The Role of Magnetic Resonance Imaging in Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: Analyzing MOCART 1 and 2.0

Casari, Fabio A.; Germann, Christoph; Weigelt, Lizzy; Wirth, Stephan; Viehöfer, Arnd; Ackermann, Jakob

doi:10.1177/1947603520946382

Cited by 23 publications

(19 citation statements)

References 53 publications

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“…Since its introduction, a handful of studies have employed the MOCART 2.0. knee score for the assessment of radiological outcome after all arthroscopic matrix-encapsulated autologous chondrocyte implantation [27] or MACI [28] in the knee and AMIC in the treatment of osteochondral lesions of the talus [29]. However, none of these studies assessed intraor interrater reliability.…”

Section: Discussionmentioning

confidence: 99%

“…However, none of these studies assessed intraor interrater reliability. Casari et al [29] employed the original MOCART score and the MOCART 2.0. knee score for the assessment of AMIC in the repair or osteochondral lesions of the talus. Whereas they did not assess intra-or interrater reliability, they found a significant correlation between preoperative lesion size and postoperative MOCART scores, but no correlation with clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

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Reliability of the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 knee score for different cartilage repair techniques—a retrospective observational study

et al. 2021

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Objectives To evaluate the reliability of the MOCART 2.0 knee score in the radiological assessment of repair tissue after different cartilage repair procedures. Methods A total of 114 patients (34 females) who underwent cartilage repair of a femoral cartilage lesion with at least one postoperative MRI examination were selected, and one random postoperative MRI examination was retrospectively included. Mean age was 32.5 ± 9.6 years at time of surgery. Overall, 66 chondral and 48 osteochondral lesions were included in the study. Forty-eight patients were treated with autologous chondrocyte implantation (ACI), 27 via osteochondral autologous transplantation, five using an osteochondral scaffold, and 34 underwent microfracture (MFX). The original MOCART and MOCART 2.0 knee scores were assessed by two independent readers. After a minimum 4-week interval, both readers performed a second reading of both scores. Inter- and intrarater reliabilities were assessed using intraclass correlation coefficients (ICCs). Results The MOCART 2.0 knee score showed higher interrater reliability than the original MOCART score with an ICC of 0.875 versus 0.759, ranging from 0.863 in the MFX group to 0.878 in the ACI group. Intrarater reliability was good with an overall ICC of 0.860 and 0.866, respectively. Overall, interrater reliability was higher for osteochondral lesions than for chondral lesions, with ICCs of 0.906 versus 0.786. Conclusions The MOCART 2.0 knee score enables the assessment of cartilage repair tissue after different cartilage repair techniques (ACI, osteochondral repair techniques, MFX), as well as for different lesion types with good intra- and interrater reliability. Key Points • The MOCART 2.0 knee score provides improved intra- and interrater reliability when compared to the original MOCART score. • The MOCART 2.0 knee score enables the assessment of cartilage repair tissue after different cartilage repair techniques (ACI, osteochondral repair techniques, MFX) with similarly good intra- and interrater reliability. • The assessment of osteochondral lesions demonstrated better intra- and interrater reliability than the assessment of chondral lesions in this study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reliability of the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 knee score for different cartilage repair techniques—a retrospective observational study

et al. 2021

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“…Remarkably, ankle instability seems to not influence cartilage repair tissue morphology when assessed with MRI, as both groups showed similar MOCART scores at final follow-up. In a recently published study, Casari et al 4 investigated the role of postoperative MRI in patients who underwent AMIC for the treatment of OLT. While osteochondral lesion size was the only factor influencing postoperative overall MOCART scores, no significant association between MOCART scores or its subscales and clinical outcome (AOFAS and Tegner scores) was detected.…”

Section: Discussionmentioning

confidence: 99%

“…The AMIC procedure to address the OLT was performed as previously reported. 4 , 34 Briefly, the damaged cartilage was identified and resected with a scalpel or curettage. Then, the subchondral bone was debrided until vital bleeding bone tissue was visualized.…”

