The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - ACI & MACI (autologous/matrix-induced autologous chondrocyte implantation) => Topic started by: Vickster on November 16, 2010, 09:34:02 PM

Title: MACI practicalities
Post by: Vickster on November 16, 2010, 09:34:02 PM
Assuming my insurers play ball, I am due to be having a scope to assess suitability for MACI on 16 December and, if appropriate, the implantation at the end of January. 

In order to sort work etc, was wondering how long you MACI veterans out there had off work after both operations, how long on crutches, when cleared to drive, frequency of physio, when able to fly etc

Defect on left lateral femoral condyle, WB surface, assessed at  1.5cm2 when scoped in Feb - currently filled with fibrocartilage but never settled (result of falling off bike 14 months ago), still shows on MRI with damage to subchondral bone. I now have an automatic car, office job, but do need to travel from time to time for work (short and long haul) and I'd quite like a holiday next spring  ;D

I realise that everyone is different and depends on location of defectwould be great to have some ballpark ideas.  At the moment, I am assuming a week off work for the scope and 6 weeks for the big op?

Cheers in advance  :)
Title: Re: MACI practicalities
Post by: cdubb on November 17, 2010, 06:40:55 AM
I just had an ACI of my patella with an AMZ of my tibial tuburcle.  Defect location different obviously, but I also have the added osteotomy; however, that would probably leave weightbearing restrictions a bit closer to what you would experience than if I had just had ACI, as my aci alone would be FWB.  The AMZ is what restrictis my WB to allow time for the bone to heal.

The scope for the biopsy is a breeze. Had mine on a Tuesday and returned to work on Thursday.  There really isn't a reason I couldn't have returned on Wednesday though.  I never used crutches, walked out of the hospital pretty much status quo walking in.  A week is a bit excessive for just the scope.  Had some swelling for a couple weeks, but really, not much to the scope at all.  Can't say I actually had any increase in my normal pain at all and it actually felt better for a couple days due to all the numbing agents injected during surgery.

The other procedure, you'll need to play by ear based upon how your range of motion is permitted back to actually fit in a vehicle and how quickly you can come off narcotics. .  I currently am locked at 30 degrees being just shy of 2 weeks post op and cannot fit in either of our cars driver seat.  I put in for 6 weeks, but think I may be able to return by 4 weeks.  By that time, I think my brace will be at 45 or 60 and I think I can manage to get in one of our vehicles.  I'll still be on crutches for another 2-4 weeks at that time, but I anticipate pain should be more under control and narcotics greatly decreased by 4 weeks out.   I also have a sedentary, desk job.   I did put in for 6 week at the outset though in case I needed it.  It's easier to return earlier from an approved leave than extend one out if you didn't plan enough.   I'd say anywhere from 2-6 weeks for the 2nd procedure based on a large variety of factors of how you respond to surgery and pain control/management, how quickly your brace is unlocked to be able to fit in your vehicle and how comfortable in general you are with returning. 
Title: Re: MACI practicalities
Post by: Vickster on November 17, 2010, 08:04:39 AM
Thanks for your reply :)

I was thinking a week for the first scope, simply because I was signed off for 3 weeks last time (and not allowed to drive for 3 weeks), but good to hear.  I don't know if that OS was making sure I rested properly as I didn't after the injury  ::)  I did use the crutches on and off for a month as the knee was pretty sore (partial menisectomy and patella shave).  It is the week before Christmas so I'll just play it by ear, workwise, better I can work between Chrismas and New Year probably (loads of leave to take by end of year, but not a lot of chance of that)!

Any idea on flying, when discussing AMIC with the first OS (not done as insurance wouldn't cover), he said no flying for 3 months due to DVT risk?  I may not need to fly for work but I want to plan a holiday for some point next year, probably long haul
Title: Re: MACI practicalities
Post by: cdubb on November 17, 2010, 03:00:39 PM
Really talk w/ your OS about flying.  I know that there are people on these boards who fly to see their surgeon and have surgery out of town.  I think some of them have mentioned being able to fly home in about 3 weeks...but really not sure at all.  I would also think there would be different protocols that different OS's follow with that. The amount of swelling that you have may also play into and what sort of anti-coagulation therapy that they do afterwards, which may play into when you are releaesd to fly.  Mine just required I take an aspirin/day for 2 weeks, but I really think that was actually more for the osteotomy than the ACI because my entire leg from thigh to ankle was (still is somewhat) awfully bruised from the bone cut. 

