Reliability of the MOCART score: a systematic review

Migliorini, Filippo; Maffulli, Nicola; Eschweiler, Jörg; Driessen, Arne; Tingart, Markus; Baroncini, Alice

doi:10.1186/s10195-021-00603-w

Cited by 17 publications

(14 citation statements)

References 54 publications

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“…Several studies analysed the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system to evaluate the quality of the chondral regeneration. However, the MOCART score demonstrated no association with patient characteristics and with the surgical outcome in patients who underwent surgical management for knee and talus chondral defects 78 . The reviewers (F. M. and H. S.) who performed the literature search, data extraction, risk of bias assessment were the main authors of two of the included studies 39 , 40 .…”

Section: Discussionmentioning

confidence: 89%

Autologous matrix-induced chondrogenesis is effective for focal chondral defects of the knee

Migliorini

Maffulli

Baroncini

et al. 2022

Sci Rep

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Focal chondral defects of the knee are common and their management is challenging. This study investigated the efficacy and safety of Autologous Matrix-Induced Chondrogenesis (AMIC) for focal chondral defects of the knee. A systematic review and meta-analysis was conducted (according to the 2020 PRISMA statement) to investigate the efficacy of AMIC in improving symptoms and to compare AMIC versus microfracture (MFx). In January 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, Embase. No time constrain was used for the search. All the clinical trials investigating AMIC and/or those comparing AMIC versus MFx for focal chondral defects of the knee were accessed. Only studies published in peer reviewed journals were considered. Studies which investigated other locations of the defects rather than knee were not eligible, nor those reporting data form mixed locations. Studies which reported data on revision settings, as well as those investigating efficacy on kissing lesions or multiple locations, were not suitable. The mean difference (MD) and odd ratio (OR) effect measure were used for continuous and binary data, respectively. Data from 18 studies (548 patients) were retrieved with a mean follow-up of 39.9 ± 26.5 months. The mean defect size was 3.2 ± 1.0 cm2. The visual analogue scale (VAS) decreased of − 3.9/10 (95% confidence interval (CI) − 4.0874 to -3.7126), the Tegner Activity Scale increased of + 0.8/10 (95% CI 0.6595 to 0.9405). The Lysholm Knee Scoring System increased of + 28.9/100 (95% CI 26.8716 to 29.1284), as did the International Knee Documentation Committee (IKDC) + 33.6/100 (95% CI 32.5800 to 34.6200). At last follow-up no patient showed signs of hypertrophy. 4.3% (9 of 210) of patients underwent revision procedures. The rate of failure was 3.8% (9 of 236). Compared to MFx, AMIC demonstrated lower VAS score (MD: − 1.01; 95% CI − 1.97 to 0.05), greater IKDC (MD: 11.80; 95% CI 6.65 to 16.94), and lower rate of revision (OR: 0.16; 95% CI 0.06 to 0.44). AMIC is effective for focal chondral defects of the knee. Furthermore, AMIC evidenced greater IKDC, along with a lower value of VAS and rate of revision compared to MFx.

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Section: Discussionmentioning

confidence: 89%

Autologous matrix-induced chondrogenesis is effective for focal chondral defects of the knee

Migliorini

Maffulli

Baroncini

et al. 2022

Sci Rep

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“… 6 However, substantial controversy existed regarding the correlation between functional outcomes and MRI findings after repair for OLT. 34 A case series with 1-year follow-up found no correlation between MOCART score and patient-reported outcomes after repair of OLT. 1 In contrast, a previous study revealed that the MOCART score was in moderate association with functional outcomes at a mean of 3.6 years (range, 2.2-8.1 years) after microfracture.…”

Section: Discussionmentioning

confidence: 97%

Radiographic and Clinical Outcomes After Arthroscopic Microfracture for Osteochondral Lesions of the Talus: 5-Year Results in 355 Consecutive Ankles

