gms | German Medical Science

Objectives: The objective of this study was to compare the clinical utility of MOCART versus MOCART 2.0 across different surgical cartilage repair techniques and timepoints.

Methods: This retrospective single centre study included 111 eligible patients with a general informed consent (age: 35 ± 10, female: 39 (35%)) who underwent cartilage repair surgery of the knee between September 2015 and March 2022. The study cohort undergoing Minced Cartilage (MCI), Autocart (AC), Autologous Cartilage Implantation (ACI) and Microfracturing (MF) was extracted from our institutional registry. 188 postoperative MRIs were evaluated by two independent examiners using MOCART and MOCART 2.0 on a scale of 0–100. Relationships between MOCART versions and Patient Related Outcome Measures (PROMs) were assessed with the Pearson correlation coefficient in RStudio using R version 4.3.1.

Results and conclusion: MOCART 2.0 scores (66 ± 13) were significantly higher than MOCART scores (58 ± 13, p < 0.001). A strong positive correlation was observed between MOCART and MOCART 2.0 scoring systems (r = 0.837, p<0.001). However, correlation between MOCART scores and change of Patient Related Outcome Measures (PROMs) from baseline such as Core Outcome Measures Index (cCOMI) (r = 0.06, p =0.442; r = 0.08, p=0.303 respectively) and International Knee Documentation Committee (cIKDC) (r = 0.06, p =0.477; r = 0.08, p =0.3293 respectively) was weak. Noticeably we found a statistically significant correlation between both MOCART and MOCART 2.0 in the AC subgroup across multiple timepoint for both cCOMI and cIKDC, which persists at combined timepoint analysis (cCOMI r = 0.45, p =0.0197; r = 0.43, p =0.027 respectively, cIKDC r = 0.6, p =0.0015; r = 0.73, p <0.001 respectively).

There is a strong correlation between MOCART and MOCART 2.0 scores, with higher scores in the MOCART 2.0. However, changes in PROMs from baseline showed poor correlation with changes in radiographic scores using this radiographic scoring systems for most techniques, except for AC. Structural imaging assessments alone seems insufficient to evaluate clinical outcomes independent of surgical technique. Our findings indicate an ongoing need to develop a clinically reproducible radiographic scoring system after cartilage repair. Additionally, further research is warranted to establish reliability and validity of these scoring instruments in after cartilage repair. Overall, these findings highlight current limitations in MRI-based structural assessment of cartilage healing and underscore the complementary need for patient-focused clinical measures.

Figure 1 [Fig. 1]