The Predictive Value of Early Postoperative MRI-Based Bone Marrow Parameters for Mid-Term Outcome after MACI with Autologous Bone Grafting at the Knee

Abstract

Objective The aim of this study was to longitudinally determine the prognostic value of early postoperative quantitative 3T-MRI (magnetic resonance imaging) parameters of subchondral bone marrow for 2-year clinical and MRI outcome after matrix-associated autologous chondrocyte implantation (MACI) with autologous bone grafting (ABG) at the knee. Design Consecutive subjects who received MACI with ABG for treatment of focal osteochondral defects received MRI follow-up 3, 6, 12, and 24 months postoperatively. Quantitative MRI included bone marrow edema-like lesion (BMEL) volume measurements and single-voxel magnetic resonance spectroscopy (MRS; n = 9) of the subchondral bone marrow. At 2-year follow-up, morphological MRI outcome included MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 scores. Clinical outcomes were assessed using Lysholm scores. Results Among a total of 18 subjects (mean age: 28.7 ± 8.4 years, n = 14 males) with defects at the medial or lateral ( n = 15 and n = 3, respectively) condyle, mean BMEL volume decreased from 4.9 cm3 at 3 months to 2.0 cm3 at 2-year follow-up ( P = 0.040). MRS-based bone marrow water T2 showed a decrease from 20.7 ms at 1-year follow-up to 16.8 ms at 2-year follow-up ( P = 0.040). Higher BMEL volume at 6 months correlated with lower 2-year Lysholm (R = −0.616, P = 0.015) and MOCART 2.0 scores (R = −0.567, P = 0.027). Larger early postoperative BMEL volumes at 3 months (R = −0.850, P = 0.007) and 6 months (R = −0.811, P = 0.008) correlated with lower MRS-based unsaturated lipid fractions at 2-year follow-up. Furthermore, patients with early postoperative bony defects showed worse MOCART 2.0 ( P = 0.044) and Lysholm scores ( P = 0.017) after 24 months. Conclusion Low subchondral BMEL volume and optimal restoration of the subchondral bone at early postoperative time points predict better 2-year clinical and MRI outcomes after MACI with ABG.

The role of autologous bone grafting in matrix‐associated autologous chondrocyte implantation at the knee: Results from the German Cartilage Registry (KnorpelRegister DGOU)

“…Therefore, confusion with the ICRS OCD classification, mislabelling or other reasons for concomitant bone grafting may In addition, the study population has insufficient baseline MRI data and no follow-up MRI data for analysis. This is unfortunate because it misses the opportunity to examine for the first time MRI data from a substantial cohort undergoing M-ACI and additional ABG [13,14]. Recently, a correlation between subchondral bone parameters, cartilage MRI signal and outcome after CR has been suggested [14].…”

“…This is unfortunate because it misses the opportunity to examine for the first time MRI data from a substantial cohort undergoing M-ACI and additional ABG [13,14]. Recently, a correlation between subchondral bone parameters, cartilage MRI signal and outcome after CR has been suggested [14]. Thus, the good clinical results of the studied population suggest adequate bone and cartilage healing, even if this finding cannot be supported by MRI data.…”

Sustained superiority in KOOS subscores after matrix-associated chondrocyte implantation using spheroids compared to microfracture

“…However, structural repair is still an important outcome. Although it currently lacks correlation with patient reported outcomes on the short‐ to midterm follow‐up, it might become more important in predicting longer term resilience of repair tissue for certain indications [15] as for instance observed for microfracture [22]. The relatively short follow‐up might also be the reason why no differences were found in the MOCART scores between the groups.…”

Knee Joint Preservation in Tactical Athletes: A Comprehensive Approach Based upon Lesion Location and Restoration of the Osteochondral Unit

“…Directly underneath this layer, the tidemark differentiates the articular cartilage from the calcified cartilage, with calcified cartilage serving as the strong attachment site between the articular cartilage and subchondral bone ( Figure 1 ) [ 5 ]. Aside from serving as the bedrock of articular cartilage, the subchondral bone appears to serve an important role in cartilage restoration (and osteoarthritis progression), with subchondral edema being predictive of worse outcomes and higher failure rates of surface based restoration procedures [ 6 , 7 , 8 , 9 , 10 ].…”