Advertisement - Hide this advert





Author Topic: Cartifill vs. A.C.I.  (Read 8738 times)

0 Members and 1 Guest are viewing this topic.

Offline WestPoint

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 0
Cartifill vs. A.C.I.
« on: May 31, 2010, 04:05:38 PM »
I was in contact with a doctor who does A.C.I. as I was interested in knowing the difference between A.C.I. and Cartifill. He told me that A.C.I. - on the downside - requires 2 operations (the first is the biopsy, the second is the implantation). It results in a hyaline rich cartilage repair and is most similar to the original hyaline cartilage.

He told me that Cartifill, on the other hand, is an experimental procedure as of now, with limited outcome studies, and is therefore not FDA approved. This is a better form of microfracture in which the stem cells are trapped in the Cartifill collagen. The major advantage is that it is a one stage procedure. However, the hyaline component is minimal and it is primarily a fibrocartilage (inferior) repair. It oftens suffices in small lesions.

Frankly, this scared me to hear this, as I was sincerely considering Cartifill. However, it seems to be something of a glorified microfracture process, with lower hyaline content than A.C.I. Any additional information regarding these two procedures would be appreciated.

I'm sure Lottie will be interested to see this.


« Last Edit: May 31, 2010, 04:32:19 PM by WestPoint »

Offline Lottiefox

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 2393
  • Liked: 16
Re: Cartifill vs. A.C.I.
« Reply #1 on: May 31, 2010, 07:14:28 PM »
I think there are also important factors in deciding between these two routes in terms of how big your lesion is, how it occurred and where it is sited. I have seen the UK pioneer of Cartifill 3 times, and indeed it is MFX with a collagen matrix/paste applied to the top of the stem cell release. It isn't ACI, and the results are new, small and may well not create the level of cartilage found in ACI. It is suitable up to 3cm lesions.

For me Cartifill holds two main appeals. My primary damage is patella (lateral and medial - lower facets). ACI on the patella is tough. It has mixed outcomes, requires two surgeries the latter of which is open and which creates a high risk of scarring as is common on patella grafting. The patella loads everytime the joint moves and shears, and ACI has one hell of a job developing in these conditions. It isn't imposible, but its a high risk option. many surgeons have ruled out ACI for the patella and go straight to PFJR. I like Cartifill as it is robust and hard from the moment of implantation. It has a good chance of creating something that is robust on the patella. OK, it might fail. But so might ACI and to me, going through one surgery (done by scope on the patella next year) is less stressful and invasive to me and my knee than two, especially as the odds of the two suceeding on the patella only fall into the 60%s or so. But I am still procrastinating. I am Queen of Eternal Debate.

Take out the patella element and perhaps my thoughts would be leaning towards ACI (well, in fact I'd be looking at MACI or variants of this) as it has good results on the condyles. BUT you still need decent cartilage around it to build an environment for the graft to grow, and in my particular knee I am not sure I have enough decent surrounding stuff to have a long term great outcome. I am probably going to be joining the bionic ranks one day.

Fundamentally cartilage repair is developing every year. One day, there will be off the shelf stem cell based hyaline cartilage grafts made to measure whatever size you need. In my view, this could well be the case within 5-10 years. I'm therefore hanging on with PT and looking after what I have left until such time I feel confident in my choice.

So, not sure if this helps - I don't think there is one "best" treatment as the best treatment is the one that suits your knee best. And a decent surgeon will know that.

Good luck with whatever you decide,

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline WestPoint

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 0
Re: Cartifill vs. A.C.I.
« Reply #2 on: May 31, 2010, 09:55:44 PM »
Hello Lottie,

I would agree with you that Cartifill sounds like a good option for the patella. As mine is a chondral lesion, I think I'll go for some sort of A.C.I. treatment as I fear that a microfracture type operation would eventually fail me.

You mentioned M.A.C.I. in a positive light. Is it really better than A.C.I.? If I were coming to the U.K. to do A.C.I. or M.A.C.I., how much would I be looking at with MRIs and the like? No specific quotes needed, just ballpark figures to give me a rough idea.

Are the other European countries such as Germany and Switzerland more or less expensive?

Lastly, do you know anything about Chondron in India? It's overseen by the same Korean company as Cartifill but is A.C.I. (i.e. two operations).


Offline Lottiefox

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 2393
  • Liked: 16
Re: Cartifill vs. A.C.I.
« Reply #3 on: June 01, 2010, 12:09:30 PM »
Hi,

I think I tend to rate MACI a bit more highly because it creates that scaffolding around the graft, but I have to say I am no expert on ACI versus MACI as i haven't gone down that road because of the patella involvement.

