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Author Topic: CMI implant for lateral meniscus in Germany  (Read 10593 times)

Offline outtograss

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CMI implant for lateral meniscus in Germany
« on: August 20, 2006, 10:32:06 PM »
Hello all, and especially Eyespy 21, who recently sent me a message.

I did not reply to that message because I was actually in Germany...yes, I decided to bite the bullet, spend my savings and get the CMI implanted. Flew to Frankfurt, got train to Koblenz, was in hospital 5 days (could have left after 4) travelled back alone no problem.

This is my first day back home so I won't write much, except to say, so far so good (though too early to tell anything significant, of course). Dr Holsten was very nice, as were his team. Over the next few weeks, I'll be glad to answer any questions not already answered by Dan H.

Best wishes,
« Last Edit: August 20, 2006, 10:34:20 PM by outtograss »

Offline EyeSpy21

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Re: CMI implant for lateral meniscus in Germany
« Reply #1 on: August 21, 2006, 09:21:10 AM »
I'm here! I'm here! How exciting!

I have been bothering Dan with all my questions... and now I have you too ;D  Did you have this done due to symptoms following meniscectomy or as a preventative measure given how much was removed?

How do I go about finding out if I am suitable? I have e-mailed Dr Holsten with some questions but not yet had a reply. I want to get things started if I can as my R knee is giving me a bit more pain (after running, shhhh don't tell anyone)

I guess that's you sitting with your feet up for a few weeks then outto! Good luck with your recovery and keep posting updates. Hope it all goes as swimmingly as Dan's has!
« Last Edit: August 21, 2006, 09:31:58 AM by EyeSpy21 »
R knee symptoms 2003
Feb 06: MRI extensive complex tear/shredded R medial meniscus
Aug 06: NHS offer removal of most of meniscus
Oct 06: Partial meniscectomy, plica resection and CMI in Germany
Mar 2008: R CMI failure
L knee symptoms 2006
Mar 2008: cartilage defect patella, pes anserine bursa

Offline outtograss

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Re: CMI implant for lateral meniscus in Germany
« Reply #2 on: August 21, 2006, 10:55:14 AM »
Hi Eyespy

Yep, couped up on the sofa for a while!

I originally had a meniscectomy on my right knee here where I live. The surgeon announced afterwards that he'd removed 70% of my lateral meniscus and I looked up the prognosis for that on the internet. I found that for someone in their 30's to have so much removed leads to a strong possibility of arthritis not too far down the road. I also had the same pain in my left knee, and I decided I wasn't going to have it done on the national health and be left with 30% in that knee too, if I could avoid it.

I read about Dan H's experience and contacted Dr Holsten. (By the way, he's always very busy or away at symposiums and sometimes doesn't check his email til he has a spare Sunday!) I asked the doctor about both knees. He said that, for the right knee, it would depend what shape of meniscus the surgeon had left in my knee to decide whether I could have an implant in that one. For that he needs a post op MRI scan, which I still haven't done. For the left knee, he suggested letting him do it from the beginning (as I wish I'd done with the right knee) so that he could either repair the tear (always preferable) or attach a CMI, depending on how it looked when he opened it up. Obviously he did the CMI on the left knee as it was beyond repair. Now in about 6 months I'm going to send him the post op MRIs from the other knee and see whether I can have CMI on that one too. I certainly hope so.

Dr Holsten won't be able to tell you whether you are suitable without an MRI scan (I sent him mine by post). To get this, you have to be referred by your doctor, and then wait a few months until you get seen. Alternatively, you should be able to get one done privately for about 300-400 GBP. It depends on how much of a hurry you are in.

One more thing: My pain originally came and went, and I carried on jogging and windsurfing. By doing this, I made the tears in my menisci larger. A small tear can obviously be repaired much more easily, but if you run on a small tear you will aggravate that weakness and make things much worse for yourself, as I did! I would recommend not doing any more running til you've had the MRI done and looked at.

Good luck and let us know what happens!

« Last Edit: August 21, 2006, 04:37:11 PM by outtograss »

Offline EyeSpy21

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Re: CMI implant for lateral meniscus in Germany
« Reply #3 on: August 21, 2006, 01:19:17 PM »
Thanks outto.

I'm taking the same stand as you... not going to let anyone take away my meniscus if there is a chance of having this procedure done.    We are in similar situation apart from fact I never went ahead with the first op, so have a known extensive tear in R knee and suspect one (or two!) in L knee due to symptoms.

My R scan was done back in Feb and I have continued to run on it since as I was running with it 2-3 years prior to scan!  L scan, this month, I paid for privately but am questioning the quality or the radiologist report.  Do you think he would need a more recent scan of R knee?  So based on your scan he was able to say it was torn and that there was enough rim for the implant if necessary?  How soon after sending your scans were you booked in for surgery?

