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Reliability of meniscus tear description: a study using MRI from the Osteoarthritis Initiative

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Abstract

Despite being one of the most common indications for surgery, data on the types of meniscus tear that should be treated surgically are limited. Improving patient selection requires agreement on meniscus tear description. This study evaluates a simple MRI tear classification system for inter-observer agreement. Knee MRI examinations from 57 subjects from the Osteoarthritis Initiative cohort were reviewed by two sub-specialty trained, musculoskeletal radiologists. Based on two pulse sequences, each meniscus was classified by: tear or no tear; location of tear in anterior, middle or posterior third or multiple thirds; and displaced or non-displaced radial, horizontal, longitudinal or complex tear pattern. A tear was defined as signal abnormality extending to the surface on at least two images and displacement as more than 2 mm of extrusion or separation measured orthogonal to the tear plane. Kappa, weighted Kappa and percentage agreement were calculated. For the medial meniscus, Kappa and percentage agreement estimates were, respectively: the presence of tear, 0.79 and 89.5%; tear with displacement, 0.70 (weighted Kappa) and 66.0%; tear description, 0.47 and 61.4%; tear location, 0.64 and 79.0%. For the lateral meniscus, estimates were: the presence of tear, 0.75 and 89.5%; tear with displacement, 0.81 (weighted Kappa) and 86.0%; tear description, 0.56 and 78.9%; tear location, 0.74 and 87.7%. The strength of agreement between readers was moderate to substantial underscoring the challenge of meniscus tear classification.

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Acknowledgements

The OAI is a public/private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; and N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners.

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Authors and Affiliations

  1. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Virginia Commonwealth University Medical Center, 1250 E Marshall St, Richmond, VA, 23298, USA

    Kevin B. Hoover, Josephina A. Vossen & Curtis W. Hayes

  2. Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology, Basement, West Hospital, Room B-100, Virginia Commonwealth University, Richmond, VA, 23298-0224, USA

    Dan L. Riddle

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  1. Kevin B. Hoover
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All co-authors take full responsibility for all aspects of the study and the final manuscript. Each author has contributed the following to this submission; made a substantial contribution to the conception and design of the work (KBH; CWH, DLR); made a substantial contribution to the acquisition, analysis or interpretation of data for the work (KBH, JAV, CWH, DLR); drafted the work and revised it critically for important intellectual content (KBH, JAV, CWH, DLR); provided final approval of the version to be published (KBH, JAV, CWH, DLR); and agreed to be accountable for all aspects of the work including ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (KBH, JAV, CWH, DLR).

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Correspondence to Kevin B. Hoover.

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Hoover, K.B., Vossen, J.A., Hayes, C.W. et al. Reliability of meniscus tear description: a study using MRI from the Osteoarthritis Initiative. Rheumatol Int 40, 635–641 (2020). https://doi.org/10.1007/s00296-019-04489-0

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