The Condition of the Meniscus and Cartilage of the Injured Knee on Preoperative Magnetic Resonance Imaging Is a Prognostic Factor Affecting Postoperative Outcomes Following Knee Cartilage Restoration Surgery

PurposeTo evaluate the relationship between preoperative whole-joint imaging evaluation of the knee with patient reported outcome measures after cartilage restoration surgery (mosaicplasty, osteochondral allograft transplantation (OCA), matrix autologous chondrocyte implantation (MACI)).MethodsWe retrospectively evaluated patients who underwent knee articular cartilage restoration at our institution from 2014 to 2020. The patients' knee MRI was evaluated with the whole joint magnetic resonance imaging score (WORMS) and semi-quantitative synovial inflammation imaging biomarkers of the preoperative MRI. To assess patient-reported outcome (PRO) score, Lysholm score and Knee Osteoarthritis and Injury Outcome Score (KOOS) were completed at minimum 2 years follow-up. Statistical analysis was performed using Spearman rank test to obtain correlation values for WORMS score and PRO score for each survey.ResultsThere were 40 patients who were enrolled in this study. The average age at baseline was 34.5 years. The average BMI was 28.2 kg/m2 and 26 of 40 were men (range, 20-58 years). The maximum preoperative WORMS score was significantly correlated with the post-operative Lysholm score (r = -0.52, p=0.0013). The WORMS Meniscus and Cartilage sub-scales were significantly correlated with the Lysholm score (r = -0.36, p=0.024 and r = -0.37, p=0.021 respectively). The maximum WORMS score was significantly correlated with the KOOS Daily living and Sports/rec sub-scores (r= -0.47, p=0.0023 and r = -0.42, p=0.0077, respectively). Semi-quantitative synovial inflammation imaging biomarkers were not significantly correlated with PRO scores.ConclusionIncreasing preoperative degenerative change in the knee, as evidenced by a higher WORMS on preoperative MRI, was associated with inferior patient-reported outcomes at a minimum of 2 years after cartilage restoration surgery (mosaicplasty, OCA, MACI). Semi-quantitative scoring of the whole joint on preoperative MRI may allow for improved counseling regarding expected benefit for patients after cartilage restoration surgery.