Banner - Hide this banner





Author Topic: Does ACI last?  (Read 10210 times)

0 Members and 1 Guest are viewing this topic.

Offline djs60

  • Regular Poster
  • ***
  • *
  • Posts: 141
  • Liked: 0
Re: Does ACI last?
« Reply #15 on: April 17, 2008, 11:59:20 PM »
To add to what Meg wrote, patellar aci is an "off label" use of Carticel - the FDA has not approved it for that specific use.  What this means practically is that insurance companies dig in their heals and label it as "experimental".  In truth, doctors use "off label" treatments all the time, and insurance companies only care when the treatment is expensive.

Agree with what other have written that you really need someone who has done a lot of patellar work.  There's nothing wrong with asking directly how many procedures the surgeon has done.  You want a number as an answer, not "a lot" or "many".  It's my view that you need a surgeon who has done 40 or 50 such procedures to really be in expert hands.  It's probably true that there are not very many surgeons in the US who have done that many.

Anyway, keep us posted and stay positive.

djs60
3/06 left knee arthroscopy - grade IV lateral trochlea defect
chondroplasy & removal of loose bodies
1/07 left knee arthroscopy/cartilage biopsy
4/27/07 left knee trochlea & patella ACI with TTO

Offline Chondrosoldier

  • Regular Poster
  • ***
  • Posts: 64
  • Liked: 1
    • Myspace
Re: Does ACI last?
« Reply #16 on: April 18, 2008, 03:21:56 PM »
Ben,

You've obviously done your homework on the procedure.  Its probably time to put your time and resources into finding a patella-experienced OS and a position with insurance to cover it.  The few guys who have done a lot of patellas know exactly what they're doing and will do whatever is necessary to correct your alignment.  The OS won't even know what needs to be tweeked until the initial scope.  Even then, there are a million biomechanical factors that determine their correction methods.

Finding an patella ACI experienced OS can be done by making a few calls, the insurance situation is much more difficult.  Paying out-of-pocket sounds nice until you look at it from the big picture.  It's not just the 10k cell culture, OS, Aneasthesiologist and hospital costs you'll incur because the process doesn't end at the OR. You'll be responsible for everything from 18 months of physical therapy to follow-up doctor visits to CPM rental, which can quickly turn $40k into 65+

Once you find that experienced OS, talk to his front office staff to see what insurance providers cover ACI and which they have problems with.   Get on board with the provider that covers, be it through a new job or a buy-in plan, have an initial visit and then worry about the procedural details.

Don't put the cart before the horse. 
1997 L Traumatic dislocation/ACL
1997-2001 L recurrent sbuluxation
2001 L TTT Realignment
2006 L Patellar Carticel biopsy/debridement
2006 L Carticel 4cm patellar reimplantation
2007 R Carticel biopsy/debridement
 Insurance Battle
2008 R TTT 4CM Patalla/3CM Trochlea Carticel implant
Happiness!

Offline bsonday

  • Regular Poster
  • ***
  • Posts: 82
  • Liked: 0
Re: Does ACI last?
« Reply #17 on: April 18, 2008, 06:26:13 PM »
Well, everyone, I have a tentative appointment to see Dr. Brian Cole in Chicago on May 5th.  I have no idea how they got me in so quick since Dr. Minas is Boston has a 9-month wait.  This is within a few hours of where my family lives (I currently live in New Jersey), so it's sort of "on the way home".  Has anybody heard anything about this guy?  I know he is very well known for Carticel studies and stuff, but I need to double-check that he has actually done patellar ACI.  I also need to get a referral from my doctor here in Princeton, which shouldn't be too much of a problem.  After that, I guess we'll start arguing over insurance.

I guess I am also a candidate for Dr. Cole's neocartilage in the patella clinical trial starting in 3-6 months (if it's approved).  I'll keep everyone updated about whether or not that goes through.  In the case that I get accepted for the clinical trial, I don't think I would have to worry about insurance.

Best,
Ben
Removal of loose bodies (cartilage pieces)--7/2/2007
Lots of rehab (quad strengthening) which didn't help much
Biopsy for ACI, 1.5cm x 1.5cm patellar cartilage lesion found--5/7/2008
Patellar ACI with Fulkerson, slight lateral release (to get under the patella)--7/2/2008
Happiness--Early 2010?

