KNEEtalk

The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: icarus on July 24, 2016, 11:14:09 PM

Title: Need Help on ACI/MACI! Re-tore ACL Graft, Menisci, and now femoral cartilage
Post by: icarus on July 24, 2016, 11:14:09 PM
Hi All,

I had a few questions regarding my complicated injury that occurred on Sunday. This is my second ACL tear. I am a 25 year old male and I live in San Francisco, CA, USA. They are with regards to an MRI report that I've pasted below my questions. answers to any of the questions would be REALLY helpful.

1) Previously, I've had no symptoms for cartilage damage, and I believe this cartilage damage is due to the injury. I am wondering whether surgeons would be willing to directly move to do ACI (autologous chondrocyte implantation) along with an ACL and meniscus repair. Will they force me to wait for symptoms to show up before they can perform ACI?
2) I think outside the USA, they use a technique called MACI. This seems much less invasive, so I was wondering whether any doctors in San Francisco or California for that matter do MACI.
3) How close is the monitoring of ACI post-surgery? Will I get an MRI every month to make sure there's no overgrowth and there is proper smoothness?
4) Are there any complications with Autologous Chondrocyte Implantation revisions?
5) If you notice anything else in my MRI reports below, please let me know!


1.Acute full-thickness tear of the ACL graft
2.Acute Mild sprains of the MCL, LCL, and PCL without tear
3.There is a complex tear of the posterior horn segment of the lateral meniscus centered at the previous lateral meniscal repair site. This tear has radial and horizontal components.
4.New vertically oriented tear extending through the posterior horn segment of the medial meniscus
5.Sharply marginated full-thickness chondral defect at the mid to posterior weight-bearing surfaces of the lateral femoral condyle measuring 12 x 34 mm in dimension. There is underlying subchondral sclerosis and bone edema. This is centered just posterior to an impaction fracture at the far anterolateral spects of the lateral femoral condyle where there is up to 3 mm of cortical depression. There is also full-thickness chondral fissuring and full-thickness incomplete chondral delamination.
6.Mild (grade 1 and grade 2) chondromalacia at the posterior weight-bearing surfaces of the medial compartment
Title: Re: Need Help on ACI/MACI! Re-tore ACL Graft, Menisci, and now femoral cartilage
Post by: bradyj7 on July 25, 2016, 04:16:46 PM
That is quite a bad injury, how did it occur?
Title: Re: Need Help on ACI/MACI! Re-tore ACL Graft, Menisci, and now femoral cartilage
Post by: icarus on July 25, 2016, 05:17:03 PM
Occured the same way as the first time I tore my ACL. Playing basketall and getting hit from the left side.

I guess once you've compromised your leg once, the second time is definitely the last.
Title: Re: Need Help on ACI/MACI! Re-tore ACL Graft, Menisci, and now femoral cartilage
Post by: Vickster on July 25, 2016, 05:23:48 PM
The damage does sound severe, a big defect, the damage to the subchondral bone is a potential issue esp on wb surface

ACI/MACI are similar, open surgeries in most cases, 2 year recovery. The rehab is v different too vs ACL, many weeks nwb and in a brace to protect the repair. ACL requires regain of ROM and strength more

This would give an idea http://www.kneeclinic.info/download/CKC_GNHFT_ACI_RehabGuide_101106.pdf

There are some newer cartilage repair techniques like cartiform in the US. Have a search around the site

I expect any surgeon would want a fully stable knee before repairing the cartilage, so ACL and meniscus fixed and fully rehabbed to avoid any risk of instability or buckling threatening the graft that needs a year or more to harden. I fear you have a long road ahead

Good luck
Title: Re: Need Help on ACI/MACI! Re-tore ACL Graft, Menisci, and now femoral cartilage
Post by: icarus on July 26, 2016, 01:52:36 AM
The damage does sound severe, a big defect, the damage to the subchondral bone is a potential issue esp on wb surface

ACI/MACI are similar, open surgeries in most cases, 2 year recovery. The rehab is v different too vs ACL, many weeks nwb and in a brace to protect the repair. ACL requires regain of ROM and strength more

This would give an idea http://www.kneeclinic.info/download/CKC_GNHFT_ACI_RehabGuide_101106.pdf

There are some newer cartilage repair techniques like cartiform in the US. Have a search around the site

I expect any surgeon would want a fully stable knee before repairing the cartilage, so ACL and meniscus fixed and fully rehabbed to avoid any risk of instability or buckling threatening the graft that needs a year or more to harden. I fear you have a long road ahead

Good luck

Thanks for the reply. Just had an appointment with a Sports med Doc and she basically recommended the same procedure you mentioned: First ACL and Meniscus repair, then 3 months later ACI implantation.

The other option (that might be limited by insurance approval) would be to first get biopsy and then do the ACL, Meniscus Repair, and ACI implantation, but she herself would not recommend it since as you said, she would want stable knees for the ACI implantation.

The only thing I forgot to address was the "delamination" She pointed it out, but she didn't comment on the plan of action to fix it.

I'm going to see more doctors, although this first one seemed to be a good one to proceed to surgery with, she is out of network.

Right now I'm leaning towards the second option of
1) Biopsy for ACI (hopefully no anesthetics are required)
2) General Anasthesia ACL Revision, Meniscus Repair, and ACI

The reason being that I have to go under general anasthesia one less time. However, I am wondering how traumatic is ACI during the second phase? It seems very invasive, but it doesn't seem that it should cause as much pain as the drilling during the ACL Reconstruction Post-op