The AMADEUS (Area Measurement And DEpth and Underlying Structures) scoring and grading system has been proposed for the MRI based evaluation of untreated focal chondral defects around the knee. The clinical practicability, its correlation with arthroscopically assessed grading systems (ICRS – International Cartilage Repair Society) and thereby its clinical value in terms of decision making and guiding prognosis was yet to determine. From 2008 to 2019 a total of 89 individuals were indicated for high tibial valgus osteotomy (HTO) due to tibial varus deformity and concomitant chondral defects of the medial compartment of the knee. All patients received a preoperative MRI (1.5 Tesla or 3.0 Tesla) and pre-osteotomy diagnostic arthroscopy. Chondral defects of the medial compartment were scored and graded with the MRI based AMADEUS by three independent raters and compared to arthroscopic defect grading by the ICRS system. Interrater and intrarater reliability as well as correlation analysis with the ICRS classification system were assessed. Intraclass correlation coefficients for the various subscores of the AMADEUS showed an overall good to excellent interrater agreement (min: 0.26, max: 0.80). Intrarater agreement turned out to be substantially inferior (min: 0.08, max: 0.53). Spearman correlation revealed an overall moderate correlative association of the AMADEUS subscores with the ICRS classification system, apart from the defect area subscore. Sensitivity of the AMADEUS to accurately identify defect severity according to the ICRS was 0.7 (0.69 for 3.0 Tesla MRI, 0.67 for 1.5 Tesla MRI). The mean AMADEUS grade was 2.60 ± 0.81 and the mean ICRS score 2.90 ± 0.63. Overall, the AMADEUS with all its subscores shows moderate correlation with the arthroscopic chondral grading system according to ICRS. This suggests that chondral defect grading by means of the MRI based AMADEUS is well capable of influencing and guiding treatment decisions. Interrater reliability shows overall good agreement.

中文翻译：

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基于 MRI 的 AMADEUS 评分能否根据 ICRS 关节镜分类系统准确评估术前软骨缺损严重程度？

AMADEUS（面积测量和深度和底层结构）评分和分级系统已被提议用于基于 MRI 评估膝关节周围未治疗的局灶性软骨缺损。临床实用性、其与关节镜评估分级系统 (ICRS – 国际软骨修复学会) 的相关性以及其在决策制定和指导预后方面的临床价值尚未确定。从 2008 年到 2019 年，共有 89 名患者因胫骨内翻畸形和伴随的膝关节内侧间室软骨缺损而接受高位胫骨外翻截骨术 (HTO)。所有患者均接受了术前 MRI（1.5 特斯拉或 3.0 特斯拉）和截骨术前诊断关节镜检查。内侧隔室的软骨缺损由三个独立的评估者使用基于 MRI 的 AMADEUS 进行评分和分级，并与 ICRS 系统的关节镜缺损分级进行比较。评估者间和评估者内的可靠性以及与 ICRS 分类系统的相关性分析进行了评估。AMADEUS 的各个子分数的组内相关系数显示出总体良好到优秀的评分者间一致性（最小值：0.26，最大值：0.80）。内部一致性结果明显较差（最小值：0.08，最大值：0.53）。Spearman 相关性揭示了 AMADEUS 子分数与 ICRS 分类系统的总体中度相关关联，除了缺陷区域子分数。根据 ICRS，AMADEUS 准确识别缺陷严重程度的灵敏度为 0.7（3.0 Tesla MRI 为 0.69，1.0 为 0.67。5 特斯拉核磁共振成像）。平均 AMADEUS 评分为 2.60 ± 0.81，平均 ICRS 评分为 2.90 ± 0.63。总体而言，根据 ICRS，AMADEUS 及其所有子评分与关节镜下软骨分级系统显示出中度相关性。这表明通过基于 MRI 的 AMADEUS 进行的软骨缺损分级能够很好地影响和指导治疗决策。评估者间信度显示总体上良好的一致性。