Case Study: Trochlear Defect Repair with MACI Skip to content

Case Study: Trochlear Defect Repair with MACI

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


  • 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


  • 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

MACI is contraindicated in patients with a known history of hypersensitivity to gentamicin, other aminoglycosides, or products of porcine or bovine origin. MACI is also contraindicated for patients with severe osteoarthritis of the knee, inflammatory arthritis, inflammatory joint disease, or uncorrected congenital blood coagulation disorders. MACI is also not indicated for use 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.

MACI is contraindicated in patients who are unable to follow a physician-prescribed post-surgical rehabilitation program.

The safety of MACI in patients with malignancy in the area of cartilage biopsy or implant is unknown. Expansion of present malignant or dysplastic cells during the culturing process or implantation is possible.

Patients undergoing procedures associated with MACI are not routinely tested for transmissible infectious diseases. A cartilage biopsy and MACI implant may carry the risk of transmitting infectious diseases to healthcare providers handling the tissue. Universal precautions should be employed when handling the biopsy samples and the MACI product.

Final sterility test results are not available at the time of shipping. In the case of positive sterility results, health care provider(s) will be contacted.

To create a favorable environment for healing, concomitant pathologies that include meniscal pathology, cruciate ligament instability and joint misalignment, must be addressed prior to or concurrent with the implantation of MACI.

Local treatment guidelines regarding the use of thromboprophylaxis and antibiotic prophylaxis around orthopaedic surgery should be followed. Use in patients with local inflammations or active infections in the bone, joint, and surrounding soft tissue should be temporarily deferred until documented recovery.

The MACI implant is not recommended during pregnancy. For implantations post-pregnancy, the safety of breast feeding to infant has not been determined.

Use of MACI in pediatric patients (younger than 18 years of age) or patients over 65 years of age has not been established.

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.

Please see Full Prescribing Information for more information.


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

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

MACI is intended for autologous use and must only be administered to the patient for whom it was manufactured. The implantation of MACI is to be performed via an arthrotomy to the knee joint under sterile conditions.

The amount of MACI administered is dependent upon the size (surface in cm2) of the cartilage defect. The implantation membrane is trimmed by the treating surgeon to the size and shape of the defect, to ensure the damaged area is completely covered, and implanted cell-side down.

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.