The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - ACI & MACI (autologous/matrix-induced autologous chondrocyte implantation) => Topic started by: Ellie on April 11, 2015, 06:17:25 PM

Title: Treatment for focal area cartilage loss
Post by: Ellie on April 11, 2015, 06:17:25 PM
I have a “focal area” of full-thickness cartilage loss behind the inferior lateral patella, and no other knee issues; this occurred over time from a bad habit of overextending.

Has anyone had successful treatment (non-surgical or surgical) for this type of issue and what was the recovery time?  PRP in particular?

Due to a recent lengthy recovery from a different issue, I’m way behind the exercise curve and my bone density has been dropping, so I’d hate to have another year-long delay before returning to weight resistance exercise; but I still want to do the right thing whatever that is.  (I guess we’re all hoping for a quick fix, right?)

Any thoughts greatly appreciated.
Title: Re: Treatment for focal area cartilage loss
Post by: willrunagain on April 14, 2015, 02:38:23 PM
I am in a similar situation.  I have a focal full thickness cartilage loss in the center of my right patella.  The rest of my knee joint is in perfect shape.  My OS recommended Denovo NT.  He said non-surgical routes won't work unless your goal is to just manage the pain and remain inactive.  However, I am about to travel to Indianapolis to get an opinion from Dr. Jack Farr.  He is doing a procedure called Cartiform on patella lesions that seems create superior repair tissue when compared to Denovo. The biopsy results actually showed 85% hyaline cartilage tissue repair.  The procedure has only been out for a year. Here is a link with more infomation:
Title: Re: Treatment for focal area cartilage loss
Post by: Ellie on April 14, 2015, 04:32:09 PM
Willrunagain, many thanks for this information.  My OS also uses Denovo... I will ask him if he has heard of Cartiform.  Please keep me posted on your progress.

Ellie (in Virginia)
Title: Re: Treatment for focal area cartilage loss
Post by: willrunagain on April 14, 2015, 09:43:21 PM

I feel your struggle.  I have been researching the hell out of all my options because I don't have any pain with ADLs and can even cycle up to 70 miles a week.  My ultimate goal from a cartilage restoration surgery is to be able to run again and do some recreational impact sports (ie basketball, softball, volleyball).  My first OS recommends I never do impact sports again which is something I will NEVER accept, being only 26 and a former competitive runner.

There is only one poster on knee guru as far as I've seen who had Cartiform.  He had it on a medial patella defect.  He stopped posting at 4 months post op, but seemed to be doing very well.  I have so far been unable to get in contact with him.  This was the original thread:

Title: Re: Treatment for focal area cartilage loss
Post by: JKG3 on April 30, 2015, 03:43:54 AM
I'll be interested to hear more about the Cartiform. I don't know if I have exactly what you's a relatively small area of full thickness cartilage loss behind my patella. I went to see Tom Minas who does cartilage replacement surgery in Boston and unfortunately he said I was not a candidate because I did not have enough cartilage left on which to grow new cartilage, and because the area where the cartilage loss occurred gets a lot of wear and any new cartilage he might try to grow there would be worn off instantly as I tried to rehab.
Title: Re: Treatment for focal area cartilage loss
Post by: willrunagain on April 30, 2015, 04:33:04 PM

