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Ultrasound validity in the measurement of knee cartilage thickness
  1. E Naredo1,
  2. C Acebes2,
  3. I Möller3,
  4. F Canillas4,
  5. J J de Agustín5,
  6. E de Miguel6,
  7. E Filippucci7,
  8. A Iagnocco8,
  9. C Moragues9,
  10. R Tuneu10,
  11. J Uson11,
  12. J Garrido12,
  13. E Delgado-Baeza13,
  14. I Sáenz-Navarro14,15
  1. 1
    Rheumatology, Hospital Severo Ochoa, Madrid, Spain
  2. 2
    Rheumatology, Fundación Jiménez Díaz, Madrid, Spain
  3. 3
    Rheumatology, Instituto Poal, Barcelona, Spain
  4. 4
    Anatomy, Histology and Neuroscience, Orthopaedic Research Laboratory, Histology Laboratory A21, Faculty of Medicine, Autónoma University, Madrid, Spain
  5. 5
    Rheumatology, Hospital Vall d'Hebron, Barcelona, Spain
  6. 6
    Rheumatology, Hospital La Paz, Madrid, Spain
  7. 7
    Rheumatology, Universitá Politecnica delle Marche, Ancona, Italy
  8. 8
    Rheumatology, Sapienza University, Rome, Italy
  9. 9
    Rheumatology, Hospital de Bellvitge, Barcelona, Spain
  10. 10
    Rheumatology, Hospital de Manresa, Barcelona, Spain
  11. 11
    Rheumatology, Hospital de Móstoles, Madrid, Spain
  12. 12
    Methodology, Autónoma University, Madrid, Spain
  13. 13
    Anatomy, Histology and Neuroscience, Orthopaedic Research Laboratory, Histology Laboratory A21, Faculty of Medicine, Autónoma University, Madrid, Spain
  14. 14
    Human Anatomy and Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain
  15. 15
    Orthopedic Surgery, Fundación Hospital Espíritu Santo, Santa Coloma de Gramanet, Barcelona, Spain
  1. E Naredo, Calle Arturo Soria 259, 4° A, 28033 Madrid, Spain; enaredo{at}


Objective: To assess the multiexaminer reproducibility and the accuracy comparing with cadaver anatomic specimens of ultrasound (US) measurement of femoral articular cartilage (FAC) thickness.

Methods: In 8 flexed cadaver knees, FAC thickness was blindly, independently and consecutively measured twice by 10 rheumatologists at the lateral condyle (LC), medial condyle (MC) and intercondylar notch (IN) with US. After the US measurements, the knees were dissected. Articular cartilage integrity was evaluated macroscopically in the femoral condyles. FAC thickness was blindly measured in the specimens using a stereoscopic magnifying loupe and a digitised image software. Interexaminer and intraexaminer reliability of US FAC thickness measurement and agreement between US and anatomic measurements were assessed by estimating the intraclass correlation coefficient (ICC).

Results: Interexaminer ICCs were higher than 0.90 for MC (p<0.001) and IN (p<0.001) and higher than 0.75 for LC (p<0.01). Mean intraexaminer ICCs were 0.832 for MC (p<0.001), 0.696 for LC (p<0.001) and, 0.701 for IN (p<0.001). Agreement between US and anatomic FAC thickness measurements was good for MC (ICC 0.719; p = 0.020) and poor for LC (p = 0.285) and IN (p = 0.332). Bland–Altman analysis showed that the difference between US and anatomic values was considerably high in the one knee with severely damaged FAC. After eliminating this knee from the analysis, ICCs were 0.883 (p<0.001) for MC, 0.795 (p = 0.016) for LC and 0.732 for IN (p = 0.071).

Conclusion: US demonstrated a good reproducibility in FAC thickness measurement by multiple examiners. In addition, US FAC thickness measurement was accurate in normal to moderately damaged cartilage.

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  • Competing interests: None declared.

  • Funding: This study was partially supported by grants from the Spanish Ministry of Health (FISS 070499) and by Zambon, Almirall and Sanofi Aventis.

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