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Validation of a new topographic classification of bone marrow lesions in the knee: the six-letter system

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to propose and validate a new six-item topographical classification of knee bone marrow lesions in coronal MRI images, to provide an easy-to-use aid to describe their location in a more reproducible and accurate way.

Methods

This study was conducted in four phases. The first was to do a literature search for methods of describing bone marrow lesions in MRI of the knee. The second was creation of a six-area topographic classification of bone marrow lesions in coronal MRI of the knee. The third phase was selection of cases with bone marrow lesions on knee MRI performed in a single hospital between January of 2017 and December of 2018. The fourth phase was categorization of the bone marrow lesions’ location according to the new proposed classification by three independent examiners, two orthopedic surgeons and one radiologist. Patient’s demographic data and associated lesions were collected. The inter-observer and intra-observer reliability of the proposed classification was then calculated.

Results

MRI examination of 4000 patients were studied and in 520 patients a total of 666 bone marrow lesions were identified and their location classified using the new system. The inter-observer and intra-observer reliability analysis found a Fleiss’ Kappa value of 0.96 (0.95–0.97) and 0.97 (0.96–0.97), respectively, confirming the high reproducibility of the proposed classification.

Conclusions

The proposed six-location classification of bone marrow lesions is highly reproducible and can help researchers develop studies and share information in a more accurate and reliable way. The correct classification of bone marrow lesions can lead to a more accurate description of this pathology and help clinicians to propose appropriate therapies for this group of patients.

Level of evidence

V.

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Authors and Affiliations

  1. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy

    Riccardo Compagnoni, Paolo Ferrua, Alessandra Menon, Carlo Minoli & Pietro Randelli

  2. Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy

    Riccardo Compagnoni, Alessandra Menon & Pietro Randelli

  3. Clinic of Orthopedics, Medical University of Łódź, Łódź, Poland

    Jędrzej Lesman & Marcin Domżalski

  4. Department of Radiology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy

    Mauro Gallazzi

Authors
  1. Riccardo Compagnoni
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  2. Jędrzej Lesman
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  3. Paolo Ferrua
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  4. Alessandra Menon
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  5. Carlo Minoli
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  6. Mauro Gallazzi
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  7. Marcin Domżalski
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  8. Pietro Randelli
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Correspondence to Riccardo Compagnoni.

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Conflict of interest

Riccardo Compagnoni, Jędrzej Lesman, Paolo Ferrua, Alessandra Menon, Carlo Minoli, Mauro Gallazzi and Marcin Domżalski declare that they have no conflict of interest. Pietro Randelli is consultant for Depuy, Arthrex, Microport and Medacta.

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No funding to declare.

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This study was approved by regional ethical committee.

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Compagnoni, R., Lesman, J., Ferrua, P. et al. Validation of a new topographic classification of bone marrow lesions in the knee: the six-letter system. Knee Surg Sports Traumatol Arthrosc 29, 333–341 (2021). https://doi.org/10.1007/s00167-020-05957-y

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  • DOI: https://doi.org/10.1007/s00167-020-05957-y

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