The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - Osteochondral autografts and allografts (eg OATS & mosaicplasty) => Topic started by: cc44 on December 07, 2005, 04:41:11 PM

Title: SaluCartilage in Canada
Post by: cc44 on December 07, 2005, 04:41:11 PM
I am in the U.S. and have inadequate health insurance; if ever I get on group plan again, ACI is still considered "experimental" by a lot of carriers,  if the FDA ever approves this, it will be years before any carrier is going to pay anything towards it. Two orthopedic surgeons and three radiologists downplayed my injury (from a fall), yet ten months laster I still have pain and swelling. The best explanation for the ongoing pain was chondromalacia, although initially there was more wrong, nothing was torn, and the lesion is not that big. That is why I think the SaluCartilage implant could help me, and if I am paying for it myself maybe I could actually get care without being dismissed for not having good insurance. Does anyone have any leads? Calling one hospital, one sports medical clinic, the SaluMedica company (plus emailing them--ignored for almost a month now), and emailing one doctor has so far gotten me nowhere, and it's expensive to keep randomly calling places in Canada.
Title: Re: SaluCartilage in Canada
Post by: blackbeltgirl on December 07, 2005, 05:44:58 PM
ACI was approved by the FDA years ago, and most insurance carriers will pay for it.  The limitations for insurance are the area that will be treated (patellar lesions are still considered experimental, femoral condoyles not experimental), the size of the lesions, etc.  They will be testing carticel 2 in 2006, but the standard technique was approved by the FDA in 1997 (I think).

As to coverage, I'm unfamiliar with the salucartilage.  But you may try calling your local social services office to see if they can advise/direct/assist.

Good luck.
Title: Re: SaluCartilage in Canada
Post by: cc44 on December 07, 2005, 07:28:39 PM
I know the FDA approved of ACI a long time ago, but having FDA approval does not stop insurance carriers from paying for procedures or prescriptions they decide are too new and/or too expensive.  SaluCartilage is not approved in the U.S., and as far as I know there aren't any trials being done, but it is approved in Canada, but as no Canadian social services office is local to me, I can't go that route.
Title: Re: SaluCartilage in Canada
Post by: blackbeltgirl on December 07, 2005, 07:52:09 PM

While it's true that FDA approval is not the same as insurance approval, most patients who have already tried microfracture and have femoral lesions have been getting ACI approved in the US.  WHich still won't help if you don't have insurance or have not tried microfracture.

As to social services - I meant to call your local office.  They won't be able to help you with this salucartilage stuff, but there is a company that has synthetic plugs approved in the US.  A few members have tried them, and there are currently a couple of other threads addressing the issue of synthetic OATS.  But your local social services office may be able to help you get better insurance, or advise you on  how to work with physicians to get the care you need with a payment plan you can afford.  I doubt the Canadian government would be willing to foot the bill if you're not a citizen or resident.  The company that produces the plugs may also be able to assist you, if you contact their patient care office.

I hope you find the care you need.
Title: Re: SaluCartilage in Canada
Post by: cc44 on December 07, 2005, 08:24:16 PM
The first orthopedic surgeon does ACI, which is why I went to him, and he dismissed my injury is not severe enough for that procedure.  The second O.S. offered me nothing, would not even give me a prescription for more physical therapy, even though I do have coverage for it, or any medication, but offered a cortisone shot, which I turned down.

I do have what coverage I can get as an individual at a price I can afford.  But after these experiences of doctors barely treating me because they know it's limited, I would rather go to Canada, pay for everything in cash, not involve insurance, and try to get this procedure that is not available in the U.S. anyway.  I was never asking for the Canadian government to foot the bill.
Title: Re: SaluCartilage in Canada
Post by: blackbeltgirl on December 07, 2005, 08:29:44 PM
I never thought you were trying to get the Canadian government to foot the bill.  Just trying to help you find someone who can assist.

