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Author Topic: Carticel surgery  (Read 4439 times)

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Offline smasha

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Carticel surgery
« on: June 23, 2006, 02:25:28 AM »
A few years ago I used this site for researching the drama's centering on my chondromalacia patellae ...
I thought it would be a good idea to let your members know about my latest treatment involving carticel implants..
My OS who has had a few goes at trying to alleviate my damaged cartilage which in effect had shredded itself away to bone over 3/4 of the inner side of the right knee ...suggested the new cartilage replacement process known as carticel or when he first became involved was called verigen before carticel's owners bought verigen out..!!
I am 10 weeks post op and about to start post op rehab (has been conservative) and all the pain has dissapeared from my knee???
During the next few weeks i will be undertaking rehab (couple of weeks walking in the pool) until I am fully weight down as I have been on crutches for 10 weeks now...
I think that all i can give some of the members of this site some hope as I have just gone through it and it is looking positive and all going well i am going to get my own cartilage back behind the knee cap where it matters...
This has been a fourteen year drama for me and i have tried everything but members of this site need to investigate the carticel option as part of their own research ... hopefully you will qualify and be a candidate...!!

Offline emphatic

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Re: Carticel surgery
« Reply #1 on: June 23, 2006, 03:34:15 AM »
Congratulations!

It would be great if you also posted your story on the ACI board (scroll down the board index page, it's under The Arthritis Department) so that others looking especially for ACI information would see it.
http://www.kneeguru.co.uk/KNEEtalk/index.php?board=35.0

I'm glad you're so happy with your result.

Meg

Offline shade

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Re: Carticel surgery
« Reply #2 on: June 23, 2006, 11:39:27 AM »
Smasha,

Wonderful news .....

It really must feel great to have gotten through the worst part of this protocol.  Wow 10 weeks NWB - Yuck!!

It's so exciting to hear that some of these newer procedures are giving people a chance for a better lifestyle.

Good for you.  Wishing you continued success with your rehab.  ~Shade
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline Cari

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Re: Carticel surgery
« Reply #3 on: June 24, 2006, 03:40:49 AM »
Smasha,

I have a question...did you have cartilage damage to the underside of your patella and if you did has the carticel helped that ??

I was told a few years ago that it has not been greatly successfull with patella damage as all my damage or missing is under the patella. I am just curious if carticel is working better in the patella.

Thanks

Cari
open lateral release 10/85, various scopes 1994-1998 for debridement, medial release 11/98,  TTT(Fulkerson)& lateral release 11/30/99, screw removal 6/27/00, tibial repair 2/13/01, dx RSD 6/25/01

Offline shade

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Re: Carticel surgery
« Reply #4 on: June 24, 2006, 03:23:40 PM »
Cari,

Have you investigated the synthetic bone substitutes (synthetic polymer plugs).  I've recently had a procedure done behind my patella - a synthetic plug (polymer) was inserted to restore the damaged area.
The rehab for this process is similar to an OATS procedure.

Found this article and it explains the process......

http://www.nbc4.tv/health/8323533/detail.html

This is a newer technique but hopefully will give many people an opportunity for a more active lifestyle again.  ~Shade

« Last Edit: June 24, 2006, 03:39:20 PM by shade »
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline emphatic

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Re: Carticel surgery
« Reply #5 on: June 25, 2006, 02:35:37 AM »
Pretty wild... this is the exact type of plug I just had placed in the trochlear notch of my knee. I had severe damage in the lateral compartment and some divots in the cartilage in the trochlea (the groove the patella glides in). Because of that, I was told I had to have a total knee replacement.

Instead, I researched the idea of a unicompartmental replacement on the lateral side, and some kind of cartilage resurfacing treatment (such as ACI/Carticel) in the trochlea. My doctors went for it, and just over 8 weeks ago, I had the partial replacement on the lateral side with one OBI plug in the part of the trochlea which was damaged.

The OBI plugs are what the article is talking about -- there is a link to OBI (the manufacturer) on the bottom of the page.

So far, so good for me. I'm quite hopeful that I will have an excellent result.

