scholarly journals The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 Knee Score and Atlas

Cartilage ◽  
2019 ◽  
pp. 194760351986530 ◽  
Author(s):  
Markus M. Schreiner ◽  
Marcus Raudner ◽  
Stefan Marlovits ◽  
Klaus Bohndorf ◽  
Michael Weber ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Cartilage Defect ◽  
Interrater Reliability ◽  
Weighted Kappa ◽  
Kappa Statistics ◽  
Bony Defect ◽  
Knee Score ◽  
Repair Tissue ◽  
Evaluation Sheet

Objective Since the first introduction of the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score, significant progress has been made with regard to surgical treatment options for cartilage defects, as well as magnetic resonance imaging (MRI) of such defects. Thus, the aim of this study was to introduce the MOCART 2.0 knee score — an incremental update on the original MOCART score — that incorporates this progression. Materials and Methods The volume of cartilage defect filling is now assessed in 25% increments, with hypertrophic filling of up to 150% receiving the same scoring as complete repair. Integration now assesses only the integration to neighboring native cartilage, and the severity of surface irregularities is assessed in reference to cartilage repair length rather than depth. The signal intensity of the repair tissue differentiates normal signal, minor abnormal, or severely abnormal signal alterations. The assessment of the variables “subchondral lamina,” “adhesions,” and “synovitis” was removed and the points were reallocated to the new variable “bony defect or bony overgrowth.” The variable “subchondral bone” was renamed to “subchondral changes” and assesses minor and severe edema-like marrow signal, as well as subchondral cysts or osteonecrosis-like signal. Overall, a MOCART 2.0 knee score ranging from 0 to 100 points may be reached. Four independent readers (two expert readers and two radiology residents with limited experience) assessed the 3 T MRI examinations of 24 patients, who had undergone cartilage repair of a femoral cartilage defect using the new MOCART 2.0 knee score. One of the expert readers and both inexperienced readers performed two readings, separated by a four-week interval. For the inexperienced readers, the first reading was based on the evaluation sheet only. For the second reading, a newly introduced atlas was used as an additional reference. Intrarater and interrater reliability was assessed using intraclass correlation coefficients (ICCs) and weighted kappa statistics. ICCs were interpreted according to Koo and Li; weighted kappa statistics were interpreted according to the criteria of Landis and Koch. Results The overall intrarater (ICC = 0.88, P < 0.001) as well as the interrater (ICC = 0.84, P < 0.001) reliability of the expert readers was almost perfect. Based on the evaluation sheet of the MOCART 2.0 knee score, the overall interrater reliability of the inexperienced readers was poor (ICC = 0.34, P < 0.019) and improved to moderate (ICC = 0.59, P = 0.001) with the use of the atlas. Conclusions The MOCART 2.0 knee score was updated to account for changes in the past decade and demonstrates almost perfect interrater and intrarater reliability in expert readers. In inexperienced readers, use of the atlas may improve interrater reliability and, thus, increase the comparability of results across studies.

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

2021 ◽  
Author(s):  
Markus M. Schreiner ◽  
Marcus Raudner ◽  
Sebastian Röhrich ◽  
Martin Zalaudek ◽  
Michael Weber ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Interrater Reliability ◽  
Osteochondral Lesions ◽  
Knee Score ◽  
Chondral Lesions ◽  
Repair Tissue ◽  
Postoperative Mri ◽  
Mri Examination ◽  
Osteochondral Repair ◽  
Repair Techniques

Abstract 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.

First-in-Human Pilot Study of Implantation of a Scaffold-Free Tissue-Engineered Construct Generated From Autologous Synovial Mesenchymal Stem Cells for Repair of Knee Chondral Lesions

2018 ◽  
Vol 46 (10) ◽  
pp. 2384-2393 ◽  
Author(s):  
Kazunori Shimomura ◽  
Yukihiko Yasui ◽  
Kota Koizumi ◽  
Ryota Chijimatsu ◽  
David A. Hart ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Femoral Condyle ◽  
Chondral Lesions ◽  
Repair Tissue ◽  
Biopsy Specimens ◽  
Implantation Procedure

