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Multirater Agreement of Arthroscopic Grading of Knee Articular Cartilage

Robert G. Marx, MD, MSc, FRCSC^*,, Jason Connor, MS, Stephen Lyman, PhD, Annunziato Amendola, MD, Jack T. Andrish, MD, Christopher Kaeding, MD^||, Eric C. McCarty, MD^¶, Richard D. Parker, MD, Rick W. Wright, MD^#, Kurt P. Spindler, MD^¶ for the Multicenter Orthopaedic Outcomes Network

From the From the Hospital for Special Surgery, New York, New York, the Cleveland Clinic Foundation, Cleveland, Ohio, the University of Iowa Hospitals and Clinics, Iowa City, Iowa, the ^|| Ohio State Sports Medicine Center, Columbus, Ohio, the ^¶ Vanderbilt Sports Medicine Center, Nashville, Tennessee, and the ^# Washington University Orthopedic & Sports Medicine Center, St. Louis, Missouri

^* Address correspondence to Robert G. Marx, MD, MSc, FRCSC, Sports Medicine and Shoulder Service and the Foster Center for Clinical Outcome Research, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 (e-mail: MarxR{at}hss.edu).

Background: Acute and chronic cartilage injury of the knee has an important impact on prognosis. The validity of the classification of such injuries is critical for prospective multicenter studies. The agreement among multiple surgeons at different institutions for articular cartilage lesions has not been established.

Hypothesis: Arthroscopic classification of articular cartilage lesions is reliable and reproducible and can be used for multicenter studies involving multiple surgeons.

Study Design: Cohort study (diagnosis); Level of evidence, 1.

Methods: A total of 6 surgeons from 5 centers reviewed 31 videos of articular cartilage lesions. With grade 2 and grade 3 combined for the analysis, observed agreement ranged from 81% to 94%, and kappa ranged from 0.34 to 0.87. An additional 22 videos comprising grade 2 and grade 3 lesions were analyzed, and the observed agreement was 80%, with an overall kappa of 0.47.

Conclusion: Arthroscopic grading of articular cartilage lesions is reproducible among surgeons at different centers.

Clinical Relevance: Articular cartilage lesions can be reliably classified among surgeons at different sites. Such reliability is important for multicenter clinical research studies involving arthroscopic knee surgery.

Key Words: multicenter • cartilage • arthroscopy • agreement

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