Section: Methodsmentioning

confidence: 99%

Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

Ackermann

Casari

Germann

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Autologous matrix-induced chondrogenesis (AMIC) has been shown to result in favorable clinical outcomes in patients with osteochondral lesions of the talus (OLTs). Though, the influence of ankle instability on cartilage repair of the ankle has yet to be determined. Purpose/Hypothesis: To compare the clinical and radiographic outcomes in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. It was hypothesized that the outcomes would be comparable between these patient groups. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six patients (13 with and 13 without concomitant ankle instability) who underwent AMIC with a mean follow-up of 4.2 ± 1.5 years were enrolled in this study. Patients were matched 1:1 according to age, body mass index (BMI), lesion size, and follow-up. Postoperative magnetic resonance imaging and Tegner, American Orthopaedic Foot & Ankle Society (AOFAS), and Cumberland Ankle Instability Tool (CAIT) scores were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART (magnetic resonance observation of cartilage repair tissue) 1 and MOCART 2.0 scores. Results: The patients’ mean age was 33.4 ± 12.7 years, with a mean BMI of 26.2 ± 3.7. Patients with concomitant LLS showed worse clinical outcome measured by the AOFAS (85.1 ± 14.4 vs 96.3 ± 5.8; P = .034) and Tegner (3.8 ± 1.1 vs 4.4 ± 2.3; P = .012) scores. Postoperative CAIT and AOFAS scores were significantly correlated in patients with concomitant LLS ( r = 0.766; P = .002). A CAIT score >24 (no functional ankle instability) resulted in AOFAS scores comparable with scores in patients with isolated AMIC (90.1 ± 11.6 vs 95.3 ± 6.6; P = .442). No difference was seen between groups regarding MOCART 1 and 2.0 scores ( P = .714 and P = .371, respectively). Conclusion: Concurrently performed AMIC and LLS in patients with OLT and ankle instability resulted in clinical outcomes comparable with isolated AMIC if postoperative ankle stability was achieved. However, residual ankle instability was associated with worse postoperative outcomes, highlighting the need for adequate stabilization of ankle instability in patients with OLT.

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“…Acute injuries, repeated strains or joint instability can produce osteochondral lesions (OL), with damage to the hyaline cartilage of the joint and to the subchondral bone [1,2]. Typically, these lesions lead to a decrease in daily activities from pain on weight bearing and exercise [3].…”

Section: Introductionmentioning

confidence: 99%

Reliability of the MOCART score: a systematic review

et al. 2021

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Background The present systematic review analysed the available literature to assess reliability of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score in the evaluation of knee and ankle osteochondral lesions. Methods All the studies using the MOCART score for knee and/or talus chondral defects were accessed in March 2021. A multivariate analysis was performed to assess associations between the MOCART score at last follow-up and data of patients at baseline, clinical scores and complications. A multiple linear model regression analysis was used. Results The MOCART score evidenced no association with patient age (P = 0.6), sex (P = 0.1), body mass index (P = 0.06), defect size (P = 0.9), prior length of symptoms (P = 0.9) or visual analogue scale (P = 0.07). For chondral defects of the knee, no statistically significant association was found between the MOCART score and the International Knee Documentation Committee (P = 0.9) and with the Lysholm Knee Scoring Scales (P = 0.2), Tegner Activity Scale (P = 0.2), visual analogue scale P = 0.07), rate of failure (P = 0.2) and revision (P = 0.9). For chondral defect of the talus, no statistically significant associations were found between the MOCART score and the American Orthopedic Foot and Ankle Score (P = 0.3), Tegner Activity Scale (P = 0.4), visual analogue scale (P = 0.1), rate of failure (P = 0.1) and revision (P = 0.7). Conclusion 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. Level of evidence Level IV.

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The Role of Magnetic Resonance Imaging in Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: Analyzing MOCART 1 and 2.0

Cited by 23 publications

References 53 publications

Reliability of the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 knee score for different cartilage repair techniques—a retrospective observational study

Reliability of the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 knee score for different cartilage repair techniques—a retrospective observational study

Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

Reliability of the MOCART score: a systematic review

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