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Author Topic: MRI results after one failed ACI  (Read 1905 times)

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Offline kmmbradley

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MRI results after one failed ACI
« on: September 16, 2005, 08:20:19 PM »
My son had ACI in June 04-see related post under ACI
Having alot of pain again.  Need help understanding this MRI report, it doesn't sound really good.

Bone marrow edema, but has diminished since last scan done Mar 04.  There is, however, a deep 8x10 osteochondral defect with associated loss of the subadjacent articular cartilage.  No loose body is seen.  That is his right knee, the one that has the ACI transplant.
Now for the left knee:
Horizonal area of increased signal is seen within the posterior and lateral horn of the medial meniscus and may extend to the inferior articular surface and nondisplaced medial meiscal tear.  No osteocondral defect is seen.
2002-arthroscope w/debridement(rt knee)
2003-arthroscope w/debridement(rt knee)
2004-arthroscope/ACI biospy(rt knee)
2004-ACI(rt knee)
2005-arthr. debridement & meniscus repair(lt knee)
2006-arthroscope-debridement

Offline blackbeltgirl

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Re: MRI results after one failed ACI
« Reply #1 on: September 16, 2005, 09:05:51 PM »
I can tell you that articular cartilage is very difficult to see on MRIs.  Anyone reading an MRI and making a *definitive* diagnosis or articular cartilage problems should be questioned.

That said, I don't know much about bone marrow edemas.  And there is no unit of measure of the osteochondral defect.  Some people have defects measure in mm, others have larger ones measured in cm.

Now for the left knee:
Horizonal area of increased signal is seen within the posterior and lateral horn of the medial meniscus and may extend to the inferior articular surface and nondisplaced medial meiscal tear.  No osteocondral defect is seen.
Signs of a torn medial menisucus.  Based on the type of location of the tear, it may bre repairable.  Longer recovery, but the better choice long-term.  There are no signs of damage to the articular cartilage.
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 kmmbradley

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Re: MRI results after one failed ACI
« Reply #2 on: September 17, 2005, 04:11:11 PM »
I asked and it is 8-10 mm, The MRI taken before ACI  Mar 04 showed a 2 cm defect and it was in fact a 5x4cm defect, so we can see the MRI wasn't even close.
If the defect is back does that mean that the ACI failed?
2002-arthroscope w/debridement(rt knee)
2003-arthroscope w/debridement(rt knee)
2004-arthroscope/ACI biospy(rt knee)
2004-ACI(rt knee)
2005-arthr. debridement & meniscus repair(lt knee)
2006-arthroscope-debridement

Offline blackbeltgirl

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Re: MRI results after one failed ACI
« Reply #3 on: September 18, 2005, 02:56:23 PM »
I'm no expert, but a 4x5CM defect is a very significant defect.  I've got a 6x3cm defect (1 of 3), and until today, it was the largest I'd seen mentioned on these boards, so your son had me beat.  That said, with larger defects the recovery time is much longer and slower.  I haven't had ACI yet, and I'm not sure if I will.  But I was told to look at a recovery period of 18-24 months.  The larger the lesions the slower the recovery goes, because it takes longer for the transplanted cells to harden and solidify.  Depending on what part of the knee the lesions are on, I was told to expect more than 6 weeks NWB becasue of the size of my lesion.  And a minimum of 12 months was likely before being allowed to resume impact activities.  It's possible that your son's rehab was more aggresive, based on the "healing power of youth".  And while it is true that younger folks heal faster than older folks, considering the complexity of this procedure, and the fact that there is a lot less documentation of success rates on larger lesions (most studies only look at lesions up to 10 square cm, vs. your son's 20 squ. cm.), he may have needed a slower recovery.

Was the surgeon who treated your son listed on the carticel.com website?  I have spoken to representatives there, and it seems they have multiple levels of training.  Many doctors complete a more basic training course, and carticel will grow the cells for these doctors, but not give out their names.  A smaller number of doctors have completed more advanced training, and carticel lists these doctors on their website for patient referral.  If your doctor isn't on this list, it may be time for a 2nd opinion from a doctor who is on the list. 

Sorry this probably isn't much help or comfort.  I hope your son starts doing better soon.
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)