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Author Topic: To have ACI or not?  (Read 5159 times)

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Offline Rennschnecke

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Re: To have ACI or not?
« Reply #15 on: February 09, 2011, 03:23:32 PM »
Hi Sune

Look up posts by Vickster who has had a similar suggestion.  Initially she was looking at AMIC, then MACI and in the end the OS suggested an osteotomy.

If your knee is at all misaligned then any procedure will be subject to wear and tear, so this is important.  However, some OSs in the US have begun to do an AMZ to offload the pressure at the patella even if the leg is not misaligned.  The reason for this is to reduce the stresses at that part of the joint. I didn't have it, but I sometimes wish it had been done.

When an OS is making a decision they're trying to weigh up all the different risks to see what might be a good outcome for you.  Their call is the 'art' bit of surgery and the better they are the better they are at this part of the job.

It's possible that the OS has suggested microfracture as it has a shorter rehab time.  It also means that he doesn't have to remove cartilage back to stable margins and that means the grade 2 cartilage can be left alone rather than removed the issue being that removal may end up with you being worse off.  As there are high shear forces on the patella which can cause the microfracture to fail then an AMZ would help.

Clearly, I don't know the reasoning your OS has followed to come to his decision, but it is worthwhile questioning why microfracture and not ACI.  What would be the benefits of the osteotomy?

As for the time taken over the appointment.  From what others have said, 15 minutes is the maximum they have ever seen their OS.  My massage therapist said that he was always out the office at 14m 30s.  My own experience has been very different and all my Drs have given me time.  Don't know if it's me or how unusual my case is, I guess the latter because on one occasion I had three consultants examining my knee and discussing the procedure in depth.

If you are feeling tentative, let your OS know this (but avoid questioning his competence as he's been certified by the appropriate medical boards).  Focus on how nervous you feel about surgery and the outcomes and express the fact that you don't know much about the ops or what it will be like for you during recovery etc., etc.  I know you've been researching this topic, but you're now trying to get a feel of where you're OS is coming from, his outlook and philosophy on knee surgery and all sorts of 'soft' clues to help assure you that this path is right for you.

Hope you settle down from your consult soon.
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope debridement, trochlear cartilage lesion (Gr4); 12/08 Scope chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope LOA, IPCS & patella infera; 9/10 Scope AIR & LR.


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Re: To have ACI or not?
« Reply #16 on: February 09, 2011, 10:24:41 PM »
You are correct that many docs standard of care is to do the AMZ (aka Fulkerson or even just a anteriorization of the TT) to offload the joint and reduce contact pressures when the PF joint is involved.  However, the exact location of the defect needs to be taken into account, as a  medial defect will have increased contact forces if an AMZ is performed.  I had the AMZ, but I did track a little off with a positive "J" sign and I actually can tell a difference now between the AMZ/ACI knee and the leg that has yet to have it done. The kneecap really just seems to move easier than the other side.  M:y defecdt was also central/distal, so it was a logical procedure to be performed on me. At 14 weeks post op, I can already tell improvement and can do 4 inch box step ups with the ACI/AMZ knee. ...only 2 inch on stepdowns and the quad is certainly weak...but I an already tell a change.