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Author Topic: How do you choose ACI vs OATS???  (Read 6456 times)

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Offline michelel

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How do you choose ACI vs OATS???
« on: January 25, 2009, 10:52:21 PM »
Hey yall, im a 40 year old mom who works full time as a nurse.  I fell on a wet floor and inturn received an osteochondral impaction fracture of the distal MFC.  I had MFX surgery 5 months ago and was still in pain from the start even more so.  Upon MRI OS confirmed MFX failed, and that the injured area has increased in size and is large,  I didnt even think of asking him how large because I was just so upset.  All I know is we (theOS and I) were looking at the MRI and hes like man thats big!! Okay so he says he has to refer me to a sports med specialist at Wake Forrest University Baptist Medical Center in Winston-Salem NC.  And that I need an OATS surgery maybe even a TKR.  But I've been doing a lot of research and it seems ias if Oats as allograft autographt or ACI.  Am I right? Im really confused about this.  I mean the OS im seeing has special interest in molecular biology of cartilage, and specializes also in the OATS procedure.  My appt isnt until March 3 but im on the "call list".  So plese give me some info on ACI vs OATS. Thank you so much im freaking out here,
Thanks yall
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 ghost

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Re: How do you choose ACI vs OATS???
« Reply #1 on: January 27, 2009, 11:42:21 PM »
Hi Michele,

I'm 49 and headed on basically the same path as you.  I had a trochaear groove mfx 2 months ago and it's not looking good, the defect is the entire groove.

One of the best cites I've found is thru the Brigham and Women's Hospital in Boston, Ma.  Dr. Tom Minas who is internationally known works from there.  He has his own website  Cartilagerepaircenter.org.  It's got alot of info and reference to all of his publications on the subject.

Keep me posted.

Sue
rt k med meniscus 1983
rt k lat meniscus 2001
lft k med meniscus 12/07
lft knee medial meniscus 6/08 with chondroplasty & debridement of the suprapatella pouch
lft knee trochlear groove MFX 12/2/08 with chondroplasty and debridement of the suprapatella pouch
7/31/09 trochlear groove resurfacing

Offline michelel

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Re: How do you choose ACI vs OATS???
« Reply #2 on: January 28, 2009, 12:53:24 AM »
Hey there Sue.
Sorry to hear about your problem.  Yeah its not very fun is it?  My appointment isnt until March 3, but am on a cancellation list so hopefully sooner because the pain is horrible.  Did your pain get worse after the MFX?  When is your appointment?  If I knew more about MFX I would of never had it done.  Im so glad that I found this website.  Let me know how u are.

Thanks for your input
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 plantgeek58

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Re: How do you choose ACI vs OATS???
« Reply #3 on: January 28, 2009, 06:46:50 PM »
Hi Michele,
sorry to hear about the MF failure. I did a lot of research into Carticel (ACI) for a Biotech class project, so hopefully I can help you understand a bit about it. First of all, the difference between this and an OATS graft is that the hyaline cartilage formed from ACI is supposed to heal in such a manner that you end up with a completely smooth surface, with no seam between it and the rest of your articular cartilage. It's supposed to fully integrate, so that your knee looks just like it did prior to any injury. That doesn't happen with the OATS graft. Although the graft heals into the site and it does consist of hyaline cartilage, there will always be a seam around the edges of it and after a number of years, this could develop fissures and break down again.
Basically, the way ACI works is, healthy cartilage cells from your knee are harvested in an arthroscopic procedure, then sent of to a tissue culture lab to be grown and multiplied. The lab ships the cells back when there are enough to re-implant and an open procedure is then performed, in which the lesion is covered with a piece of periosteum taken from the tibia, then the cells are injected under the flap and it is stitched and glued shut. Supposedly the cells then adhere and grow to form new hyaline cartilage to fill in the defect.
As I've learned through my research, however, ACI doesn't always work as it's supposed to. Some studies indicate that the cartilage that forms may not be entirely hyaline, but may consist of a mixture of hyaline and fibrocartilage. Fibrocartilage is what forms from microfracture surgery and its makeup is very different from the ultrasmooth hyaline cartilage that covers the ends of your bones. Fibro is more spongy and less suited to the shear forces from bones gliding across each other. It eventually breaks down and sloughs away, which is why microfracture surgery is not considered a permanent solution for articular cartilage lesions.
Many people also have problems with graft overgrowth, which is where the cells produce too much cartilage. That can cause the knee to start catching and locking. This problem then requires a third surgery to shave down the excess tissue.
My OS also pointed out that there have been cases where the tissue lab was unable to get the harvested cells to grow, yet the patient has still had to pay. This is another consideration you'll want to talk to your doc about.
Finally, this is an expensive procedure, which a lot of insurance companies still consider experimental. I've heard of people having to fight to get their insurance to pay for it. I'd advise checking with yours to see what their policy is. Find out, too, if your insurance company sets age limits for this type of procedure. At 49, you may be just under the wire for getting acceptance. I'm 51 and found out this past fall that BCBS wouldn't pay for the OATS allograft I was scheduled to have, because I was over their age limit. They consider OATS and ACI to be most effective for patients under age 50.
I hope this doesn't sound discouraging. ACI has produced good results for some people, in spite of the problems I mentioned. Then again, OATS has a high rate of success, too. You'll want to discuss all the pros and cons with your surgeon before making your decision. You may even want to talk to him/her about the second generation of ACI, in which the cartilage cells are cultured within a collagen matrix. This more closely simulates their natural environment and promises to eliminate some of the problems with ACI. Trials are underway on this new procedure in the US now.
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 ghost

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Re: How do you choose ACI vs OATS???
« Reply #4 on: January 28, 2009, 08:12:03 PM »
Hey Terre,


Havent' heard from you in ages.  How's the weather out on the coast.  Snow turning to rain here in Manchester. 

