Multimodal approach in the use of clinical scoring, morphological MRI and biochemical T2-mapping and diffusion-weighted imaging in their ability to assess differences between cartilage repair tissue after microfracture therapy and matrix-associated autologous chondrocyte transplantation: a pilot study  G.H. Welsch, S. Trattnig, S. Domayer, S. Marlovits, L.M. White, T.C. Mamisch  Osteoarthritis and Cartilage  Volume 17, Issue 9, Pages 1219-1227 (September 2009) DOI: 10.1016/j.joca.2009.03.018 Copyright © 2009 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Morphological isotropic 3D – DESS sequence used for the MOCART score of a patient after MFX. Sagittal (a) and coronal (b) reconstruction focused on the cartilage repair area (arrows). The MOCART scoring showed with 85 points complete repair filling, intact integration and surface, slightly altered structure and altered subchondral lamina and bone. Osteoarthritis and Cartilage 2009 17, 1219-1227DOI: (10.1016/j.joca.2009.03.018) Copyright © 2009 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Morphological isotropic 3D – DESS sequence used for MOCART score of a patient after MACT. Sagittal (a) and coronal (b) reconstruction focused on the cartilage repair area (arrows). The MOCART scoring showed with 90 points complete repair filling, intact integration and surface, homogen structure and altered subchondral lamina and bone. Osteoarthritis and Cartilage 2009 17, 1219-1227DOI: (10.1016/j.joca.2009.03.018) Copyright © 2009 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Quantitative maps of the same patient (Fig. 1) after MFX for diffusion-weighted imaging (a) and T2-mapping (b) with the cartilage repair area marked by arrows and the ROIs plotted for cartilage repair tissue and healthy control cartilage. Visible higher diffusivity (red) and shorter T2 values (blue) within the cartilage repair tissue compared to the surrounding cartilage. For the T2 map, a magic angle effect is likely visible within the trochlea with prolonged T2 values. Short T2 values within the dorsal part of the femoral condyle can be due to partial volume effect. Osteoarthritis and Cartilage 2009 17, 1219-1227DOI: (10.1016/j.joca.2009.03.018) Copyright © 2009 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 Quantitative maps of the same patient (Fig. 2) after MACT for diffusion-weighted imaging (a) and T2-mapping (b) with the cartilage repair area marked by arrows and the ROIs marked for the repair tissue and the control cartilage. Visible slightly higher diffusivity (red) and unchanged T2 values (blue) within the cartilage repair tissue compared to the surrounding cartilage. Nevertheless, the prolonged T2 values within the cartilage surface can also be due to partial volume effects. Osteoarthritis and Cartilage 2009 17, 1219-1227DOI: (10.1016/j.joca.2009.03.018) Copyright © 2009 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 The graphs show the DWI index (left, black, circles, continuous line) and the T2 index (right, grey, triangles, and dotted line) for every patient related to the post-operative interval after MFX (a) and MACT (b). Furthermore to show the progression over time, a regression line is added with its slope (R Sq linear). It is visualized that after MFX, the DWI index, according to its fitting line, is increasing and thus diffusivity, whereas the T2 index remains stable on a low level. In contrast to that after MACT, the DWI index remains stable, whereas the T2 index decreases on a higher level. Osteoarthritis and Cartilage 2009 17, 1219-1227DOI: (10.1016/j.joca.2009.03.018) Copyright © 2009 Osteoarthritis Research Society International Terms and Conditions

Fig. 6 Correlation plots with 95% confidence interval of the Lysholm score and the MOCART score (r=0.484; P=0.031) (a); the Lysholm score and the T2 index (r=0.304; P=0.193) (b) and the Lysholm score and the DWI index (r=−0.557; P=0.011) (c). Osteoarthritis and Cartilage 2009 17, 1219-1227DOI: (10.1016/j.joca.2009.03.018) Copyright © 2009 Osteoarthritis Research Society International Terms and Conditions