KNEE ARTHRITIS - Cartilage plug transfer :

Mosiacplasty alternatives..... - - Posted by Victrola (Victrola), 7 February 2003

OK hi all, this is my first time posting here and maybe someone can give me some direction to go...I fell in '99 and damaged my patella and my medial femoral chondyle....I have had three surgeries since then and went in last week for Mosiacplasty but came out of surgery with nothing being done...I never quite understood the reason he said he couldnt do it but he didnt and said that I would have to deal with the pain another 20-30 years since I am too young <33> to have TKR...I have tried synvisc and cortisone injections with no help..I am a nurse and am on my feet all day and it has been very difficult this past year and I cant see how I can wait another 20 years....OS says that my patella has a large hole with no cartlidge on it and that it doesnt meet my other defect unless my knee is 100 degree flexion and that the femoral defect it deep into the bone...not a ridge and that was why he couldnt do it....if anyone knows the reasoning for this I would like to know since I dont have my follow up appointment with him until next week...so I guess my question is what else is there to do? Is there any alternatives for a large defect like that if Oats or Mosiacplasty isnt an option? Ok thanks and hope to hear some feedback....thanks Vic
Posted by lbdeharak (Linda), 8 February 2003

Hey Vic,

I responded to this post in another section. Basically, if I were you, I would go get another few opinions from OS's that specialize in ACI and other cartilage restoration surgeries.

So far my ACI surgery is doing well. I would do it again.

Linda
Posted by Victrola (Victrola), 8 February 2003

thanks Linda,
This OS specialized in Mosiacplasty and Oats....what is ACI? And is it available here in the US... I live in a metropolitan area and there are so many OS that I dont know where to begin to find a OS in my area that can do that....any suggestion on where to start looking to find one Thanks Again, Vicki
Posted by JG (JG), 10 February 2003

Hey Vicki,

I responded to your posting on www.arthroscopy.com by emailing you.  For some reason I could not post a response on the website so I sent you an email (I have not heard back from you).  So basically it sounds like the defect in you medial condyle is too deep for a graft and a bad patella.  I have a few questions.  Were you going to have an autograft or allograft (frozen or fresh)?  How large are your defects? What is your functional status (what can't you do).  I am actually surprised that either x-ray or mri didn't show the extent of your problem on the femur.  I am curious who you went to/where you live.  There really are just a handful (dozen or so) of surgeons who specialize in this.  May surgeons say they are specialist but few really focus on this area.  I have done a ton of research in this area (I have probably put in more than 200 hours of research on osteochondral grafting).  I actually have a spreadsheet that tracks the surgeons, their research and their results as well as the +/- of the different procedures, +/- of the graft type, etc.    

There are a couple of lesser known physicians using new techniques for osteochondral defects such as Dr. Kevin Stone (San Francisco).  He uses a "slurry" that is derived from the intercondylar groove.  He has seen regrowth of cartilage in this area post notchplasty on ACL patients.  He grafts the bone, crushes it making a paste, and place it on the defect.  He has performed this procedure on 75 patient.  Check out www.stoneclinic.com.  SaluMedica received approval for a synthetic implant, but it is not approved in US.  I am talking to them next week.

Other techniques being used are "Shell allografting" which takes larger pieces of allograft (not the small circular graft).  Dr. Allen Gross and Dr. John Garrett are actually replacing large pieces of bone and cartilage (like the entire lateral tibial compartment).  However, this is used in conjuction with some type of mechanical alignment.  I know they have used this with the tibia, not sure about the condyle.  Dr. Shawn O'Driscoll is using a periosteal graft.  Esstentially, periosteum is used to "patch" the defect.  The outer inner cambium layer is rotated outward, the patch sewn in place and cartilage may grow out of the undifferentiated cambium layer of the graft.  

To my understanding Dr. William Bugbee (San Diego), Dr. Brian Cole (Chicago), Dr. Tom Minas (Boston) and Dr. Joe Buckwalter (Iowa City) are a few of the top US surgeons.  Dr. Cole has a website (www.cartilagedoc.org) which is good.  

Good luck...Janice

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