The Genovese grading scale is not reliable for MR assessment of collagen meniscus implants

• Published in: The knee 2017-01, Vol.24 (1), p.9-15
• Main Authors: Hirschmann, A, Schiapparelli, F.F, Schenk, L, Keller, L, Amsler, F, Hirschmann, M.T
• Format: Article
• Language: English
• Subjects: Adult; Agreements; Bone marrow; Collagen; Collagen meniscus; Edema; Ethics; Female; Genovese grading; Humans; Joint Diseases - diagnostic imaging; Joint Diseases - etiology; Joint Diseases - surgery; Knee; Magnetic Resonance Imaging; Male; Meniscal substitution; Menisci, Tibial - diagnostic imaging; Menisci, Tibial - surgery; Middle Aged; Morphology; MRI; NMR; Nuclear magnetic resonance; Observer Variation; Orthopedics; Prostheses and Implants; Reproducibility of Results; Studies; Transplants & implants
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2016.10.011

Abstract Purpose The purpose of the study was to evaluate the intra- and inter-observer reliability of the Genovese grading on MRI in patients after collagen meniscus substitution. Methods 84 MRI images of 74 consecutive patients who underwent partial meniscus substitution using collagen meniscus implant (CMI) were assessed. MRIs were evaluated using the Genovese grading system. Furthermore, meniscal extrusion was assessed. Two observers performed the grading twice, blinded to each other and to the previous results, with a six weeks interval. The inter- and intra-observer reliability was assessed using Kappa and weighted Kappa values. Results The criterion “morphology/size” showed a weighted Kappa value inter-observer reliability of 0.069 (rater 1) / 0.352 (rater 2) and intra-observer reliability of 0.170 (1st rating) / 0.582 (2nd rating). The criterion “signal intensity” showed a weighted Kappa value inter-observer reliability of 0.175 / 0.284 and intra-observer reliability of 0.294 / 0.458. The criterion “cartilage lesions” showed a Kappa value inter-observer reliability of 0.091 / 0.525 and intra-observer reliability of 0.409 / 0.413. The criterion “bone marrow edema” showed a Kappa value inter-observer reliability of 0.667 / 0.808 and intra-observer reliability of 0.702 / 0.715. The criterion “cartilage lesions” showed a Kappa value inter-observer reliability of 0.091 / 0.525 and intra-observer reliability of 0.409 / 0.413. Regarding meniscal extrusion Kappa values for the inter-observer reliability were 0.625 / 0.940 and 0.625 / 0.889 for intra-observer reliability. Conclusions Three of the four Genovese grading items showed only slight to moderate inter- and intra-observer reliability in evaluating CMI on MRI. Hence, such grading results need to be considered with all due care. Only the criteria “bone marrow edema” and “meniscal extrusion” showed a good agreement for both inter- and intra-observer reliability.