Osteochondral allograft mri scoring system (OCAMRISS) in the knee: Interobserver agreement and clinical application

Abstract

Introduction: Osteochondral allograft (OCA) transplantation is a suitable treatment option for large osteochondral defects. Magnetic resonance imaging (MRI) is an objective, reproducible, noninvasive monitoring tool for postoperative assessment after cartilage surgery. Objective: To correlate Osteochondral Allograft MRI Scoring System (OCAMRISS) in patients undergoing OCA transplantation in the knee with clinical outcomes and determine interobserver agreement of this scoring system. Methods: Fifteen patients underwent OCA transplantation in the knee and received a postoperative MRI. Four examiners read each MRI and completed an OCAMRISS. Interobserver agreement and intraclass correlation coefficients (ICCs) were assessed. Clinical outcomes were evaluated. Correlation between the OCAMRISS and clinical outcomes was calculated using Spearman's correlation coefficients. Results: Interobserver agreement on individual features of the OCAMRISS was superior (kappa = 0.81-1.0) in 65% of comparisons, substantial (kappa = 0.61-0.8) in 14%, moderate (kappa = 0.41-0.6) in 18%, and fair (kappa = 0.21-0.4) in 3%. Agreement among readers was very strong for the cartilage, bone, ancillary, and total scores with 96% of comparisons having an ICC >0.80. International Knee Documentation Committee (IKDC) function scores were correlated with OCAMRISS cartilage score (rho = 0.53, P = 0.044) and total score (rho = 0.67, P = 0.006). The Knee injury and Osteoarthritis Outcome Score (KOOS) sports/recreation subscale was correlated with OCAMRISS ancillary score (rho = 0.58, P = 0.049) and total score (rho = 0.64, P = 0.024). No correlation was observed with subchondral bone features of OCAMRISS and any of the outcome scores. Conclusions: The recently described OCAMRISS is a reproducible grading system for in vivo evaluation after osteochondral allograft transplantation.