My mfx is not looking too optimistic.  Lots of catching and locking.  I thought that was a good sign, but I've been told that it's more likely a sign that the mfx failed and the knee is catching on the rim of cartilage that's left.  I've made an appointment with Dr. Minas at Brigham and Women's for June.  My 6 month mark to see if I'm a candidate for ACI.  I know Harvard Pilgrim covers the proceedure but I don't know if there is an age cut off.  I'm 49 now and will turn the big 50 in June.

How's you knee holding up these days.  I still plan to head your way for a walk on the beach when the weather finally relents.

Sue
rt k med meniscus 1983
rt k lat meniscus 2001
lft k med meniscus 12/07
lft knee medial meniscus 6/08 with chondroplasty & debridement of the suprapatella pouch
lft knee trochlear groove MFX 12/2/08 with chondroplasty and debridement of the suprapatella pouch
7/31/09 trochlear groove resurfacing

Offline plantgeek58

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Re: How do you choose ACI vs OATS???
« Reply #5 on: January 28, 2009, 10:35:26 PM »
Hey Sue,
slushy mess here, but my hubby just got home from work and says the roads aren't too bad. We're gonna try to hit the gym after dinner tonight.

Sorry to hear about the MF. Mine isn't all that wonderful either. The knee felt a lot better after a cortizone shot last month, but the effects of that seem to be wearing off and I'm getting a lot of twinges and pains again. Might have to go back to wearing my unloader after all.  ::)

Let me know how things go with Dr. Minas. I'd love to hear what he has to say. My OS doesn't like ACI and has discouraged me every time I've brought the topic up. If this knee starts to get worse, though, maybe I'll think about talking to Dr. M.

Look me up when you head over this way. I'd love to join you for that walk and I know all the best places to eat.  :)
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 ghost

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Re: How do you choose ACI vs OATS???
« Reply #6 on: January 29, 2009, 09:53:47 AM »
Hi Terre,

It stopped snowing around 3 pm yesterday and then it turned to freezing rain which piled up another couple of inches.  I would guess we go about 8" in total.  It's amazing how different the weather can be just a few miles away.

My bledsoe brace has been off about a week (without the OS permission), but I did keep it on the full 8 weeks.  Yesterday I went to clean my car after work and found out quickly that if that leg slips or slides even one iota it's an instant trip to mars.  Ouch!!!  I hate to conceed but I'll probably wear the brace for any outdoor activites today. 

I have no idea if ACi is the best route, but the rest of my knee is in good shape so they won't consider a tkr or pkr at this point so it seems like my only option.  Dr. Gill down at Mass General did the MFX, but they do not do ACI's as they're not convinced yet that they are the route to go.  Having said that he started my first post op visit with "you know MFX isn't always successful."  My heart kind of sank, but it is what it is.  I asked him about options if if failed and he told me that he didn't do ACi but to start researching Dr. M. and his Cartilage Repair Center as that would be his recommendation as the next option for me.  So when I was told that the catching locking was an early sign of potential MFX failure I figured I might as well get on the books with Dr. M.  Made an appt for June, 6 months pst mfx.  If things improve over the next couple of months I have plenty of time to cancel.  If they don't, than I'm lined up to take the next step without wasting more time.  In the interim, if this thing doesn't stop aching pretty soon I'm going to start sharpening the kitchen knives.

Stay warm,  it's cold and very windy here this morning.

Sue
rt k med meniscus 1983
rt k lat meniscus 2001
lft k med meniscus 12/07
lft knee medial meniscus 6/08 with chondroplasty & debridement of the suprapatella pouch
lft knee trochlear groove MFX 12/2/08 with chondroplasty and debridement of the suprapatella pouch
7/31/09 trochlear groove resurfacing

Offline michelel

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Re: How do you choose ACI vs OATS???
« Reply #7 on: January 29, 2009, 01:12:57 PM »
Terre thank you soooo much for the detailed info, I cant tell you how much it has helped me understand things.  You are very knowledgable and I am very thankful for your reply to my post.  I am the type of person, that just wants all the detail ya know?  I will keep you posted on my saga I see the OS March 3, hopefully sooner Im on the cancel list.  The pain is very difficult to deal with.  By the way, do any of yall know if  MFX (that has failed) can cause the defect to enlarge, my current OS says mine has  gotten bigger.
Thanks again
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 michelel

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Re: How do you choose ACI vs OATS???
« Reply #8 on: January 29, 2009, 01:14:49 PM »
Sue thanks alot for your information and advice.  I am so glad that I have found this website.  I'll keep yall posted, as my appt with the specialist is March 3.
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.