Interobserver reliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears.

BACKGROUND: Consistency of arthroscopic evaluation and documentation in meniscal tears between investigators is essential to the validity of multicenter studies. A group of experts developed a classification of meniscal tears that may be used internationally. HYPOTHESIS: The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears provides sufficient interobserver reliability for pooling of data from international clinical trials designed to evaluate the outcomes of treatment for meniscal tears. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 1. METHODS: A pilot study was performed by having 8 members of the committee grade 10 arthroscopic videos for classification of tear depth, rim width, location, tear pattern, and quality of the tissue. The results of the pilot study were used to change the instruction sheet and evaluation form. International interobserver reliability was determined by having 8 orthopaedic surgeons who practice in different countries evaluate 37 arthroscopic videos selected to represent different meniscal tear characteristics. The Spearman ρ correlation coefficient was used to compare the area of the meniscus excised, as drawn on the diagram, with the numeric percentage of meniscus excised. RESULTS: There was an 87% agreement for anterior-posterior location of the tear (κ = .65); 79% agreement for tear pattern (κ = .72); 88% agreement for tear depth (κ = .52); 68% agreement for anterior, middle, and posterior location of the tear (κ = .46); and 72% agreement for tissue quality (κ = .47). There was 54% agreement for the rim width (κ = .25) and 67% agreement if the tear was central to the popliteal hiatus (κ = .36). Based on the Landis and Koch criteria for κ coefficients, there was substantial agreement for anterior-posterior location of the tear and tear pattern; moderate agreement for tear depth, anterior, middle, and posterior location of the tear, and tissue quality; and fair agreement for rim width and if the tear was central to the popliteal tear. Interobserver reliability based on the intraclass correlation coefficient (ICC) was good for tear length (ICC = .83) and moderate for percentage of meniscus that was excised (ICC = .65). The mean ρ for all raters was .92 (95% confidence interval [CI], .89-.94) comparing the values for percentage of meniscus excised with the area on the diagrams. CONCLUSION: The ISAKOS classification of meniscal tears provides sufficient interobserver reliability for pooling of data from international clinical trials designed to evaluate the outcomes of treatment for meniscal tears.

Prediction of patient-reported outcome after single-bundle anterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to identify preoperative and intraoperative factors that predict patient-oriented outcome as measured by the International Knee Documentation Committee (IKDC) Subjective Knee Form after anterior cruciate ligament (ACL) reconstruction. METHODS: We identified 402 subjects who had undergone primary single-bundle arthroscopic ACL reconstruction at a mean follow-up of 6.3 years (range, 2 to 15 years). The IKDC Subjective Knee Form was used to measure patient-reported outcome and was dichotomized as above or below the patient-specific age- and gender-matched population mean. Potential predictor variables included subject demographics, activity level before surgery, previous meniscectomy, and surgical variables. Multivariate logistic regression analysis was performed to identify the best subset of predictors for determining the likelihood that the IKDC score was better than the age- and gender-matched population mean. RESULTS: The dichotomized IKDC score was associated with body mass index (BMI), smoking status, education, previous medial meniscectomy, and medial chondrosis at the time of ACL reconstruction. The multivariate model containing only factors known before surgery included BMI and smoking status. Subjects with a BMI greater than 30 kg/m(2) had 0.35 times the odds of success as subjects with a normal BMI. Subjects who smoked had 0.36 times the odds of success as subjects who did not smoke. A model including medial chondrosis at the time of surgery had a slightly higher discriminatory power (area under the receiver operating characteristic curve, 0.65 v 0.61) and negative predictive value (71.4% v 60.0%) but similar positive predictive power (86.3% v 85.9%). CONCLUSIONS: Lower patient-reported outcome after ACL reconstruction was strongly associated with obesity, smoking, and severe chondrosis at the time of surgery. LEVEL OF EVIDENCE: Level III, prognostic case-control study.

Cardiopulmonary bypass for lung transplantation in cystic fibrosis: pilot evaluation of perioperative outcome.

OBJECTIVE: The purpose of this study was to determine whether cardiopulmonary bypass (CPB) reduces the incidence of perioperative graft infection after lung transplantation in adults with cystic fibrosis (CF). DESIGN: Retrospective and observational. SETTING: University hospital. PARTICIPANTS: Adults with CF who underwent lung transplantation (1998-2003). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Cohort size was 26: group A (n = 10) who underwent CPB for implantation of both lungs, group B (n = 8) who underwent CPB only for implantation of the second lung, and group C (n = 8) who did not undergo CPB. The 3 cohort subgroups were similar (p > 0.05) in demographics, preoperative lung function, and anesthetic management. Group A had a lower incidence of perioperative pneumonia (p = 0.02). CPB exposure increased transfusion (B > A > C) of fresh frozen plasma and platelets but not packed red blood cells. There were no differences (p > 0.05) in clinical outcome as reflected by duration of mechanical ventilation, tracheal re-intubation, re-exploration for bleeding, sepsis, primary graft dysfunction, renal dysfunction, length of stay, and mortality. CONCLUSIONS: CPB is associated with decreased incidence of early graft infection after lung transplantation for adult CF when used for implantation of both lungs. This may be because of improved decontamination of the operative field before graft implantation.