KNEE ARTHRITIS - Cartilage plug transfer :
Question about ACI - - Posted by blackbeltgirl (blackbeltgirl), 21 December 2004
I just had surgery to remove a meniscus tear and clean up some bone spurs. The dr. found a 3cm x 6cm lesion on the lateral side, and is recommending ACI. I'm currently overweight, and will have to lose about 70 pounds before he'll do the procedure.
Everything I know about ACI I just learned from the Genzyme website. My dr. made it sound like my lesion is pretty significant, but I have no context. ANd of course, I'm currently frustrated that I went through surgery to get rid of pain, and it proved to be more diagnostic than actually eliminating the source of pain.
So if anyone knows of some good websites or articles, and can help me put this in context, I would appreciate it. I would like to know if this procedure is considered "radical", what the recovery time is like, what they do if it doesn't work, how many people end up with TKR 10 years later (ok, it may be too soon to know that one). I'm trying to lose the weight regardless of the procedure, but what decision making criteria did you use before deciding to have it done? Were you offered other options?
And is my lesion considered "large"?
Thanks in advance.
Posted by hmaxwell (Heather M.), 21 December 2004
I know it's confusing, but the ACI posts are in another thread lower down--this section on 'cartilage plug transfer' deals with OATS procedures, which are a completely different method of cartilage restoration. Most doctors do one procedure or the other, so you really will need to see at least three or four to understand what your best option is. That is usually determined by the location of the defect, its size, whether you have arthritis in any other compartments, how you got the defect (severe traum like knees meet dashboard in car accident or overuse or bad mechanics), and so forth.
You will find references to doctors who perform OATS in this section, and ACI specialists in the section that deals with this procedure (about three or four threads down from this one): http://www.kneeguru.co.uk/cgi-bin/KNEEtalk/YaBB.pl?board=aci
Here is a great web page with overviews on the various procedures. It's from the Rush Center in Chicago.
http://www.cartilagedoc.org/knee_library.cfm
Good info can also be found at http://www.kneehippain.com go to the 'for patients' link and read through all of the menus that drop down--lots of links for you. If you find that information helpful, I recommend you buy Dr. Grelsamer's book "What your doctor may not tell you about knee pain and surgery" as it should truly be required reading for any younger patient facing cartilage issues.
Additionally, here's a great overview of chondral defects, which is basically what you have. I believe if your defect is measured in centimeters rather than millimeters...well, that's big. Your options will depend on the factors I listed above. And you are right, likely the doctor won't do anything until you lose the excess weight--which is of course incredibly tough since you can't exercise! I'm in the exact same boat as you, only my defect is on the patella--this severely limits my options....
Anyway, the link on chondral defects:
http://www.steadman-hawkins.com/knee_chondral/overview.asp
Information on microfracture, which is commonly used on large defects:
http://www.steadman-hawkins.com/knee_microfracture/overview.asp
Overview on poor knee mechanics and what this can mean:
http://www.steadman-hawkins.com/pate/overview.asp
Heather
Updated Sat Nov 21 2009
