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Single-stage or two-stage cartilage repairCartilage repair decisions hinge on defect size: lesions below roughly 1.5–2 cm² suit single-stage surgery, those of 2–4 cm² permit either approach, and larger defects typically require tissue replacement rather than repair.Cartilage repair decisions hinge on defect size: lesions below roughly 1.5–2 cm² suit single-stage surgery, those of 2–4 cm² permit either approach, and larger defects typically require tissue replacement rather than repair.
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When cartilage repair is the right choiceCartilage repair succeeds for a focal defect in otherwise healthy joint tissue in younger patients, but fails in diffuse arthritis. Lesion size, depth, patient age, and activity level determine the appropriate technique.Cartilage repair succeeds for a focal defect in otherwise healthy joint tissue in younger patients, but fails in diffuse arthritis. Lesion size, depth, patient age, and activity level determine the appropriate technique.
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How ACI and MACI differ for cartilage repairMACI pre-seeds cultured chondrocytes onto a collagen membrane fixed with fibrin glue, eliminating the sutures required in earlier ACI variants. The technique enables arthroscopic implantation and supports faster recovery than open surgical approaches.MACI pre-seeds cultured chondrocytes onto a collagen membrane fixed with fibrin glue, eliminating the sutures required in earlier ACI variants. The technique enables arthroscopic implantation and supports faster recovery than open surgical approaches.
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When is it too late for cartilage repair?Once cartilage loss becomes generalised and surfaces contact bone, no restoration procedure works; repair is viable only for focal defects.Once cartilage loss becomes generalised and surfaces contact bone, no restoration procedure works; repair is viable only for focal defects.
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AMIC versus MACI for focal cartilage repairAMIC repairs focal cartilage defects in one operation: drilling channels into damaged cartilage releases a blood clot rich in stem cells, which a collagen membrane then stabilises and concentrates to guide tissue repair. A 2025 trial found it equivalent to MACI at two years.AMIC repairs focal cartilage defects in one operation: drilling channels into damaged cartilage releases a blood clot rich in stem cells, which a collagen membrane then stabilises and concentrates to guide tissue repair. A 2025 trial found it equivalent to MACI at two years.
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Choosing ACI, MACI or single‑stage cell surgeryACI and MACI are two-stage repairs for localised full-thickness cartilage defects, while single-stage techniques place cells or cell-rich material into the defect in one operation. MACI has the strongest long-term follow-up, but single-stage methods still rest mainly on smaller, less comparable series.ACI and MACI are two-stage repairs for localised full-thickness cartilage defects, while single-stage techniques place cells or cell-rich material into the defect in one operation. MACI has the strongest long-term follow-up, but single-stage methods still rest mainly on smaller, less comparable series.
