Designing a Personalized MACI Surgery Rehab Program Skip to content

Designing a Personalized MACI Surgery Rehab Program

After MACI knee cartilage repair implantation has been completed, the road to recovery begins. With insight from Dr. Mike Essa, a physical therapist at Duke University, we gathered tips for planning a rehab program for your MACI patients.

Participating in a physical therapy program during recovery from MACI surgery.

 

 

Individualized Planning

As Dr. Essa likes to say: “rehab programs are not cookbooks — an individualized plan improves outcomes.” Individual factors like body weight, age, previous medical history, patient goals, and the individual’s operative note are essential to consider when developing any rehab plan and should be considered well-before the first physical therapy assessment.

 

Early Education and Goal Setting

Have an open and earnest conversation with patients about the MACI rehab timeline from the start of your consultations so patients know what to expect post-surgery. While MACI requires a 6–9-month rehab timeline to return to sport, patients will see incremental improvements throughout their recovery.

It is important to encourage patients to set small, attainable goals throughout their journey so they can observe their progress. A MACI patient who is solely focused on her long-term goal of her return to sprinting after surgery may become more frustrated than a patient who focuses on intermediary benchmarks like her ability to perform single leg balances by month three.

 

Emphasize Enjoyable Activities

Help patients find enjoyment and motivation during their recovery process by integrating the activities they love into rehab. For example, a soccer player might practice balance exercises on his involved leg while kicking a ball with his healthy leg. A basketball player might be encouraged to shoot free throws or work on her dribbling while balancing.

 

Adjust the Timeline

Because each patient heals at his or her own rate, rehab timelines will be unique to the individual. For example. sometimes range of motion or loading may be delayed because of increased swelling or pain, and you should adjust the patient’s rehab regimen to get the patient back on track. Likewise, patients who are exceeding expectations, particularly later in recovery, may be allowed to accelerate their activity.

Every patient is unique but there are certain benchmarks that signal a patient is ready to proceed to the next phase of activity:

  • At 0-3 months: Full, pain-free range of motion (ROM), active knee hyper extension/SLR, minimal to no pain when walking without assistive devices.
  • 3-6 months: Return to activities of daily living (prolonged walking, standing, stairs, low impact exercise), low to no pain with loaded strength training
  • 6-9 months: Return to desired activity level (for lower impact activities) or jogging, hopping, low level agility exercises
  • 9+ months: Return to unrestricted activity with minimal pain or swelling
     

Returning to an active life after MACI knee cartilage repair.

 

My MACI App

Encourage patients to download the My MACI App to keep them motivated throughout the MACI rehab process. The app includes goal-setting sections, exercise tracker, and calendars to help patients monitor progress.

 

Download the My MACI App for rehab   Download on the App Store  Get it on Google Play

Please see below for full indication and ISI.

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MACI repairs knee cartilage using your patient’s own chondrocytes

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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.

Indication

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.