Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS): Longitudinal MRI-based whole joint assessment of anterior cruciate ligament injury

Frank W Roemer; Richard Frobell; L Stefan Lohmander; Jingbo Niu; Ali Guermazi

doi:10.1016/j.joca.2014.03.006

Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS): Longitudinal MRI-based whole joint assessment of anterior cruciate ligament injury

Osteoarthritis Cartilage. 2014 May;22(5):668-82. doi: 10.1016/j.joca.2014.03.006. Epub 2014 Mar 19.

Authors

Frank W Roemer¹, Richard Frobell², L Stefan Lohmander³, Jingbo Niu⁴, Ali Guermazi⁵

Affiliations

¹ Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany; Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA. Electronic address: frank.roemer@uk-erlangen.de.
² Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
³ Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden; Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
⁴ Clinical Epidemiology and Training Unit, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
⁵ Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA.

PMID: 24657830
DOI: 10.1016/j.joca.2014.03.006

Abstract

Objective: To develop a whole joint scoring system, the Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS), for magnetic resonance imaging (MRI)-based assessment of acute anterior cruciate ligament (ACL) injury and follow-up of structural sequelae, and to assess its reliability.

Design: Baseline and follow-up 1.5 T MRI examinations from 20 patients of the KANON study, a randomized controlled study comparing a surgical and non-surgical treatment strategy, were assessed for up to six longitudinal visits using a novel MRI scoring system incorporating acute structural tissue damage and longitudinal changes including osteoarthritis (OA) features. Joint features assessed were acute osteochondral injury, traumatic and degenerative bone marrow lesions (BMLs), meniscus morphology and extrusion, osteophytes, collateral and cruciate ligaments including ACL graft, Hoffa-synovitis and effusion-synovitis. Cross-sectional (baseline) and longitudinal (all time points and change) intra- and inter-observer reliability was calculated using weighted (w) kappa statistics and overall percent agreement on a compartmental basis (medial tibio-femoral, lateral tibio-femoral, patello-femoral).

Results: Altogether 87 time points were evaluated. Intra-observer reliability ranged between 0.52 (baseline, Hoffa-synovitis) and 1.00 (several features), percent agreement between 52% (all time points, Hoffa-synovitis) and 100% (several features). Inter-observer reliability ranged between 0.00 and 1.00, which is explained by low frequency of some of the features. Altogether, 73% of all assessed 142 parameters showed w-kappa values between 0.80 and 1.00 and 92% showed agreement above 80%.

Conclusions: ACLOAS allows reliable scoring of acute ACL injury and longitudinal changes. This novel scoring system incorporates features that may be relevant for structural outcome not covered by established OA scoring instruments.

Keywords: ACLOAS; Anterior cruciate ligament injury; Magnetic resonance imaging; Osteoarthritis; Reliability; Scoring.

Publication types

Randomized Controlled Trial

MeSH terms

Acute Disease
Adult
Anterior Cruciate Ligament / surgery
Anterior Cruciate Ligament Injuries*
Anterior Cruciate Ligament Reconstruction
Cross-Sectional Studies
Female
Humans
Knee Injuries / complications*
Knee Injuries / diagnosis
Knee Injuries / surgery
Longitudinal Studies
Magnetic Resonance Imaging / methods
Male
Menisci, Tibial / pathology
Observer Variation
Osteoarthritis, Knee / diagnosis
Osteoarthritis, Knee / etiology*
Reproducibility of Results
Severity of Illness Index
Synovitis / etiology
Trauma Severity Indices*
Young Adult