You may respond differently to the biopsy scope than I did.  Mine was so easy that I even decided to have my right knee scoped at the same time as my left knee ACI/AMZ to assess the defect in that knee and determine a plan for that and get a biopsy taken if need be.  Genzyme was called during surgery and they had enough sample from initial biopsy though.  That knee also has a grade 4 patella defect, so some patella clean up was done to the right knee when the left ACI/AMZ was done. Only reason I felt comfortable doing both knees at same time was because of how easy the left biospy scope was...and it worked out just fine.

Good luck and I hope your insurers play ball!  I was worried after my scope that my insurance company would squawk a bit since it's a patella ACI and they don't always like to cover those...luckily, it was approved in less than 2 weeks from submission. 
Title: Re: MACI practicalities
Post by: Vickster on November 17, 2010, 03:19:15 PM
Thanks again

The insurers do seem open to covering as it would seem to fit their criteria but they have requested some very specific information from the OS which is taking a while to obtain as he is somewhat busy and his sec hasn't seen him for a while!

I didn't think the success for patella grafts was great due to shearing forces, but they so seem to be done ... my patella wear and tear is 'only' grade III, had a short back and sides, and although pops and grinds every time I bend my knee, my other OS told me not to worry about it!
Title: Re: MACI practicalities
Post by: Rennschnecke on November 17, 2010, 04:12:48 PM
Hi Vickster

You may be on crutches for 6 weeks but it could be more.  I think thevoice was on crutches for 6 months.

People have returned to work after 2 or 3 weeks with adjustments.  You may have a lot of physio to do and you need to ensure you can ice and elevate the knee appropriately.  Most people tend to return part-time first and some have moved their offices to the ground floor as well as arrange for disability parking at work.

OSs may have different criteria for returning to work.  Sometimes it is a standard 6 weeks after major surgery as long as you are also comfortable.  Some say you need to be off narcotics.  Whichever, the insurance company asks that the OS confirms you are fit to drive or it is invalidated.  Your ability to drive may be limited more by your brace than anything else.

Physio frequency seems to differ according to each physio's approach.  I had physio once or twice during the first 6 weeks then once a week or two thereafter – but I was discharged after only 4 months when I was still on crutches (this was a major beef for me so I won't go into detail).  Physio can be more intense so you need to check with your own particular set up what will happen.

I know people have gone on holidays flying quite early on e.g. 5 weeks post-op, but you may need to have a wheelchair to get around.

The recovery from ACI varies quite a lot from person to person.  If it were me, I'd apply for as much leave as possible to allow yourself the maximum time to concentrate on rehab.  You have to play so much by ear.  It could just be me, but I was able to run quite well by 6 weeks post-ACLr so this journey has been really hard.

If you ask your OS they will give you the minimum periods before you can do the things you've asked about.  If you plan your life on this you need to assume that everything will go smoothly on your recovery, and you're best placed to assess how happy you are with this approach.

Best of luck with your forthcoming op!
Title: Re: MACI practicalities
Post by: Vickster on November 17, 2010, 07:46:32 PM
Cheers Renn - invaluable feedback as ever :)

 Work will be reasonably flexible I am sure, having with the company for 10 years, entitled to plenty of sick leave and a friendly GP who will sign me on/off as required

6 months on crutches  :o  6 weeks will be bad enough.  I'll need to find a local physio (as the OS is 60 miles away around the M25  ::) ), doubt the current one has much experience, but can see.  Seems to know his stuff and he has never been overly aggressive on rehab so far, so hopefully be fine.  Am single and live alone in a house with stairs and no downstairs loo so I'll have to decamp somewhere for the second stage!  Going to be a logistical challenge to say the least!

