ACI & MACI for the Management of Osteochondritis Dissecans

Osteochondritis dissecans (OCD) is defined as a focal idiopathic alteration of subchondral bone and/or its precursor with risk for instability and disruption of adjacent articular cartilage that may result in premature osteoarthritis. A robust treatment for unstable and unsalvageable OCD lesions, as well as those failing other treatments, is autologous chondrocyte implantation (ACI). In ACI procedures, a sample of healthy chondrocytes are biopsied and expanded ex vivo for subsequent insertion into the OCD lesion. When a biological matrix is used for chondrocyte seeding and placement rather than a periosteal flap or collagen membrane, the procedure is termed matrix-associated autologous chondrocyte implantation (MACI). This chapter aims to define the algorithm for the use of ACI and MACI in the treatment of OCD, to review available products used in ACI and MACI procedures, to discuss relevant operative techniques to implement these technologies, and to describe the reports of these methods to bolster the orthopedic surgeon's armamentarium in the fight against OCD lesions.