MACI or ACI

“If you can make it to the new year, this is our best option.”

In the first quarter of 2017, the FDA approved Matrix-Induced Autologous Chondrocyte Implantation (MACI) for use on articular cartilage defects of the knee joint in the US. Insurance companies, as usual, lagged behind for coverage of all defects.

MACI replaced the ACI procedure that had been in use for quite a few years. The greatest difference between these two procedures is that MACI utilizes a man-engineered matrix to load healthy cells into your defect, whereas ACI mostly utilizes your own tibial periosteum to hold the healthy cells. Both procedures require an initial surgery to take a biopsy of healthy tissue that can be used to develop these cells which can mature anywhere from 12-18 months. Both procedures are also frequently coupled with an osteotomy or anteromedialization.

The goal of the MACI or ACI surgery coupled with an osteotomy of the tibial tubercle is to move the weight bearing surface of the joint away from the defect. Almost like a semi-safety net that should allow for a decrease in pain and other symptoms just in case the graft ends up failing.

None of this was explained to me. As I peppered my doctor with a multitude of questions on what procedure would result in the best outcome for my specific defect area, he insisted that the revolutionary aspect of MACI was my best option with the highest chance of success.

While beginning my research, I believed an 85% success rate was good enough for me, but I had tunnel vision. Everything leading up to hearing about MACI has been the worst case scenario that was presented. I didn’t consider many of the things that could go wrong committing to a procedure that was just brought overseas.

And so I left 2016, and the 16th year of my life looking forward to the next year. It would only take two surgeries, and a solution was in sight. It wasn’t experimental, it was medicine. Little did I know.

Summer “Workouts”

“One of our top Juniors is out for now with a knee injury, but we’re not concerned.”

It was a blip in a local article. Just a blip. But for some reason I couldn’t help but feel that everyone knew something I didn’t. Why mention it? Why let every coach in the conference know that I was injured when I would be playing 6 rotations for the first time in my life? But God, forget about it, it’s just a blip.

Soon the article wouldn’t matter, because the giant J-shaped brace to push over my patella to help relieve pain and my inability to run or move laterally gave myself away before I could even get out of the summer “workout” season.

Maybe it was these “workouts” that killed me. Grueling 2-4 hour practices in a non-air conditioned gym that would help “condition” us for the upcoming season. In reality these practices resulted in the greatest number of injuries, and helped to worsen the mangled mess of cartilage that laid hidden within my knee joint.

I spent that summer bouncing between practice and physical therapy with a cortisone and Synvisc-one shot mixed in–all without a diagnosis. My MRI was inconclusive; physical therapy and shots were providing no relief, and I was waking up each morning in more and more pain.

At this point, it wasn’t about the recruiting. It wasn’t about being ready for the fall season, or even getting through a single summer “workout.” I was in the worst pain in my life, unable to straighten my leg in bed or walk up or down the stairs.

I wanted out. I wanted answers. I wanted help.

The Best Medicine is a Good Doctor

Almost 3 years ago now, I spent my last day without pain. I was coming off the high of the biggest win of a national tournament thus far, and I couldn’t wait to play against the top 16 teams in the country the following day. As I muttered under my breath to my roommate for the trip “I hope I don’t wake up tomorrow morning in pain,” I knew something was very wrong.

I played, but it was and never will be the same way it was only 12 hours before.

Weak and helpless. Two words that defined how I felt for 6 months without a diagnosis. Two feelings that I have constantly and consistently felt for the last three years. But two words that my doctor has never made me feel.

With a blind referral and a three hour wait time, I knew that somehow I had gotten lucky–clearly a contradiction from what I just described. That is because in the years to come, my doctor would provide more than just excellent treatment. He provided options and suggestions that no Dr. Google could ever recommend, and in one of the largest medical cities in the country, I found myself beginning treatment for an articular cartilage defect at 16 years old.