Case Study: Trochlear Defect Repair with MACI
Important Safety Information
Full Prescribing Information
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Case Study: Trochlear Defect Repair with MACI

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MACI surgery offers healthcare providers the versatility to treat cartilage defects in multiple areas, including the femoral condyles, patella and trochlea. A recent case explores how a 23-year-old former college athlete pursued surgical treatment to address knee cartilage pain caused by a trochlear defect. Review the patient’s case history, treatment with MACI knee cartilage surgery and outcome.

The Patient

  • 23-year-old male patient
  • Former college lacrosse player, plays recreational basketball and snowboards

Patient’s Knee History

  • Recurrent damage from continued athletics and small injuries
  • Pain worsening over last two years.
  • Swelling occurred with kneeling, pain and popping with any squatting or cutting
  • No prior surgery

Arthroscopy Findings

  • Arthroscopy revealed a trochlear defect of 2.5 x 2 cm
  • Meniscus and patella both intact
  • No bony involvement, good surrounding cartilage
  • No comorbidities

Arthroscopy image shows the removal of loose bodies in a 23-year-old patient’s knee

Surgical Approach

Following the initial arthroscopy, Dr. Garcia proceeded with MACI surgery and took a multi-pronged approach:

  • Due to the size of the defect, a larger cartilage procedure was warranted, so MACI surgery was selected
  • The defect size post debridement equaled 2.5 x 2 cm and one MACI implant was used during the surgery

: Intraoperative image of patient knee showing trochlear defect prior to MACI knee procedure

Intraoperative image of patient knee showing MACI implantation onto trochlear defect to repair articular cartilage damage

Rehab

  • Brace for 6 weeks, continuous passive motion machine (CPM) x 3 weeks, advance diet as tolerated (ADAT)
  • Weight-bearing-as tolerated (WBAT) when straight leg raise test performed
  • Goal range of motion 0–90 after first 2 weeks
  • Stairs avoided for 6 months, no squats first 12 weeks, then progressed to full squat
  • Started elliptical & bike 3 months
  • Started running around 6 months

Outcome

  • Patient returned to all sports at 9 months post-op with full range of motion and no swelling

Explore MACI knee cartilage repair clinical trials and patient outcomes here.

Individual results may vary.

 

Please see below for full indication and ISI. Blog posts are intended to provide educational information only and do not constitute medical advice.

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Indication and Important Safety Information

Important Safety Information

Contraindications: MACI is contraindicated in patients with a known history of hypersensitivity to gentamicin, other aminoglycosides, products of porcine or bovine origin; in patients with severe osteoarthritis of the knee, inflammatory arthritis, inflammatory joint disease, or uncorrected congenital blood coagulation disorders; in patients who have undergone prior knee surgery in the past 6 months, excluding surgery to procure a biopsy or a concomitant procedure to prepare the knee for a MACI implant; or in patients unable to cooperate with a physician-prescribed post-surgical rehabilitation program.

Warnings and Precautions:
  • Malignancy: The risk of MACI in patients with malignancy in the area of cartilage biopsy or implant is unknown. Expansion of malignant or dysplastic cells present in biopsy tissue during manufacture and subsequent implantation may be possible.
  • Transmissible infectious diseases: Because patients undergoing procedures associated with MACI are not routinely tested for transmissible infectious diseases, cartilage biopsy and MACI implant may carry risk of transmitting infectious diseases.
  • Presurgical Comorbidities: Local inflammation or active infection in the bone, joint, and surrounding soft tissue, meniscal pathology, cruciate ligament instability, and misalignment should be assessed and treated prior to or concurrent with MACI implantation.
  • Product Sterility: Final sterility test results are not available at the time of shipping.

Adverse Reactions: The most frequently occurring adverse reactions reported for MACI (≥5%) were arthralgia, tendonitis, back pain, joint swelling, and joint effusion. Serious adverse reactions reported for MACI were arthralgia, cartilage injury, meniscus injury, treatment failure, and osteoarthritis.

Specific Populations:
  • Use of MACI in pediatric patients (younger than 18 years of age) or in patients over 65 years of age has not been established.
  • The MACI implant is not recommended during pregnancy. For implantations post-pregnancy, the safety of breastfeeding to an infant has not been determined.

To report negative side effects, contact Vericel Corporation at 1-800-453-6948 or FDA at 1-800-FDA-1088 (1-800-332-1088) or www.fda.gov/medwatch.

Please see Full Prescribing Information.

Indication

MACI® is an autologous cellularized scaffold product indicated for the repair of single or multiple symptomatic, full-thickness cartilage defects of the knee with or without bone involvement in adults.

MACI® (autologous cultured chondrocytes on porcine collagen membrane) is an autologous cellularized scaffold product indicated for the repair of single or multiple symptomatic, full-thickness cartilage defects of the knee with or without bone involvement in adults.

Limitations of Use

Effectiveness of MACI in joints other than the knee has not been established.

Safety and effectiveness of MACI in patients over the age of 55 years have not been established.