Kompendium 2020 Forschung & Klinik

TOP-Studien
52
The MOCART 2.0 Knee Score:
Morphological MRI for the
Assessment of Cartilage Repair
„Orthopedic surgeons and radiologists
with a special focus on musculoskeletal
radiology and cartilage repair joint
forces to develop a new and updated
version of the original MOCART score,
which would incorporate the developments
in cartilage repair surgery and
MR imaging alike. This culminated in
the publication of the MOCART 2.0 knee
score and atlas.“
Markus Schreiner
Symptomatic focal cartilage defects in young and active patients
pose a significant challenge to the orthopedic surgeon. Left untreated,
focal cartilage defects may increase in size and ultimately
progress to OA. With an increasing number of different surgical
techniques and scaffolds having become available, the comparison
of clinical outcome between these techniques becomes
increasingly important.
While clinical scores provide information on the overall joint-health and
patient satisfaction, morphological and quantitative MRI may provide
additional information on the status of the repair tissue. The qualitative and
quantitative assessment of cartilage repair tissue has been the focus of the
interdisciplinary research group between the Department for Orthopedics
and Trauma surgery and the High-Field MR Center of the Medical University
of Vienna for some time and lead to the introduction of the MOCART (Magnetic
Resonance Observation of Cartilage Repair Tissue) score.
Study:
Schreiner MM, Raudner M,
Marlovits S, Bohndorf K,
Weber M, Zalaudek M, Röhrich
S, Szomolanyi P, Filardo G,
Windhager R, Trattnig S.
The MOCART (Magnetic Resonance
Observation of Cartilage
Repair Tissue) 2.0 Knee Score
and Atlas. Cartilage. 2019 Aug
17:1947603519865308. doi:
10.1177/1947603519865308.
[Epub ahead of print]
However, since the introduction of the MOCART 2.0 knee score, MRI hardware
as well as MR sequences evolved. Similarly, surgical cartilage repair
techniques were refined, and the MOCART score did not reflect these new
developments. In addition, continuous use of the score for more than a
decade exposed some weaknesses of the scoring system. Hence, orthopedic
surgeons and radiologists with a special focus on musculoskeletal radiology
and cartilage repair joint forces to develop a new and updated version of the
original MOCART score, which would incorporate the developments in cartilage
repair surgery and MR imaging alike. This culminated in the publication
of the MOCART 2.0 knee score and atlas.
Main improvements of the score
The main improvements of the score include the elimination of the assessment
of adhesions, the variable „subchondral lamina“, and the variable
„synovitis“. Regarding the variables that were adapted, the variable „volume
of cartilage defect filling“ now allows for a more precise evaluation of defect
filling in 25% increments. Furthermore, hypertrophic filling of up to 150%
being is now being scored with the same scoring as complete repair, as it has
been previously shown that minor hypertrophy has no detrimental effects
on clinical symptoms or long-term outcome. The variable „integration“
was changed in a way that it now only assesses integration to neighboring