Hmmm but both knees and all that recovery.... it's going to be a long and expensive process.  But worth it if it works and preserves the knees for the future eh?
R knee symptoms 2003
Feb 06: MRI extensive complex tear/shredded R medial meniscus
Aug 06: NHS offer removal of most of meniscus
Oct 06: Partial meniscectomy, plica resection and CMI in Germany
Mar 2008: R CMI failure
L knee symptoms 2006
Mar 2008: cartilage defect patella, pes anserine bursa

Offline outtograss

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Re: CMI implant for lateral meniscus in Germany
« Reply #4 on: August 21, 2006, 04:35:23 PM »
Hi again Eyespy....


 Do you think he would need a more recent scan of R knee? I think the more recent the better, but I'd send him what you've got anyway.

 So based on your scan he was able to say it was torn and that there was enough rim for the implant if necessary? Based on the scan he was able to say that it could be a repair job or an implant, but that he wouldn't know for sure til he went in. Of course, if he had found out it was just a repair job, I would have ended up paying for that when I could have got it done free on the NHS, but as he's a leading specialist I decided to have him do it either way.

How soon after sending your scans were you booked in for surgery? He squeezed me in fairly last minute...I suddenly had some time available, let him know and was on a plane 3 days later. But if you don't want to share a room, want your partner to stay with you on the next bed or whatever, you may be better off giving more notice. (In fact he'd told me to give at least 4 weeks I think)

worth it if it works and preserves the knees for the future eh? Absolutely...if Dan H's experience is anything to go by..I guess I'll find out over the next few weeks!
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Offline jb-knee-geek

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Re: CMI implant for lateral meniscus in Germany
« Reply #5 on: August 21, 2006, 07:02:43 PM »
Hi outto, thanks for starting this thread. I hope you continue to do well.

I'm resting after ACLr and 40% trim of the medial meniscus. My OS tells me a full a return to activities is possible with some exceptions, like basketball, marathin running, work requiring deep squats, which I've no involvment in. I have concerns about long term wear though there is a nice thick meniscus where he trimmed, I have photos.

Where did you do research re: future after partial meniscetomy?

Also what did Dr. Holsten say about duration of the CMI? What is the comparison vs. meniscus transplant w- allograft?

thanks,
torn RK ACL March 2001, surgery Aug. 14 2006, after 4 knee sprains since Oct. '05.  Allograft, ~40% medial meniscus removed, some wear in the trochlear groove. Everything else looks good.

Post-op diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=29749.

Offline Brownie

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Re: CMI implant for lateral meniscus in Germany
« Reply #6 on: August 22, 2006, 07:14:56 AM »
Way to go Outto!  Hang in there EyeSpy!  ;D

I have examined several CMI pages and it sure does look impressive.  As far as I know--for those of us in the States--it still hasn't been approved but it shouldn't be too much longer.

Here's the result of one study that looks impressive.  -  Brownie  8)

http://www3.aaos.org/anmeet2006/podium/podium.cfm?Pevent=154

Offline outtograss

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Re: CMI implant for lateral meniscus in Germany
« Reply #7 on: August 22, 2006, 02:24:21 PM »
Hi there and thanks for your message and support. I'll try to answer your questions as well as I can, but of course remember I am not in any way medically qualified!

I'm resting after ACLr and 40% trim of the medial meniscus. My OS tells me a full a return to activities is possible with some exceptions, like basketball, marathin running, work requiring deep squats, which I've no involvment in. I have concerns about long term wear though there is a nice thick meniscus where he trimmed, I have photos. Sounds like a good prognosis from what I have read!

Where did you do research re: future after partial meniscetomy? I read countless published medical papers about the CMI tests and about partial removal of the meniscus, mostly through Google (there's a link to one of them in the message above). They all seemed to concur that removal of a large part of the meniscus considerably increases the pressure on the bone, which in turn can lead (after 10-15 years, depending on what you've been doing) to arthritis. Once you have the arthritis, there's no turning back. However, you still have 60% of your meniscus, which is very good. I have 30%, and I figured that as I am 35 and I like sports such as snowboarding, I might have arthritis for a long time if I didn't do anything to prevent it.

Also what did Dr. Holsten say about duration of the CMI? What is the comparison vs. meniscus transplant w- allograft? I think Dr Holsten backed up what I'd read on the internet, and I wouldn't like to quote him in case I get anything wrong. However, my understanding is that tests have shown conclusively that CMI stimulates your own meniscus to grow back, with noticeable results even after one year. So far, people who had CMIs 7 years ago and have returned to full activity since then, have reported that they are fine. (There are no studies for longer periods yet). With CMI (which I believe is cow collagen) you avoid the risks associated with transplant, such as rejection. I'm not sure how a transplant is performed or how much it costs, but for me the facts that CMI is planted through keyhole surgery, and that it was relatively affordable, were important. One thing Dr Holsten certainly did point out: It's impossible to give guarantees in medicine. He said that it' s always possible a CMI won't work or you'll damage your knee again, but that could be said about most things.