You said the first surgeon said your injiry wasn't severe enough for ACI.  Did he explain hoe he selects patients for ACI?  Did he offer alternative treatment?  Have you tried anything besides physical therapy?  What drove you to explore ACI and SaluCartilage in the first place? 
Title: Re: SaluCartilage in Canada
Post by: shade on December 07, 2005, 08:50:57 PM


This sounds like an interesting procedure.... have not heard of this procedure before, but the SaluCartilage implant sounds very promising.  Hope you find some answers and can get some help.
This is the only site that I could find.....
Good luck.  ~Shade
Title: Re: SaluCartilage in Canada
Post by: cc44 on December 07, 2005, 08:53:57 PM
He did not explain how he selects patients for ACI.  He prescribed me NSAIDs, p.t. and an MRI.  When the p.t. ran out, had to go to a different O.S. because of a new insurance plan.  He would not do anything.  When to a different p.t. facility that didn't need an rx, they did nothing for me but leave me alone with handouts and ankle weights.  The first p.t. place did not accept the new insurance, but at least they did ultrasound, tens, massage with Biofreeze, balancing exercises, etc.  Have been occassionally working out carefully since then, bought Masai balance technology sneakers that do not apply a shock to the heel when walking (my own idea after feeling the difference while walking in sand), reluctantly traded in my car with a manual transmission as driving with the clutch in traffic hurts too much.  Don't know what else I can do.   Don't think the knee will heal any more than it has at this point.  Got interested in SaluCartilage as it seems to be catered to people with small chondral defects, and because of the low recovery time.  From what I read about OATS and microfracture there is a long recovery with expensive therapy afterwards.
Title: Re: SaluCartilage in Canada
Post by: blackbeltgirl on December 07, 2005, 09:10:38 PM
It's true that the standard cartilage surgeries all have extensive recovery times.  From what I remember from the kneegeeks who had the OBI implants (synthetic plugs for OATS) they had a very similar post-op protocol.  Interseting that this is a shorter recovery time.

I'm guessing you're still in quite a bit of pain, or you wouldn't still be pursuing care.  If your insruance allows it, you may want to try for a 3rd opinion - see if you find someone willing and interested in helping you get well.  If you're not already taking them, you may want to try different supplements.   Glucosamine chondroitin is a common one for cartilage issues.  I take high doses of MSM, which is a natural anti-inflammatory (and I find it helps way more than the glucosamine).  Others find success with fish oil or flax seed oil.

Do you know the size of your lesion or the location?  Was it diagnosed from the MRI?  Was it the result of trauma (like a car accident) or wear and tear?  And if it's wear and tear, have you been checked for malalignment? 
Title: Re: SaluCartilage in Canada
Post by: stgiles16 on December 09, 2005, 12:23:03 PM
You can purchase Biofreeze and a TENS unit on your own (well with  a script for the TENS) and do some of that at home. I got the biofreeze from my chiro and a script for the TENS unit from my GP. The company allows you to pay monthly so it isnt too bad. Both of those treatments are simply for pain relief, they dont actually fix anything. Ultrasound is for calming down inflammation. That still wont actually fix anything, though it may help in pain relief.

Where are your lesions located and how big are they? The size and location of the lesions will help determine the treatment that is best for them.

I would be surprised to hear that an OS (let alone 2 ) would not treat you because you have "inadequate" insurance. I have heard of them turning down people who have NO insurance but not the ones who have some form of insurance.
Title: Re: SaluCartilage in Canada or U.K.
Post by: cc44 on December 14, 2005, 08:37:59 PM
I went back to the first O.S. today with the MRI.  He said that MRIs are not very accurate, especially with cartilage injuries, and that anyone who determines the size of a lesion without a scope is lying.  Therefore, I cannot tell you the size, just that is a lateral femoral chrondyte (? I don't have this in writing) lesion.  It was from a fall ten months ago snowboarding, even though I had kneepads on, it was the lower left-hand side of the left knee, an unprotected area, and the surface was icy.  It was shear force, not a twisting motion (as your feet are strapped to the board); it is only a cartilage injury at this point, the rest has healed.  He said it will not heal anymore and that only surgery could fix it--and he said that mosaicplasty/OATS only works if the lesion is small enough and the right size, otherwise that the surgery changes to microfracture and this cannot be determined until it is underway.  Both of these procedures sound horrible to me--OATS because you are then putting holes in other parts of your knee and have a long, painful recovery, and microfracture because you only end up with fibrocartilage, with a long recovery and possibly ending up needing surgery again in the future anyway.  He said that insurance never pays for ACI unless one of these conventional treatments fail. 

