Cartilage injuries, particularly in the knee, pose significant challenges due to the limited natural healing capacity of cartilage. Recent advancements in regenerative medicine have introduced several promising procedures: Matrix-induced Autologous Chondrocyte Implantation (MACI), DeNovo NT, and Microfracture, often combined with adjunct therapies such as PRP, BioCartilage, and viscosupplementation to optimize healing and outcomes.
Brian Reiter, MD, is a Board-Certified, Fellowship-Trained Orthopaedic Surgeon at Atlantis Orthopaedics, specializing in the latest non-operative and surgical techniques for knees and shoulders. Dr. Reiter frequently offers these advanced procedures to maximize cartilage repair and function.
Matrix-Induced Autologous Chondrocyte Implantation (MACI)
MACI is a third-generation autologous chondrocyte implantation that involves culturing a patient’s own cartilage cells and implanting them onto a collagen membrane to repair cartilage defects.
Clinical Outcomes
- Long-Term Efficacy: Studies with 10-year follow-up show durable improvements in pain, function, and defect fill, with low reoperation rates (source).
- Comparative Effectiveness: MACI has demonstrated superior outcomes compared to microfracture for larger lesions (source).
Considerations
- Two-stage procedure with cell harvesting and implantation.
- Best for patients with large, symptomatic full-thickness cartilage defects.
DeNovo NT (Particulated Juvenile Articular Cartilage)
DeNovo NT uses juvenile cartilage allograft tissue to repair cartilage defects in a single-stage procedure.
Clinical Outcomes
- Effective for patellar and femoral cartilage defects, improving pain and function (source).
- Favorable safety profile with low complication rates (source).
Considerations
- Suitable for smaller defects or patients preferring a single-stage procedure.
- Graft integration may vary between patients.
Microfracture: One of the Original Cartilage Regeneration Surgeries
Microfracture remains a valuable tool for cartilage repair, particularly for smaller lesions and younger patients. The procedure stimulates the formation of fibrocartilage by creating small fractures in the underlying bone.
Clinical Outcomes
- Good short-term pain relief and functional improvement (source).
- Long-term durability may be less than native cartilage, occasionally requiring further intervention (source).
Considerations
- Best for smaller lesions when other regenerative techniques are not feasible.
- Fibrocartilage formed is less durable than hyaline cartilage.
Adjunct Therapies to Support Cartilage Healing
To further enhance cartilage regeneration and recovery, adjunct therapies are often used alongside the main surgical procedures:
- Platelet-Rich Plasma (PRP): Injected into the joint to deliver growth factors that promote healing and reduce inflammation.
- BioCartilage: A micronized allograft cartilage matrix combined with PRP to enhance repair after microfracture.
- Viscosupplementation: Hyaluronic acid injections improve joint lubrication, reduce pain, and support cartilage health.
These adjuncts can optimize outcomes, accelerate recovery, and provide additional support for cartilage repair—particularly in patients with complex or borderline lesions.
Conclusion
Each cartilage regeneration technique—MACI, DeNovo NT, and Microfracture—offers distinct advantages depending on the patient and lesion characteristics. Adjunct therapies such as PRP, BioCartilage, and viscosupplementation may further enhance healing and outcomes.
Dr. Brian Reiter evaluates each patient individually, combining the most appropriate surgical technique with adjunct therapies when indicated, to maximize joint function and long-term success.