Going to be difficult to ice and elevate leg at work, the building does have a lift, and undergound carpark accessed by said lift - and I have a nice big space to be able to open the doors wide (3 door Golf, so nice big doors but lowish )

Not going to book a holiday, but good to plan and have something to look forward to :)

I'll wait until the insurance signs off and then quiz the OS for the details :)
Title: Re: MACI practicalities
Post by: cdubb on November 18, 2010, 06:05:20 AM
Patella ACI's do have lower success rates, but recent studies show that when combined with the antermedialization of the tibial tuburcle, success rates jumped from 50% - 80%.  Which is why I  had the AMZ done in conjunction with  my patella ACI.  A lot also depends on the location of the defect on the patella.  A lateral defect may respond well to an isolated AMZ, but my defect was central to medial, so the isolated AMZ only carried a 50% success rate, but if I hads the ACI in conjunction, success rates increase to 80+%.  Going into my biopsy scope in August, I actually didn't know if I would be leaving with just a scope and biopsy or if the AMZ would have been done and microfracture was even a possibility.  MRI showed a lateral defect, but it was actually central to medial (in's half my kneecap if you look at my operative photos of the defect and the patch). 
Title: Re: MACI practicalities
Post by: KartBoy on November 18, 2010, 11:51:01 AM

I'm in twelfth week after Femoral condyl MACI, non-weight bearing for first four weeks and partial for next two and in brace for most of that time. I drove for the first time at eight weeks, partially because you have to be able to get into and out of car which is still fairly slow process and needs plenty of space to get door fully open. I wanted to be confidant that I could put maximum pressure on brake for emergency stop without any pain before I felt safe to drive. I'm a consultant and could work part-time after about ten weeks but it depends on how much medication your on and what side-effects/ tiredness you feel. I still don't sleep well so full days work is still not possible. I assume the operation is at Stanmore or nearby private (e.g Bushey) by one of their consultants but you shouldn't have much problem with finding a local physio which you really need, even if inexperienced with MACI they will get detailed info from hospital, I'm using NHS physio who has been really great, didn't have any prior experience but just called Stanmore a few times to clarify what was in the notes and everything has been fine.

All the best, I'm still recovering which means lots of work to rebuild quads which haven't really had much use in operated leg for over two years but so far operation has transformed things, in much less pain and more mobile. If I can get off the last of the meds then hopefully will sleep better and all will be well. It was a long wait and major struggle to get the operation but it seems well worth it as I write these words.


Title: Re: MACI practicalities
Post by: Vickster on November 18, 2010, 02:04:12 PM
Thanks Andrew

Yes, likely at Stanmore / Bushey assuming it happens

My function is actually quite decent - can walk, albeit not that quickly and I can feel the knee all the time, and can use the static bike / XT but none of it is very comfortable or fluid and I have seen no improvement for what seems like forever (probably the last 6+ months) - plenty of ups and downs, the knee never feels right and is always puffy but some days are ok but other days plenty of discomfort, burning, stiffness.  I cannot squat or kneel or jog/run.  My quads and calves are ok as I have been able to use the bike, albeit not as much or as well as I would like.  I don't sleep as well as I would like either, partly due to the knee (uncomfortable when I lie on it) but stress too, both knee and work related

My local physio is good, and of course, there is the local OS in case of issues, so that's of less concern - only a 5 minute bus ride away too - so much easier than Bushey!

Good luck with your continuing recovery, sounds like you've had a tough old time of it

Driving wise, I have an automatic car and is my left leg that is gammy, so braking is fine
Title: Re: MACI practicalities
Post by: KartBoy on November 19, 2010, 10:08:10 PM

You actually sound like a good candidate, suggest you get that holiday in early. It will help you get through initial recovery if you have recent happy memories to dwell on. I haven't been able to kneel for almost three years and look forward to being able to hand back cane to NHS one day sooner rather than later. You probably won't need access to OS after surgery but local physio that you trust is major positive, they will get all they need from Stanmore/ Bushey and just need to call if you/ they have any queries after your op because everyone is different.

