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Matrix-induced autologous chondrocyte implantation (MACI) in the knee: clinical outcomes and challenges

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated effectiveness in treating isolated cartilage defects of the knee but medium- and long-term evidence and information on the management of postoperative complications or partially successful cases are sparse. This study hypothesised that MACI is effective for up to 5 years and that patients with posttreatment problems may go on to obtain clinical benefit from other interventions.

Methods

A follow-on, prospective case series of patients recruited into a previous controlled, randomised, prospective study or newly enroled. Patients were followed up 6, 12, 24 and 60 months after surgery. Outcome measures were Tegner (activity levels) and Lysholm (pain, stability, gait, clinical symptoms) scores. Zone-specific subgroups were analysed 6, 12 and 24 months postoperatively.

Results

Sixty-five patients were treated with MACI. Median Tegner score improved from II to IV at 12 months; an improvement maintained to 60 months. Mean Lysholm score improved from 28.5 to 76.6 points (±19.8) at 24 months, settling back to 75.5 points after 5 years (p > 0.0001). No significant differences were identified in the zone-specific analysis. Posttreatment issues (N = 12/18.5 %) were resolved with microfracture, debridement, OATS or bone grafting.

Conclusions

MACI is safe and effective in the majority of patients. Patients in whom treatment is only partially successful can go on to obtain clinical benefit from other cartilage repair options. This study adds to the clinical evidence on the MACI procedure, offers insight into likely treatment outcomes, and highlights MACI’s usefulness as part of an armamentarium of surgical approaches to the treatment of isolated knee defects.

Level of evidence

Prospective case control study with no control group, Level III.

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Acknowledgments

The authors would like to thank Dr. Gerrit Eichner for his assistance with the statistical analysis.

Conflict of interest

The lead author received a grant from Genzyme Biosurgery (a Sanofi company) for statistical analysis and medical writing services. The other authors have no conflict of interest.

Author information

Authors and Affiliations

  1. ATOS Clinic, Center for Knee and Hip Replacement and Regenerative Joint Surgery, Bismarckstrasse 9-15, 69115, Heidelberg, Germany

    Erhan Basad

  2. Department for Trauma and Orthopedic Surgery, Asklepios Klinik Langen, Röntgenstrasse 20, 63225, Langen, Germany

    Fabian R. Wissing

  3. Sportklinik Stuttgart GmbH, Taubenheimstr. 8, 70372, Stuttgart, Germany

    Patrick Fehrenbach

  4. Department for Orthopaedic Surgery, Giessen University Hospital, Klinikstrasse 33, 35392, Giessen, Germany

    Markus Rickert & Bernd Ishaque

  5. Laboratory for Experimental Orthopaedics, University of Giessen, Paul-Meimberg-Str.3, 35392, Giessen, Germany

    Jürgen Steinmeyer

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  1. Erhan Basad
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Correspondence to Erhan Basad.

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Basad, E., Wissing, F.R., Fehrenbach, P. et al. Matrix-induced autologous chondrocyte implantation (MACI) in the knee: clinical outcomes and challenges. Knee Surg Sports Traumatol Arthrosc 23, 3729–3735 (2015). https://doi.org/10.1007/s00167-014-3295-8

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  • DOI: https://doi.org/10.1007/s00167-014-3295-8

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