Meg

Offline Cari

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Re: Carticel surgery
« Reply #6 on: June 25, 2006, 07:07:50 AM »
Shade,

Very interesting !!!!!!!! I had not seen this before ! The knee I am inquiring about is the NON TTT knee, in fact it has never had any surgery and my OS agrees that an MRI will only confirm what we know and a scope is only a bandaid. He can tell by the xrays and the exam of my knee that the "compartments" are ok and it is all patella/patella femoral area. As I am now in between jobs I was trying to buy a few years time. So far the cortisone injections still help, the pain is much reduced though the grinding and cracking is so loud eveyone can hear it when I bend my knee and I know each time I hear it just what is being damaged.

I will bring this up to my OS when I see him in September .

Thanks again!!
Cari
open lateral release 10/85, various scopes 1994-1998 for debridement, medial release 11/98,  TTT(Fulkerson)& lateral release 11/30/99, screw removal 6/27/00, tibial repair 2/13/01, dx RSD 6/25/01

Offline shade

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Re: Carticel surgery
« Reply #7 on: June 25, 2006, 12:14:02 PM »
Cari,

Hopefully you'll find answers in Sept that will help with your situation.  It's nice that the injections are giving you some relief in the meantime though. 

http://www.obi.com/patients_brochure.htm

Good luck and let us know how everything goes. 

Meg,

Glad to hear you've been doing so well post-op from your procedures.  I've found the OBI plug has really relieved that constant gnawing pain. 
How's the partial knee replacement going?  I've heard some people have had great experiences with the PKR procedure - hopefully that'll be your experience also.  Nice hearing from you.   ~Shade
« Last Edit: June 25, 2006, 05:48:02 PM by shade »
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline smasha

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Re: Carticel surgery
« Reply #8 on: June 30, 2006, 11:44:22 AM »
Wow... I am glad you guys are interested in this new option for chondromalacia patellae sufferers!!
i have some great pics of a) the damage to patellae surface b) OS preparing the site for implant procedure c) implant in place before the incision is closed back up!! Is there anywhere i can post it on this site?
I have also been a member of the chondromalacia patellae sufferers group at Yahoo for a number of years (about 700 members) who are all quite excited about this procedure and I was the first to do it and there are already two others now decided to try it as well...
It is hard to describe the feeeling after 14 years of constant pain and now (apart from muscle stiffness through lack of exercise) there is NO pain..!!!!
Hope this helps a few of you ... if there is a spot for the pics let me know!
Mark

Offline brattkids

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Re: Carticel surgery
« Reply #9 on: June 30, 2006, 03:19:10 PM »
Thats great you guys are having relief with the OBI plugs. I had several OBI plugs on weight bearing areas of the MFC and the LFC and had no luck. The plugs flaked out and caused catching and my knee to lock. I wonder if the difference is the major weight bearing area compared to lighter/non weight bearing areas behind the patella and trochlear grove.

The trochlear goove is where they took my OATS plugs from after the OBI failure and my current OS says the OBI plugs would be perfect for that area. My kneecap is catching on the defects there now and its great to hear that there is success in that area with the OBI plugs!!!!!!

Paulette
4/04 microfracture
5/04 debris removal
8/04 OATS with synthetic plugs
11/04 OATS traditional autograft medial femoral chondyle
05/05 debris removal and OATS assessment
6/05 Cadaver Allograft OATS lateral femoral chondyle
9/05 OATS redone could not save allograft plug
12/2006 2007 and 2008 scop

Offline shade

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Re: Carticel surgery
« Reply #10 on: June 30, 2006, 07:30:24 PM »
Hi,

Patella and Femur contact areas.........
The location of contact for the patella and femur vary with different degrees of flexion and joint load. At 0°, no contact occurs; in early flexion, the distal patella contacts the proximal trochlea; at 90° of flexion, the superior aspect of the patella contacts the femur; when flexion is greater than 90°, the contact area returns to the center of the patella; and when the knee is fully flexed, the inner border of the medial femoral condyle is in contact with the small vertical ridge of the medial facet.

Found this article explaining knee contact areas - of course this is for a normal knee and obviously none of us have those, but maybe we're getting closer......