Make sure you get an extra couple of pairs of anti-thrombosis stockings, they keep the leg warm and helped keep swelling down in those first few weeks, The other option would be thick ski socks, anyway thats a digression, all the best getting the insurers on board.
Title: Re: MACI practicalities
Post by: Lottiefox on November 19, 2010, 11:22:25 PM

One of the members on here, Cricket, has a fabbo blog about her femoral ACI. Here:

She has posts with Things that I wish I'd thought of, and essential things to get prior to surgery! Really useful information. Its a warts and all account but she is 7 months out and doing great....

Lottie x ;D
Title: Re: MACI practicalities
Post by: Vickster on November 19, 2010, 11:30:26 PM
Cheers Lottie - I assume no gruesome pics?  :o

And thanks again, Andrew :)
Title: Re: MACI practicalities
Post by: KartBoy on November 20, 2010, 09:50:46 PM

I've seen Alison's blog and its a good reference, there are a few gruesome pics but your warned which ones to avoid if you have a delicate stomach.

Title: Re: MACI practicalities
Post by: JuhaH on November 21, 2010, 03:46:51 PM
Hi there,

I have also damage in my articular cartilage due to the meniscectomy about one year ago. I was in skiing accident in january 2010.

What did your OS say about ACI treatment after meniscectomy? I have only 20% medial meniscus left and I'm thinking that is it possible to have ACI surgery without medial meniscus?

Thanks in advance and good luck.
Title: Re: MACI practicalities
Post by: Rennschnecke on November 21, 2010, 03:52:33 PM
As far as I know ACI is performed only if the other structures in the knee are intact.  However, ACI is done alongside other procedures, e.g. ACLr, meniscus transplant etc.

DennisBadKnee has had ACI with meniscus transplant and may be able to comment more on your own case.
Title: Re: MACI practicalities
Post by: Vickster on November 21, 2010, 06:13:27 PM
Not mentioned, but it's a different OS to who did the menisectomy (only 10-15% removed apparently) - this new chap is of course aware of the previous surgery.  It wasn't the meniscectomy that has caused the damage, the meniscus got torn at the same time as the cartilage damage
Title: Re: MACI practicalities
Post by: mlashmar on November 23, 2010, 08:19:11 AM
Hi Vickster

Sounds like you've got a good situation regarding return to work.  General rule seems to be about 6 weeks, but worth making arrangements so that you may work from home if you can (you may get bored within the 6 weeks or may feel that you would like to remain at home longer to concentrate on physio).

Regarding holiday, I booked to go to Dubai last for the end of October, about 2 months post op.  I had booked it well before the op was scheduled.  The holiday did give me something to look forward to, but it also put a strange pressure on the recovery process.  In the end, I cancelled the holiday, My physio and I didn't think I'd be able to deal with the flight (bending the knee etc) and when I got there, I wouldn't be able to do anything.  I actually felt relieved to cancel the holiday rather than disappointed!  Insurance covered it, but I lost admin fees from Opodo and there was also the excess, all in all about £75 was lost.  I'd suggest holding fire on booking something until you know how things are going, at 3 months I'm confident I could now go on holiday and have a good time of things so I''d feel confident booking a holiday now, but only 3-4 weeks ago I was still walking with crutches and uncomfortable when my knee was bent.

Title: Re: MACI practicalities
Post by: Vickster on November 26, 2010, 01:48:12 PM
Update - the insurance company have agreed to the MACI - scope on 16th December and then the second op on the 27th January if appropriate.  Eek!
Title: Re: MACI practicalities
Post by: KartBoy on November 28, 2010, 01:39:11 PM
They know what they are doing the Stanmore/ Bushey consultants and must have convinced the insurance company it was worth it and that is the attitude to take, any surgery is scary but I haven't regretted my MACI for a second, Prof Briggs told me it was a way better alternative to knee replacement and so far he has been 100% right.

Exercise as much as you can to strengthen the quads before the operation, wastage isn't a problem but the stronger they are the better and stock up on dvds/ book for the first few weeks as you will be as bored as ... we all have been in those first few weeks.


Title: Re: MACI practicalities
Post by: Vickster on November 28, 2010, 03:00:06 PM
Thanks Andrew

I am still using the gym - cycling 20 mins 3 x a week, as well as 10 minutes on the XT or today the treadmill (which my knee still hates  ::) ) .  Also a couple of 15 rep sets on the leg press

After the scope, I am hoping to be off work for a week as I will need to work between Xmas and New Year most likely.  I haven't quite figured out likely time off after the second op - seems to be very variable - will need to have that conversation with the OS when I know it is actually happening.  I have said 6 weeks to work, but that might be optimistic from what others have said?  ???

I have now set my sights on a 2 week trip to the West Coast USA in September - the original plan was May, but that isn't going to happen if I have the MACI!  Would be a driving trip, and I should be able to fly premium economy at least so more room
Title: Re: MACI practicalities
Post by: cdubb on November 29, 2010, 05:40:27 AM
Depending on what kind of job you have, 6 weeks should be plenty.  If you have a job where you are on your feet a lot, then more time llikely required.  If it's a desk job, you should be alright.  I'm returning 4 weeks from my ACI/AMZ, but from home for 3 days, the following week half days in the office and finishing up half at home and then the following week to the office full time.  That would be me full time in the office 5 weeks, 5 days post op.  My biggest obstacle is going to be getting from the parking lot into the building and then up to our floor, since I will still be on protected weight bearing and on crutches when I return.  I'll let you know how it goes as I return and if I change my tune....
Title: Re: MACI practicalities
Post by: Vickster on November 29, 2010, 07:55:59 AM
Thanks cdubb

Desk job, but won't have access to ice and will be difficult to elevate my leg simply because how the desks are designed.  I don't know how long I will be in a brace for, as I guess that will make driving challenging, even though it is my left leg and I have an auto car.  Parking not an issue, I have a big space so should be able to open the doors wide and the car park is under the building with a lift to my floor.  I will have to see what the surgeon says.  When I was talking to the first OS about AMIC (didn't happen due to the insurance) he said it would be 6 weeks off.  I was signed off and no driving for 3 weeks after the scope in Feb.

I think they tend to be more conservative in the UK, it's a 2 night stay here after MACI usually, while in the US seems to be day surgery
Title: Re: MACI practicalities
Post by: CR_UK on November 29, 2010, 01:34:16 PM
I started driving at 4 weeks with brace on as was allowed full ROM and the car automatic. Short trips only 10-15 minutes as got uncomfortable sitting with knee bent if longer. So if your workplace not too far you may be able to get to work OK despite the brace.
Title: Re: MACI practicalities
Post by: Vickster on November 29, 2010, 01:45:45 PM
Thanks CRUK.  It's around 5 miles, but in the rush hour, the drive can take 30 minutes!  Got to love suburban Surrey traffic.

Where is your defect located, also on the femur?  How long before you were back at work?  Getting to follow up appointments is going to be interesting too, as I am 60 miles from Bushey, although there is a direct train service from my local station, which I shall be trying out on the 16th!
Title: Re: MACI practicalities
Post by: cdubb on November 29, 2010, 03:14:21 PM
Icing and elevation will be somewhat difficult for me too when I return, but now at 3 weeks, 5 days out, I only ice 1-2's day anyway since swelling isn't really isn't much of an issue at this point.  Although, I'm sure once I return to work, the leg will get fired up and swell a bit more since it will be down so much more through the day. 

I have also noticed that the UK is more conservative with some things like hospital stay.  I was out the door and heading home and hour after I woke up from surgery. 

Driving could be a challenge depending on the range that your Dr. permits you to have with the brace and the progression.  I am still at only 45 degrees in my brace and I could get in a drivers seat, but it would be a challenge, but on Friday I get unlocked to 60 and I should fit much better. 

So, you'll probably be able to return ealier than 6 weeks, but if it's not a problem getting it and you don't feel any  pressure from your employer, take the full 6.  I felt somewhat obligated to return earlier (self induced...not pressure from employer) because just before my leave I was promoted, so I kind of feel I should get back as quickly as possible to get settled into my new position.
Title: Re: MACI practicalities
Post by: Rennschnecke on November 29, 2010, 07:03:08 PM
I'm going to be repeating myself here, but some people have been known to return to work from 2 weeks post-op with adjustments to location and/or hours.  The ability for anyone to return to work depends on both their work and their recovery rate – there are no guarantees.