Background: Articular cartilage has limited healing capacity, owing in part to poor vascularity and innervation. Once injured, it cannot be repaired, typically leading to high risk for developing osteoarthritis. Thus, cell-based and/or tissue-engineered approaches have been investigated; however, no approach has yet achieved safety and regenerative repair capacity via a simple implantation procedure. Purpose: To assess the safety and efficacy of using a scaffold-free tissue-engineered construct (TEC) derived from autologous synovial membrane mesenchymal stem cells (MSCs) for effective cartilage repair. Study Design: Case series; Level of evidence, 4. Methods: Five patients with symptomatic knee chondral lesions (1.5-3.0 cm2) on the medial femoral condyle, lateral femoral condyle, or femoral groove were included. Synovial MSCs were isolated from arthroscopic biopsy specimens and cultured to develop a TEC that matched the lesion size. The TECs were then implanted into chondral defects without fixation and assessed up to 24 months postoperatively. The primary outcome was the safety of the procedure. Secondary outcomes were self-assessed clinical scores, arthroscopy, tissue biopsy, and magnetic resonance image–based estimation of morphologic and compositional quality of the repair tissue. Results: No adverse events were recorded, and self-assessed clinical scores for pain, symptoms, activities of daily living, sports activity, and quality of life were significantly improved at 24 months after surgery. Secure defect filling was confirmed by second-look arthroscopy and magnetic resonance imaging in all cases. Histology of biopsy specimens indicated repair tissue approaching the composition and structure of hyaline cartilage. Conclusion: Autologous scaffold-free TEC derived from synovial MSCs may be used for regenerative cartilage repair via a sutureless and simple implantation procedure. Registration: 000008266 (UMIN Clinical Trials Registry number).

Magnetic Resonance Imaging to Assess Knee Cartilage Repair Tissue After Microfracture of Chondral Defects

2010 ◽  
Vol 20 (03) ◽  
pp. 228-234 ◽  
Author(s):  
Arun Ramappa ◽  
Thomas Gill ◽  
Catharine Bradford ◽  
Charles Ho ◽  
J. Steadman
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Resonance Imaging ◽  
Knee Cartilage ◽  
Repair Tissue ◽  
Chondral Defects

scholarly journals Autologe Knorpelzelltransplantation mit Knochenaufbau zur Behandlung osteochondraler Defekte am Knie

2021 ◽  
Author(s):  
Christoph Stotter ◽  
Stefan Nehrer ◽  
Thomas Klestil ◽  
Philippe Reuter
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Knee Injury ◽  
Autologe Chondrozytentransplantation ◽  
Repair Tissue ◽  
Outcome Score ◽  
Autologe Knorpelzelltransplantation ◽  
Entzündliche Gelenkerkrankungen ◽  
Osteochondrale Defekte ◽  
Matrixgestützte Autologe Chondrozytentransplantation

Zusammenfassung Operationsziel Offene Therapie osteochondraler Läsionen des Kniegelenks zur vollständigen Auffüllung knöcherner Defekte und Wiederherstellung der Gelenkfläche. Indikationen Fokale, symptomatische osteochondrale Defekte des Kniegelenks ab einer Knochendefekttiefe von ≥ 5 mm und Größe von ≥ 1,5 cm2. Kontraindikationen Arthrose (> KL Grad 2), „kissing lesions“ (ICRS > Grad 2), Alter > 50 Jahre, unbehandelte Bandinstabilitäten oder Beinachsenfehstellungen zum Nachteil des betroffenen Gelenkkompartiments, fehlendes Defektcontainment, entzündliche Gelenkerkrankungen. Operationstechnik Zweizeitiger Eingriff: Ersteingriff (arthroskopische Knorpelprobenentnahme): Defektevaluierung, Entnahme von Knorpelstücken für die Chondrozytenkultivierung, bei Bedarf Behandlung von Begleitpathologien. Zweiteingriff (offene Defektbehandlung): Arthrotomie, Präparation des knöchernen Defekts, Auffüllung mit autologen Spongiosazylindern aus dem Beckenkamm, Knorpeldefektpräparation (kann größer als knöcherner Defekt sein) und matrixgestützte autologe Chondrozytentransplantation. Weiterbehandlung Ersteingriff: frühfunktionelle Nachbehandlung mit schmerzorientierter Vollbelastung je nach Begleiteingriffen. Zweiteingriff: keine Drainage, funktionelle Kniegelenkorthese in Streckstellung für 1 Woche, danach schrittweise Freigabe der Flexion, Teilbelastung für 6 Wochen, Motorschiene (CPM) ab dem 1. postoperativen Tag. Ergebnisse Seit 2018 sind 8 Patienten (mittleres Alter 29,4 Jahre, Spanne 18 bis 36) mit der beschriebenen Technik behandelt worden. Alle Patienten konnten nach durchschnittlich 12 Monaten nachuntersucht werden. Der Gesamt-KOOS (Knee injury and Osteoarthritis Outcome Score) verbesserte sich im Mittel von 45,8 auf 81,3, und die postoperativen radiologischen Kontrollen zeigten die Einheilung der Spongiosazylinder bei allen Patienten. Der MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) Score ergab 80,4 Punkte.