I would still rather take a chance on the SaluCartilage surgery, and then move to one of these procedures if it didn't work.  Maybe since it was only approved in Canada in July no one is doing it.  I would also consider the U.K.--since this a a U.K. board, maybe someone knows of a doctor there? 
Title: Re: SaluCartilage in Canada
Post by: stgiles16 on December 14, 2005, 10:58:35 PM
The only problem that you might run into is waiting so long for the salucart. to get approved that your lesion could grow to the size that only a TKR will fix it.

Good luck
Title: Re: SaluCartilage in Canada
Post by: blackbeltgirl on December 15, 2005, 01:14:46 PM
You need to do more research on articular cartilage health before pursuing any surgical options.  If you haven't tried it yet, a good website is  Go to the resources section, and then knees.

And if you can, consider another opinion.  Yes, it is true that articular cartilage shows up poorly on mri, so an exact measurement (or even diagnosis) is unlikely.  But past that - microfracture works best on small lesions - less than 2 sq cm.  Oats is generally for lesions up to 4 sq cm, although it may require an allograft (cartilage from a cadaver) rather than an autograft (cartilage from your own knee).  If OATS fails, you can try another OATS procedure, but you can't go back and try microfracture or ACI, because too much bone has been destroyed.  I don't know much about the salucartilage, but from the website it sounds like it's synthentic plugs for OATS.  I don't know if they pin it into the bone, or if there is any bone damage as a result.  YOu should check that out before making a decision.  And many insurance companies won't cover OATS or ACI if you haven't tried microfracture.  While it can be frustrating, it's just reality.

How much pain are you in?  Does your knee hurt doing everyday activities?  I've had surgery for cartilage damage, and have scheduled more surgery not because of pain, but because my doctor said the bone-on-bone (which is my entire lateral half of the knee) is doing so much damage to the bone that if it gets much worse I won't have any option but a total knee replacement.  But otherwise I can easily live with this - certain things do set it off, but 90% of the time it doesn't bother me at all.  If you're in a lot of pain, I understand wanting this treated.  But if it's minor, you may benefit from a scope just to find out what's really going on - maybe there is no lesion at all, maybe it's a cartilage flap, mabye they can just clean up the edges to reduce pain and slow further damage (like unraveling a thread - if you leave it hanging it will keep unraveling, but if you clip it it will hold)

Nothing is guaranteed with surgery.  Going to canada for a new, relatively untested procedure may not give you any greater benefits than staying in the US and having a well-documented procedure.  And they are getting ready to start clinical trials in the US for the 2nd generation of ACI - which will be arthroscopic, with an easier recovery, etc.  FDA approval is still at least a year or 2 away, since the trials haven't started, but maybe you're either eligible for the trial, or a good candidate to wait until it's approved.

No matter what you decide, good luck.
Title: Re: SaluCartilage in Canada
Post by: cc44 on December 15, 2005, 05:05:10 PM
I went to a third O.S., a partner to the first one who does take my insurance, and just went ahead and scheduled whatever surgery it will end up being and hope that it gives me some relief.  He said exactly what you said on in the third paragraph--could be scar tissue or a cartilage flap, then it would be debridement, but there will be no way to know beforehand.  Otherwise, he seemd to be more in favor of microfracture.  I just have a feeling that this won't end up being the last surgery.  But I have to do something, because I have been in pain for ten months, and it is difficult for me to do everyday things, like move out of the way from people in the sidewalk, climb stairs or a ladder, hold a heavy object and open a door, etc.
Title: Re: SaluCartilage in Canada
Post by: blackbeltgirl on December 15, 2005, 05:14:38 PM
Now that you've scheduled your surgery, it's time to hop on the optimism bus.  Believe this will work - whatever they do.  Believe you will come out of the rehab and recovery period without pain, and with your life back.  And be DILIGENT in your rehab.  It's at least 50% of your recovery (the surgery being the other 50%).  Since there is a possibility of microfracture, you may want to ask the OS about his rehab protocol in advance - will you be on crutches?  How long?  How soon will you start formal PT?  Etc.  Microfracture is a long recovery period, and a lot of people get depressed when they're not "better" 2 months later.  I found that around month 5 I started seeing HUGE improvements, but I was furstrated till then.  So just set your expectations for the recovery period, set your mind on success, and do the rehab.