I have a 2x2cm defect right in the center of my patella.  I saw Dr. Jack Farr this Monday and he told me I would be a great candidate for cartiform.  He has performed 8 of these procedures and of the 6 he's followed up with they have all had self reported good or excellent outcomes at the 9 month mark.  He quoted me a 85% success rate, so I went ahead and had him send the letter to my insurance to try and get it approved ASAP.  The good thing about cartiform is it is much more likely to get approved by insurance because it falls under the osteochondral allografting code.  Not the same can be said of ACI or Denovo, which are difficult to get insurance approval for.  I think cartiform is really a game changer.  There hasn't been  much research because it is so new, but the one study comparing it to Denovo showed superior tissue morphology (91/100 vs 51/100).  Also, histology results in a clinical study of a trochlea showed repair tissue with 85% hyaline cartilage (not just hyaline like, ACTUAL Hyaline cartilage).  I have really been trying to get the word out about cartiform on knee guru.  There is only one post op diary on here for it. I truly believe it should take the place of ACI and Denovo.  They are now obsolete treatments in my opinion.
Title: Re: Treatment for focal area cartilage loss
Post by: Ellie on April 30, 2015, 06:01:22 PM
willrunagain, you have really worked hard for this...I hope everything goes in your favor.  Thanks for the update. I'm keeping all of your information for my own future reference.  I'm in the starting stages of PT right now, which of course they'll require me to try all conservative measures initially.  Good luck!
Title: Re: Treatment for focal area cartilage loss
Post by: jess07 on September 13, 2016, 02:20:01 AM
Could you tell me more about Cartiform? I see Dr. Jack Farr this Friday actually. Do you like him pretty well? I here nothing but could about him. I had an ACI july of 2015 with another surgeon. I like him a lot, really good doctor, but I have not had the best results from my ACI. I did realize going into this that because I had a long past of chronic patellofemoral knee pain (since 2008) from overuse of running on my knee and malalignment of the knee resulting in four surgeries prior, I knew that I would never be "perfect" or feel exactly the same again. That is just unrealistic and my doctor stressed this to me. Also evidently ACI is not identical to articular cartilage, so you have to take all this into account. So I knew all this, but was willing to try anything to get better! Its hard to rate my success. I feel like walking pain did improve. But I can't walk super fast or it is painful. Went to an amusement park this summer and was on my knee for 8 hours and it didn't hurt. So the walking was definitely coming around. However anything functional is out of the question. Stairs, squats, lunges, or anything that involves the slightest bend in the knee is very painful :/. I feel like a grandma climbing and going down stairs. As I said my doctor did what he could on his part, I believe he is a great surgeon, but I am learning that there is more advanced stuff out there. Dr. Farrs office looks very advanced. Maybe there is something out there for me that could get me even better. With as much pain as I had post surgery it was still hard to get through therapy and get strong. I am strong than pre surgery but I need to be stronger. I'm only 23 and the thought of living like this the rest of my life makes me cringe. I want to be able to start living life and not have to put restraints on my life. I can accept not running again, sports, or working out hard core. also had a huge flare up with my knee at the end of August and not much relief. So I am just worried and still not where I want to be. Its just hard for me to accept that this is "as good as it gets" As I said I'm only 23 and do want to be able to do more things with my life in the future. Maybe you could email me? Would love to hear more info on the cartiform!
Title: Re: Treatment for focal area cartilage loss
Post by: mknmaa on September 13, 2016, 06:10:19 AM
Hi Jess07! Your past surgical history is very similar to mine.  I saw Dr. Farr last September, after a failed ACI.  I had an AMZ, however, it was determined that I was only medialized- which I did not need to be.  This caused my patella to maltrack even more so than it had in the past.  I was never anteriorized- which is what I DID need. Needless to say, my ACI failed very quickly mainly due to my botched AMZ. 

I was very interested in cartiform, or maybe another cartilage regeneration procedure, as I knew my only other option would be a PFA (patellofemoral arthroplasty- partial knee).  Dr. Farr told me that I was not a candidate due to the fact that I had an ACI.  He said that since it had failed, the chances of any cartilage regeneration succeeding was extremely low.  The two options he gave me were either a PFA or an allograft.  I opted for the PFA because the thought of another failed procedure was depressing- also I would have to wait for a donor- which could have been months.

Sadly, I've had nothing but problems since my PFA.  I'm in more pain than I was before the procedure.  I can't stress enough how much I despise Dr. Farr- sorry to be so discouraging.  When you first meet him and all is going well with the recovery, he's tolerable.  The first time you question if something is wrong, he is very confrontational, complacent (stuck in his ways), and dismissive.  It seems to be a power trip, and he doesn't want to admit he's wrong.  He's extremely arrogant and has zero compassion.  He also contradicts himself constantly to avoid having to admit wrongdoing. I have more issues now than before surgery- like my patellar tendon rupture.  My tendon is clearly to the side, and he told me it was normal for six months after surgery- even thought it wasn't like that initially after surgery, but happened during my rehab after I felt a pop.  I told him I had the same ripping and bone pain. He said, "I did cut your kneecap in half and cut a huge osteophyte off." When I brought it up at my next appt, he said, "that's impossible, bone doesn't have pain."  I've never had a doctor make me feel like such a hyperchondriac- when I know I'm not.  He told me that if it were up to him, he would never treat patients who have already had surgery because they think they know everything.  He mentioned doing a revision, but in the end, he wanted to pawn me off on one of his colleagues to do a total replacement.

I have an appt. on Oct. 6th in Chicago with a reconstructive and replacement specialist to see if he can fix what Dr. Farr screwed up.  I'm not trying to scare you. I just want to prepare you for what you can possibly expect. 
Title: Re: Treatment for focal area cartilage loss
Post by: jess07 on September 16, 2016, 11:22:33 PM
Darn. I am glad I read your reply. That does scare me. I saw him today, but felt a bad feeling in my gut. As you can see I have had an MPFL reconstruction, lateral release and an AMZ and ACI done together. He said everything was wrong. That he wanted to do a lateral retinculum tightening since I had it released in the past and maybe undo the MPFL. Plus he didn't like my AMZ either, said my knee cap was sitting too far down. The thought of having all this revised does really scare me!!! I don't know who to believe anymore or who to believe anymore! I am getting MRIs and special scans done. But the thought of changing all that does scare me! Glad you posted that. I might just not take any action. I am at the point where I might just leave my knee the way it is and suffer. I don't know if I trust anyone cutting me open again :( What is your thoughts though? Do you think my AMZ might possibly be botched from previous surgery or it is fine and he is wrong. I don't know who to believe ughh :( I am probably going to just leave my knee. Sad that I have to settle for less, but what can u do.
Title: Re: Treatment for focal area cartilage loss
Post by: jess07 on September 16, 2016, 11:25:42 PM
Also maybe we could email back and forth? Might be easier than trying to communicate this way.