scholarly journals Supporting the clinical use of the ICF in Japan – Development of the Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set, its operationalization through a rating reference guide, and interrater reliability study

2020 ◽  
Author(s):  
Masahiko Mukaino ◽  
Birgit Prodinger ◽  
Shin Yamada ◽  
Yuki Senju ◽  
Shin-Ichi Izumi ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Interrater Reliability ◽  
Japanese Version ◽  
Weighted Kappa ◽  
World Health ◽  
International Classification Of Functioning ◽  
Kappa Statistics ◽  
Reference Guide ◽  
Health Organization ◽  
Icf Core Sets

Abstract Background: The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) in 2001 and has been in the process of implementing it in clinics since then. Current international efforts to implement ICF in rehabilitation clinics include the implementation of ICF Core Sets and the development of simple, intuitive descriptions for the ICF Generic-30 Set (also called Rehabilitation Set). The present study was designed to operationalize these ICF tools for clinical practice in Japan. This work included 1) the development of the Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set, 2) the development of a rating reference guide for Activity and Participation categories, and 3) the examination of the interrater reliability of rating Activity and Participation categories. Methods: The Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set was developed following the process employed to develop the Chinese and Italian versions. For further operationalization of this ICF Set in practice, a rating reference guide was developed. The development of the rating reference guide involved the following steps: 1) a trial of rating patients by several raters, 2) cognitive interviewing of the raters to analyze the thinking process involved in rating, 3) drafting of the rating reference guide, and 4) review by ICF specialists to confirm consistency with the original ICF concepts. After the rating reference guide was developed, interrater reliability of the rating with the reference guide was determined. Interrater reliability was examined using weighted kappa statistics with linear weight. Results: Through the pre-defined process, the Japanese version of the simple, intuitive descriptions for 30 categories of the ICF Generic-30 Set and the rating reference guides for 21 Activity and Participation categories were successfully developed. The weighted kappa statistics ranged from 0.61 to 0.85, showing substantial to excellent agreement of the ratings between raters. Conclusions: The present study demonstrates that ICF categories can be translated into clinical practice. Collaboration between clinicians and researchers would further enhance the implementation of the ICF in Japan.

scholarly journals Understanding Magnetic Resonance Imaging of Knee Cartilage Repair: A Focus on Clinical Relevance

Cartilage ◽  
2017 ◽  
Vol 9 (3) ◽  
pp. 223-236 ◽  
Author(s):  
Daichi Hayashi ◽  
Xinning Li ◽  
Akira M. Murakami ◽  
Frank W. Roemer ◽  
Siegfried Trattnig ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Clinical Relevance ◽  
Osteochondral Allograft ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Knee Cartilage ◽  
Ongoing Research ◽  
Repair Tissue

The aims of this review article are (a) to describe the principles of morphologic and compositional magnetic resonance imaging (MRI) techniques relevant for the imaging of knee cartilage repair surgery and their application to longitudinal studies and (b) to illustrate the clinical relevance of pre- and postsurgical MRI with correlation to intraoperative images. First, MRI sequences that can be applied for imaging of cartilage repair tissue in the knee are described, focusing on comparison of 2D and 3D fast spin echo and gradient recalled echo sequences. Imaging features of cartilage repair tissue are then discussed, including conventional (morphologic) MRI and compositional MRI techniques. More specifically, imaging techniques for specific cartilage repair surgery techniques as described above, as well as MRI-based semiquantitative scoring systems for the knee cartilage repair tissue—MR Observation of Cartilage Repair Tissue and Cartilage Repair OA Knee Score—are explained. Then, currently available surgical techniques are reviewed, including marrow stimulation, osteochondral autograft, osteochondral allograft, particulate cartilage allograft, autologous chondrocyte implantation, and others. Finally, ongoing research efforts and future direction of cartilage repair tissue imaging are discussed.

