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Author Topic: Has anybody experience with microfracture failure and then subsequent ACI?  (Read 13561 times)

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Offline David3

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I am 6 months post microfracture (surgery Sep06). Microfractured 3 areas in left knee: MFC, LFC and Trochlear. All 3 lesions were between 1 to 2 sq. cm. Progress was good up to 5-1/2 months, in fact almost pain free at 5 months for cycling, stairs and walking. However, there has been a strong reoccurrance of pain recently and I am very concerned that one of the microfracture sites has failed. Has anybody experienced microfracture failure and then progressed on to ACI? I'd be very interetsed to hear of your experience.

I'm debating whether to ask for a new microfracture or consider ACI.....

Also, has anybody experience with ACI on multiple lesions?

David
« Last Edit: March 21, 2007, 01:48:02 AM by David3 »
2006: Left Knee (LK) microfracture (MFC, LFC, Trochlear), failed at 6 months
7/07: ACI/TTO of LK (MFC, LFC, trochlea, patella)
2014: Considering ACI treatment on RK.

Offline bioprof

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David,

I'm sorry to report that your experience closely mimics my own; microfracture for a MFC lesion.  The procedure provided temporary relief, but ultimately failed - not an uncommon ocurrence as I have found.  I had ACI for two lesions the MFC and trochlea.  IMO, I would not place to much faith on another microfracture.

Mike
8/05 - Cortisone injection, L. knee
10/05 - Meniscus repair, microfracture, L. knee
7/06 - Arthroscopy, Carticel biopsy, L. knee
8/06 - ACI, L. knee
5/07 - L. knee arthroscopy; post-ACI "clean up"

Offline runnerbeth

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David,

I had a microfracture for a patella defect in September 2005.  Within 6 months, it was obvious that the microfracture hadn't worked for me.  In April 2006 I had the biopsy for ACI.  I had the ACI and an osteotomy in June.  I'm about 9 months out now.  It's still too early to tell for sure if it has worked, but it feels like this one has had better results.

I sought multiple opinions before decided to have the ACI.  I did have one surgeon who wanted to do the osteotomy and redo the microfracture.  He felt that fixing my alignment would give the microfracture a better chance to work.  Ultimately I decided that undergoing another microfracture was not worth the effort since it is a temporary fix at best.  So personally, I agree with bioprof that I wouldn't ever undergo a second microfracture.

Feel free to contact me if you have any questions.  Best of luck!
Beth

Offline David3

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Thanks Mike and Beth. I've seen alot of people indicate that microfracture is "only a temporary fix".  There are certainly a number of reports on the microfracture site from people with apparently successful microfractures which then fail after 1 to 3 years. 

However, you both imply that ACI is a more permanent solution. Is there good evidence to say that ACI is a longer term fix? My understanding is that the initial success rate of microfracture and ACI at around 1 year is pretty similar in % terms, but I haven't seen any good evidence on longevity. Perhaps ACI simply lasts longer?  Clearly I don't want to go through another operation, make it throught the first year (which I failed to do this time), only to find that I'm back at square one after another 2 or 3 years.
2006: Left Knee (LK) microfracture (MFC, LFC, Trochlear), failed at 6 months
7/07: ACI/TTO of LK (MFC, LFC, trochlea, patella)
2014: Considering ACI treatment on RK.

Offline Peg Leg

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Hi David, I also had a microfracture Oct. 24 '06 that failed.  Mine was on the MFC and I never thought mine worked at all.  I had cells harvested in Apr. and will have the implantation June 28th. It sounds like our timing is very similar. It would be nice to keep in touch!

Robin
10/06  Miicrofracture Rt knee on mfc
defect was 1.3x2, small defect under patella
04/07 Arthroscopy/Cell harvest for Carticel
06/28/07 Carticel surgery ,Rt. Knee
12/27/07  Scope to debride Patella lesion,Rt. Knee
4/17/08  Fulkerson AMZ, Rt. Knee
6/25/09 ConforMis BiCompartmental Knee Replacement

Offline David3

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Hi Robin,  You're right - it does sound like our timing is similar. I had cells harvested in May, have received insurance approval and have just had my implantation surgery scheduled for 24th July. I'll be going through a combined ACI and TTT - the TTT to unload pressure from my trochlear. The addition of the TTT and the fact that I have multiple lesions probably means that I'll have a slower rehab than you - you'll be slow, I'll be super slow! However, would be good to stay in touch.

David
2006: Left Knee (LK) microfracture (MFC, LFC, Trochlear), failed at 6 months
7/07: ACI/TTO of LK (MFC, LFC, trochlea, patella)
2014: Considering ACI treatment on RK.