Paulette, if you try the OBI plugs again I'm hoping you'll have better luck with the trochlear groove area.  How maddening having to go through the original procedure & then having to get an OATS afterwards. 
Good luck.  ~Shade

July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline Leigh55

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Re: Carticel surgery
« Reply #11 on: June 30, 2006, 08:41:20 PM »
Wow, I was excited to see this post because I just saw my doctor yesterday and I was worried about this Carticel surgery that was suggested.  One doctor recommended it and the 2nd opinion did not.  He was concerned that the area in which my surgeon wants to perform the procedure is not found to be successful. Unfortunately, I also have to have 2 ligaments reconstructed-- so I am torn on what to do.  My surgeon suggested doing them all at once to avoid the 2 different rehabs...however this 2nd opinion yesterday said he thought it was a bad idea?? Now I am torn.  He thinks I should do the surgeries separately because of the vastly different Physical Therapy you do with cartilage versus Ligaments.  He also suggested looking into an OBI plug instead?  I dont know alot about the extent of my damage i just know that it is a rather small section he intends to work on.. Anyone have any advice? 

SMASHA- glad to hear about your success! Its promising to hear about Carticel success...

Offline shade

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Re: Carticel surgery
« Reply #12 on: June 30, 2006, 10:01:55 PM »
Leigh,

Lost my post................Grrrrrrrrrrrrrrrr...

Had a combined procedure myself a fulkerson ttt, an open lateral release, an obi implanted in the apex of the patella.  The protocol was 6 - 8 weeks NWB with crutches and 2 - 4 weeks PWB with crutches.  The protocol I had was like a weight-bearing OATS protocol.  I wore an immobilizer for just over 6 weeks - all the time except once a day I could try bending the knee.  Needed 90 degrees by week six - no more - no less..... also did ankle pumps daily.  It's a long, boring rehab, but doable.  I had very little swelling and bruising on my leg. 

Emphatic - had a combined procedure also - a PKR on lateral side and OBI plug in troclea groove. 

If you trust the surgeon, understand & are willing to comply with the protocol, and have an experienced surgeon then these combined procedures can work out well for a person.  I've heard of contraindicated procedures working well together if the right protocol is tailored for the procedures. 

Good luck to you and let us know how everything goes.  Smasha will have to discuss the Carticel procedure protocol.....  ~Shade
« Last Edit: July 03, 2006, 10:43:24 PM by shade »
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline smasha

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Re: Carticel surgery
« Reply #13 on: July 01, 2006, 02:24:31 AM »
hey Leigh55....
within 2 days of the carticel implant you are placed onto a constant passive movement (CPM) machine which starts exercising the knee and leg without quad contractions ... I had to do this in one hour sessions then two hour sessions for the next 9 days..!!!
I would ask the OS who says you can do both surgeries together if that exercise is consistent with the other ligament repair work as the CPM appears to be critical treatment after carticel implants are done...
My research and discussions with my OS said that no movement for two days (waiting for their special glue to bond the implant) is also very important and so you need to make sure that these two protocols are observed with the carticel implant (remember this costs a lot of money) and if they are consistent with the ligament repairs then go for it!!!
I have attached the photos of the carticel implant operation in progress before the incision is closed for those that can stomach it as a picture paints a thousand ships ... or something like that???
Mark.

Offline shade

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Re: Carticel surgery
« Reply #14 on: July 01, 2006, 12:19:39 PM »
Mark,

Your pictures are fascinating.......  Thanks for posting them - it makes it so much easier for people to understand.  I've seen pictures before of the carticel procedure and found them awesome. 
The before and after shots say it all.  Hopefully this procedure will give you a more pain-free lifestyle. 

It's going to take time to study the long-term effects from all these procedures, but I'm also a believer in patient selection.  Eventually we'll see more of these combined procedures & protocols will be more tailor made.  It seems the doctors who think out-of-the-box have no problems mix-matching protocols & procedures.    
Sounds like we all have luckily found this type of surgeon...... Yeah!!

Have a great knee day everyone......  ~Shade
« Last Edit: July 01, 2006, 06:05:50 PM by shade »
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT