I'm going to talk about the importance of staging arthroscopy for chondral defects of the knee. Disclosures can be found on the website. Chondral defect is identified on knee arthroscopy in about 30% of the general population. In patients under the age of 40, a full thickness focal lesion, at least 1 to 2 centimeters in size can be identified in about 4 to 6%. And this represents a group that may benefit from cartilage restoration surgery. A systematic review of 27 studies reported a wide range of values for the diagnostic performance of MRI for identifying knee cartilage abnormalities. The authors reported that or attributed the large differences to varying methodology among studies and noted higher values in level 1 versus level 2 studies. Another review delved further into this matter, evaluating the methodological quality of 29 studies based on a validated scale specifically designed for assessing clinical studies of radiologic findings. And it was found that several standards were rarely met in the literature. While many sources of bias presented on this scale can be avoided in a well-designed prospective study, others are more difficult to prevent without unethical compromise of patient care. For example, avoiding diagnostic review bias would prevent surgeons from reviewing MR images prior to arthroscopy. Another meta-analysis on eight studies on the accuracy of MRI in grading chondral defects of the knee reported an overall sensitivity of 75% and specificity of 94%. The authors also calculated positive and negative likelihood ratios, and these represent one of the best ways to measure and express diagnostic accuracy. So you can see in this plot that with a pretest probability of 51%, a positive MRI increases the post-test probability to 93%, but in the setting of a negative MRI, the probability of having a chondral defect is still 22%. So the authors concluded that a negative MRI should not preclude diagnostic arthroscopy in patients with clinical suspicion of a chondral defect. The purpose of our study was to evaluate the role of staging arthroscopy for chondral defects of the knee, recognizing the limitations of a retrospective review in making a direct comparison of radiologic and arthroscopic findings. We aimed to determine the rate at which staging arthroscopy leads to a change in surgical plan. We performed a CPT search of three surgeries that are commonly preceded by staging arthroscopy, including autologous chondrocyte implantation, osteochondral allograft transplants, and meniscal allograft transplants. All patients with record of a proposed surgical plan before and after the staging arthroscopy procedure were included, and we recorded any changes after verifying them with the subsequent operative report. Our initial search returned a total of 133 results, and after applying our criteria, 35 patients were deemed ineligible, and the remaining 98 were included in our analysis. A total of 37 patients had at least one change in treatment plan following staging arthroscopy. In 14 patients, a previously undetected lesion that warranted cartilage restoration surgery was identified. In 15 patients, at least one defect that was initially thought to warrant cartilage restoration surgery was instead managed with debridement alone. In four patients, the initial plan of osteochondral allograft transplant was changed to autologous chondrocyte implantation, and the opposite change was made in another case. And lastly, the plan to address meniscal pathology in two patients was changed following arthroscopy. Results of our study include its retrospective design, the lack of a control group, and a relatively small sample size, and in addition, patients who did not undergo a subsequent meniscal transplant or cartilage restoration procedure were not included in our analysis, and therefore our results may be an underestimation of the rate at which staging arthroscopy leads to a change in plan. In conclusion, staging arthroscopy influenced a change in surgical plan in more than a third of our cohort, highlighting its importance in the assessment of patients with chondral defects of the knee. Thank you.

arthroscopy

chondral defects

surgical plans

MRI

cartilage restoration surgery