The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - ACI & MACI (autologous/matrix-induced autologous chondrocyte implantation) => Topic started by: Linda on October 03, 2002, 01:45:34 AM

Title: ACI Surgery
Post by: Linda on October 03, 2002, 01:45:34 AM
I have ACI surgery scheduled for Nov. 6 2002. Any helpful hints for rehab? Anyone else that has had this and can tell me about it?
Title: Re: ACI Surgery
Post by: tazmanian_devil on October 04, 2002, 07:27:39 AM
Do you mean ACL surgery? That is one of the ligaments right in the center of your knee. Theresa.
Title: Re: ACI Surgery
Post by: Linda on October 04, 2002, 06:59:30 PM
This is Autologous Chrondrocyte Implantation (ACI). It is to replace cartilage that is missing in the knee at the end of the thigh bone. The OS removes healthy cartilage cells from an area of the knee that is relatively unscathed. These cells are sent to the Genzyme Tissue Repair Lab and the lab uses proprietary methods to grow new cells from the biopsy. The resulting multiplied cells are then put back in the knee during a second surgery. The rehab then takes 9 - 18 months.  Linda
Title: Re: ACI Surgery
Post by: Heather M. on October 04, 2002, 09:10:21 PM
Check out the arthritis section below.  Not many have had this surgery, but there are some posts there.

Title: Re: ACI Surgery
Post by: Linda on October 04, 2002, 09:29:18 PM
Hello Heather,

I did wander around yesterday and read just about all the posts on the site. it is very cool that there is a place like this for people to talk about things they are going through! There seem to be many kind helpful people out there.

The only things knee wise that I have been through is a lateral release and a scope for clean up and biopsy. that seems like too much already! Hopefully I can get through this and get back to a more normal life. I do not even want to consider all the things many of you have gone through.

I guess that as long as there are things to try, you can keep looking foreward though.

Thank you for responding.
Title: Re: ACI Surgery
Post by: gailg3 on October 04, 2002, 11:06:14 PM
Linda, I had my Carticel implant done April 13, 2001.  I had a medial condyle defect on my left knee.  I had minimal pain following the implant surgery believe it or not.  I had major pain in my knee before, so it was a relief to have the surgery.  Yes, the surgery is major and the rehab is tough, but pain wise, it was manageable.  I used a CPM and started PT on day 3 post-op. I iced almost constantly.  I had alot of swelling for a long time.  I still have some swelling if I do too much with my knee.  I'm always aware of my knee and i'm very careful with my knee.  I do have limitations but I'm very glad I had the surgery.  I don't think it'll be the last surgery for me though.  I think it bought me some time until I can have a TKR.  I'm only 26 years old (almost 27) but still way too young.  My advice would be push hard for your ROM but listen to your knee. Don't be too concerned about the protocol except for the ROM part (that's important).  Everthing else will come in time. Listen to your PT and your OS but most important your knee.  I still struggle for strength.  I had to go back to PT for 2 months at 1 year post op b/c i had not gotten my strength back on my own after doing 5 months of formal PT following the surgery.  I went 3 times a week for 3 months and then 2 times a week for 2 months.  I spent 8 weeks totally non weight bearing.  It was supposed to be 6 weeks but I tried partial weight bearing and had pain so we backed off.  Like I said, listen to your knee.  Anyway, if you have any questions you can e-mail me if you want.  I don't check back here too frequently.  Gail
Title: Re: ACI Surgery
Post by: Laura945 on October 10, 2002, 10:33:18 PM
I would strongly suggest getting a second opinion before having the surgery.  I was told by my OS that ACI for the knee doesn't really work.  Because the knee takes more pounding than any other joint in the body, the ACI will eventually shear off.

I had asked my OS specifically about this when I was looking for options for my own knee problems.  I'm 42, and I've already had a patella realignment, a lateral release, and an arthroscopy (to remove cartlidge debris and inflamed tissue), this last back in June.

But Gail is right.  Listen to your PT (they often know about what's going on than the OS), and listen to your knees.  
Title: Re: ACI Surgery
Post by: Linda on October 10, 2002, 10:48:10 PM
Hi Laura,

Thanks for the input. The three docs I saw tell me that it about the only option I have except for Knee Replacement! I am 38, so that is not an option yet. They tell me that it should last for at least 10 years. they said that even if it only lasts for 5, I have not created any more problems, and have gained a few years of knee use.

It is so tough to know what to do!

My PT sent me to this Doc. She felt that this would be a good option.

It helps to know that others are interested and looking for answers too.

Title: Re: ACI Surgery
Post by: jimbeaver on October 11, 2002, 11:44:22 AM
Hi everyone!

