Matrix Associated Chondrocyte Implantation

By Carlos Tandron, MD

MACI Matrix Associated Chrondrocyte Implantation

Your knee is a complex joint where three major bones come together: the shin bone (tibia), the thigh bone (femur), and the knee cap (patella). Ligaments and cartilage connect and protect these bones at the knee joint.

Cartilage is a strong, rubbery, and key connective tissue found in many parts of the body, including joints. The two types of cartilage found in the knee. One of them is the meniscus, which acts as a cushion between the femur and the tibia. The other is the articular cartilage which covers the ends of the bones to ensure smooth movement.

This articular cartilage can be damaged in many ways. Chronic or repetitive actions from exercise, sports, or physical work can cause articular cartilage to weaken and wear out with time.  Acute or traumatic events such as a fall, a forceful twist, or a sports injury can also cause immediate and severe cartilage damage. This can create a hole or roughening to the smooth surface which is known as an articular cartilage defect.  Therefore, symptoms of articular cartilage defects can include pain, swelling, clicking, and locking.

Unfortunately, cartilage does not heal on its own.  Cartilage injuries are chronic and often get worse as time goes on. If conservative treatment has not worked to relieve pain, surgery is often the next step.  One can use the analogy of an ice skating rink to explain this damage to cartilage.  When you are young, your cartilage is smooth as the ice before an ice hockey game.  As you age, injuries can cause bumps or divots in your cartilage.  The same is true to the nice smooth ice and its appearance after the ice hockey game.  The ice is no longer smooth, it is rough with chips and divots.

Traditional Surgical Treatment Options for Damaged Knee Cartilage:

• Chondroplasty:

  • Also called debridement and lavage. The physician will trim the cartilage and irrigate with water.  Chondroplasty may offer temporary relief but does not repair the cartilage.

• Marrow Stimulation:

  • Such as microfracture, abrasion arthroplasty, and subchondral drilling. Your physician will drill mall holes into the bone, allowing blood and bone marrow cells to seep out. This creates a blood clot that forms repair tissue. The surgical techniques form closer to fibrocartilage tissue rather than the more durable hyaline cartilage found in normal articular cartilage.

• Osteochondral Implants:

  • Autologous or Allograft. Healthy pieces of both cartilage and bone are placed into damaged areas, using a patient’s own tissue (osteochondral autograft, also called OATS®) or tissue from a cadaver (osteochondral allograft).

• Autologous Chondrocyte Implantation (ACI):

  • A biologic procedure uses a patient’s own cartilage cells in a lab to grow additional cells implanted in the damaged area. The new tissue has properties similar to hyaline cartilage, the durable tissue found in articular cartilage.

ACI  provides long-lasting pain relief and help patients regain knee function. The newly adopted MACI® procedure is the third generation ACI.  It  offers a safer way to deliver cells to the damaged area of cartilage.

MACI (autologous cultured chondrocytes on porcine collagen membrane) is a procedure that repairs cartilage using the patient’s own cells. The cells grow in a laboratory with placement on a film.  This film is implanted into the damaged cartilage   Therefore, this provides long-lasting pain relief and improvements in the function of the knee.

Here’s How the MACI Process Works

First, Dr. Tandron will determine if a surgical intervention is necessary.  A knee arthroscopy will be performed to assess the knee’s cartilage damage.  Therefore, if he thinks that MACI may be an option for you, Dr. Tandron will take a biopsy (a sample of tissue approximately the size of two Tic Tacs) of your healthy knee cartilage. The biopsy ships to a state of the art, cell processing facility in Cambridge, MA, that has FDA approval for storage.  In a proprietary process, cartilage cells expand and uniformly seed onto a resorbable collagen membrane.

The MCAI implant is delivered to the operating room on the day of your surgery and will be shaped by your physician to the size and shape of your cartilage defect.  In other words, this implant will be placed onto your knee and affixed to the damaged area. Over time, the implanted cartilage cells will continue to grow and solidify, covering and filling the affected area leaving the patient with a new cartilage surface.

Rehabilitation Timeline Following an MACI Procedure

Following the MACI procedure, immobilization of the knee will be with a brace.  You will need to follow to enter a physical therapy program specific to this procedure.  Consult with Dr. Tandron and your physical therapist to determine when you might be able to drive and return to work or other activities.

A support program is available to assist with a smooth recovery. The commitment you make to the rehabilitation program will play a key role in your return to activity. Recovery time varies greatly as no two patients are alike. However, most can expect to resume normal daily activities in 3-6 months, recreational activities in 6-9 months, with full return to normal function in 9-12 months.

To schedule for Physical Therapy, please call 904-858-7045. 

Research studies show MACI provides three important things:

• A functional repair tissue:
  • MACI produces a type of repair tissue that alleviates symptoms and restores joint function.  Studies show this formoration as early as 6 months after the MACI procedure.

• Reduced pain and improved function:
  • In the SUMMIT clinical trial, MACI has shown to offer greater pain relief and improvement in function than microfracture.

• Patient satisfaction:
  • Also in the SUMMIT clinical trial, MACI patients reported a higher quality of life scores.  Additionally, a greater ability to perform recreational and sports activities and improved overall knee function.

The safety and long-term clinical benefit of MACI have only been studied in the knee joint. MACI has approval for use in the knee only at this time. The safety and effectiveness of MACI have not been proven for patients 55 years old and older.

1. Saris D, Price A, Widuchowski W, et al. Matrix-applied characterized autologous cultured chondrocytes versus microfracture: Two-year follow-up of a prospective randomized trial. Am J Sports Med. 2014;42(6):1384-9

Related Articles: Knee Pain Can’t Wait and  Anatomy of the Knee VIDEO 

If you would like to discuss this new option for cartilage repair, click the link below to set up a consultation with Dr. Carlos Tandron.  Finally, you can also call 904-JOI-2000 or  schedule online.

JOI and JOI Rehab

JOI Physicians continue to offer online new patient appointments. This is another option to make it more convenient to make new patient appointments with less phone hold times. Follow the link below to select your JOI MD and schedule online.

You can still call 904-JOI-2000 to make new patient JOI Physician Appointments if that is your preference.

To make appointments with JOI Rehab, please call 904-858-7045.

By: Dr. Carlos Tandron, Orthopedic Surgeon.