Comparison Of Diagnostic Methods For Medial Cartilage Damage In Elderly Patients With Knee Osteoarthritis

Research background and purpose: The cartilage damage in the medial compartment of the knee joint is the most common in patients with knee osteoarthritis,which is mostly treated by unicompartmental knee arthroplasty（UKA）.In the past,the diagnosis of medial compartment cartilage damage of knee joint was mainly judged by indirect signs such as joint space narrowing,subchondral sclerosis or osteophyte hyperplasia suggested by knee joint X-ray,which was subjective.At present,magnetic resonance imaging（MRI）is mostly used in clinical diagnosis of medial cartilage damage of knee joint,but MRI also has its limitations.It is not only expensive,but also has certain contraindications,and individual differences of patients or different examination equipment in the diagnosis process have certain interference to the results.Through clinical follow-up observation in the early stage,we found that patients with medial knee pain and positive physical examination "one indication" tended to have more common knee medial cartilage damage during surgery.Therefore,this research intends to compare the diagnostic value of physical examination,knee X-ray and MRI in the diagnosis of medial knee cartilage damage in elderly patients with medial knee pain.Object and methods: This research was a retrospective cohort analysis.Group A cases were selected from patients who underwent unicompartmental knee arthroplasty in our hospital from October 2018 to August 2020.A total of 62 cases were included,including 11 males and 51 females,aged 46-80 years,with an average of（61.2±7.1）years old;28 cases on the left side and 34 cases on the right side.Group B selected 34patients who received conservative treatment from November 2020 to June 2021 in the outpatient department of our hospital,including 10 males and 24 females,aged 40-58years,with an average of（48.1±5.1）years old;16 cases on the left side and 18 cases on the right side.By calculating Spearman’s rank correlation coefficient（Spearman’s Rho,SR）,the correlation between cartilage damage diagnosed by different preoperative examination methods and intraoperative findings of cartilage damage and the correlation between different examination methods in the diagnosis of cartilage damage were evaluated.Results: There is no significant differences in gender（P=0.186）,side（P=0.858）,BMI（P=0.201）,but there are significant differences in age（P < 0.001）and course of disease（P < 0.001）between group A and B.Specifically,the patients in group A were older and had long course of disease.There was A low and significant correlation between physical examination and intraoperative cartilage damage（SR=0.357）（P=0.004）.Physical examination had a low correlation with intraoperative carti lage damage（SR=0.357）and a significant correlation（P=0.004）.X-ray was highly correlated with intraoperative cartilage damage（SR=0.618）and had a significant correlation（P <0.001）.MRI was highly correlated with intraoperative cartilage damage（SR=0.675）and had a significant correlation（P < 0.001）.There was a low and significant correlation between physical examination and X-ray（SR=0.361）（P=0.003）,and a moderate correlation between physical examination and MRI（SR=0.417）（P=0.001）.There was a moderate correlation between X-ray and MRI（SR=0.573）and a significant correlation（P < 0.001）.In group B,the patients were young and had a short course of disease.There was a low correlation between physical examination and X-ray（SR=0.255）,but no significant correlation（P=0.146）;there was a low correlation between physical examination and MRI（SR=0.224）,but no significant correlation（P=0.203）.There was a low correlation between X-ray and MRI（SR=0.362）and a significant correlation（P=0.035）.In this research,the diagnosis of medial cartilage damage of knee joint in group A through physical examination or X-ray was significantly correlated with MRI or intraoperative cartilage damage;However,in group B,the diagnosis of medial cartilage damage of knee joint through physical examination was not significantly correlated with X-ray or MRI,and X-ray diagnosis of cartilage damage was significantly correlated with MRI,but only a low degree of correlation.Conclusion: For patients with young age or short disease duration,when preparing for UKA,it is necessary to consider whether MRI should be performed to further clarify the damage of the medial cartilage of the knee joint.For patients with advanced age and a long course of disease,combined with the physical examination of the knee joint and the results of knee X-ray examination,an accurate judgment of the medial cartilage damage of the knee joint can be made to a certain extent.Research background and purpose: Clinically,conservative treatment can be used for mild cartilage damage,while destructive cartilage damage（DCD）requires surgical treatment.Therefore,determining the degree of cartilage damage is an important basis for selecting treatment.MRI is a commonly used non-invasive examination.The diagnosis of cartilage damage is based on the change of cartilage morphology and/or abnormal signal.It has high sensitivity and specificity,so it is not difficult to diagnose cartilage damage;However,the thickness and signal of knee cartilage vary greatly in different ages,genders and anatomical sites,and conventional MRI cannot quantitatively analyze cartilage damage,so it is difficult to judge the degree of cartilage damage.Previous research has shown that bone contusion,medial meniscus damage,and anterior cruciate ligament injury are positively correlated with DCD,which can be used as indirect signs for the diagnosis of DCD,but the sensitivity is low.The meniscus is located between the femoral condyle and the tibial plateau.When the meniscus extrusion,there will be direct impact on the upper and lower cartilage surfaces of the knee joint,which is bound to cause destructive cartilage damage.At present,there is a lack of research on the correlation between meniscus extrusion and DCD at home and abroad.Objects and methods: This research was a retrospective cohort analysis.The cases were selected from patients who underwent UKA in our hospital from October 2018 to August 2020.A total of 62 cases were included,including 26 males and 36 females;aged 46-80 years,with an average of 61.2 years.There were 37 cases in meniscus extrusion group,including 8 males and 29 females,age 50-80 years,with an average of（61.1±6.8）years;There were 25 cases in no meniscus extrusion group,including 3 males and 22 females,age 46-77 years,with an average of（61.3±7.5）years.The incidence of DCD observed in UKA was compared between the meniscus extrusion group and the no meniscus extrusion group.Results: There were no significant differences in age（P=0.448）,gender（P=0.331）,BMI（P=0.801）and side（P=0.880）between meniscus extrusion group and n o meniscus extrusion group.There were significant differences between meniscus extrusion group and no meniscus extrusion group in destructive cartilage damage（P<0.001）.And the probability of medial compartment destructive cartilage damage in the meniscus extrusion group is higher.The sensitivity of medial meniscus extrusion in the diagnosis destructive cartilage damage was 70.6%,the specificity was 90.9%.Conclusion: From the perspective of MRI diagnosis,the signs of medial meniscus extrusion can be used to diagnose DCD of the knee joint.