In terms of costs, my MRI scans involving T2 mapping for the in depth cartilage analysis were around the £500 mark. A simple arthroscopy in the UK is usually charged at about £2000-£2500 if you are self funding, depending on what they do. With ACI you will then need the open surgery to implant and I am unsure of costs although I do remember someone seeing a bill for about £6,000 upwards when they were researching things. It isn't going to be cheap! The RNOH at Stanmore has excellent MACI work going on, as does Tim Spalding in Warwickshire. Several people on KG have been treated at Stanmore and have good results many years on (look up Julian UK and his history on his).

No idea on other Eurpoean countries but given the state of our currency they are probably better value! No clue on Chondron either. Have you looked at De Novo NT - this uses donor cartilage from a juvenile cadavar. There is a thread on here and the author is seeing very good results so far:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=51324.0

Good luck and if I can help with any practicalities on UK stuff just give me a shout.

Lottie  :)
« Last Edit: June 01, 2010, 12:11:20 PM by Lottiefox »
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline WestPoint

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 0
Re: Cartifill vs. A.C.I.
« Reply #4 on: June 02, 2010, 10:05:45 AM »
As usual, your comments are very helpful. I understand then that I would be looking at around £9,000 for an A.C.I. operation in the U.K.. Iím thinking about going for Chondron in India, but Iím not as confident about seeking medical treatment over there as I am in Europe.
Iím actually in a bit of a bind as I donít know the actual size of the lesion. My doctor did some shaving around the lesion and never told me the actual size. I was just told that it was small and that I should be ok (which Iím not!). Iíve been back to see the doctor to get a CD of the operation, but he told me that the operation was not recorded. According to his recollection of the operation, he does not think I would be a candidate for A.C.I. as he thought the lesion would be too small (A.C.I. is not available in the country Iím stying in) and suggested O.A.T.S. instead.
What I donít understand is the consistent discomfort and pain I feel from such a ďsmall lesion.Ē I can only walk for part of the day. I use up this time at work and then rest for the remaining part of the day when I get home. Iím sure that I can do a 3D MRI, but even that is not so accurate at defining the exact lesion size from what I can see on this board. Even if my lesion were a bit smaller than the minimum requirement for A.C.I., wouldnít they be able to increase it to the minimum size (I know that sounds terrible) as I cannot live like this, nor am I interested in microfracture or O.A.T.S.. From what I can see in the diagrams of the A.C.I. procedure, they always widen and clean up the lesion anyway.
By the way Lottie, I can understand the logic behind wanting to use Cartifill in your patella (which is a non-weight bearing area and best suited for this type of fast setting gel treatment), but I feel you should think twice about using it for your weight bearing lesion. In effect, you will be receiving microfracture for that lesion. I think you might want to consider A.C.I. or something else. Perhaps Dr. Shetty also uses Chondron (same company) which is A.C.I. with a gel (two operations though). I remember one post saying that Dr. Shetty has another gel treatment. Maybe that is what it is?
Oliver

Offline WestPoint

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 0
Re: Cartifill vs. A.C.I.
« Reply #5 on: June 03, 2010, 05:41:09 PM »
raised...

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4817
  • Liked: 399
  • Neelie knee!
Re: Cartifill vs. A.C.I.
« Reply #6 on: June 04, 2010, 06:58:23 PM »
I am not sure the size of the lesion actually has too much bearing, more the position and state of it?  I have a 1.5cm2 on my lateral femoral condyle which was found to have healed over with fibrocartilage when the knee was scoped in February (caused by a cycling accident not ear and tear).  It was left in peace at that time (might have been drilled but wasn't required as the scar tissue was fellt to be decent).  However, I still have persistent pain and swelling in the knee (which is ever present but gets worse if I do anything much on it) which the OS is pretty sure is down to this defect. 

I can't even walk half a mile (and to be honest far less if a slope up or down) without pain (or actually for 5 minutes on a treadmill at 4mph),  nor can I run across a road nor sit for any length of time without pain and/or stiffness.  I have been advised to stop all exercise (was cycling - static and proper, plus rowing, stepping in gym for the last couple of months), keep walking to a minimum and only swim (I can't do breast stroke only crawl) for 3 months.  It has also affected my gait.  If the knee doesn't settle / pain persists, I am likely facing debridement of fibrocartilage some sort of drilling / membrane or grafting / membrane surgery all for a little lesion (albeit on a WB surface).  My OS specialises in knee and indeed cartilage treatments (part of MACI trial) so I do believe what he is saying!   
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline WestPoint

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 0
Re: Cartifill vs. A.C.I.
« Reply #7 on: June 04, 2010, 08:38:21 PM »
Hello Vickster,

Have you thought about doing the MACI trial with this doctor? If lesion size is not of great importance, wouldn't this be the best choice?

Oliver


Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4817
  • Liked: 399
  • Neelie knee!
Re: Cartifill vs. A.C.I.
« Reply #8 on: June 04, 2010, 08:52:45 PM »
Hi
It may be MACI that he is considering - in the last consultation he talked about drilling while in his letter to my GP (which I get copies of), he mentions debridement and grafting with a collagen membrane.  I don't think the trial is is being recruited right now anyhow.  I have private healthcare through work so cost and wait time are not a consideration for me fortunately (all my treatment and physio to date has been done privately). 

