Denovo NT

[GSB]

My doctor recommended that I have Denovo allograft implantation.  I have the following questions:

1) what is the difference between Denovo NT and ET?
2) is Denovo implantation similar enough to ACI that a surgeon who has performed numerous ACI procedures but never performed Denovo would be competent to perform it?
3)  Is there any information about success of Denovo in clinical trials?
4)  The manufacturer of Denovo claims that there have been no problems with rejections.  Is there a reason for that?  Is there sufficient data to support that?

Thanks

[lizlove2110]

Let me see if I can help
1. NT=natural tissue (the graft taken from a juvenile donor), ET=engineered tissue (created in a petri dish)
2. The DeNovo procedure is not the same ACI although it serves the same purpose.  In the DeNovo the tissue is glued on the defective area instead of sewn on as in the ACI.  I would work with a doctor who has done this procedure before.  I am having the DeNovo procedure next month in Atlanta and my doctor has done 2 other DeNovo surgeries both within the last 6 months.
3. There is no information about the success of DeNovo because the rehab is  18-24 mos.  I would ask the doctor you select if you can talk to his/her patients directly who have had the procedure.
4. Is there is not enough data to support the claim that no rejections have occurred.  Of the 500 or so procedures that have taken place in the US, a majority of these have been done in the last two years.  The ISTO and Zimmer folks expect to have this data in 2013.

I hope this helps.

[GSB]

Thank you, very helpful.

The defect I have could be repaired with Microfracture, but as I understand it, doctors are starting to use Denovo as an improvement on MF rather than as a second line of defense where MF fails.  What I am trying to figure out is if the pontential improvements on MF outweight the risks of undergoing a new and not well-documented procedure.  Any thoughts?  Also, were you told 18-24 mo. rehab?  I was told more like 6-9 mo.'s.

Thanks, again. 

[nyctri]

Hi, I was wondering where you found information on the Denovo ET? A good friend of mine is having denovo done by a guy in NYC who has done 5 in the last  6 months (3 of which on pro football athletes) and was not offered the ET?
Is it better than the NT, or less painful? He was also told he could start sports in 6 months. Thats a big difference from 18 months, why the different amounts?

[IR]

Denovo ET is still a few years away from the market - similar tissue donor source, but the cells are expanded kind of like the ACI process.  There have been over 900 Denovo NT cases done - latest i have heard.  Rehab shouldn't be anywhere near 18-24 months - i think that might have been a reference to a 2-year outcomes study they are currently running.  There was a paper at AAOS (American Academy of Ortho Surgeons) they handed out this year that talked about the early results of that study - very promising.  And there is much less risk of young cartilage cells (from young donors) being viewed as a foreign object than adult cartilage cells.  All in all, a very simple surgery from a technical standpoint.  I expect rehab to be similar to microfracture at worst.

[pfokus]

I just had this procedure performed by Dr Farr at OrthoIndy on a 1.2 x 2cm rectangular lesion in the trochlear groove.  Surgery was March 10th so 1 month ago.
There was a previous failed MF done as well.
Chance of rejection is small bc the area doesn't have bloodflow.
Notice when scoped everything is clear and fluid filled but you don't see blood.
This was what I was told was a reason.

24 months is the length of the clinical trial I am in as well.
The benefit of the trial is the MRIs at 3, 6, 12, and 24 months.
Big benefit to me is at 24 month they scope the knee and take a picture of the defect.

Hope that helps.

PS

[ajschnelk]

Is this and open procedure like ACI?  Do they do any other procedures along with it; like a TTO/HTO?

[courtpt8]

I had Denovo NT, medial meniscal transplant, lateral meniscal repair, ACL revision all done 12/2008 & have had nothing but great results thus far.  I have regained full ROM, have limited (if any) restrictions, I am biking daily, rollerblading, gardening.....all without pain or any problems.  I would say my results thus far are excellent.  Overall, I am extremely pleased & will be participating in a mini-triathlon in August (My MD said I should be good to run short distances infrequently).  If you have questions, let me know!!  Best of luck to all of you.  I hope  your outcomes are as good as mine!!

[ajschnelk]

I had Denovo NT, medial meniscal transplant, lateral meniscal repair, ACL revision all done 12/2008 & have had nothing but great results thus far.  I have regained full ROM, have limited (if any) restrictions, I am biking daily, rollerblading, gardening.....all without pain or any problems.  I would say my results thus far are excellent.  Overall, I am extremely pleased & will be participating in a mini-triathlon in August (My MD said I should be good to run short distances infrequently).  If you have questions, let me know!!  Best of luck to all of you.  I hope  your outcomes are as good as mine!!

This is great news regarding the latest cartilage procedure.  If you don't mind me asking, what was the location of your cartilage lesion and size of the defect?  Who did the procedure? 

[marcinaz]

Am likely having De Novo at the end of the month. Has anyone been able to run after it?

