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Author Topic: Surgery to replace cartlidge?  (Read 1544 times)

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Offline bbcygnar

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Surgery to replace cartlidge?
« on: September 08, 2005, 09:20:39 PM »
Hi Everyone,

I have a question.. Has anyone had a surgery where they put cartlidge back into your
knee? What surgery is it? What do they do?
My OS said I may have to have that surgery because of the arthritis under my patella
and on the side of my knee. Any info anyone could give me would be great..
Thanks
Brooke
Scope with LR -  07/13/05 
Scope with Harvesting - 11/30/05
ACI & TTT scheduled - 02/02/06
Married with three beautiful boys!

Offline blackbeltgirl

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Re: Surgery to replace cartlidge?
« Reply #1 on: September 08, 2005, 09:25:24 PM »
There are a few options, but it sounds like your surgeon is talking about ACI.  I will outline the basic options, and reference where you can find more info on each.

1) microfracture: they basically drill holes in the bone, in the hope that the bone marrow will generate a special type of scar tissue cartilage.  Often considered a first line treatment.  See the board on Bone Marrow Stimulation under arthritis.
2) ACI: also known as carticel.  In Europe they have also started the next generation, called MACI.  basically, they take a healthy piece of cartilage, send it off to a lab to grow more cells, and plant those new cells in your knee.  check out carticel.com for the basics, and the ACI (autologous chondrocyte implantation) board under arthritis.
3) Cartilage plug transfer, aka OATS: basically, depending on the size of your damage, they take a plug of healthy cartilage from you, or from a cadaver, to "fill the hole"  see the cartilage plug transfer board under arhtirits.

All of these procedures have lengthy rehab and recovery periods.  And in some cases, you may have to battle the insurance company to get approval.  Especially if your doctor doesn't want to try microfracture before trying one of the other 2 procedures.

Hope this helps.
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline bbcygnar

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Re: Surgery to replace cartlidge?
« Reply #2 on: September 08, 2005, 09:30:45 PM »
Thanks for the info Jess,

Is it an open knee surgery, or arthroscopic? How long is the recovery?
Do you have to stay overnite in the hospital?
I am sorry for all these questions.
Thanks,
Brooke
Scope with LR -  07/13/05 
Scope with Harvesting - 11/30/05
ACI & TTT scheduled - 02/02/06
Married with three beautiful boys!

Offline blackbeltgirl

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Re: Surgery to replace cartlidge?
« Reply #3 on: September 08, 2005, 09:34:17 PM »
Brooke -

Microfracture is usually arthroscopic, outpatient surgery.

ACI requires 2 surgeries.  The first is arthroscopic, to take the biopsy of the healthy cartilage.  The 2nd requires 2 open incisions - one in the knee, and one in the shin.  The next generation eliminates the need for the incision in the shin, but that hasn't even started clinical testing in the US, so unless you're overseas, assume you get 2 incisions.  (You can find a very clear outline of the procedure at carticel.com)  Hospital stay varies by insurance and surgeon.

OATS I'm not too sure.  I think it's open, but I could be wrong. 

If you check out the message boards for each treatment, you'll find all sorts of info, and probably find others who've asked many of your questions (and the responses from those who've been there.)

jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline bbcygnar

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Re: Surgery to replace cartlidge?
« Reply #4 on: September 08, 2005, 09:41:05 PM »
Thanks Jess.
Scope with LR -  07/13/05 
Scope with Harvesting - 11/30/05
ACI & TTT scheduled - 02/02/06
Married with three beautiful boys!

Offline Heather M.

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Re: Surgery to replace cartlidge?
« Reply #5 on: September 09, 2005, 09:21:15 AM »
Here are some links you might find helpful as you do your research (also, check out the sections already mentioned, where there are threads dedicated to each of the cartilage restoration techniques).

Chondral Damage in General and Overview of Techniques
About chondral lesions or damaged articular cartilage:  http://www.steadman-hawkins.com/knee_chondral/overview.asp 

Also, the kneeguru main page has a great overview of this topic, see this link:  http://www.kneeguru.co.uk/html/knee/knee_arthritis_02/cartilage.html 

Another very easy to understand yet detailed overview of cartilage damage and the various techniques is found here--also note the bibliography and links to other great sources on the topic:
http://www.kneeclinic.info/problems_articular_cartilage.php

This overview also goes into the other surgical procedures that deal with articular cartilage damage--including osteotomy--as well as restoration/repair techniques:
http://www.cartilagerepaircenter.org/treopt.HTM

A final overview page that is very detailed is found at this, the site for the Hospital for Special Surgery or HSS in NYC.  http://www.hss.edu/Conditions/Cartilage-Restoration/Cartilage-Regeneration---An-Overview

Specific Treatment Options/Procedures

All about Microfracture, including the procedure and recovery, rehab and FAQ's, from the doctor who pioneered the procedure:  http://www.steadman-hawkins.com/knee_microfracture/overview.asp

Here's a very detailed overview of ACI/Carticel procedures that goes into why the rehabilitation is so important and what the considerations and limitations are during this period.  If this is what your doctor is considering, you should try to slog through the technical language.  We can help you with any "foreign" terms, or you can look them up in google. 
http://66.102.7.104/search?q=cache:fYGBcY2odLwJ:www.kneeclinic.info/download/Carticel_ACI_Rehabilitation_Guide.pdf+ACI+Carticel+overview&hl=en

Here is a good, easy to understand introduction to OATS or Mosaicplasty.  There are other links within this web page, so follow them to get even more information.  http://www.stoneclinic.com/oats_knee_surgery_failure.htm

If there's anything that seems like it's written in Greek, please post the sections and we can help put it in terms that are easier to understand.  It might be intimidating at first, because you are just starting this whole research process--once you've read some web sites the terms will become more and more familiar to you.  You'll find yourself throwing them around in conversations with your doctor without batting an eye  ;D ;)

Hope this information helps.  There's also tons of information and many links in the specific sections dealing with arthritis and treatment options.  These sections are found at the bottom of the main bulletin board page under the topic "Arthritis Department."  For example, here's the microfracture thread: http://www.kneeguru.co.uk/KNEEtalk/index.php?board=31.0  and the OATS thread http://www.kneeguru.co.uk/KNEEtalk/index.php?board=32.0

Good luck.  Information and knowledge of the issues involved will be your very best option to successfully navigate all the options and surgeons out there.  Many doctors think their method (whether it's microfracture or ACI or paste grafting or whatever) is the best, and they frankly don't PERFORM the other cartilage restoration procedures.  So you could say that they are very loyal to their chosen method.  But their method may have some specific contraindications (like it may work on one area of the knee better than other parts of the joint) that would keep it from being the best procedure for your particular knee issue....however, because the doctor in question only performs this one technique, it's all that he/she can recommend for you.  So it's very important to see multiple doctors for multiple opinions--find different doctors who each perform one or more of the techniques discussed above and ask each why their particular procedure is the best one for your knee.  Ask them to refute or explain why other procedures would not be a good idea.  So that way you will get a range of opinions.  You will find you get the best results with research, asking lots of questions, finding the best doctors who have extensive experience with cartilage repair/restoration, and then trusting your instincts and going wholeheartedly with your chosen surgeon and method.  Find a great physical therapist, too--preferrably one who works closely with your OS and is used to cummunicating with them and adjusting the rehab regimen for your particular needs.

Good luck and keep us posted.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
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