov Russian National Research Medical University

Email: zumi19979@yandex.ru
ORCID iD: 0000-0001-6845-5253

MD, resident

Russian Federation, Moscow

Yuriy G. Lipkin

Pirogov Russian National Research Medical University

Email: lyg@mail.ru
ORCID iD: 0000-0002-3306-0523
SPIN-code: 6396-4125

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Moscow

Grigoriy S. Dibrivnyy

Filatov Municipal Children Hospital

Email: dibrivniy11091976199@mail.ru
ORCID iD: 0000-0002-6263-5488

MD, Radiologist

Russian Federation, Moscow

Ivan N. Isaev

Filatov Municipal Children Hospital

Email: i.n.isaev@gmail.com
ORCID iD: 0000-0001-7899-5800

MD, Orthopedic and trauma surgeon

Russian Federation, Moscow

Vladimir V. Koroteev

Filatov Municipal Children Hospital

Email: 9263889457@mail.ru
ORCID iD: 0000-0003-4502-1465

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Moscow

Nikolay I. Tarasov

Filatov Municipal Children Hospital

Email: tarasov_doctor@mail.ru
ORCID iD: 0000-0002-9303-2372

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Moscow

Yulia I. Lozovaya

Pirogov Russian National Research Medical University; Filatov Municipal Children Hospital

Email: u.lozovaya@gmail.com
ORCID iD: 0000-0003-3899-1420

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Moscow; Moscow

Dmitriy Y. Vybornov

Pirogov Russian National Research Medical University; Filatov Municipal Children Hospital

Email: dgkb13@gmail.com
ORCID iD: 0000-0001-8785-7725

MD, PhD, Dr. Sci. (Med.)

Russian Federation, Moscow; Moscow

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Supplementary files

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2. Fig. 1. Magnetic resonance imaging of the knee joint of a child with a focus of osteochondritis dissecans in PDFS mode in the sagittal projection. The continuous line marks the area of ​​increased intensity in the maternal part of the bone, corresponding to the edema of the bone substance. The latter occupies approximately 25% of the condyle. The arrow indicates the hypointense band between the osteochondral fragment and the maternal bone. The latter occupies about 80% of the length of the entire lesion from front to back, with mosaic hyperintense areas corresponding to the bone tissue that still partially connects the fragment to the maternal bone.

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3. Fig. 2. Magnetic resonance imaging of the knee joint of a child with a focus of osteochondritis dissecans in PDFS mode in the sagittal projection. The arrowheads indicate the zone of the bone part of the osteochondral fragment in the focus of osteochondritis dissecans, the latter of hyperintense coloration, on a gray-black color scale, closer to the articular cartilage

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4. Fig. 3. Classification of articular cartilage damage by the International Cartilage Repair Society (ICRS). The scale is replaced by a 100-point system for ease of use. Grade I corresponded to 85 points: solitary areas of hypointensity among the unchanged cartilage thickness. Grade II corresponded to 60 points: increased thickness/irregularity of the cartilage margins. Grade III corresponded to 30 points: thinning and irregular cartilage. Grade IV corresponded to 0 points: lack of cartilage in the area (the full-thickness defect)

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5. Fig. 4. Magnetic resonance imaging of the knee joint of a child with a focus of osteochondritis dissecans in PDFS mode in the sagittal projection. Thinning and hypointensity of the signal from the articular cartilage in the area of the focus of osteochondritis dissecans. The magnetic resonance picture corresponds to the III stage of cartilage damage according to ICRS

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6. Fig. 5. The general scheme for assessing healing, represented by four main parameters for assessing the healing of the focus of osteochondritis dissecans: edema of the bone substance (circled in the figure on the left with a solid line), the degree of consolidation (the line between the osteochondral fragment of the focus and the maternal bone is indicated by an arrow in the figure on the left), bone structure (estimated by the density and structure of bone tissue), articular cartilage structure (indicated by arrows in the picture on the right)

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7. Fig. 2. Magnetic resonance imaging of the knee joint (sagittal PD-FS image) of a child with an osteochondritis dissecans lesion. The arrowheads indicate the bone zone in the osteochondral fragment in the OD lesion. It has a hyperintense coloration and is closer to the articular cartilage on a gray-black color scale

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8. Fig. 4. Magnetic resonance imaging of the knee joint (sagittal PD-FS image) of a child with an osteochondritis dissecans lesion. Thinning and hypointensity of the signal from the articular cartilage in the OD lesion are observed. The magnetic resonance picture shows a grade III cartilage damage, according to ICRS

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9. Fig. 5. The general scheme for healing assessment, represented by four main parameters for assessing the healing of the osteochondritis dissecans lesion: the bone substance edema (circled in the figure on the left with a continuous line), the degree of consolidation (the line between the osteochondral fragment of the lesion and the maternal bone is indicated by an arrow in the figure on the left), bone structure (estimated by the density and structure of the bone tissue), and articular cartilage structure (indicated by arrows in the figure on the right)

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Copyright (c) 2022 Semenov A.V., Zubtsov M.S., Lipkin Y.G., Dibrivnyy G.S., Isaev I.N., Koroteev V.V., Tarasov N.I., Lozovaya Y.I., Vybornov D.Y.

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