Best wishes and hope that helps
« Last Edit: August 22, 2006, 02:43:53 PM by outtograss »

Offline jb-knee-geek

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Re: CMI implant for lateral meniscus in Germany
« Reply #8 on: August 22, 2006, 02:40:46 PM »
excellent post outto, thanks, CMI is an exciting development, I hope you have a great recovery and are back on the slopes soon.  Keep posting.

torn RK ACL March 2001, surgery Aug. 14 2006, after 4 knee sprains since Oct. '05.  Allograft, ~40% medial meniscus removed, some wear in the trochlear groove. Everything else looks good.

Post-op diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=29749.

Offline outtograss

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Re: CMI implant for lateral meniscus in Germany
« Reply #9 on: August 22, 2006, 02:42:20 PM »
Costs

Hi again

Someone asked me in a private message how the costs of the trip to Koblenz broke down.

This is a rough version of how it went. If Dr Holsten or the hospital in Koblenz contradict me, it is they who are right...I am doing this from painkiller induced foggy memory as the invoices are too far away from the sofa :)

(All prices in euros)
Anaesthetist: About 250
Hospital fee: About 2000 (Includes all meals, physio, etc..I think the accommodation fee is the same for a fixed number of days, eg 1-20)
Dr Holsten's fee: About 2800 (includes, among other things, surgery and CMI implant)
FastFix system (used during operation) 200 each (I had 5; depends on size of tear I think)
Knee brace: About 900

Total: About 7000 euros

However, there is an easy way to save about 500 euros: The knee brace is a Donjoy 4titude. These can be bought online for about 400 euros. Dr Holsten even recommended me to do this, but as I finally went last minute, I couldn't, and was left to the mercies of the local supplier (who must be holidaying in Barbados on the proceeds as we speak!) Also, remember that these are rough prices, and the number of FastFix devices can vary. Finally, I think the CMI implant costs about 1800 of Dr Holsten's fee, so if he ends up doing the repair instead, you can subtract that.

I hope that soon I'll be echoing Dan H and calling it the best money I've ever spent.

Koblenz is in a beautiful part of Germany on the Rhine, and if you take a partner they can either organise that they share a room with you (not sure how much that costs) or there are plenty of guest houses around.

By the way, the hospital food was good :)

Oh, one other thing: You get an HIV and Hepatitis test when you arrive. You have to give your consent, and they have to operate on you even if you are HIV positive. But one thing to consider is this: Like many people I guess, I was fairly sure I would be negative, but 99.9% rather than 100%! So I then had the dilemma of whether I would want to be told the result whilst alone, in a foreign country, with my leg in a brace! Firstly I told them I didn't want to know until I left, but then I couldn't wait any longer and asked a nurse to tell me. Thankfully it was negative, but if you're not sure, you may want to have a test at home, with your emotional support system around you, before going off to Germany and having one done there.
« Last Edit: August 22, 2006, 02:52:19 PM by outtograss »

Offline EyeSpy21

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Re: CMI implant for lateral meniscus in Germany
« Reply #10 on: August 22, 2006, 07:03:40 PM »
Hi Outto... thanks for all the info you are providing.

I hope I haven't torn both meniscii L knee requiring two implants as this could add another 2000 to the bill!  How does this work if they don't know the full extent of damage until the surgery?  I may never run again anyway for fear of damaging my 10,000 knees!!!

How are you doing now Outto, one week on?  Much pain and swelling now?  Are you using cryocuff or similar?  How long do you wear the brace for and is it worn overnight too?  I didn't realise a brace was involved as the NHS don't do that do they?  I have read Dan's post-op stuff but what were you told with regard to non-weightbearing period?  I am self-employed and cannot take any longer then two weeks away from business.  I will be on my feet at times but not moving about much so can stand on the other leg.
R knee symptoms 2003
Feb 06: MRI extensive complex tear/shredded R medial meniscus
Aug 06: NHS offer removal of most of meniscus
Oct 06: Partial meniscectomy, plica resection and CMI in Germany
Mar 2008: R CMI failure
L knee symptoms 2006
Mar 2008: cartilage defect patella, pes anserine bursa

Offline outtograss

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Re: CMI implant for lateral meniscus in Germany
« Reply #11 on: August 23, 2006, 12:44:04 PM »
Hi again

The brace has to be worn 99.9% of the time. You only take it off to shower or to do the mobility exercises. The brace is set so that your leg has to be straight for the first 6 weeks, though you are gradually able to put more weight on the operated leg (30% of body weight from week 2, 50% from week 3, 50-90% from week 5, 100% from week 7) From week 7 you keep the brace on for support, but you reset it so that you can bend it to 90

The swelling in my knee is going down fairly quickly, with daily icing and anti inflammatories.

