title: Arthroscopic estimation of the extent of chondropathy.
abstract: BACKGROUND
  Arthroscopy has been used to evaluate articular cartilage (AC) pathology in osteoarthritis (OA) for outcome measurement and validation of non-invasive imaging. However, many fundamental aspects of arthroscopic assessment remain un-validated.
  
  
  OBJECTIVE
  This study evaluated arthroscopic estimates of extent of chondropathy.
  
  
  METHODS
  Serial arthroscopic assessments were performed in a group of 15 sheep before and after bilateral stifle medial meniscectomy (MMx). Post-mortem assessments were performed in un-MMx sheep and 4 and 16 weeks post-MMx. Arthroscopic assessments of the extent of each grade of chondropathy were compared with a non-arthroscopic hybrid assessment that incorporated biomechanical, thickness and macroscopic assessments.
  
  
  RESULTS
  Arthroscopy evaluated only 36% of AC and missed significant pathological changes, softening and chondro-osteophyte, occurring in peripheral regions. The patterns of change in arthroscopic assessments were similar to those of the non-arthroscopic assessment but there was a very strong tendency to over-estimate the extent of softened AC after MMx. In spite of these limitations arthroscopic assessments were responsive to change. Estimates of the extent of normal and softened AC were most responsive to change over time followed by estimates of superficial and deep fibrillation. Arthroscopy was as an excellent discriminator between normal and OA. Assessments of chondro-osteophyte and exposed bone were not responsive to change.
  
  
  CONCLUSIONS
  Arthroscopic estimates of extent of chondropathy are prone to substantial error. While experience and training may reduce these errors other approaches may more effectively improve performance.
authors.affiliation: Rheumatology Department, Guys & St. Thomas' NHS Foundation Trust, London, United Kingdom. stephen.oakley@gstt.nhs.uk
authors.forename: S P
authors.initials: SP
authors.lastname: Oakley
authors.forename: I
authors.initials: I
authors.lastname: Portek
authors.forename: Z
authors.initials: Z
authors.lastname: Szomor
authors.forename: R C
authors.initials: RC
authors.lastname: Appleyard
authors.forename: P
authors.initials: P
authors.lastname: Ghosh
authors.forename: B W
authors.initials: BW
authors.lastname: Kirkham
authors.forename: G A C
authors.initials: GA
authors.lastname: Murrell
authors.forename: M N
authors.initials: MN
authors.lastname: Lassere
mesh_terms: D000818:Animals; D001182:Arthroscopy / Q000592:standards*; D002357:Cartilage Diseases / Q000473:pathology*; D002358:Cartilage, Articular / Q000473:pathology*; D005069:Evaluation Studies as Topic; D023421:Models, Animal; D010003:Osteoarthritis / Q000473:pathology*; D015203:Reproducibility of Results; D012756:Sheep; D013264:Stifle