Okay, so firstly, thanks to the AO SSM for having me here, and also thanks to the Ortho Regeneration Network for the award. There are our disclosures. So as we know, articular cartilage is quite a remarkable tissue, but it does have quite a poor capacity to repair. Whilst there are a range of cartilage repair techniques, we've seen Macy demonstrating success, particularly in the early and mid-term stages, and regenerating a hyaline-like cartilage repair. Despite these outcomes, we still lack good longer-term outcomes, and certainly many of these published studies are in relatively small cohorts, and some do lack a more robust MRI-based evaluation. So the aim of this study was to investigate the longer-term clinical and MRI-based outcomes in a larger prospective series of patients undergoing Macy, and also to see whether there were any clinical and MRI-based differences between those undergoing tibiofemoral and patellofemoral Macy. So this was a cohort that was enrolled between 2002 and 2012. So I'll be presenting on 168 patients, which includes 182 grafts. All patients underwent Macy via the standard two-stage technique, so there was an arthroscopic biopsy, and then Macy performed through an open arthrotomy, and all of these patients participated in a progressive rehab program. A range of PROMs were undertaken. What I'll touch on today includes the CUS and patient satisfaction. We also looked at a range of objective measures, so things like range of motion and hop capacity, but today the focus will be more on the limb symmetry indices of quad strength and hemi-strength. And high-resolution MRI was undertaken, and the focus today will just be on tissue infill, but also that overall MRI composite score as per the MOCART scoring system. So here's the CUS subscales. We saw a significant improvement in time, but what was most encouraging was the lack of a significant decline between two and five years and five and ten years. And we did see a relatively high satisfaction rate, so about 92% of patients beyond ten years were satisfied with pain relief and also undertaking ADLs. And even beyond ten years, 75% of patients were happy with their ability to participate in sports. We did see an improvement in most objective measures over time, and again what I've got here are just those LSIs for quad strength and hamstring strength, so even beyond ten years we did see mean LSIs well beyond 90%, so a fairly sound recovery of lower limb strength symmetry. We also saw quite encouraging MRI-based outcomes at two years, and what was encouraging again was that there was no statistically significant decline in any MRI variable between two years and five years and two years and ten years. So even including some of the failures that we did see, the survivorship was actually quite good. Of the MRIs beyond ten years, we did identify 14 graft failures. In addition, we also had a series of patients that we did not assess for different reasons. Of those, seven had already gone down the path of a knee replacement, and one had actually undergone MACE a second time to the same site. So overall, at ten to 16-year follow-up, there was a 10% to 11% graft failure rate. Comparing graft sites, the tibiofemoral group actually reported significantly better KUS subscale scores for the quality of life and for sport. They actually demonstrated a significantly better quad-strength LSI at that 10- to 16-year follow-up, and statistically, the tibiofemoral group did actually demonstrate significantly more infill, tissue infill, but of interest, there were no differences in that overall composite score for the graft. So in conclusion, MACE produced encouraging clinical outcomes and relatively sound graft survivorship beyond ten years with good satisfaction. Of interest, those undergoing tibiofemoral MACE reported better clinical scores, despite largely similar MRI-based outcomes, and we are obviously in the process of continuing follow-up with these patients. Thank you very much.

Macy technique

articular cartilage repair

hyaline-like cartilage

long-term outcomes

clinical and MRI-based outcomes