title: In Vivo Evaluation of the Potential of High-Frequency Ultrasound for Arthroscopic Examination of the Shoulder Joint.
abstract: OBJECTIVE
  Accurate arthroscopic evaluation of cartilage lesions could significantly improve the outcome of repair surgery. In this study, we investigated for the first time the potential of intra-articular ultrasound as an arthroscopic tool for grading cartilage defects in the human shoulder joint in vivo and compared the outcome to results from arthroscopic evaluation and magnetic resonance imaging findings.
  
  
  METHODS
  A total of 26 sites from 9 patients undergoing routine shoulder arthroscopy were quantitatively evaluated with a clinical intravascular (40MHz) ultrasound imaging system, using the regular arthroscopy portals. Reflection coefficient (R), integrated reflection coefficient (IRC), apparent integrated backscattering (AIB), and ultrasound roughness index (URI) were calculated, and high-resolution ultrasound images were obtained per site. Each site was visually graded according to the International Cartilage Repair Society (ICRS) system. "Ultrasound scores" corresponding to the ICRS system were determined from the ultrasound images. Magnetic resonance imaging was conducted and cartilage integrity at each site was classified into 5 grades (0 = normal, 4 = severely abnormal) by a radiologist.
  
  
  RESULTS
  R and IRC were lower at sites with damaged cartilage surface (P = 0.033 and P = 0.043, respectively) and correlated with arthroscopic ICRS grades (r s = -0.444, P = 0.023 and r s = -0.426, P = 0.03, respectively). Arthroscopic ICRS grades and ultrasound scores were significantly correlated (rs = 0.472, P = 0.015), but no significant correlation was found between magnetic resonance imaging data and other parameters.
  
  
  CONCLUSIONS
  The results suggest that ultrasound arthroscopy could facilitate quantitative clinical appraisal of articular cartilage integrity in the shoulder joint and provide information on cartilage lesion depth and severity for quantitative diagnostics in surgery.
authors.affiliation: Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland.
authors.forename: Jani
authors.initials: J
authors.lastname: Puhakka
authors.affiliation: Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Afara
authors.affiliation: Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland; Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Teemu
authors.initials: T
authors.lastname: Paatela
authors.affiliation: Department of Radiology, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Sormaala
authors.affiliation: Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
authors.forename: Matti A
authors.initials: MA
authors.lastname: Timonen
authors.affiliation: Cancer Centre, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Virén
authors.affiliation: Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
authors.forename: Jukka S
authors.initials: JS
authors.lastname: Jurvelin
authors.affiliation: Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Töyräs
authors.affiliation: Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland; Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Kiviranta
keywords: arthroscopy; cartilage; shoulder; subchondral bone; ultrasound