Intended for U.S. health care professionals only
The Science of MACI.
The Choice of Delivery.
Introducing the first and only FDA-approved autologous cell-based cartilage therapy for arthroscopic delivery.
MACI provides a durable approach to cartilage restoration in the knee and can now be delivered arthroscopically in patients with ≤4 cm2 accessible defects.1,2
Watch these videos to learn more about delivering MACI via:
A step-by-step guide to the MACI procedure
Take a small sample of healthy cartilage from a non–weight-bearing area of the patient’s knee
Typical harvest sites include the intercondylar notch and the proximal aspect of the medial and/or lateral femoral condyle
Click a delivery technique below to learn more
Send the sample to the Vericel facility in Cambridge, Massachusetts, a state-of-the-art cell-processing facility that provides optimal product quality and safety
Chondrocytes are extracted from the sample, expanded, and uniformly seeded onto a resorbable Type I/III collagen membrane using proprietary methods
MACI delivers a controlled, uniform dose of cells with a density of 500,000 to 1,000,000 per cm2
On the day of the procedure, the MACI implant is brought by courier to the treatment facility for delivery through the surgical technique that’s appropriate for the patient
Position spinal needle in center of cartilage defect
Measure defect size using the Arthroscopic Measurement Probe
Place the appropriately sized MACI Cannula Assembly
Score cartilage defect using the appropriately sized MACI Arthroscopic Cutter
Debride cartilage defect using the preferred Curette(s)
Dry cartilage defect with spongy tip of MACI Applicator
Shape MACI implant using the appropriately sized MACI Cutter
Load MACI implant cell side up on MACI V-Shuttle Delivery Device
Apply a thin layer of fibrin sealant to cartilage defect
Deliver MACI implant via MACI V-Shuttle Delivery Device
Adjust placement of MACI implant using silicone end of MACI Applicator
Allow fibrin sealant to set
Please see the MACI Open and MACI Arthro surgical training manuals for complete details on how to successfully deliver MACI using a mini-arthrotomy or arthroscopic technique.
Send the sample to the Vericel facility in Cambridge, Massachusetts, a state-of-the-art cell-processing facility that provides optimal product quality and safety
Chondrocytes are extracted from the sample, expanded, and uniformly seeded onto a resorbable Type I/III collagen membrane using proprietary methods
MACI delivers a controlled, uniform dose of cells with a density of 500,000 to 1,000,000 per cm2
On the day of the procedure, the MACI implant is brought by courier to the treatment facility for delivery through the surgical technique that’s appropriate for the patient
Using the MACI Open Surgical Cutting Templates and Mallet to create a uniform shape in the knee cartilage defect, debride back to healthy, stable cartilage with a Ring Curette
Using the MACI Open Surgical Cutting Templates, Mallet, and Cutting Block, template the MACI implant to the exact size of the debrided knee cartilage defect
Position MACI and secure in place using fibrin sealant; suture fixation is not required
The MACI implant completely fills the defect
Please see the MACI Open and MACI Arthro surgical training manuals for complete details on how to successfully deliver MACI using a mini-arthrotomy or arthroscopic technique.
MACI instrumentation is designed to support the delivery technique you choose.
MACI Arthro instrumentation is designed to create a reproducible technique for arthroscopic delivery while maintaining cell viability on the implant.3
With a range of Cannula, Cutter, and V-shuttle sizes to address accessible defects of the knee that are ≤4 cm2, MACI Arthro instruments are packaged separately to provide surgeons with the option to select the appropriate tools for each case. Ask your MACI Representative for more information.
Important note: MACI Arthro instrumentation is not available or appropriate for all MACI procedures. The content presented here is for informational purposes only and does not constitute medical advice.
MACI Open instrumentation is intended to assist with delivery of MACI via mini-arthrotomy. Ask your MACI Representative for more information.
Important note: MACI Open instrumentation is not available or appropriate for all MACI procedures. The content presented here is for informational purposes only and does not constitute medical advice.