Offline plantgeek58

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Hi David,
The first of my three right knee surgeries was a microfracture, which did result in new fibrocartilage, but only a thin layer. It wasn't enough to relieve the pain and my OS suggested OATS as the next option. I had that surgery two years ago and it worked very well for me. I was pain-free until I developed a lesion at a different location. My OS again did microfracture and it again doesn't seem to have worked. However, he told me that the OATS graft still looked pristine and was the best-looking cartilage in my knee.
So I have to say, I'm not a fan of microfractures.
Terre
RK 7/04 part. m. menisc., plica resect., MF
    3/05 part. m. menisc., open OATS
    1/07 part l. menisc., MF, patellar chondroplasty
    9/08 MF
LK 11/04 & 8/06 part m. menisc.
     7/07 LR, patellar tendon debrid., part m. menisc.

Offline Jo-knee

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Hi All,

I had to put my opinion in too.  I have 2 oc defects on my mfc that I had microfratured Oct 2005, at the time I was 38 years old.  The recovery was torture.  However I am doing well with daily celebrex, mind you I can bike and swim and work and am not as good as before, however I have been able to "buy" myself 1 1/2 years of walking/ walking in my own knee so far.  I would try microfracture again if my OS recomended it.  He did mention that the next step for me will likely be OATS.  While I think microfracture was hell, it has this far been worth it for me at this age and I would do it again given a choice.  For me it's about buying time.  I reserve the right  to change my mind if my luck wears out in the near future!

Joanie
Gotta love that ice!  10/05 lat menisectomy, microfracture to 2 medial femoral defects.

Offline LadeeStingray

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Hey all 


Here comes my two cents...   Ive had the OATs and i can say this..... they used 1 auto plug from a non weight bearing area and two synthetic plugs.   The auto plug is great.... the synthetic plugs failed and now i have deeper bone damage from the failed plugs that no longer allows me to be a "good candidate" for ACI surgery which should have been my next step. 
So just a warning to all going down this road.  My doctor didnt explain all the details ... which isnt his fault.... but ive learned so much more about different knee surgeries now.  Had i known back then that they actually had to remove portion of bone to insert the plugs... i may have thought differntly about allowing the synthetic plugs being use?  I went in hoping that would solve my problem and now im stuck in the "what do i do now" category, because i actually have more damage now than what i started with.   Ok  enough about me  LOL   

I wish you all the best !!
Ladee
10/05 Rt medial meniscal tear repair 1/06 synvisc injections
3/06 cortisone injection   6/06 open OATs MFC
9/06 drained/cortisone  11/06 biopsy for ACI surgery
6/07 scoped again....failed OBI plugs
awaiting approval for HemiCAP

Offline michelel

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Hi i had MFX surgery 5 months ago that was torture from the begining.  I was in sooo much pain even more pain than before the MFX.  Well after 4 months of pain OS sent me to have another MRI, it confirmed MFX had failed.  The defect which is distal MFC had even increased iin size.  The MFX actually produced no growth of fibrocartilage.  He doesnt do ACI or OATS and has referred me to sports med OS who specializes in molecular biology of cartilage, and ACI and OATS.  My current OS says he believes she'll suggest ACI my defect is 2cm long and 1/2 cm wide.  I've done alot of research and asked alot of questions here (thanks kneegeeks) and what I get is anything  2cm and over is automatic ACI.  But my appointment is March 3 guess I'll find out then.  In the mean time im in alot of pain everyday, going up and down steps is terrible, getting up from sitting position is horrid.  I take pain killers and they take the edge off, but i really cant wait til that appt.  As far as trying another MFX in my opinion HELL no.  Keep us posted
Michele
Right Knee:  1983 meniscal tear scope debridment &lateral release. 1991, 1997, 2001
2003 scope meniscal tears. 
8-08 MFX MFC lesion FAILED.
 4-09 Went in for OATS-not a canidate.
 6-09 Uni Right MFC.

Offline Julie P

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Re: Has anybody experience with microfracture failure and then subsequent ACI?
« Reply #10 on: February 02, 2009, 01:24:36 AM »
Hi David.  I had a microfracture to lateral trochlea December 2006.  I was pain free for the first 4 months and then same as you pain came back so I was scared it failed.  It is a long story from then to now, but to sum it up I had a CT arthrogram.  That will verify if your microfx worked or not.  Mine showed that it worked the top part was good, but the underlying tissue was still soft.  So my surgeon recommended that it needed to be unloaded and an ACI wasn't necessary.  Which is good, cause an AMZ  is easier to recover from than ACI.  I had an AMZ January 8, 2009.  I am in the midst of recovery.  So my advice is to talk to your OS about getting a CT arthrogram to look at things and figure out what is going on so you know how you need to proceed.  I have my diary is PO diaries <100 if you want to chat.

Hope this helps.
Julie
L hardware removal and scar revision 6/4/9
Left AMZ and medial release 1/8/09
ACI biopsy 11/4/08 and bilateral scopes
12-22-06  L -Microfracture lateral trochlea, LR, and removal of loose bodies
1999-Right knee Loose body removal chondromalacia

Offline David3

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Re: Has anybody experience with microfracture failure and then subsequent ACI?
« Reply #11 on: February 03, 2009, 03:22:39 AM »
Interesting to see a post that I started in March 2007 suddenly re-emerge. Yep, I was in a bad way then when my MFX failed, and by early summer 2007 I was in a lot of pain.