Like lbdeharak, Im going for my ACI on my left knee on the 24th Oct. I had the initial harvesting done on the 2nd Oct, which went along well.  Prior to this ACI, I had 2 anthroscopy done at the start of this year.

Having read the postings here, I am beginning to have
apprehensions about going through the final surgery!  :'(
My OS deemed this procedure as the only option barring
a total knee replacement, considering that Im 33 years old

Presently, my knee will swell and have jabbing pains whenever I over-exert myself at the slightest form of
exercise like swimming, stationary bicycling etc.  Even
walking up & down the stairs will cause throbbing pains.

I didn't really have much of a choice apart from taking up what my OS recommended.  Considering my age, I wanna get back to sports & exercises and also to trek & tour like before.  I just wanna get over this and put it all behind me.

But having read the postings, I have to lower my heightened expectations, and be ready for the worst, in that, it may not cure my knee problem.

My concerns are as follows:
1)  The "trauma" of having to go under the knife for the
     4th time this year.
2)   The rehab period is gonna be tainful, long & tough!
3)   The cost of the entire surgery.
4)   The extended period of absence from work may
      render me a unemployed!

To gailg 3:  How long did it take for you to start walking and resume your activities (like work, school etc) again?

Im praying hard that this shall be the final op needed for
my problematic knee!!

Good luck to all!!

Title: Re: ACI Surgery
Post by: PJS on October 11, 2002, 01:22:30 PM
I had carticel a year ago for a 2.4cm2 lesion in my right knee.  I had no pain prior to the operation and only had the operation on the advice of the OS who convinvced me that I could return to competitive sports and tournaments. One year on I still suffer from an occassional pain over the implant site if I push the knee.  My knee is extremely variable in its feeling. Sometimes no pain for a couple of days, then a twinge whilst walking, sometimes no pain with leg lifts and then sometimes a dull ache.   At this moment in time I am worse off than before the operation and hope that my progression continues over the next 6-12 months to allow me to play football again.   I was also told that it would take 18mths to 2 years, I am now into year 2 and starting to worry that the OS has made we worse off.
It is very difficult to establish what is going on inside the knee and it worries me greatly about the stability of this operation.  The OS Carticel surgeons are great at explaining the 95% success rate, I am begging to believe that they have greatly exaggerated the benefits and success rates of Carticel for their own commercial and selfish reasons.    My advice to anyone would be to think long and hard before undertaking this operartion.
If I could turn back the clock I would say NO, not worth all the rhabilitation pain with the high assocaited risk of failure (I believe this to be 50% and 95%).
It would great to hear how others are coping with their ACI rehabiliation.

Title: Re: ACI Surgery
Post by: mj/usa on October 11, 2002, 05:06:37 PM

Before I had my O.A.T.S. operation 4 weeks ago, my surgeon mentioned that one of my options would be ACI.  WE discussed all the pros and cons and in the end he strongly discouraged ACI, because he said that the success rates are over-inflated, and that he has seen  implants that keep growing and growing and causing trouble because of that.  I felt caught between a rock and a hard place; no decision like this is easy to make and I am sure that we all hope we have made or make the right one.  In my case, I did opt for the oats because my defect is on the smaller side.  Only time will tell if I did make the right choice, but so far everything seems to be ok.
I wish you luck with the ACI, or whatever other choice you might make.

Title: Re: ACI Surgery
Post by: Linda on October 11, 2002, 08:14:34 PM
I am not a candidate for OATS since my defect is so large. I had just about decided that I would live with this awhile and see how things went, but then last weekend when i walked my dog, just that little bit of walking caused terrible swelling and pain. i am still working on getting the swelling to a more reasonable point.

I did talk to my OS again, and he gave me a very long list of names of people that have had the ACI surgery. I called many of them. All but one was very happy with the results. The unhappy one admitted to not following the rehab protocol. I do feel a little better now.

i also got a list of names from a different OS. That list did not have as many positive results. Not sure if the surgeon was the cause? There were many flap problems.

A question for everyone. My OS said that while this is a good site for info, to remember that people that are successful in their treatments go on with their lives and quit posting. Do any of you think that there is truth in that?

I hope everyone is doing well. i sure am torn about the November 6 date.


