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Reliability of Semi-Automated Volumetric Quantification of Knee Effusion Using MRI After Acl Injury
Reginald O Chinweze1, Neal C Weldon1,2, Matthew A Tao1,3
1Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA.
The Iowa Orthopaedic Journal
|July 23, 2026
Summary
Quantifying knee effusion volumes (EV) using magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) injury is reliable. Volumetric quantitative measurements (VQM) show excellent intra- and inter-rater consistency, supporting their use in ACL research.
Area of Science:
- Orthopedics
- Radiology
- Biomedical Engineering
Background:
- Knee effusion is common after anterior cruciate ligament (ACL) injury and reconstruction.
- Reliability of quantifying knee effusion volumes (EV) on routine MRI is not established.
Purpose of the Study:
- Evaluate intra- and inter-rater reliability of volumetric quantitative measurements (VQM) for knee effusion volumes (EV).
- Utilize axial proton density-weighted, fat-suppressed (PD-FS) MRI sequences for assessment post-ACL injury and reconstruction.
Main Methods:
- Analyzed 20 MRIs (10 ACL-injured, 10 uninjured knees) from participants aged 15-35 years.
- Two independent raters used a custom MATLAB protocol for EV analysis.
- Assessed reliability using intraclass correlation coefficients (ICC3,1) and Bland-Altman plots.
Main Results:
- Mean EV higher in injured knees (11.88±8.14 mL) vs. uninjured (2.03±0.76 mL).
- Excellent intra-rater (ICC3,1=0.993) and inter-rater (ICC3,1=0.974) reliability for VQM.
- Minimal detectable change: 0.145 mL (intra-rater), 0.504 mL (inter-rater). No systematic bias, but variability increased with larger volumes.
Conclusions:
- VQM using standard axial PD-FS MRI sequences demonstrates excellent reliability.
- Semi-automated VQM can serve as a biomarker for monitoring EV in ACL research and rehabilitation trials.
