AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Non-CME presentation

Non-CME presentation_ Vericel MACI-Brian R. Waterman, M.D.

Pdf Summary

The document introduces MACI (Matrix-Induced Autologous Chondrocyte Implantation), an advanced treatment for repairing full-thickness cartilage defects in the adult knee. MACI uses autologous cultured chondrocytes seeded on a resorbable porcine Type I/III collagen membrane, customized by the surgeon for precise defect fit. The procedure involves defect assessment and biopsy, chondrocyte propagation with membrane seeding, and implantation of the MACI membrane.<br /><br />MACI represents the next generation of Autologous Chondrocyte Implantation (ACI), improving on earlier ACI techniques that used periosteal or collagen patches. Since FDA approval, MACI has shown superior clinical outcomes compared to traditional microfracture (MFX) surgery through trials such as the SUMMIT study. The SUMMIT trial involved patients aged 18-55 with symptomatic cartilage defects and demonstrated that at 2 years, MACI significantly improved Knee Injury and Osteoarthritis Outcome Scores (KOOS) for pain and function versus MFX (P<0.001). These improvements were sustained at 5 years in an extension study. Additionally, a higher percentage of MACI patients achieved meaningful clinical response compared to MFX patients.<br /><br />Manufactured under stringent GMP standards in an FDA-licensed facility, MACI undergoes extensive quality testing for cell viability, sterility, potency, and a uniform dose delivery. The dual-sided collagen membrane facilitates chondrocyte attachment on the rough surface and inhibits cell migration from the smooth side, promoting cartilage regeneration post-implantation.<br /><br />MACI is suitable for moderate to large cartilage defects (≥2 cm² and ≤6 mm deep). For defects with bone involvement deeper than 6 mm, bone grafting with MACI is recommended. Ideal candidates are adults aged 18-55 with symptomatic, full-thickness defects, able to comply with rehabilitation and having realistic expectations. Proper knee alignment, meniscal integrity, and stability must be optimized to ensure durable repair.<br /><br />In conclusion, MACI provides a safe and effective treatment option offering significant and lasting improvements in pain and function over microfracture for focal knee cartilage defects.

Keywords

MACI

Matrix-Induced Autologous Chondrocyte Implantation

cartilage repair

knee cartilage defects

autologous chondrocytes

collagen membrane

SUMMIT trial

KOOS scores

microfracture surgery

FDA-approved cartilage treatment