ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper


Assessing The Role Of MOCART Score 1 And 2.0 For Patients After Autologous Matrix-Induced Chondrogenesis (AMIC) For Osteochondral Lesions Of The Talus (OLT)

Fabio A. Casari , MD, Zurich SWITZERLAND
Christoph Germann, MD, Zurich SWITZERLAND
Lizzy Weigelt, MD, Zurich SWITZERLAND
Stephan Hermann Wirth, MD, Zurich, Zurich SWITZERLAND
Arnd Viehöfer, MD, Zurich SWITZERLAND
Jakob Ackermann, MD, Winterthur SWITZERLAND

Balgrist University Hospital, Zurich, Zurich, SWITZERLAND

FDA Status Cleared


Analyzing MOCART 1 and 2.0 for postoperative outcome evaluation of patients who underwent Autologous Matrix-Induced Chondrogenesis (AMIC) procedure


MRI imaging is the tool of choice for assessing articular surfaces after cartilage surgery. The MOCART score is a common tool for assessing regenerative cartilage tissue. The score was originally developed for use in the knee joint. Previous literature showed as a clear limitation with the lack of correlation of the score with clinical outcome after AMIC procedure for OLT. The aim of this study was to evaluate the now updated MOCART 2.0 score for use after AMIC procedure for OLT.

This retrospective cohort study was approved by our ethics review board.
Patients who underwent isolated AMIC for symptomatic focal OLT between October 2009 and August 2015, had postoperative follow-up MRI imaging with same-day documentation of clinical scores (American Orthopaedic Foot and Ankle Society, AOFAS, and Tegner Score) were included. Patients with inflammatory arthritis and/or advanced osteoarthritis were excluded. Demographic, clinical, lesion-specific, and data regarding surgical procedure were documented.

35 patients could be included in the study. Mean: clinical and MRI follow-up was 4.5 ± 1.8 years, age was 34.4 ± 10.7 years and defect size was 0.9 ± 0.6 cm2. Of the patients, 14 (40%) were female, 17 (48.6%) were smokers and 27 (77%) received a bone graft to fill the defect. The final AOFAS score was Ø 92.63 ± 8.3 and the Tegner score was Ø 5.1 ± 1.8 which significantly improved from Ø 3.7 ± 2.0 (p=0.002). MOCART scores 1 Ø 59.0 ± 14.9 and 2.0 Ø 65.1 ± 13.9 correlated significantly with each other (r = 0.885; p < 0.001). Patients with shorter follow-up (<4.5 years) showed significantly better MOCART 1 scores ( Ø 64.7 ± 10.8 vs. Ø 52.9 ± 16.6, p=0.02) and tended to have better MOCART 2.0 scores ( Ø 69.4 ± 12.4 vs. Ø 60.6 ± 14.3, p=0.058). However, analysis of MOCART 1 and 2.0 showed no correlation with clinical scores (AOFAS, Tegner).

By implication, the MOCART score decreases over time. Neither the MOCART 1 nor 2.0 score can give us clinically relevant information, since the clinical outcome does not correlate with the radiological score. Thus, the MOCART 1 and 2.0 score does not play a relevant role in the treatment of symptomatic OLTs with AMIC procedure.

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