Matrix-induced autologous chondrocyte implantation (MACI) in the knee

  • Davide Enea
  • Stefano Cecconi
  • Alberto Busilacchi
  • Sandra Manzotti
  • Rosaria Gesuita
  • Antonio GiganteEmail author



Matrix-induced autologous chondrocyte implantation (MACI) has been in use for chondral defect repair since 2000, but to date, only little is known about its histological outcomes in the repair of knee cartilage defects. This prospective multicentre study aims to evaluate (1) the quality of the repair tissue obtained from biopsies taken during second-look arthroscopy and (2) the relationship between the histological outcome, the macroscopic appearance of the repair and the patients’ functional status.


Thirty-three second-look core biopsies from 30 patients treated with MACI were analysed. At the time of biopsy, the surgeon reported the reason for the second-look arthroscopy, the quality of the repair tissue and the patient’s functional status on a standardised form. Biopsies together with patient data were sent to our centre to undergo blind histological evaluation and data analysis.


The median overall ICRS II histological score of the examined population was 57 (1st–3rd quartile 41–75). According to the ICRS cartilage repair assessment (CRA) arthroscopic evaluation, 10 biopsies (30%) were classified as normal, 17 (51%) as nearly normal, 4 (12%) as abnormal and 2 (6%) as severely abnormal. The histological outcome was not significantly related either to the macroscopic appearance of the lesion or to the patient’s functional status at the time of biopsy.


In the examined population, the macroscopic appearance of the repair tissue gave an overly favourable impression in comparison with the real histological composition of the tissue, which was possibly still maturing in many cases. The healing process after MACI needs to be better understood through a larger histological study, and a longer follow-up is needed to better clarify the relationship between histology and long-term functional status.

Level of evidence



Cartilage Autologous chondrocyte implantation MACI Histology Core biopsy 



The authors would like to acknowledge the following orthopaedic surgeons for providing biopsies and helping with patients’ data collection: Dr. Claudio Zorzi—Verona; Dr. Franz Erschbaumer—Bressanone; Dr. Vittorio Zaffarana—Vigevano; Dr. Corrado Bait, Dr. Roberto D’Anchise, Dr. Antonio Memeo, Dr. Alberto Ventura and Dr. Piero Volpi—Milano; Dr. Nicolo’ Coletti—Oderzo; Dr. Daniele Clementi—Bollate; and Dr. Roberto Pessina—Vicamerate. The authors would like to thank Dr. Dan Reynolds (University of Cambridge) for the help in editing this manuscript.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Davide Enea
    • 1
  • Stefano Cecconi
    • 1
  • Alberto Busilacchi
    • 1
  • Sandra Manzotti
    • 1
  • Rosaria Gesuita
    • 2
  • Antonio Gigante
    • 1
    Email author
  1. 1.Department of OrthopedicsPolytechnic University of MarcheAnconaItaly
  2. 2.Centre of Epidemiology, Biostatistics and Medical Information TechnologyPolytechnic University of MarcheAnconaItaly

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