Well, things move on, and as you can see from my signature / footnote, I did have ACI to 4 lesions and am doing well 18 months post op. Back doing cycling, swimming, golf, some hiking. No pain at all in activities of daily living, stairs, etc. Knee still improving. Life is fun again! For anybody who is having microfracture, I really wish you the best of luck - I know some people do have success. However, for folks that experience MFX failure, it should be reassuring to you to know that there are 'next step' solutions that can work out well.

David
2006: Left Knee (LK) microfracture (MFC, LFC, Trochlear), failed at 6 months
7/07: ACI/TTO of LK (MFC, LFC, trochlea, patella)
2014: Considering ACI treatment on RK.

Offline markld

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Re: Has anybody experience with microfracture failure and then subsequent ACI?
« Reply #12 on: September 01, 2009, 12:28:02 AM »
Yes, I had microfracture which failed. I am 6 weeks post aci. I waited over a year to do the aci. I knew at approx 4 months that it failed. I also had aci in the other knee 6 months post op on it. Both were trochlear 1.5 cm sq. I would recommend doing the aci because the studies show the more times you have mf the worse the chances are that the aci will work. the aci has the potential to be better repair tissue and will definitely last much longer. If you need a good doctor I used Bert mandelbaum in santa monica california he is truly one of the very in the country. Tom Minas of boston mass is also amongst the best.

Mark D
April 2008 microfracture left knee trochlea
Jan 2009 ACI harvest from right knee
Mar 2009 ACI right knee trochlea
July 2009 Aci left knee
Nov 2009 left knee scope to check graft

Offline courtem10

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Re: Has anybody experience with microfracture failure and then subsequent ACI?
« Reply #13 on: September 01, 2009, 03:18:11 PM »
Hi David,

I was breezing through some of these older ACI posts & I came across yours. I see that you are now over 2 years out from your ACI on the left knee and I was curious how things have been going.....Do you feel back to normal?? What activities are you doing?? And are there any things that you still have limitations with?? Running?? Thanks for your help.

Courtney
7/08 Left knee microfracture
12/08 Left knee ACI biopsy
4/09 Left knee ACI/AMZ

Offline Murph324

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Re: Has anybody experience with microfracture failure and then subsequent ACI?
« Reply #14 on: September 10, 2009, 05:33:49 AM »
I noticed everyone on here seems to have very similar timing to each other and myself.  I had the microfracture in Jan. and I will be going for the biopsy for the ACI in about 2 weeks.  I am in more pain now then I was before January.  Hoping this gives me the results i've been searching for.  Had first surgery in June 2008 (lateral release).
03/04/08- Left Knee Injury
06/18/08- Lateral Release
01/26/09- TTO/Microfracture
10/16/09- LOA/Cartilage Biopsy
01/06/10- ACI
03/24/10- LOA/Hardware Removal
06/04/10- LOA w/ Drain/Lateral Release

Offline courtem10

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Re: Has anybody experience with microfracture failure and then subsequent ACI?
« Reply #15 on: September 14, 2009, 05:18:21 PM »
Murph- wish you the best luck with your upcoming ACI procedure!
7/08 Left knee microfracture
12/08 Left knee ACI biopsy
4/09 Left knee ACI/AMZ

Offline Murph324

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Re: Has anybody experience with microfracture failure and then subsequent ACI?
« Reply #16 on: September 14, 2009, 05:31:33 PM »
Thank you!  Biopsy is sched for oct 14th!
03/04/08- Left Knee Injury
06/18/08- Lateral Release
01/26/09- TTO/Microfracture
10/16/09- LOA/Cartilage Biopsy
01/06/10- ACI
03/24/10- LOA/Hardware Removal
06/04/10- LOA w/ Drain/Lateral Release

Offline LILS

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Re: Has anybody experience with microfracture failure and then subsequent ACI?
« Reply #17 on: September 29, 2009, 05:55:14 AM »
Hi,
   I am looking for advice post microfracture surgery. I am post op only 4 months and luckily my OS did the ACI harvest during my microfracture "just in case" the microfracture didn't work. My cells are already ready to go if needed. I feel the surgery didn't work. I am now limping which I wasn't doing before the surgery and the pain is worse. I have an appointment with my OS in a few days. My questions are: Since it has only been 4 months since my surgery, is it too soon to ask my OS to go ahead and schedule the ACI? Will my knee get any better even though it has already been 4 months and it seems worse? Any advice is appreciated!
Mar 16, 2010 ACI/HTO Surgery
May 26, 2009 Microfracture Surgery/ACI Harvest
2003 Medial Meniscal Tear Repair

Offline madel23

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Re: Has anybody experience with microfracture failure and then subsequent ACI?
« Reply #18 on: November 09, 2009, 07:22:12 PM »
My knee did not start to feel significantly better until 7 months after microfracture, but I have an MRI showing that cartilage filled in.  I think you have some time to wait.