Title: Re: ACI Surgery
Post by: gailg3 on October 12, 2002, 06:03:43 AM
To Jim, Linda and everyone else,  I agree that people who are doing well move on, as I have.  I only resently started checking back to this site b/c I wanted to tell people I was doing well actually.  While it is a long hard road and there is not guarantee, and I don't expect this to be a long term fix for my knee b/c I am so young, for now, my knee feels good.  
To Jim, I actually took 5 months off work, b/c I could.  I could've gone back sooner.  I was walking after 8 weeks.  I had pain when I tried at 6 weeks so I waited until 8 weeks.
To Linda as far as the flap problems, my OS modified the operation technique and only uses one long insicion instead of two as suggested.  He gets the flap from the top of the medial condyle of the femur instead of the shin b/c the quality of the periosteum is better.  It is thicker and holds up better.  
So I'm happy I had the operation overall.  Everyone has to make their own decision though.  Gail
Title: Re: ACI Surgery
Post by: noddy on October 13, 2002, 02:27:35 PM

I am 9 1/2 weeks post op from ACI.  My only other option to this surgery is a TKR.  My OS was very realistic when suggesting this surgery for me. He said that at worst, I would be no worse off than I am now and at best I will get some relief from the constant pain I have when walking.  I am only 47 so it was worth a go.  I am going back to work tomorrow and am unsure how I will fair.

The rehab is long and time consuming.  I go to physio 3 times a week and to the pool as much as I can in between.  You must follow the OS's instructions to the letter to get the best results.

I don't regret having the surgery and hope it can save me from a TKR at a young age.
Title: Re: ACI Surgery
Post by: jimbeaver on October 13, 2002, 08:48:42 PM
Dear all,

Thanks vm for your replies and kind advice!

I reside in Singapore and I believe I'm one of a few here who has this problem.  They have taken out a portion of
my cartilage and have sent in over to Australia for harvesting and processing.  My op for the implant will be
3 weeks after the harvesting.

I have decided to go ahead with it.  I have another session with my OS prior to the next op and I do have several questions for him,  having garnered some pointers through the postings here.
As mentioned in my earlier posting, I have lowered my
heightened expectations for this surgery.  I trusted my
OS entirely, and I take it that he will help me cure my
problematic knee.  But Im not so sure anymore, since this
is a very experimental surgery here.  

Having read the replies of gailg3 & noddy, I have turned positive again...but I know it's gonna be a long, hard, not to mention a painful road ahead.

Hope to hear from you guys on your progress, and I shall
definitely share my experience here too, since I will have plenty of time on hand during the rehab.   :-/

Wishing all of you a speedy recovery ahead!
Title: Re: ACI Surgery
Post by: Linda on October 15, 2002, 02:50:05 AM
Hello everyone,

Thank you for all the input. I saw my OS today for the check before the "BIG" surgery on Nov. 6. I am lucky and got an early morning surgery time. Now that I have decided that this is what I am going to do, the waiting is terrible. i am very thankful for the early morning surgery, because I don't think I could stand the wait that day.

Gail and Noddy, thanks for the positive input! I am in Colorado, and my surgeon does this relativly often. His success numbers are supposedly in the 95% range. Of course the 95% success is based on more function and less pain than prior to surgery. His success for returning to past activities is in the 80% range. All of those numbers sound better than what I am looking at with no surgery, so off I go.

Good luck to everyone!
Title: Re: ACI Surgery
Post by: noddy on October 21, 2002, 10:55:55 AM
Goodluck Linda

I am sure you won't regret it. Let us all know how you go.

Title: Re: ACI Surgery
Post by: Linda on October 21, 2002, 07:10:38 PM
Hello Noddy,

Thanks for the positive thoughts! That really helps. I was thinking about doing a journal here through the surgery recovery. I will be keeping one at home for sure.

Did your return to work come out okay? I only have two weeks off, but at least I have a desk job.

Did you do much pool work, and what type? I am hoping to use the pool.

Good luck on the rest of your recovery!
Title: Re: ACI Surgery
Post by: noddy on October 22, 2002, 09:24:07 AM
Hi Linda

My return to work is going well.  I am only working half days at the moment to allow for rehab.

My pool program consists of freestyle swimming as a warm up, stretches, walking in the pool both forwards and backwards, 100m backstroke, more stretches and warm down with 100m freestyle.  The swimming also helps to keep up your fitness levels. I try to do this about 3 times a week.

If you want to know anything else just ask.

