INTEROBSERVER RELIABILITY OF THE ARTHROSCOPIC QUANTIFICATION OF CHONDROPATHY OF THE KNEE

Background: Several scoring systems have been proposed in order to qua ntify the degree of cartilage damage observed by arthroscopy of the kn ee in patients with osteoarthritis. Objective: To evaluate the inter-o bserver reliability of five different scoring systems of arthroscopic evaluation for chondropathy in osteoarthritis of the knee and to evalu ate the utility of a training session between different observations o n these scoring systems. Methods: Videotapes of knee arthroscopies on five patients with osteoarthritis demonstrating different levels of se verity of cartilage damage of the medial tibiofemoral compartment were analyzed by nine observers prior to (pre-training evaluation) and 2 m onths after a 6 h training session (post-training evaluation) by the f ollowing scaring systems: (1) cartilage deterioration by a 100 mm visu al analogue scale (VAS), (2) overall assessment of degeneration in the entire medial, compartment (cartilage, meniscus, osteophyte) using a 100 mm VAS, (3) French Society of Arthroscopy (SFA) Scoring System, (4 ) SFA Grading System, (5) American College of Rheumatalogy (ACR) Scori ng System. Results: At the pre-training evaluation, the SFA grading sy stem produced the highest coefficient of reliability (r = 0.94), the o ther systems recording levels of less than or equal to 0.80. At the po st-training evaluation, the coefficient of reliability was r > 0.80 fo r four of the five scoring systems, with lack of improvement in the AC R Scoring System. Conclusion: There was an improved and acceptable int er-observer reliability for at least 2 months follow-up in four of fiv e evaluated scoring systems of arthroscopically graded osteoarthritis of the knee following a training session. A scoring system using a 100 mm VAS may produce the best inter-observer reliability. These results show that scoring chondropathy is possible and demonstrate the import ance of training in the analysis of articular cartilage breakdown.