Assuming that all goes well, you will still need to ensure your pain, heat and swelling are controlled.  Icing and elevation are very important for that.  Uncontrolled inflammation can increase the risk of adhesions forming and can lead to complications.

Also important is the time required for doing your PT.  My regime for the early weeks was pretty full on with CPM and other exercises.  Even now at 10/11 weeks post-op (different procedure), I am spending up to 8 h a day on my PT.  Can't fit in my work and that is something I could do at home.

Vickster, you really ought to check with your OS to see what they say.  If they give you a minimum of 6 weeks till you can drive, your insurance is likely to only cover you with that condition.  I know that after my scope I was told I could only drive after 2 weeks and only if comfortable (e.g. no pain or swelling).  After my ACL I was told I could not drive for at least 6 weeks.  I could have driven without cover at 2 weeks post-ACLr, but I'm still testing out whether my knee will stand up to driving short journeys to the gym near home after my scope.

I know you want to make plans, but your minimum constraints will be set by your OS.  BTW the sick notes are now different, they no longer give you a blanket time off work but will also stipulate under what conditions you may return to work, e.g. time off for PT, elevation etc.  If things are better for you you can negotiate with your GP at that point.

Title: Re: MACI practicalities
Post by: KartBoy on November 29, 2010, 07:28:30 PM
See what the OS says but I would think six weeks would be a minimum, I kept my leg elevated the whole time I was non/ partial weight bearing unless I was doing physio exercises icing on a regular basis, no way was I safe to drive at six weeks, I had as little as 60 degrees of rom in the first few weeks and while it came back quickly once I started active physio no way would I have wanted the stress of thinking about returning to work in those early stages.
Title: Re: MACI practicalities
Post by: Vickster on November 29, 2010, 07:29:42 PM
Thanks Renn.

I can take the time off as required.  Under the terms of my contract, I am able to have 16 weeks off sick a year.  Doing 8 hours of PT a day is going to be a challenge. I will be able to wah and go to appointments as needed, but to be effective in my job, I will need to be in the office at least part time.  I am also not a big fan of working at home, not really set up for it.  I can get to work on public transport, but involves walking and stairs, so also not ideal (especially if it's as cold as it is now  :o ).  I am hoping to be able to work between Christmas and New Year, but if I can't then so be it.  OS sec said a week off is usual, so that will work fine as will have more like 11 or 12 days.

I will of course quiz the OS once I know the second stage is actually happening - not a given until the scope

I realise everyone is different, but I thought that the Bushey/Stanmore femoral condyle MACI veterans could give me some extra pointers :)
Title: Re: MACI practicalities
Post by: Vickster on November 29, 2010, 07:57:52 PM
Another question on the PT front...

When do most people start post op.  My plan is to go and stay with my parents for a bit - I'm single, live alone in a house with no downstairs loo and only a shower over the bath, while my mum makes a smashing cup of tea, is a great cook and, more to the point, they have a downstairs bathroom with a walk-in shower  ;D

However, they are in Oxfordshire about 100 miles from me  and about the same from Bushey.  I obviously want to stick to the protocol, but depending on when (instructed) PT starts, I will need to look at possibilities local to them (there is a hospital in Oxford which is part of Active which gives me an option, albeit temporary)!

Apologies for all the questions - I do like to have all my ducks in a row  :D  Been waiting for this to be agreed for months!

Cheers :)
Title: Re: MACI practicalities
Post by: Vickster on December 01, 2010, 10:40:07 PM
Found this with some Googling, answers quite a lot of questions (not Stanmore but UK)

HR asked for some details, might send to them as well (not many gory pictures  :o)
Title: Re: MACI practicalities
Post by: Vickster on December 17, 2010, 01:57:10 PM