Offline David3

  • Regular Poster
  • ***
  • Posts: 143
  • Liked: 0
Re: Does ACI last?
« Reply #18 on: April 18, 2008, 10:32:05 PM »
Ben,   You've done well - Dr Cole is among the top few ACI doctors in the USA. I've had no contact with him - I ended up having ACI with Dr Minas - but from the research I did before having ACI, Dr Cole definitely has a fabulous reputation. I don't know how much patella ACI he has done (probably alot), but he is highly experienced with ACI in general. Worth asking him about patella work. In addition, his clinical trials with neocartliage make this a particularly interesting possibility for you. I think you are in safe hands with one of the very best.....

Good luck, and keep us posted.
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 djs60

  • Regular Poster
  • ***
  • *
  • Posts: 141
  • Liked: 0
Re: Does ACI last?
« Reply #19 on: April 18, 2008, 11:45:45 PM »
Ben,

Agree with David that Dr. Cole is one of the top cartilage repair guys in the country.  I would be quite surprised if he hasn't done lots of patellar aci, but let us know what happens.

It's great you could get in so fast.

I think I waited 9 months to see Dr. Minas (I live in Boston).

Dan
3/06 left knee arthroscopy - grade IV lateral trochlea defect
chondroplasy & removal of loose bodies
1/07 left knee arthroscopy/cartilage biopsy
4/27/07 left knee trochlea & patella ACI with TTO

Offline bsonday

  • Regular Poster
  • ***
  • Posts: 82
  • Liked: 0
Re: Does ACI last?
« Reply #20 on: April 19, 2008, 12:00:50 AM »
Based on the recommendations of others here on this site, I might also go with Dr. Andrew Levy here in New Jersey.  This is closer to where I currently live and he has done patellar ACIs.  I guess there are a lot of factors in choosing between Cole and Levy.  Both are great, but the real battle here is insurance and stuff.  Even though Chicago is further away, Dr. Cole is great and a few trips up to Chicago is nothing if they will help me with my upcoming insurance battle.
Removal of loose bodies (cartilage pieces)--7/2/2007
Lots of rehab (quad strengthening) which didn't help much
Biopsy for ACI, 1.5cm x 1.5cm patellar cartilage lesion found--5/7/2008
Patellar ACI with Fulkerson, slight lateral release (to get under the patella)--7/2/2008
Happiness--Early 2010?

Offline Goju

  • MICROgeek (<20 posts)
  • *
  • Posts: 11
  • Liked: 0
    • The Networkers Nest
Re: Does ACI last?
« Reply #21 on: April 19, 2008, 09:45:49 PM »
Hi Ben. I went with Dr. Levy, i'm in north jersey. He has a few offices so that may help your seeing him. His staff was outstanding with dealing with the insurance company on my behalf. Mine is a workers comp case so they don't want to part with a dime. As much as the insurance adjuster was difficult at times to deal with, Dr. Levy and staff made it easier because they were not afraid to argue my case directly with the number crunchers. Hope it helps.

Offline celinenj03

  • SuperKNEEgeek
  • *****
  • Posts: 1688
  • Liked: 0
Re: Does ACI last?
« Reply #22 on: April 20, 2008, 05:17:02 PM »
Casey referred me to Dr. Levy. I went to visit him in January. I have a Grade 3 lesion on my femoral lateral condyle.  I found him to be very experienced and the staff is really great. I haven't opted to go with ACI as of yet since I have some other issues to take care of first and hardly any pain with my lesion (just had chondroplasty in Sept. 2007). But I know when the time comes to do ACI I am going with Dr. Levy and I 'm really glad he is close by as I also live in NJ.
Terrible Triad - 1/16/06 - Basketball
3/15/06 - Scope/Cleanout of to achieve full ROM
5/3/06 - Surgery-ACL Reconstruction-Allograft
9/12/07 - Large Loose body removed;Grade 4 Lesion on LFC
9/17/08-Microfracture, Lateral Release (all right knee)

Offline bsonday

  • Regular Poster
  • ***
  • Posts: 82
  • Liked: 0
Re: Does ACI last?
« Reply #23 on: April 21, 2008, 07:44:37 PM »
Hey everyone,

I have what is probably a silly question.  I have gotten a few personal messages that are very nice and I would like to respond with a personal message of my own, but I can't figure out how to respond.  There is no "reply" button when I open the messages, or at least I'm not seeing it.