Good luck!
Title: Re: SaluCartilage in Canada
Post by: brattkids on December 16, 2005, 01:33:42 AM

I had the synthetic OBI plugs for OATS and they did not work for me. I had them both on the medial and lateral femoral chondyles and both sides failed within a year. I then had a traditional OATS on one side and the cadaver allograft on the other and I am now doing pretty good. I still have limited pain at times but am feeling much better and am doing the stairs with out having to hold on and doing them regular. My last OATS was sept 28 ,2005 so I think I am getting along great.

Just wanted to let you know that there is light at the end of the tunnel and I hope you get some pain relief soon

Title: Re: SaluCartilage in Canada
Post by: cc44 on December 17, 2005, 09:33:57 PM
Something else I am worried about is the fact that both of these doctors in the practice say that unless it is a transplant, then you don't use crutches at all, nor CPM, nor is there any kind of brace or something to protect and support the knee afterwards, which does not seem to be the standard--maybe it is if it is only lavage and debridement, but for microfracture?  It seems counter-intuitive to put weight on a knee that is trying to form a clot.  On top of all of this, I have been mostly unemployed since shortly after this injury, but frantically job-hunting and interviewing and working part-time and doing job training classes, and I am running out of unemployment and savings, and if I do get a job before the surgery that starts afterwards, if I show up on crutches, I will lose the job, or if I go to interviews on crutches I won't get the job, and to prove the reason is due to temporarily disability I won't have a leg to stand on (ha-ha) because the answer would be that I should have gone on disability, which then I'm worried would be in my permanent record and keep me from getting jobs in the future, anything in which they do a background check.  Which brings me back to why I still wish I could get a name of any doctor that does the SaluCartilage implant in the first place--I would sell my car to pay for it, because at least if it worked I would have a shorter recovery and I could get back to being functional and be capable of working at more types of jobs and not showing up on interviews noticeably limping.
Title: Re: SaluCartilage in Canada
Post by: cc44 on January 03, 2006, 04:28:21 PM
Since I last replied, I heard from two doctors--one in Canada unfamiliar with this procedure and did not know of anyone performing it, and the one mentioned in another forum in Italy.

In any event, tomorrow I am having something done, and it was supposed to be any one of the other procedures mentioned, but I am very against the idea of microfracture--I do not see the point of months of recovery and pain, just to know that it will not last more than a few years.  So I have that this not be done.  I have requested that if at all possible just do lavage and debndement, as that recovery sounds the shortest, and I feel like that should be what is tried first.  I hope I am not making a mistake by requesting only this for now.
Title: Re: SaluCartilage in Canada
Post by: shade on January 03, 2006, 05:02:01 PM

Hi, hope that the debridement and lavage works for you.  It is not known for long-lasting results.  I've had that & did not have any pain relief at all & I'm almost 6 months post-op.  Really can't see why you would not have the microfracture surgery - you might get over five years pain relief from the procedure......
Good luck with whichever procedure you have.  ~Shade
Title: Re: SaluCartilage in Canada
Post by: cc44 on January 05, 2006, 11:58:40 PM
I finally got a call about what happened yesterday, and now I'm told the knee was "fine", so I just went through anthoscopy for nothing?  When I get the stitches out I am supposed to see the pictures and report.  What was found was a "minimal" lesion which was not corrected, and a "hypertrophic fat pad overgrowth" near the tibia that was not caused by the fall?  In any event this "fluff" was trimmed, and maybe that is going to help?  I wish I would have been given the size of the lesion, and is it true that small lesions do not cause pain?