In my case, I was very clear with Dr Holsten that I'd need to drive from the end of September, and I told him I wouldn't have it done now unless I'd be able to use my clutch foot after 5.5 weeks. (I have to drive from Spain to the UK). He said that it would be OK, despite what I have written above (which comes from Regen Biologics). I guess if you are sitting in a car and occasionally using the clutch you are not putting full weight on the leg so it'll be OK. The other question (which I only thought of afterwards) is insurance..I have to check and see whether there's any smallprint on my car insurance that would prevent me driving so soon. If so I'll fly back to the UK and then collect my car some other time!

I think if you're self employed and can do without driving you shouldn't need more than a week off work to go to Germany, come back and have a day's rest...but I guess it depends on what you do. Computer and telephone based stuff is fine for me....and if it were not for the fact that my "good" leg recently had 70% of the lateral meniscus removed from it, I'd be moving around alot more on the crutches, as I did when travelling back from Germany.

Hope that is helpful!

PS Just using plastic bag and ice cubes on the knee...can't afford anything more fancy!!

Offline EyeSpy21

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Re: CMI implant for lateral meniscus in Germany
« Reply #12 on: August 23, 2006, 01:18:03 PM »
Thanks, the info about the brace is useful as I didn't realise straight-legged for so long.  At least when I broke my ankle the cast only came up to the knee... so this will be more limiiting.  How did you manage on the plane?  Trip anyone up?  So keeping your leg straight for so long doesn't cause other probs as long as you are doing the mobility exercises?

Again, on a similar theme to yourself... my newest injury, and causing more bother, and is my clutch foot.  Although not using it as often, I find it easier keeping the more constant pressure on brake and accelerator with the other leg than the short in out of the clutch.  Hmmm... maybe I should borrow my mum's automatic for a bit.  So my dilemma still involves which knee to be done first if both are suitable, as I don't know my L knee is up to taking the strain of the R knee but it is the R knee that has the definite diagnosis.  I wish I could wind the clock back a couple of months and this surgery could have been the answer with the one knee.  Also, those braces come in R and L versions which means the same one won't do the next time.  I'll tell you what, I'll get the right one done first and we can swap braces in between!  I realise finances will dictate but was it the Dr that suggested the six month wait between ops to let your L knee fully recover before taking the strain for the R one?

I was thinking of getting a cryocuff to give me the option of wearing it in work if necessary... but won't get that on as well as the brace will I?  I suppose it is just more expense.  The wee expenses all add up too like I needing a passport, copies of scans, a handrail for my stairs, etc.

Glad to hear the swelling is subsiding fairly quickly.  Is this on a par with your previous op?  You don't say much about pain and discomfort though, hopefully 'cos there isn't much!
R knee symptoms 2003
Feb 06: MRI extensive complex tear/shredded R medial meniscus
Aug 06: NHS offer removal of most of meniscus
Oct 06: Partial meniscectomy, plica resection and CMI in Germany
Mar 2008: R CMI failure
L knee symptoms 2006
Mar 2008: cartilage defect patella, pes anserine bursa

Offline jb-knee-geek

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Re: CMI implant for lateral meniscus in Germany
« Reply #13 on: August 23, 2006, 04:58:21 PM »
PS Just using plastic bag and ice cubes on the knee...can't afford anything more fancy!!

A decent ice bag works just as well.

User review
I've got a cryocuf, mainly for convenience. Don't have to get up as often. Iced water circulates from cooler via gravity to an ice bag or cuff held by velcro. So, fill it and forget it for about 6 hours. Great design. I like the velcro straps which hold the cuff in place.

I got mine on Ebay for about $50, I'm happy with it, but an ice bag does the job for less. I can buy > 25 bags of ice for the $50.         
torn RK ACL March 2001, surgery Aug. 14 2006, after 4 knee sprains since Oct. '05.  Allograft, ~40% medial meniscus removed, some wear in the trochlear groove. Everything else looks good.

Post-op diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=29749.

Offline Laura66

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Re: CMI implant for lateral meniscus in Germany
« Reply #14 on: August 27, 2006, 11:33:38 AM »
For Outtagrass: I just found your postings about meniscus surgery in Koblenz......was curious about this Dr Holsten, where he is, and what he specializes in. I also had a meniscectomy in Koblenz (I live there) last fall but with a different doctor. You also mentioned having similar pain in your other knee - this is the first time I've seen any posting on this - and wanted to ask about that. How did you tear your meniscus in either knee? I'm also having pain in my good knee, 11 months post-op on the bad knee, but am not ready to face another surgery now.

Cheers

 















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