Denovo NT

[ella5509]

Great to hear cdubb is doing well.
ACI procedure is a two stage procedure and very expensive.
Denovo NT is about 3 yrs old and has limited follow up but all of it is very positive. It has been used in the PF, patella femoral, joint successfully. Denovo NT has juvenile stem cells which are able to "grow" much better then adult, over 25, stem cells. When MF, microfracture, is done, the "new" tissue is closer to scar than cartilage. Now, whether the "scar" tissue is any worse then the Denovo NT or ACI, I think is still being debated. If there are any surgeons on this topic, I would love to hear there side of the story.

[cdubb]

ACI is expensive!  My US Bioservices (Genzyme) EOB, which is the only provider in the country providing the cell expansion services, came in at $61K.  Now...that was billed and not the conracted rate and there are still recons going back and forth between my insurance and US Bioservices...but it's pricey.  Tack on the surgeon, asst surgeon, facility, anesthesia, DME, PT...it's costly...not to mention there is the biopsy scope also.  Wonder how much Denovo NT costs for the cubed juvenile cells?  Denovo ET is only being used in clinical trial at this time.  ET, I believe, is more like traditional ACI, but the cells are from juvenile donor cells.  My doc has clinical trials going on right now to compare various cartilage restoration techniques...unfortunately, with 2 bad knees...I am not a candidate.  You have to have one good knee.

I plan on asking more questions to my doc comparing the two when I'm closer to feeling like I'm ready to do my right knee.

[swift_ny]

Hi - I'm new to the site, although I've been browsing it for a few years as I narrowed down  my surgical options. My knee doc is now recommending the TTO with Denovo donor cartilage (I'm a now-ex marathoner with stage 3 patella chondromalacia that is causing almost daily pain and skewing my body so that I'm now having back pain. Been going on ~10 yrs. I'm a 42-yr-old woman).

I've been trying to find someone on this site with very similar experiences, b/c I'm very concerned about recovery, and, honestly, the TTO scares the you-know-what out of me. Cutting into healthy bone just seems wrong, but every orthopedist I've seen over the past 10 yrs has said it's the conservative surgery of choice for bad patella problems (I have a 1.5+cm hole in there, too). No one else has suggested doing any kind of cartilage repair, citing poor stats.

Denovo is so new that there are no long-term figures for how well it works, but has anyone who has been advised to have a TTO had only Denovo instead? If so, how did it work for you?

If you had just a TTO and nothing else, how are you doing a year or more out? I've read such diverse results... some folks say they are miserable and wish they could go back; others are running 10Ks and saying they should have done it sooner...

Adding to the fun is that I'm scheduled for hip surgery 6 wks before the knee surgery (two tears of the rt labrum and impingement). Both my surgeons are in NYC and considered among "the best," but I've been told by other knee surgeons that my knee guy - the one pushing Denovo or Tru-Fit, which he experiments with - is known for using patients as guinea pigs. That makes me lean toward doing the TTO only, since all the docs recommend it, but from what I've read here, many of you have had docs say what my knee guy has; i.e., that there's no point in doing the TTO if we don't fix the hole while we're in there...

Sorry for the long post and multiple questions; at this point, I feel that anecdotal evidence from other banged-up athletes is what I need to decide which route to take... after all, unlike the surgeons and the companies, there are no agendas here... thanks for any advice or insight...

[cdubb]

As you can see from my above posts, I had the TT w/ ACI to treat a patella defect.  I think the specifics of your knee mechanics and location of your defect need to be evaluated to determine if a TT is indicated and what kind of TT.  I had an anteromedialization of my tibial tuburcle, more commonly known as a Fulkerson.  ACI vs. Denovo....that is a decision between surgeon and patient.  ACI has more history and Denovo is newer without long term studies, but it is very promising and the grafts appear to be maturing faster than ACI. 

There is another poster on here who is about 2 months out from Denovo NT w/ the TT and she had her surgery in NYC.  You can e-mail her for more specifics.  Her name is Kasia NY or something like that....her diary thread is in post op diaries I believe < 100, but it could be in the 100-300 section.  My diary is in the 100-300 section. 

