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Author Topic: Steroid injections and ACI/MACI  (Read 2972 times)

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Offline Rennschnecke

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Steroid injections and ACI/MACI
« on: February 18, 2010, 01:28:27 AM »
I'm trying to tap into the collective wisdom of those who have had ACI/MACI.

I'm down to have a steroid injection in my knee and I'm just around 8 months post-implantation.  I had an MUA with arthroscopy at 3 months as my knee did not bend to 90 degrees and now the patella tendon is scarred down so further release is needed.  As I'm still getting attacks of severe pain the OS wants to settle the knee with the steroid injection before doing an anterior release at the end of June.

Just to clarify, I'm not getting pain because of inappropriate activity and the OS is worried because he saw one of the episodes in clinic after he asked me to walk around his room without crutches and nothing more.  He does not think my pain is related to the scarring but called my knee 'irritable' (mind you, wouldn't you be after 6 surgeries? :-[).  The injection will hopefully get me off crutches and onto walking and ADL.

I've tried researching the possible effects of such an injection on the outcomes for M/ACI but it's been difficult and the results are mixed.  Some papers indicate it would inhibit cell growth; others indicate it would be beneficial.  I think this is a judgement call but I'd be interested to know if anyone else has had a steroid injection within a year of their implant and I'd be interested in hearing people's opinions as to the pros/cons of having this injection.

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.

Offline ajschnelk

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Re: Steroid injections and ACI/MACI
« Reply #1 on: February 18, 2010, 06:57:41 PM »
this is an interesting topic.  I know my doctor is okay with anti inflammatories, but I also know Dr. Minas says "none" for the first 6-9months.  I'm assuming your doctor is not hesitant with going forward?  The question is whether or not the absence of swelling out weighs the side effects of  a steriod (if there are any).  I have had swelling issues with my other knee and my OS wanted me to try celebrex (NSAI), but I have decided against it just to play it safe. 
« Last Edit: February 18, 2010, 07:03:25 PM by ajschnelk »

Offline Rennschnecke

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Re: Steroid injections and ACI/MACI
« Reply #2 on: February 18, 2010, 08:34:37 PM »
Hmmm, yes, I had a look at NSAIDs effects on ACI.  What I found a little while ago is that there is no in vivo evidence of problems.  All studies pointing to a problem with NSAIDs (specifically ibuprofen) and chondrocytes are in vitro studies.  As I was given ibuprofen in hospital I didn't have a chance to influence it.  I did cut back once I read about the concerns – just to be safe.

I think steroids are another class of drugs yet again.  Never had a steroid injection before so not looking forward to it based on others' accounts.  Also that persistent niggle that it'll compromise the cell growth.  On the other hand, when I'm in pain I'm not sure what to think or do  :-\.
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.

Offline thevoice

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Re: Steroid injections and ACI/MACI
« Reply #3 on: February 18, 2010, 09:13:46 PM »
Id go with whatever your OS advies. If there was clear evidence to say X Y Z inhibit ACI then the manfacts would advise it on the label so to speak and then everyone would follow it.

Offline ajschnelk

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Re: Steroid injections and ACI/MACI
« Reply #4 on: February 18, 2010, 10:36:12 PM »
Hmmm, yes, I had a look at NSAIDs effects on ACI.  What I found a little while ago is that there is no in vivo evidence of problems.  All studies pointing to a problem with NSAIDs (specifically ibuprofen) and chondrocytes are in vitro studies.  As I was given ibuprofen in hospital I didn't have a chance to influence it.  I did cut back once I read about the concerns – just to be safe.

I think steroids are another class of drugs yet again.  Never had a steroid injection before so not looking forward to it based on others' accounts.  Also that persistent niggle that it'll compromise the cell growth.  On the other hand, when I'm in pain I'm not sure what to think or do  :-\.

yes, I too took ibuprofen for the first two weeks after surgery.  My OS said that regular doses will not cause any problems, but I did not want to risk it and stopped all together. 

Offline Rennschnecke

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Re: Steroid injections and ACI/MACI
« Reply #5 on: February 20, 2010, 01:42:19 AM »
I think I'm with you on being conservative.  Unfortunately, my pain is getting out of control with FWB w/o crutches so I'm back to discussing strategies with pain man and OS.  Maxed out on paracetamol, gabapentin and tramadol and so topping up with ibuprofen.

Does anyone know anything about latent pain and managing it?  What causes it?  Google hasn't been very helpful this time  There are few readable informative articles around.  They either seem to merely define the term or go so deeply into the biochemistry that I fall asleep. :-[
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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