Good luck

Title: Re: ACI Surgery
Post by: chr12t1ne on October 22, 2002, 03:08:38 PM
I had ACI Dec 01 and the biopsy was done Nov 01, 4 weeks prior to implant, you seem to have had your biopsy done in June?  I was told that impant had to be 3-5 weeks after biopsy, so what have they done with your cells in the meantime, are they frozen?  Just curious!
A few bits & pieces from me to help (I hope).  It hurts!!  I was given plenty of pain relief and I certainly needed it!  This, however, is short term stay positive the pain does of course ease with time.  You will be totally reliant on your crutches for a couple of weeks so remember you wont be able to make hot drinks, plates of food and carry them where you want, this proved tricky!  You will definitiley need someone around to help you for a couple of weeks.  I couldnt drive for 12 weeks but was back working in 2.  I had daily physio for 10 weeks, 30 mins session.  Everyone else has told you about rehab, it is hard work but a positive attitude is important and you seem to have this.  I am now scheduled for an arthroscopy in Dec to check the progress, this is standard where I had my treatment in UK but doesnt seem to be the case in US.  They have also told me I will probably have another one 2 years post surgery.  This is because the cells can continue to grow and they simply shave the area.  I have had synthetic patches and I did read that there is less chance of cell overgrowth with these!  Good luck, Sue
Title: Re: ACI Surgery
Post by: Linda on October 22, 2002, 08:07:07 PM
Thanks Noddy. I hope I will be able to get in the pool stuff as well. How soon after the implant were you able to start swimming? I had never done any swimming before, but took 10 lessons a little over a month ago to prepare. What do you think helped you the most during your first two months of recovery? After a little over two months, are things starting to feel better? Do you feel that you are headed toward a positive outcome? Knee  replacement has been mentioned to me as well. I am 38, so they would prefer not to go that route yet. my hopes for the outcome is no longer to return to competitive sports. I do hope to be able to return to hiking and backpacking, and hopefully maybe some skiiing here and there. Pain releif would be great too.

Sue, I had the biopsy done June 4. They did freeze the cells after an initial check to see if they would be viable and grow. We knew that it would be a fight to get the insurance to okay this surgery. They are still calling it experimental. We finally got through all the insurance arguing and appeals about three weeks ago, and scheduled the surgery for Nov 6. They needed the time to thaw the cells and then complete the growing process. As far as I know there are no follow up surgerys scheduled, although I was told that it was highly likely that they would have to go in and do the shaving that you spoke of. They told me that it would not be any worse than the harvest surgery. That was a piece of cake (walked out two hours after - no crutches, and was back to regular fitness routine three days later with pain no worse than prior to surgery), so I am not concerned about that. Growing extra stuff is the least of my worries! thanks for the input about the crutches and hot plates! I am hoping that I am tough and the pain won't get to me too bad. I am kind of stressing over that point! I rent my parents basement, so there will be people around. I am moving up to the couch for at least a few days since there are too many stairs and no bathroom where I am. Why did they make you wait so long before you could drive? That might be the biggest problem that I have not planned for. What do you think helped you the most during the first two months of your recovery? Since you are now almost a year from the implant, how are things? Are they better than before? Would you do it again?

Once again, thank you to everyone that has given input. The positive and negative really helps. It is better for me to know what to expect, and look out for. I also feel better knowing what bad things to worry about, rather than just have an uneasy mind in general.

Good luck to everyone else out there! Reading all the things that everyone has and continues to go through just boggles my mind! The only small piece that I can offer everyone is that no matter how bad it gets, latching onto something positive always helps. There are many studies that seem to point at much better healing results when there is a positive atmosphere.

Thanks again,
Title: Re: ACI Surgery
Post by: chr12t1ne on October 23, 2002, 02:37:00 AM
It's interesting to see how this treatment varies across the globe I wonder if the surgeons have all agreed to experiment with different methods and then all get together at their conferences to compare notes!  No-one told me I couldnt drive, but it took me a while to regain reasonable ROM so physically couldnt.  My leg was in a full leg plaster for 2 weeks and when they removed it my leg was fixed and it took a lot of hard work to even get to 45 degree flexion.  After 8 weeks I had a mua to break down adhesions plus a couple of days in hospital on CPM and the recovery after this was very quick with gym and pool work.  In the US I notice some people have had a leg brace & CPM, I believe this is better than plaster cast!  Do a bit of upper body work as well, this helps with the crutches.  What helped afterwards was having as much information as possible which is how I stumbled across this site.  Everyone knows knee surgery requires a bit of hard work afterwards to aid recovery, I've had plenty so I know how tough it can be.  The pool initially was probably the easiest for me, providing you can get in and out safely, and then the static bike, plus of course all the standard stuff but you should be given a protocol to follow.  I had 2 grafts on the patella and 1 on the med fem cond and the arthritic pain relief is immediate, ignoring the surgical pain.  I can get to sleep now without that knawing pain you probably can relate to.  Like you I dont intend on returning to competitive sport and I cant say my knee is perfect that would be a lot to expect but I am glad to have had this surgery and think that there is still time for things to improve even further!  By the way you mentioned the bathroom hope you can get to the loo and have enough room to keep your leg straight!  A raised loo seat is a real bonus.  Sue
Title: Re: ACI Surgery
Post by: Linda on October 23, 2002, 03:03:30 AM
Sue, Yes, I am hoping that the Loo doesn't  prove to be too much of a challenge! It is not raised. I will be in a brace with a CPM machine. It will be interesting to see what the protocals will be in 10 years, or what else they will be doing for that matter! I am just glad that there is an option besides a knee replacement at this point! The leg they are working on is not the one that I use to drive with, so hopefully I will be able to get it in the car and still drive. Thank you again for all the encouragement, and info!