I had the scope yesterday but am not going to be having the second stage - the femur defect fibro is still of decent quality but more importantly, there is extensive softening of the cartilage on the tibia opposite - with kissing lesions, the OS thinks the chance of success are simply too low to put me through the op and rehab.  He performed chondroplasty and gave me a hyaluronic acid injection which he is confident should help.  He talked about an osteotomy being a future option to shift the weight from the affected lateral side to the medial side which is ok. in the short term I need to get over the scope (very sore and swollen today) and see if strengthening the muscles further with static cycling helps.  So I'll be getting an exercise bike for Christmas!  I see him again for follow up in 6 weeks so can discuss the options further.   So a somewhat unexpected outcome but a potential option for the future :)  3 weeks off work for me and then time to plan a spring holiday!
Title: Re: MACI practicalities
Post by: Rennschnecke on December 17, 2010, 03:38:32 PM
Hi Vickster,

Good to hear that your OS is trying to spare you the long rehab from MACI with low possibility of success.

I was in your position 2 years ago and had chondroplasty but I didn't have the hyaluranic acid injection.  I also had a hemarthrosis following the arthroscopy so recovery was complicated and didn't go too well.  As a result, I was put on the list for MACI for kissing lesions, but in the PFJ.  I'm guessing that kissing lesions at the condyles are subject to more stress as they are weight-bearing.

It's lucky ( ???) that your lateral side is affected so that an osteotomy is an option.  I just hope that it isn't needed and that your cartilage holds up for a long while yet.

Take care over Christmas and enjoy the holiday!
Title: Re: MACI practicalities
Post by: markld on December 28, 2010, 09:55:03 PM

MACI can and has been used for kissing lesions. It sounds like your surgeon doesn't have much confidence. Here in the US Tom Minas performs ACI to kissing lesions quite often and has great success with it. It is a matter of finding a surgeon who has lots of experience.
Title: Re: MACI practicalities
Post by: Vickster on December 28, 2010, 10:06:47 PM
Hi markld

I don't think confidence is his issue here, he has done 100s of MACI ops (including plenty on members of this forum), one of the leading OS's in the country doing cartilage repair.  I have a lateral femoral defect which is full of fibrocartilage (which developed after the initial trauma and is in decent condition according to the two OS who have scoped my knee), plus the extensive and diffuse grade 1-2 softening on the lateral tibia (no full thickness).All on WB surfaces unfortunately - I think that is the main contraindication here, not the fact the lesions are kissing

I also have grade III damage on the lateral facet of the patella.  It does seem to make sense that there is some malalignment (the OS did recognise a slight genu valgus / knock knee on initial exam) and that maybe an osteotomy is the way to go.  I am hoping the tidy up and Durolane injection helps.  I will be glad to be rid of the scope stitches tomorrow too! 

I see the OS at the end of Jan, so can talk next steps then.  I am inclined to leave anything until at least October as I want to spend the summer cycling on the bike I bought for myself today  ;D  This will also build up the leg muscles which should also benefit the knee obviously  :)
Title: Re: MACI practicalities
Post by: Rennschnecke on December 28, 2010, 11:13:55 PM
Hi Mark

I think Vickster may be correct in her assessment of risk.  The guidelines here embargo MACI for kissing lesions although I was granted an op for kissing lesions after my OS consulted with international colleagues.  However, mine were in the PFJ which are non-weightbearing when static.  Even so, I am regarded as well beyond operational guidelines for the UK surgeons, but I guess it can be justified in the name of research.

I have researched this op and believe that kissing lesions that are treated are more likely to be in the PFJ – open to learning otherwise.  If the lesions are the result of malalignment then this needs to be sorted out otherwise the defects may occur again.  If the malalignment can be corrected by an osteotomy then there may be no need for a MACI as the forces through the joint will be changed.  I guess the conservative approach would be to go for the osteotomy and see what the result is.  If a MACI is still needed then it could be reviewed then in the light of further knowledge.

I have to say, if she can get relief without MACI I'm all for it!
Title: Re: MACI practicalities
Post by: KartBoy on January 04, 2011, 08:22:25 PM

Your in good hands at Stanmore/ Bushey and if they don't think its worth going forward then I too would be inclined to accept it. I think its worth rembering that MACI/ ACI is still really experimental surgery and although many of us (me included) have benefitted there is still much to be learned and they don't know enough yet to be able to fix all knee cartilage failures, its is good to hear though that there are still options going forward and I wish you all the best for the new year.