You can always do the TT only and go back later for the Denovo.  When I had my initial ACI biopsy scope, it was scheduled as "arthroscopy with possible microfracdture, possible ACI biopsy and possible AMZ (what my doc calls the TT).  So, going into surgery, I could have had just a scope and biopsy or the TT could have potentially been done that day depending on the findings going in.  I asked it to be done under spinal, so I could be awake and involved in the decision process. As my Dr. was scoping me, the defect that showed on the MRI as lateral, was actually central.  So, he rattled off some statistics about an isolated AMZ only carrying a 50% success rate, but combined with the ACI it goes up to 80% or above....so he took his biospy and bailed.  We then went back 2 months later for the ACI/AMZ procedure.  So...really...it could be a game day decision.  Bonus is with Denovo, you don't need the biopsy scope, but I'm sure that there are some insurance authorizations that need to be put into place ahead of time.

Now....being able to return to running marathons....that may not be viable no matter what decision you make.  I'm a former college softball player, but have no aspirations of returning to competitive sport...I just needed to get through my day without several instances daily of sharp anterior knee pain stopping me in my tracks.  If I can return to some light slow pitch softball or easy recreational tennis..that's just bonus!

[mfactor]

For all those looking for denovo information. I am undergoing the procedure on my l patella and part of trochlear groove tomorrow 3/15/11.  Will keep all posted on recovery.  I am an "older" (56)but still very active in racquetball and hope to run short distances again at some time. over the past year it has become increasingly difficult to move from sit to stand to sit , steps are difficult and sports activities are limited.  Was scoped in early Feb and found left lat patellar facet is deteriorated with bone visible.  plan is to complete l knee first then possibly r about 3 months later.  md is Dr Norman Marcus as Virgina Cartilage Institute.  I like him,-direct, to the point and willing to explain and answer questions.  Further updates to follow.  Feel free to Email me at mc.bickley@hotmail.com.   

[skierboy]

MC--

Let the group know how your procedure went.  I am also a patient of Dr. Marcus in Springfield, VA and his Virginia Cartilage Institute.  See http://www.normanmarcusmd.com/.  My DeNovo NT procedure originally scheduled for early April has had to be postponed several months due to other medical issues not relating to the problem knee.  I do so want to get this done and get back on my traditional exercise regimen.  Dr. Marcus did a microfracture on my left knee over two years ago, and it has been overall successful.  But I know that the fiberous cartilage that MF creates is not as durable as the articular cartilage that should be generated by a DeNovo NT allograft.

[kitkool]

mfactor and Skierboy.  I had Denovo NT done on my right knee with Dr. Marcus on 1/4/2011. So this is my 14th week after surgery and I am feeling really good. I am able to walk normally and quickly without any pain. I have been cleared to do elliptical and biking. I followed what Dr. Marcus told me and have not attempted to kneel or squat. The only thing I currently have to take my time on is walk down steps. The motion in my knee doesn't seem as fluid when taking steps down but it has improved from a lot than before. I did not have any issues post surgery but was on crutches for 5 weeks and then 1 crutch/cane for about a week. I use to get pain from walking 10 -15 mins pre-surgery but now I have done that a few times and have no pain what so ever. Only thing is during some bad weather the knee does get slightly tender.

I went to the PT right next to Dr. Marcus's office and I have to say that they really helped me a lot with my recovery. The place is a bit small but the staff is great.

Let me know if anyone has any questions and I will try my best to answer them.

[skierboy]

Kitkool--

Great to hear you are progressing well after DeNovo NT treatment by Dr. Marcus earlier this month.  I am still in the process of scheduling my surgery with him.  Working out the insurance issues has been a hassle.  But I want to get this work done regardless whether my insurance company will cover a portion or not.

I'm well familiar with the non-chain PT staff that operates in the same suite as Dr. Marcus.  That's who I used when I did my rehab from the doctor's microfracture on my LK two and a half years ago.

Do keep posting on how your recovery progresses.