Best,
Ben
Removal of loose bodies (cartilage pieces)--7/2/2007
Lots of rehab (quad strengthening) which didn't help much
Biopsy for ACI, 1.5cm x 1.5cm patellar cartilage lesion found--5/7/2008
Patellar ACI with Fulkerson, slight lateral release (to get under the patella)--7/2/2008
Happiness--Early 2010?

Offline casey2291

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1011
  • Liked: 0
  • User's Text
Re: Does ACI last?
« Reply #24 on: April 21, 2008, 09:05:54 PM »
Ben,
I might be wrong but I think you have to have around 20 posts before you can send a personal message to someone. 
Casey
LOA #2 and hardware removal 12/15/08-new cartilage from ACI looks "GOOD"
LOA on left knee 3/18/07
ACI and HTO on left knee 10/22/07
scope of right knee on 6/21/07
microfracture left knee 3/18/05

dileigh

  • Guest
Re: Does ACI last?
« Reply #25 on: April 23, 2008, 12:23:39 AM »
Yup, from what I've seen it is 20, but you can go into the quizzes and games room and get there pretty quickly.  There are a lot of threads to post in.


Diana

Offline bsonday

  • Regular Poster
  • ***
  • Posts: 82
  • Liked: 0
Re: Does ACI last?
« Reply #26 on: April 23, 2008, 03:33:59 AM »
Great!  In that case, I will...
Removal of loose bodies (cartilage pieces)--7/2/2007
Lots of rehab (quad strengthening) which didn't help much
Biopsy for ACI, 1.5cm x 1.5cm patellar cartilage lesion found--5/7/2008
Patellar ACI with Fulkerson, slight lateral release (to get under the patella)--7/2/2008
Happiness--Early 2010?

Offline bsonday

  • Regular Poster
  • ***
  • Posts: 82
  • Liked: 0
Re: Does ACI last?
« Reply #27 on: April 23, 2008, 03:34:25 AM »
...continue...
Removal of loose bodies (cartilage pieces)--7/2/2007
Lots of rehab (quad strengthening) which didn't help much
Biopsy for ACI, 1.5cm x 1.5cm patellar cartilage lesion found--5/7/2008
Patellar ACI with Fulkerson, slight lateral release (to get under the patella)--7/2/2008
Happiness--Early 2010?

Offline bsonday

  • Regular Poster
  • ***
  • Posts: 82
  • Liked: 0
Re: Does ACI last?
« Reply #28 on: April 23, 2008, 03:34:54 AM »
...posting :)
Removal of loose bodies (cartilage pieces)--7/2/2007
Lots of rehab (quad strengthening) which didn't help much
Biopsy for ACI, 1.5cm x 1.5cm patellar cartilage lesion found--5/7/2008
Patellar ACI with Fulkerson, slight lateral release (to get under the patella)--7/2/2008
Happiness--Early 2010?

Offline bsonday

  • Regular Poster
  • ***
  • Posts: 82
  • Liked: 0
Re: Does ACI last?
« Reply #29 on: April 23, 2008, 03:39:19 AM »
I called Dr. Andrew Levy's office today and got an appointment there as well.  So now I have two appointments:  one with Dr. Levy and one with Dr. Cole.  I feel kind of bad about keeping both of them, but I have heard nothing but bad news from doctors so far and I am trying to hedge a bit so that at least one of them says something favorable.  Also, I do not know if I will be in New Jersey or near Chicago this summer, so this is a good way to see both of them and discuss timeframes.  Even though I am slightly more inclined to go with Dr. Levy due to the fact that I will probably be in New Jersey and that his office is great with insurance, Dr. Cole is also beginning a patellar neocartilage trial (if it gets approved) this fall, and the results look promising.  That's all for now.  Thanks for reading and thanks for writing!
Removal of loose bodies (cartilage pieces)--7/2/2007
Lots of rehab (quad strengthening) which didn't help much
Biopsy for ACI, 1.5cm x 1.5cm patellar cartilage lesion found--5/7/2008
Patellar ACI with Fulkerson, slight lateral release (to get under the patella)--7/2/2008
Happiness--Early 2010?















support