Title: Re: ACI Surgery
Post by: noddy on October 24, 2002, 09:49:57 AM
Hi Linda

I started swimming about 4 weeks post op. I didn't have my staples removed until then. It is good to be able to do pool work as you can work on your ROM and quad strength without putting pressure on the implant site and in a relative weightless situation. Don't worry if you can't swim. Just walking and bending in the water will be good.  Check with your physiotherapist about what to do.  Mine gave me the programme I follow.

The thing that helped the most, other than my husband who was invaluable, was the CPM and doing static quad work. It is hard to get the quads working and the range of motion happening.  Do as much quad work as you can before the op and this will help after.

Things are starting to feel better and those around me both at physio and friends and family say they can see the improvement in my movement. I feel that I will probably need an arthroscopy to remove scar tissue, but other than that I am very hopeful that all will be well.  You need to have realistic expectations and I feel that you do.  My hopes were that I can walk without the pain I have had for the past 4 years and get down on the floor and play with my grandchildren. My OS is positive.

Don't get frustrated if you are slow in recovering. That is the nature of ACI.  It takes a year or more to fully know if it has worked as the cells are constantly maturing. Rehab is a slow process and you must only do what your surgeon tells you.

I hope this helps. Feel free to ask me anything else you want to know.

Title: Re: ACI Surgery
Post by: Linda on October 28, 2002, 07:03:15 PM

Thanks for all the info! I hope you continue to improve. It sounds as though you are working very hard at it.

Title: Re: ACI Surgery
Post by: jimbeaver on November 25, 2002, 09:17:15 AM
Hello to all!  :)

Im into my 5th week after my Femoral Condyles ACI surgery here in Singapore.  The op went well, and much to my relief, the pain was bearable for me. (I was given morphine to control the pain after the op)

I was hospitalised for 7 days at the advice of my surgeon so that I can have medical stuff to help me monitor my progress on the CPM and the physio therapies.  My knee was iced throughout the night over the 7 days at the hospital so as to keep the swelling down.  

I started at 40 degrees on the CPM machine and attained 90 degrees by the 2nd week.  By the 4th, I achieved 130.

Im now on partial weight-bearing, walking on both legs but with the crutches.  My left knee had lost alot of muscles over the few weeks of inactvity, so I must "reintroduce" my leg to weight-bearing gradually.

My knee still swells, and there are some pain around the knee cap area, which my surgeon said was normal.  Im now looking forward to chuck my crutches away and going back to work next Monday.  In between I will have to go for my physios and doing progressive strengthening exercises on my own to gain back the strength on my left leg, and also to allow my knee to absorb shocks through harsher demands like climbing, squatting etc.  Im not sure if Im rushing through the protocol, but I do "listen" to my knee alot and only push as far as my knee can hold.

At this point, I am unable to tell if the op was a success in curing my cartilage problem as the rehab takes much longer than this, but Im glad that the pain prior to my op seemed to have gone, and the pain from my op wasn't as fearful as I had expected.

There is still a long way to go, but I certainly look forward to the day I can play basketball & soccer again!

Keeping my fingers crossed!

Title: Re: ACI Surgery
Post by: downhillrunner on February 23, 2003, 04:28:36 PM
Hi all

put off my medial compartment ACI for a year - just plain scared and hoping putting off will not cause area of damage to increase / become inoperative...?

Scheduled at the same time is a tibial osteotomy ( wedge of bone inserted to correct slight bow / take pressure off inside of knee)  -  anyone got experience of this dual op?

Having this done at the Agnus ortho hospital in shropshire - any one got experience of them?

Has anyone got back to FULL fitness following ACI?  I know this may be the wrong palce to look for succes stories - but you never know.
I thought this op. has been done for 10+ years in sweeden?

Questions, questions...

My only real advise to you all is "use it or loose it" however lightly you exercise you must regularly to prevent quads wastage / knee stiffness - Maybee I am just reminding my self to not put off because of a bit of pain...?

ramble mode off. ::)