KNEE ARTHRITIS - Bone marrow stimulation :

Microfracture vs. ACI/Carticel - Interesting study - - Posted by PFS_Mod (PFS_Mod), 1 May 2003

Those considering either of these procedures may find this link of interest:

http://www.medsport.pl/ortopedia/efort/art6a.htm

PFS Mod
Posted by violin1 (mj/usa), 4 May 2003

Thanks for bringing this to our attention!  It is indeed an interesting article and gives one lots to think about.
Basically this is what my os said when telling me which options I had to fix my chondral fracture.  We opted for OATS (the defect was small enough, thank Goodness!) and so far this seems to have been the right choice.
I am intrigued by the discrepancy between the MRI finding and patients' own feelings about their own knees....It really seems that MRIs don't tell the whole story.  I wonder what the reason for this is--or indeed if there is an explanation.  Obviously there is still a lot to learn about knees!

Mary Jane

Posted by TCO (TCO), 30 April 2004

link does not work.
Posted by TCO (TCO), 30 April 2004

Can you summarize findings?  I am considering debridement or debridement plus microfracture.
Posted by hmaxwell (Heather M.), 30 April 2004

If I recall correctly, the results were interesting in the difference between the subjective vs. the objective findings after examining the patients in the years following their procedures.

Basically, both the microfracture and Carticel patients were re-examined with x-rays and arthroscopy at some point post-op (can't remember if it was 3 or 5 years, but it was a fairly long study).  What was interesting is that the objective findings showed that the Carticel patients had true, healthy articular cartilage in their knees--i.e. the procedure had worked and the body had accepted the transfer and created hyaline cartilage cells in the surgical sites.  These cells were not noticeably different from the neighboring areas of undamaged cartilage.  On x-rays, the knees looked very healthy as well.

The microfracture knees, on the other hand had only fibrocartilage in the treated areas--scar cartilage, in other words.  These were clinically different from the neighboring areas of healty hyaline cartilage.

So the study doctors assumed this would mean that the Carticel patients had better results in terms of function and subjective reports of pain.  But actually, the opposite was true.  There was no explanation given, but the percentage of microfracture patients who has less subjective complaints of pain and functional limiteds was statistically significant and much higher than the patients with same subjective reports from the ACI group.

In essence, it blew the surgeons away.  So they idea was that maybe ACI isn't the bee's knees, so to speak.  I think that the OATS procedure wasn't part of this study, if I recall correctly, even though it was more widely used than Carticel in this country at the time of the study.

Heather
Posted by pomo2000 (pomo2000), 27 October 2004

Even if these results are correct, pain is not the only issue.

Hyaline cartilage should last long, as it is the correct articular surface and can respond flexibily to loads. The fibrocart. might wear away quicker leading to deg. joint disease.

Even if ACI isn't perfect, it's one of the few treatments that promises a healthy joint surface. OATS should also work, since it takes healthy hyaline cart. from elsewhere.

This old Forum was so valuable that we have kept it as an archive. It is just for reference. If you want to ask questions or offer advice, there is also a current Bulletin Board which you can access from our home page.