[ajschnelk]

Hi marc,

It depends on the location if a doc will recommend it or not, but I can tell you that many on this board were able to get back to most activitites, including running, after having ACI.  However, it's a very long recovery period.  Denovo NT is very new and I don't believe there are too many on here, but from  what I know about it, recovery is very similar to the standard ACI procedure.  Has your OS done many Denovo procedures?  What is he/she tellling you?  Personally, I had ACI for a throchlea defect (after a failed mfx in '04) on Dec. '09 and I am hoping to get back to running, biking, and skiing. 

I'll be sure to follow your recovery.  Best of luck!   

[hwa]

I had the Denovo procedure (juvenile donor cartilage) 5 weeks ago.  Doctor also performed a TTO to raise the kneecap (said raises success rate from 65% to 85%.  Also my knee cap was tight as hell from old ACL surgery.  When doc did scope said defect a lot larger than anticipated.  Size of a silver dollar.  But he had enough donor cartilage to cover the defect.  Usually they just glue it, but he used the artificial patch from the ACI to cover it for added support.  The doc has a lot of these procedures and is participating in a few studies.  He told me that he would do the Denovo verse the ACI.  Since he does the TTO, at 6 months he goes in to take the screws out and looks at the cartilage.  he said it is amazing, grows fast and strong.  A true cartilage verse the ACI which looks like scar tissue.  Also said that should be mature at 8 months, not 12-14 like ACi since they are starting with minced cartilage verse the ACI cells.  Dr. Fleshcli at OrthoCarolina in Charlotte.  I may have spelled his name wrong.  His clinic is participating in a study now with your own cells which is similar procedure to Denovo.  See their website under clinical studies.  Hard to find, but I found it this morning.  Only problem with the TTO is that cannot full weight bear for 5 weeks.  Leg feels great.  In PT, doing a lot of to get it moving.  At 90 degrees now.  I was going to get the procedure in May but the company that supplies the cartilage did not have any.  Same thing the week prior in August, but the day prior, they had it.  Short supply since procedure is becoming popular. 

[aajaybird99]

For those considering Denovo NT for Articular Cartilage tears:  I had the proceedure done 11 weeks ago today (10-07-2010).  I had an allograft transplant on the right medial condyle (inside bottom of femur bone)  Graft was about 2.5 by 1.5 cm and took two packets of DeNovo stem cells.  I had degenerative wearing in that area and could not participate in sports (golf, basketball, running) without a medial unloading brace on (and even then it was limited).  I am 45 yrs. old but still remain very active in those sports.  After surgery I was totally non-weight bearing for 3 weeks followed by gradual to full over the next 2 1/2 weeks.  I had rehab for 4 weeks (once per week) mainly in the transition from non to full weight bearing.  Rebuilding quad and hamstring strength was and is the complete focus.  I was walking normal at 6 weeks with or without the unloading brace.  Elliptical machine at 7 weeks and have increased from 10 miles per week to 24 miles per week since.  Numbness and swelling in the knee gradually decreased from week 4 and is almost non-existent now in week 11 (starting week 12).  I jogged 150 yards for the first time since way before surgery today without any brace on.  I have video to prove it!  Felt great.  Looking forward to more of same and slow increase.

Key to success with this surgery: Get to a good fighting weight before surgery.  I had a scope meniscus repair last December (year ago).  I was 188 at surgery at 5'10".  After MRI showed this articular tear in July of this year, Doc said to drop weight to help recovery.  I worked hard on elliptical and went to Body Pump class 3 times per week along with lifting heavier only a couple times per week.  Ate right too.  Dropped 16 lbs. prior to surgery on Oct. 7 and felt great going in.  That was and is absolutely the key to this and any other knee surgery in my opinion.  I am now at 172 with a constant goal of 167.  I am working toward the last 5.  Be patient post-op - this is a 4-5" incision and will take time to heal.  Easy for the first 3-4 weeks and stay off it for sure.  The graft will grow quickly but needs that first 3-4 week head start before you get crazy.

I owe a big shout to my friend Marc Rubin at http://www.10-hours.com who went through this surgery before me.  If it weren't for him I would not have done it.  That is why I am sharing my story with everyone here.  This is a good proceedure.  I have seen too many MFX cases fail to even consider that method.  This is truly state-of-the-art stuff with the DeNovo NT Allograft.  Any questions email me jpayne@turfsolutionsgroup.com 

[PA6-5000]

This is an extremely helpful thread.  Thanks to all who contributed.  Keep posting!

[cdubb]

It is a helpful thread and I'm really just posting to make sure I don't miss anything if somebody else is posting. I'm 12 weeks post patella ACI with a TT and am up in the air about what to push for when it comes time to do my other knee with a similar size defect.  (Left was 2 cm x 2 cm).  My doc that did my ACI also does Denovo NT, so pretty sure I could push for whichever one I think would provide a better outcome.  I'm doing pretty well 12 weeks post op now of patella ACI/TT, so why mess with something else....but others say that Denovo NT is a quicker recovery?  Anybody know of any 5+ year studies out there for Denovo NT in the PF joint?