KNEE ARTHRITIS - Autologous chondrocyte implantation (A.C.I.) :
ACI - Truth or Hype??? - - Posted by Nathan (Nathan), 11 September 2004
Hi All,
I had a microfracture treatment for a femur chondral lesion (medial) classified as class III or IV (outerbridge). The surgery was done in January 2004. Unfortunately the surgery treatment has not worked as the symptoms persisted immediately following surgery and have progressively become worse. 
I have read a lot about ACI / MACI and reading some of the postings on this site are very encouraging. However, I have been told by my OS that ACI / MACI is not as effective as other treatments (transplants / etc) and he does not recommend ACI / MACI.
I am currently living in London but am originally from Australia and have the option of getting the surgery in either of these places...Does anyone have any good OS contacts in either of these places that specialise in ACI/MACI
Pre-injury I taught competitive areobics and would ultimately like to return to this level of activity. What is the success of ACI/MACI for returning people to their full level of activity or is ACI/MACI just marketing hype
Posted by levyglen (levyglen), 12 September 2004
i had a microfracture in attempt to repair a lesion too. it also made me worse. fact is, there has been no real treatment for a chondyle defect up until now. ACI is the first true attempt at repairing the hyaline cartilage at the end of your bone.
is it guaranteed to work? from the research i've done, the answer is no, it's not guaranteed. in some cases you're right where you started. but there have also been lots of success stories out there where people have been helped tremendously. so it's a bit of a roll of the dice.
i'm in the same situation and i've decided to go for it... with my pain and lack of any activity, it's worth a shot.
(i too am looking for a great surgeon anywhere in the states.)
Posted by hmaxwell (Heather M.), 12 September 2004
on 09/12/04 at 17:05:42, levyglen wrote:i'm in the same situation and i've decided to go for it... with my pain and lack of any activity, it's worth a shot.
(i too am looking for a great surgeon anywhere in the states.)
Dr. Tom Minas in Boston is considered a pioneer in this field. http://www.brighamandwomens.org/orthopedics/research/cartilagecenter.asp
So is Dr. Gillogly in Atlanta
http://www.vjortho.com/cgi/content/abstract/5051
There are several other doctors on the west coast in the bay area--look through the threads in this section.
Heather
PS another great article that covers the whole issue is this one:
http://www.emedicine.com/orthoped/topic431.htm
And this discusses OATS http://www.emedicine.com/orthoped/topic595.htm
Posted by blue_ezzie (blue_ezzie), 13 September 2004
Hi,
I can only comment on my own experience with MACI. It was the only option recommended to me after I had a fall in March this year, in which I broke my left patella in a couple of places and had most of the cartilage behind my patella removed.
For the 10 weeks between the first op (where pieces of my patella/cartilage was removed and remaining cartilage was taken to be harvested) and the MACI op, I had a very high level of constant pain in my knee joint. Within a couple of weeks of the MACI operation this pain subsided. Whether this was because I took a long time to recover from the first operation or whether this was a result of MACI I can't honestly say, but the difference after the MACI was incredible.
The muscles in my left leg are still noticeably smaller than the right one and I still can't bend my left leg as much as I can bend the right one. The muscles around the knee are always stiff and sore. I can now walk without the assistance of a cane but I get tired very quickly, particularly going up stairs or hills. Running is out of the question for the time being. So, four months down the track, I've still got a long way to go. But faced (at age 22) with the prospect of constant knee pain for the rest of my life, I was willing to take the risk!
I had mine done in Australia, at the North Sydney Sports Medicine Centre, which I believe is very well regarded. I was really pleased with the treatment I received. If you would like further info please feel free to message me.
ezzie
Posted by Nathan (Nathan), 13 September 2004
Hi All,
Thanks for your responses!! It is great to hear success stories!
Heather, thanks for the information & links - In your experience / research would you say that the plugs are better than ACI / MACI
Ezzie do you have the contact details of the surgeon that did your work in Sydney?
Thanks 
Posted by Jules (Jules), 25 September 2004
Hi Nathan,
I am due to have ACI in Oct then Nov this year, I too have done alot of research and have found that ACI does work for alot of people although at different levels, some total recovery and some enough improvement to have made it all worth while.
But I also found that it is likely to be more unsuccessful if the lesion is large, so the smaller the lesion the higher success rate.
I have also found in reading about ACI and MACI, that ACI is more successful than MACI.
I am having mine done at Oswestry, Shropshire. UK. It has taken about 15 months from my consultation date to my op date, but am hoping it is all worth the wait, so its a case of watch this space.
Best of luck to you.
Jules
Posted by Nathan (Nathan), 27 September 2004
Hi Jules,
Thanks for the information!
I hope that everything goes well for your surgery!
My research also leads me to the same conclusion in that the smaller the lesion, the better the chances of success! However, I have not noted any differences between MACI & ACI results....
Do you have any information / links /etc that show the differences between results achieved by these procedures
Thanks and GOOD LUCK!!!
Posted by JulianUK (JulianUK), 27 September 2004
Nathan,
I had microfracture on my left leg in May 2002 and within 2 months the pain was back and worse. I waited over a year before having MACI on it August 2003, at Stanmore. I just had my 12month biopsy and it looks so much better, and it's comfortable to walk on.
I had a 3cm defect on my femoral condyle and had my patella grafted. I was told that it was too big for OATS and so opted for this instead. There are a lot of people that have had mixed results. All I can say is that from my experience it has worked so far. It's a new thing and people still don't know the long term affects, but short term it's made my leg so much better. I'm now having the right done on 26th October due to a 1.5cm defect on my femoral condyle, but no patella problems which is good news because this is the one that generally does'nt work as well.
It's ultimately you're choice but if you go for this one then be prepared for a long-haul and lots of PT and ice.
Slow and steady definitely wins this race.
regards,
Jules.
Posted by Jules (Jules), 27 September 2004
Hi Nathan,
I have no links but you could search on the internet.
Best regards
Jules
Updated Fri Mar 19 2010