Yang

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Arthroscopic microfracture for osteochondral lesion of the talus (OLT) has shown good functional outcomes in the short and long term. Purpose: To investigate 5-year radiographic and clinical outcomes after arthroscopic microfracture in treatment of OLT and the effectiveness of adjunct therapies including platelet-rich plasma (PRP) and hyaluronic acid (HA). Study Design: Cohort study; Level of evidence, 2. Methods: We prospectively enrolled 432 patients who underwent arthroscopic microfracture for OLT from May 1, 2011, to May 31, 2015. Magnetic resonance imaging (MRI) and weightbearing radiographs were performed annually after the initial surgery. The MOCART (magnetic resonance observation of cartilage repair tissue) score was used to evaluate the structure of the repaired cartilage on MRI, and patient-reported outcomes (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale [AOFAS] and the Foot and Ankle Outcome Score) were collected annually. The primary outcome measure was 5-year AOFAS score. We recorded baseline characteristics including age, body mass index (BMI), and lesion size, and other potentially related factors including number of PRP/HA injection and change in BMI from baseline. Results: Included were 355 patients, all with minimum 5-year follow-up data. The overall reoperation rate was 9.0% (32 of 355). According to multivariable analysis, 5-year AOFAS scores were associated with number of PRP injections (correlation coefficient, 3.12 [95% CI, 2.36 to 3.89]; P < .001), BMI at baseline (correlation coefficient, -0.222 [95% CI, -0.363 to -0.082]; P = .002), and mean BMI change from baseline (correlation coefficient, -1.15 [95% CI, -1.32 to -0.98]; P < .001). When comparing number of PRP injections (0, 1-2, or ≥3), we found that patients who had serial PRP injection (≥3 with at least a 3-month interval between injections) had diminished functional and radiographic deterioration over time. Conclusion: Arthroscopic microfracture improved patient-reported and structural outcomes for patients with OLT at 5 years after surgery. Serial PRP injections and reduction in BMI from baseline were able to slow radiographic and functional deterioration. Future trials regarding the combination of microfracture and PRP in treatment of OLT should focus on the efficacy of longer term, intra-articular, serial injections of PRP instead of single injections.

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“…Using an overall or composite MOCART score without reference to individual domains did not allow for interpretation of the degree of integration in many of the studies eligible for full-text screening. The evidence already suggests that MOCART scores might not correlate well with patient characteristics and surgical outcomes [ 30 ]. Therefore, if we are to understand how integration relates to improved clinical outcomes, future studies will have to consider integration independently.…”

Section: Discussionmentioning

confidence: 99%

“…For studies evaluating integration using MRI, the “integration to the border zone” component was extracted from scoring systems such as the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, which post-operatively assesses cartilage repair in comparison to adjacent hyaline cartilage [ 30 , 31 ]. The results were sometimes presented as the proportion of patients achieving a predefined MOCART border integration score: (1) complete integration with adjacent cartilage; (2) incomplete integration (split like border visible); (3) a visible demarcating border of <50% of the length of the repair tissue; or (4) a visible defect >50% of the length of the repair tissue.…”

Section: Methodsmentioning

confidence: 99%

“…The results were extracted for studies that used their own MRI composite scores, which were deemed comparable with MOCART and included in the analysis. As the MOCART scoring system is commonly used to evaluate the overall quality of the implant [ 30 ], other pertinent components were extracted such as the degree of defect filling, how intact the surface of the implant was, the homogeneity of the implant (described as its structure) and the status of the subchondral lamina and bone.…”

Section: Methodsmentioning

confidence: 99%

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The Use of Autologous Chondrocyte and Mesenchymal Stem Cell Implants for the Treatment of Focal Chondral Defects in Human Knee Joints—A Systematic Review and Meta-Analysis

Epanomeritakis

Lee

et al. 2022

IJMS

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Focal chondral defects of the knee occur commonly in the young, active population due to trauma. Damage can insidiously spread and lead to osteoarthritis with significant functional and socioeconomic consequences. Implants consisting of autologous chondrocytes or mesenchymal stem cells (MSC) seeded onto scaffolds have been suggested as promising therapies to restore these defects. However, the degree of integration between the implant and native cartilage still requires optimization. A PRISMA systematic review and meta-analysis was conducted using five databases (PubMed, MEDLINE, EMBASE, Web of Science, CINAHL) to identify studies that used autologous chondrocyte implants (ACI) or MSC implant therapies to repair chondral defects of the tibiofemoral joint. Data on the integration of the implant-cartilage interface, as well as outcomes of clinical scoring systems, were extracted. Most eligible studies investigated the use of ACI only. Our meta-analysis showed that, across a total of 200 patients, 64% (95% CI (51%, 75%)) achieved complete integration with native cartilage. In addition, a pooled improvement in the mean MOCART integration score was observed during post-operative follow-up (standardized mean difference: 1.16; 95% CI (0.07, 2.24), p = 0.04). All studies showed an improvement in the clinical scores. The use of a collagen-based scaffold was associated with better integration and clinical outcomes. This review demonstrated that cell-seeded scaffolds can achieve good quality integration in most patients, which improves over time and is associated with clinical improvements. A greater number of studies comparing these techniques to traditional cartilage repair methods, with more inclusion of MSC-seeded scaffolds, should allow for a standardized approach to cartilage regeneration to develop.

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Reliability of the MOCART score: a systematic review

Cited by 17 publications

References 54 publications

Autologous matrix-induced chondrogenesis is effective for focal chondral defects of the knee

Autologous matrix-induced chondrogenesis is effective for focal chondral defects of the knee

Radiographic and Clinical Outcomes After Arthroscopic Microfracture for Osteochondral Lesions of the Talus: 5-Year Results in 355 Consecutive Ankles

The Use of Autologous Chondrocyte and Mesenchymal Stem Cell Implants for the Treatment of Focal Chondral Defects in Human Knee Joints—A Systematic Review and Meta-Analysis

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