Sonographic evaluation of lateral meniscal extrusion: implementation and validation
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ARTHROSCOPY AND SPORTS MEDICINE
Sonographic evaluation of lateral meniscal extrusion: implementation and validation Philipp W. Winkler1,2 · Robert Csapo1,3 · Guido Wierer3,4 · Caroline Hepperger1,3 · Bernhard Heinzle5 · Andreas B. Imhoff2 · Christian Hoser1,3 · Christian Fink1,3 Received: 9 February 2020 / Accepted: 4 November 2020 © The Author(s) 2020
Abstract Introduction Meniscal extrusion (ME) is an important indicator of and prognostic factor for various knee pathologies. To date, no standardized protocol for the ultrasound-based examination of lateral ME exists. The purpose of the present study was to test the reliability and validity of lateral ME measurements using a standardized ultrasound-based examination protocol. Materials and Methods A group consisting of 11 healthy volunteers (Group I, male and female, 18–45 years) as well as a group of 10 consecutive patients who had undergone all-inside lateral meniscal radial tear repair were included (Group II, male and female, 23–43 years). Lateral ME, the main outcome parameter, was measured by ultrasound (US; both groups) and magnetic resonance imaging (MRI; Group II only). Both knees of all subjects were examined in an unloaded state and under axial compression of the knee (50% of body weight). Repeated measurements obtained in Group I by 2 observers were used for reliability testing, and the validity of US was assessed through comparison with MRI data (Group II). Results A total of 66 US images of Group I, obtained by each observer, were analyzed for reliability testing. Forty US and MR images of Group II were assessed for validation. Results showed good interrater (ICC = 0.904) and excellent intrarater (ICC = 0.942) reliability of US-based measurements of lateral ME. Agreement with MRI results was poor (ICC = 0.439), with US systematically overestimating results by 1.1 mm on average. Conclusions Ultrasound is a reliable, quick and cost-effective technique for lateral ME measurement, but results are not readily comparable with MRI. Trial registration The study was registered in the European Union Clinical Trials Register (EudraCT-Number: 2017-005037-24). Keywords Lateral meniscal extrusion · Ultrasound · Stress MRI · Validation · Dynamic ultrasound · Dynamic extrusion
* Philipp W. Winkler [email protected]
1
Gelenkpunkt, Sports- and Joint Surgery, Olympiastraße 39, 6020 Innsbruck, Austria
Robert Csapo [email protected]
2
Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
3
Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Eduard‑Wallnöfer‑Zentrum 1, 6060 Hall in Tirol, Austria
4
Department of Orthopedics and Traumatology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
5
Department of Radiology, MRT-CT Diagnostics Wörgl, Fritz‑Atzl‑Str. 8, 6300 Wörgl, Austria
Guido Wierer [email protected]
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