scholarly journals Supporting the clinical use of the ICF in Japan – Development of the Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set, its operationalization through a rating reference guide, and interrater reliability study

2019 ◽  
Author(s):  
Masahiko Mukaino ◽  
Birgit Prodinger ◽  
Shin Yamada ◽  
Yuki Senju ◽  
Shin-Ichi Izumi ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Interrater Reliability ◽  
Japanese Version ◽  
Weighted Kappa ◽  
World Health ◽  
International Classification Of Functioning ◽  
Kappa Statistics ◽  
Reference Guide ◽  
Health Organization ◽  
Icf Core Sets

Abstract Background: The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) in 2001 and has been in the process of implementing it in clinics since then. Current international efforts to implement ICF in rehabilitation clinics include the implementation of ICF Core Sets and the development of simple, intuitive descriptions for the ICF Generic-30 Set (also called Rehabilitation Set). The present study was designed to operationalize these ICF tools for clinical practice in Japan. This work included 1) the development of the Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set, 2) the development of a rating reference guide for Activity and Participation categories, and 3) the examination of the interrater reliability of rating Activity and Participation categories. Methods: The Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set was developed following the process employed to develop the Chinese and Italian versions. For further operationalization of this ICF Set in practice, a rating reference guide was developed. The development of the rating reference guide involved the following steps: 1) a trial of rating patients by several raters, 2) cognitive interviewing of the raters to analyze the thinking process involved in rating, 3) drafting of the rating reference guide, and 4) review by ICF specialists to confirm consistency with the original ICF concepts. After the rating reference guide was developed, interrater reliability of the rating with the reference guide was determined. Interrater reliability was examined using weighted kappa statistics with linear weight. Results: Through the pre-defined process, the Japanese version of the simple, intuitive descriptions for 30 categories of the ICF Generic-30 Set and the rating reference guides for 21 Activity and Participation categories were successfully developed. The weighted kappa statistics ranged from 0.61 to 0.85, showing substantial to excellent agreement of the ratings between raters. Conclusions: The present study demonstrates that ICF categories can be translated into clinical practice. Collaboration between clinicians and researchers would further enhance the implementation of the ICF in Japan. Trial registration: not applicable

scholarly journals Clinical and Radiographic Outcomes After Fixation of Chondral Fragments of the Knee in 6 Adolescents Using Autologous Bone Pegs

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096305
Author(s):  
Takahiro Ogura ◽  
Hiroki Sakai ◽  
Shigehiro Asai ◽  
Hideaki Fukuda ◽  
Tatsuya Takahashi ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Full Range ◽  
Cartilage Tissue ◽  
Trochlear Groove ◽  
Repair Tissue ◽  
Radiographic Outcomes ◽  
The Mean ◽  
Autologous Bone

Background: Little is known regarding the optimal treatment for displaced, purely chondral fragments in the knee. Purpose: To report the clinical and radiographic outcomes of chondral fragment fixation in adolescents through use of autologous bone pegs. Study Design: Case series; Level of evidence, 4. Methods: This retrospective, single-center study evaluated 6 patients (mean age, 12.9 years) who underwent fixation of chondral fragments (no visualized bone attached) using autologous bone pegs (mean postoperative follow-up, 5.2 years; range, 1.4-10.9 years). The causes were trauma (n = 5) and osteochondritis dissecans (n = 1). Lesions were located in the trochlear groove (lateral, n = 3; medial, n = 2) or posterior part of the lateral femoral condyle (n = 1). The mean lesion size was 3.8 cm2 (range, 0.8-9.0 cm2). Patients were evaluated via physical examination and magnetic resonance imaging (MRI) using magnetic resonance observation of cartilage repair tissue scores. Results: In total, 5 patients successfully returned to sports without restrictions at a mean of 7 months (range, 6-8 months) postoperatively. At the latest follow-up, these 5 patients had full range of motion and no joint effusion. The mean magnetic resonance observation of cartilage repair tissue score was 85 (range, 70-95) at a mean duration of 3 years (range, 1-5 years). One patient experienced failure at 1.3 years postoperatively after a traumatic injury and subsequently underwent removal of the fixed fragment and a drilling procedure. Conclusion: In most adolescents, fixation of chondral fragments with no visualized bony portion using autologous bone pegs provided a satisfactory success rate and good healing of cartilage tissue confirmed on MRI scans.

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