MACI can be delivered to a wide range of knee cartilage defects via mini-arthrotomy and can now be delivered arthroscopically in patients with ≤4 cm2 accessible defects
Condyle
Trochlea
Patella
The following is an overview of the progression for rehabilitation from MACI*
Achieve routine
0–3 months
After the immediate post-surgery phase, patients should be able to work towards a pain-free and full passive knee extension with limited weight bearing. Over time, the goal is to be free of ambulation devices and knee braces while becoming thoroughly independent with rehabilitation exercises.
Functional goals include:
- Mobile with crutches within first week
- Limited weight bearing and pain-free, full knee extension by 2–3 weeks
- Independent home exercise as early as 1 month
- Full weight bearing and full knee range of motion by 8–12 weeks post-surgery
- Free from knee brace by 8–12 weeks post-surgery
Build strength
3–6 months
During this phase, patients should begin to feel comfortable returning to recreational activities. An exercise program will help re-build muscle strength and endurance. Patients may feel ready for more strenuous activity, so you may need to give explicit direction on what activities they are ready for at this stage.
Functional goals include:
- Full and pain-free weight bearing and range of motion
- Continue progression of strengthening exercises without pain or swelling
- Transition to gym/home based rehab
- Free from crutches
Be active
6–9 months
Patients should be able to enjoy a return to recreational activities and sports by gradually increasing the difficulty of their exercises. Every patient’s recovery is unique and should be guided by your assessment of graft maturation as well as mental preparedness of the patient and the general physical function and level of specific knee strength, stability, and support.
Functional goals include:
- Increase distance, time, and difficulty of exercises
- Ability to tolerate lengthy walking distances
- Return to a pre-operative level of activity
Over the course of a year, the matrix continues to expand and fill the cartilage defect.2
After implantation, chondrocytes migrate from the MACI membrane and adhere to the subchondral bone, forming new cartilage.3 As the matrix matures, it produces a durable repair tissue that expands to fill the defect.2
Tissue phases during MACI rehabilitation
0–3 months
Implantation & protection
Cells adhere to bone and begin to proliferate throughout the defect
3–6 months
Transition & proliferation
Continued proliferation forms a defect-spanning matrix
6–9 months
Remodeling & maturation
Expansion of the cell matrix into puttylike consistency, progressive hardening until durable repair tissue forms
9+ months after MACI
“I’m close to being back to the best shape of my life and keep improving every day. I have been able to get back to all the physical activities I love doing, like running, squatting, jumping, lunging, weight lifting, taking fitness classes, boxing, hiking, and camping.”
Chris, MACI patient
Paid testimonial by a MACI patient.
*Recovery time varies greatly as no two patients are alike. The goal is to restore optimal function in each patient as safely as possible. These timeframes are not universal and should be used for general guidance on which goals to reach before progressing to the next. MACI is contraindicated in patients who are unable to follow a physician-prescribed post-surgical rehabilitation program.
Timelines are based on clinical observations and should not be considered medical advice. Individual results for activity and repair tissue progress will vary.
Recovery from MACI treatment is highly individualized. The rehabilitation program is tailored specifically to each patient’s unique goals and objectives. Everyone heals at their own rate and cartilage will continue to mature over time. Patients should return to heavy impact activities such as cutting or pivoting as directed.
References: 1. Data On File (design history files 21-087-TR and 21-081-TR). 2. Saris D, Price A, Widuchowski W, et al; SUMMIT study group. Matrix-applied characterized autologous cultured chondrocytes versus microfracture: two-year follow-up of a prospective randomized trial. Am J Sports Med. 2014;42(6):1384-1394. 3. Brittberg M, Recker D, Ilgenfritz J, Saris DBF; SUMMIT Extension Study Group. Matrix-applied characterized autologous cultured chondrocytes versus microfracture: five-year follow-up of a prospective randomized trial. Am J Sports Med. 2018;46(6):1343-1351.