Correlation between arthroscopic and histopathological grading systems of articular cartilage lesions in knee osteoarthritis

Osteoarthritis Cartilage. 2009 Feb;17(2):205-12. doi: 10.1016/j.joca.2008.06.010. Epub 2008 Aug 3.


Purpose: Arthroscopic and particularly histopathological assessments have been used to evaluate alterations of knee cartilage in osteoarthritis (OA). The aim of this study was to examine the correlation between an arthroscopic method to grade the severity of chondropathies and the histological/histochemical grading system (HHGS) applied to the corresponding articular cartilage areas in knee OA.

Methods: The articular cartilage surface was examined by chondroscopy using the Beguin and Locker severity criteria, analysing the lesions in 72 chondroscopic areas. Afterwards, samples were obtained by dividing the cartilage surface of the medial tibiofemoral compartment of three OA knee joints into equal squares and they were evaluated histologically using the HHGS. The correlation between both grading methods was assessed using the weighted Kappa coefficient (K(w)).

Results: The results obtained with both scores showed good agreement (K(w): mean+/-standard deviation, 0.619+/-0.071). While the average HHGS scores of the chondral samples showed a better agreement with arthroscopic grades 0, I and II, the arthroscopic evaluation has a tendency to overestimate chondral lesions for histological grades III and IV. The intra- and inter-observer reliability of the HHGS evaluation of chondral lesions was excellent (Intraclass Correlation Coefficient: 0.909 and 0.941, respectively).

Conclusion: In this study, we found a good quantitative correlation between established arthroscopic severity and histopathological scoring systems, particularly in less advanced lesions. Our results suggest that the arthroscopic method is a valuable tool in clinical research to score chondropathies in the medial femorotibial compartment of the OA knee, although some limitations should not be overlooked.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arthroscopy / methods
  • Cartilage, Articular / pathology*
  • Female
  • Femur / pathology
  • Humans
  • Knee Joint / pathology
  • Male
  • Observer Variation
  • Osteoarthritis, Knee / diagnosis*
  • Osteoarthritis, Knee / pathology
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Tibia / pathology