MACI Knee Repair and a Return to Running Skip to content

MACI Knee Repair and a Return to Running

For some of us, running is a chore, but for others it’s an exhilarating way of life. When those in the latter category find themselves having to consider knee cartilage repair surgery, the news might feel overwhelming, but there are treatment options like MACI that can help get runners back on the road. We have created some high-level tips that may help inform your decision and plan out your rehabilitation program. Always talk to your doctor with any questions and before starting any new exercises.

Why MACI for runners?

Running enthusiasts put wear and tear on their knees, and this can cause debilitating symptoms like significant pain and swelling that keep them off the road. MACI knee cartilage repair can help restore function in runners suffering through these cartilage-related symptoms, as it heals patients’ damaged cartilage.

Running during recovery from the MACI knee cartilage repair procedure

Rehabilitation Timeline

How quickly will runners be able to get back out on the road following MACI surgery? It depends on the person. Factors like an individual’s rate of healing, the size of the defect and any co-occurring procedures will impact the timeline.

“Generally speaking, patients can return to walking for exercise in 3–4 months, jogging at 7–9 months, and distance running between 9–12+ months after surgery,” says Duke University physical therapist Dr. Mike Essa.

During that recovery, there are plenty of things runners can do to stay active, including exercising with arm bikes, cycling, swimming with a pull buoy, training for upper body strength or performing core work, to name a few.

All of these activities will help patients work up to the ultimate goal of a return to running.

Swimming during rehab after MACI surgery

Rehab Exercises for Runners

Following the MACI procedure, a patient will graduate through three phrases of rehab that involve exercises that increase in intensity.

Dr. Essa recommends the following exercises for MACI patients seeking to return to running:

0-3 months: Early rehab focuses on gaining range of motion and quad activation, so exercises like heel slides, indoor cycling, straight leg raises, quad sets, and calf raises are important. Aquatic therapy can be helpful for restoring walking when transitioning away from crutches.

3-6 months: Body weight exercises like squats, runners’ step-ups, lunges, deadlifts and banded walks are important to restoring functional movements in this phase of rehab. Exercises such as leg presses, knee bends with a knee extension machine, and weighted hamstring curls are critical for developing strength. The goal for this stage is to regain full range of motion, and to fully resume day-to-day, low impact activities with minimal to no pain. For runners, getting back onto an elliptical is a common benchmark.

6-9 months:  In this phase, single leg squats and hops are important to help a patient develop the strength and power needed to return to running. After MACI, patients should wait for the green light from their doctors and physical therapists, but the 7-month mark is commonly when many runners start to get back to the road.


Post-Rehab Running Maintenance

After 9+ months, runners may find themselves back to their regular running program, but it is important to keep up with rehab exercises to protect the longevity of the MACI repair.

Dr. Essa recommends two days of strength training per week to supplement a running program. Running is a straight-ahead task, and the hip muscles that stabilize the knee from shifting side-to-side forces often get neglected. Maintenance work focusing on hip, core, quad, and hamstring strength can help keep your knee healthy as you return to normal activities.


Please see below for full indication and ISI. Blog posts are intended to provide educational information. Always talk to your doctor with any questions.

Rehab icon

A key component of your preparation is getting set up with a rehab program and physical therapist who can help get you back to your active lifestyle with personalized exercises and proper care.

Return icon

How you rehab after the procedure is so important in your return to living life on your terms.

Indication and Important Safety Information

Important Safety Information

MACI should not be used if you:

  • are allergic to antibiotics such as gentamicin, or materials that come from cow, pig, or ox;
  • have severe osteoarthritis of the knee, other severe inflammatory conditions, infections or inflammation in the bone joint and other surrounding tissue, or blood clotting conditions;
  • have had knee surgery in the past 6 months, not including surgery for obtaining a cartilage biopsy or a surgical procedure to prepare your knee for a MACI implant;
  • or cannot follow a doctor-prescribed rehabilitation program after your surgery

Consult your doctor if you have cancer in the area of the cartilage biopsy or implant as the safety of MACI is not known in those cases.

Conditions that existed before your surgery, including meniscus tears, joint or ligament instability, or alignment problems should be evaluated and treated before or at the same time as the MACI implant.

MACI is not recommended if you are pregnant.

MACI has not been studied in patients younger than 18 or over 55 years of age.

Common side effects include joint pain, tendonitis, back pain, joint swelling, and joint effusion.

More serious side effects include joint pain, cartilage or meniscus injury, treatment failure, and osteoarthritis.

Please see Full Prescribing Information for more information.


MACI® is made up of your own (autologous) cells that are expanded and placed onto a film that is implanted into the area of the cartilage damage and absorbed back into your own tissue.

MACI® (autologous cultured chondrocytes on porcine collagen membrane) is made up of your own (autologous) cells that are expanded and placed onto a film that is implanted into the area of the cartilage damage and absorbed back into your own tissue.

MACI is used for the repair of symptomatic cartilage damage of the adult knee.

The amount of MACI applied depends on the size of the cartilage damage. The MACI film is trimmed by your surgeon to match the size and shape of the damage, to ensure the damaged area is completely covered.

Limitations of Use

It is not known whether MACI is effective in joints other than the knee.

It is not known whether MACI is safe or effective in patients over the age of 55 years.