Cartilage Repair

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TE PRODUCTS: MACI® (Verigen)

MACI® was developed originally in Sweden as a treatment for lesions of the articular cartilage in knees. The treatment is for Grade III and Grade IV cartilage tears as described in the picture beside. These tears are often associated with traumatic injury or for the shoulder with dislocations and long-term instability of the joint. MACI® treatment is described in the following steps (20):

  1. Biopsy of healthy chondrocytes.
  2. Growing of chondrocytes in vitro cell culture
  3. Debridement of the lesion
  4. Bovine Collagen I/III membrane cut to size of damage location and sutured to the bone leaving opening for chondrocyte implantation. Often suturing is accompanied with fibrin sealant.
  5. MACI® chondrocytes implanted under the collagen membrane for seeding and cartilage repair.

The main difference between the MACI® treatment and Carticel® is the usage of a bovine collagen membrane rather than an autologous periosteal patch. MACI® reduces the number of grafts and graft sites necessary decreasing potential vascular damage and recovery time. Also, the collagen membrane increases the potential patient range for this therapy, allowing individuals without healthy donor sites to have ACI/ACT treatment, ex. Osteoarthritic individuals. However, the use of bovine collagen membranes, although scientifically proven to be safe, does not the same appeal to patient population as the idea of autologous grafting. This technique has been used in Europe for 17 years with positive results for recipients. Only since 2002 (21) has the MACI® technique been used specifically for shoulders with positive results where repeat arthroscopic surgeries had failed to relieve pain and increase joint mobility.

In 2002 the partnership between Verigen and Mitek Worldwide (Johnson & Johnson) set forth to introduce MACI® as a Carticel® competitive treatment (22). At this time no randomized trials have been run to compare the advantages of these two treatments or any analysis of the literature to determine product superiority.

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Created by: Blair Smith, Connie Lee, Daniel Solomon, Matthew Whitson and Stephanie Chang
Date last modified: 5/2/2004