KNEE ARTHRITIS - Autologous chondrocyte implantation (A.C.I.) :
Am I a candidate for ACI? - - Posted by Nick_Knack (Nick_Knack), 21 December 2004
hi,
where was all of yours pain? I have grade 3 medial femoral condyle changes and grade 3/4 trochlea changes and my cartilage under patella is shot. Anyone else with this diagnosis who had ACI? My pain is aching all the time particularly with knee bent. 33 years old.
I really appreciate everyone's feedback.
Nick
Posted by hmaxwell (Heather M.), 22 December 2004
It's my understanding that ACI patients usually have focal lesions in only one compartment--it sounds like you have two compartments involved, which is problematic.
Some doctors insist that patient selection is the key for successful outcome, so take that for whatever it's worth.
Also, it's my understanding that cartilage restoration techniques with high success rates elsewhere have proven woefully inadequate for patello-femoral defects--especially kissing lesions on the patella and trochlea. The problem is partly in refining the mechanics sufficiently to ensure that the new cartilage doesn't get chewed up like the old stuff did.
I've been quite interested in ACI, but I personally don't fit the patient criteria in numerous ways: weight, multiple compartments involved, previous arthrofibrosis, patellar lesions/kissing lesions, global damage, uncorrected PFS, onset of symptoms over extended period of time rather than distinct trauma. Pretty depressing, in general.
Here's a link:
http://www.health.state.mn.us/htac/ac.htm
The depressing quote: Quote:While specific patient selection criteria have yet to be definitively established, expert opinions indicate that autologous chondrocyte transplantation is most appropriate in individuals between the ages of 15 and 55 years old who have full thickness, localized lesions of the femoral condyles, who do not have joint malalignment or generalized chondromalacia of the tibia, and who are willing and able to undergo rigorous physical therapy.6,8,9 When comparing the cost effectiveness of autologous chondrocyte transplantation to alternative treatments, including total knee replacement, there are many influencing factors such as age, type of work, degree of disability, and amount of physical therapy required. Since little data is available on the long-term durability of the transplant it is uncertain at this time if it is cost effective.7 The cost of the cell culturing service for the autologous chondrocyte implant is $11,500. The cost for the procedure varies depending upon provider and facility fees. There is also a wide variation among third party payors in terms of the degree of coverage provided.5 Currently, the procedure is considerably more expensive than alternative treatments for knee damage like debridement, subchondral drilling, and microfracture techniques.
That being said, people here have had ACI for patellar lesions...they just had complications and were 'lost to further follow-up' as the jargon goes. Linda had a knee situation comparable to mine, and she was dealing with her post-op therapy for debridedment of scar tissue when she stopped posting a while ago. She's the only one I know of who had chronic knee issues--chondromalacia and previous history of lateral release. Her surgery was done by the ACI guy out of Denver.
For further reading, here is a link to dozens of articles on cartilage restoration. You also know about findarticles.com, which is where I'd start to look for info on clinical trials.
http://www.cartilagedoc.org/knee_library.cfm
Heather
Posted by pcfu (fp), 22 December 2004
Nick, i had ACI to the trochlea and patella. It was a kissing lession, 3X2 cm and 1X1.5 cm. I am just 12 months post-op and have been confirmed by a scope at approx 10 months that cartilage growth was succesfull (too successfull actually, since i had some overgrowth shaved off), and my 12 month MRI also showed it was succesful.
It will all depend on your surgeon wether he thinks you will be succesfull. Correcting any malalignment is a must, or else you will have the same problem. Before my ACI i had a lateral release about 6 months previously. From everything i have read kissing lession are a big problem, but from what i can tell are becoming more and more of a success as more are being done. Remember that this is a fairly recent technological development which will keep improving, and that a lot of articles will be a few years old.
I havent heard a lot about people having ACI to both the MFC and PFJ at the same time, usually it is one or the other.
Anyway, goodluck.
Posted by Nick_Knack (Nick_Knack), 22 December 2004
Hi Guys,
I don't mean to monopolize the posts here; I am just trying to get the best info possible from people who have gone thru this.
The doc I saw today told me the cartilage under patella looks good, so it is not a "kissing lesion". The damage is on the trochlea, and frankly that is where my symptoms are.
Other docs have told me there is damage under patella. I don't know what the hell to believe at this point. But if I go on symptoms alone the aching pain I feel is in the trochlea area.
I am wondering if any of you tried microfracture first as this seems less time consuming/expensive (if out of pocket).
Have people tried microfracture and then failed or gone right into ACI?
Heather, I too had an arthrofibrosis in my past which has been taken care of. It's just that now I am left with this cartilage defect in the trochlea.
Incidentally, I don't have any mal-tracking issues. My defect is the result of not having full-extension for so long, which I now do.
ALL ADVICE/OPINIONS are much appreciated. I have an appointment with Tom Minas in Boston in JUNE. DAMN, that is a long ways away!
Posted by Jules (Jules), 22 December 2004
Hi Nick,
As I said on my post 'follow my ACI start to finish, starts 18/10/04' I have had three grafts, two on the trochlea and one under the patella, one graft was from the shin bone and the other two were collegen grafts. The lesision sites were 8cm square in total.
Now in my experience:- having having had 9 operations between both knees, eight of those arthroscopies for debriding, microfracture, lateral releases. Mine was just wear and tear, not through sport injury, which is more common. I have chondromalacia in both knees grade 4. My OS says my knees are bald of cartilidge. In my experience all the athroscopies I have had, and procedures to correct my problem has been unsuccessful and I wished they would have gone for the ACI after the 1st or 2nd arthroscopy.
In the research I have read and people I have heard from on here, ACI is 80% successful, BUT, having multiple lesions, epecially on the tibia and behind the patella, the success rate is slighlty lower, but does not mean it will not work. As for the realignment, yes it is important that this is corrected, and I know of someone who has had two grafts and realignment and fixing (all at the same time), but still in the early days yet.
Therefore my personal view, from my experience is to make sure that your OS is very certain that microfracture will do something for you before having it done (especially when your paying for it!), if he says he can't be certain, which I'm sure he can't be, then I would choose to go straight for ACI.
I am to have my left knee done after my right knee has had the all clear that it has been successful... if it is. But my thoughts are now, that if it is not, I will not go through it again and ask for a total knee replacement, as I have been messed about with enough!
But in saying all that, I am 6 weeks post ACI, and everything is going to plan, and I haven't had any major complications post op, I even managed to walk up the stairs last night for the first time on both legs after being non-weight bearing for six weeks. So I suggest you do your own research, which is up to date as possible, and get advice from your OS, take into account what you have read off here, from those who have actually had the ACI done with mulitple lesisions and then make up your own mind.
I hope this helps you Nick, please ask if you want to know any more. But bear in mind everyone is different, and has different problems, and recover differently, so the same op for one may not work for another, it's difficult I know, I've had years of it now, but have learnt along the way, that I should have gone straight to the ACI and not all the minor procedures that did nothing for me, but you may be different to me. Please write your questions and concerns down before you see your OS, that way at least you will get all your answers before making up your own mind.
Best of luck.
Jules
Updated Thu Apr 29 2010