If the no exercise regimen doesn't work and I am still struggling in a couple of months, I will of course discuss the options with him :)  I am not at all keen on microfracture as obviously I don't seem to fare to well with fibrocartilage!  I will take the OS's advice (I don't get the impression he is gung-ho about surgery, was 5 months post injury that the last scope was done and now we are waiting another 3)

I am not sure I want the rigmarole of being in a trial (it has 2 arms from what I read, one MACI and one MFX, and not guaranteed).  I believe I am a decent candidate for these types of treatments as I don't have arthritis in the knee- it is pretty decent on the whole - and I am *only* 37)

Vicks
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline WestPoint

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 0
Re: Cartifill vs. A.C.I.
« Reply #9 on: June 04, 2010, 09:04:05 PM »
Sounds like your symptoms are very similar to mine. Exercise or more than walking around at work (evenings are for sitting down) causes pain that takes about 2-3 days to get rid of, and resting causes stiffness and sometimes pain.

I'd say you need to find out exactly what it is he's going to do. Hope everything works out for the best. I'm going to post something about a relatively new treatment called Autologous Matrix-Induced Chondrogenesis (AMIC). It's sort of like microfracture, but is supposed to be better.

« Last Edit: June 06, 2010, 11:19:07 AM by WestPoint »

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4817
  • Liked: 399
  • Neelie knee!
Re: Cartifill vs. A.C.I.
« Reply #10 on: June 06, 2010, 08:05:55 AM »
I will take whatever advice is given if I am still having issues in a couple of months.  My discomfort and swelling are more or less ever present - actual persistent 'painkiller' pain is rare but actually it was even early on when basically the defect would have been through to bone

This is the hospital where I am being treated and this link shows the cartilage treatments my OS specialises in http://www.stanthonys.org.uk/Specialised_procedures/cartilage_injuries.html .  Describes two - MACI and then microfracture + membrame (maybe this is the other one you are talking about?  ??? )
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline WestPoint

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 0
Re: Cartifill vs. A.C.I.
« Reply #11 on: June 07, 2010, 06:16:25 PM »
It seems that those who are dealing in stem cell research are most concerned with mesenchymal stem cells, as they have the ability to form into other types of cells including osteoblasts (bone cells), chondrocytes (cartilage cells) and adipocytes (fat cells). What concerns us in this discussion is of course the chondrocytes.

The Regenexx people stated the following:

The type of adult stem cell that is most often seen in research as being associated with tissue repair is a mesenchymal stem cell (MSC). MSCís canít generally be harvested from blood nor can they be obtained in clinically relevant numbers at the bedside, processed, and re injected in the same day. All of the high quality research involving MSCís involves culture expansion. This means that the cells are grown in culture to higher numbers before being used for treatment. This usually takes 10-18 days.

It would make sense to me, therefore, that procedures such as Cartifill might do well if they are not only doing microfracture, but actually being harvested from hips with that 2 Ĺ week culture expansion and then being implanted in the lesion with the gel. Iím just wondering if anyone knows of such a technology, as it would still be within the domain of a single operation instead of the ACI model which requires two operations. I wouldnít consider the insertion of a needle into the hip an operation as such.

Offline Lottiefox

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 2393
  • Liked: 16
Re: Cartifill vs. A.C.I.
« Reply #12 on: June 07, 2010, 10:43:16 PM »
I think you've probably hit the nail on the head with the last paragraph there. I think that is the aim of Mr Shetty and the process that he hopes to develop, using stem cells harvested from the iliac crest, expanded and then introduced either directy at surgery or via canula post surgery. I have to say that Shetty is such a cartilage enthusiast it is easy to get a bit lost and overwhelmed with his new ideas in a 50 minute consultation! I am definitely keen to see what is discussed at this conference in the Autumn if I can sneak my way in (white coat and stethoscope anyone?).

Just regards costs for MACI etc - sorry if I gave you dff information. I was going on what I thought I had read from someone who had been told the scope plus an open procedure (circa 9k), but I may well have been recalling things wrongly. In some ways I am not surprised at the cost you mentioned, it is a lengthier and more specialised process than a TKR in many ways and that usually rates between 8 and 12k for a total replacement. I know Cartifill is currently being quoted around the 5-6K mark, depending on scope or open. It is a far cheaper material with less time and expertise growing cells. That is partly the rationale behind it; Shetty quotes a vision where banks of cartifill can be shipped to countries like India that do not offer knee surgery options at the moment for the general population.

Its a fascinating field, but a tough one when it relates to your own health.

Any decisions yet Westpoint?  ???

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline WestPoint

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 0
Re: Cartifill vs. A.C.I.
« Reply #13 on: June 08, 2010, 02:43:30 PM »
Unfortunately, Iím not as sure about what I should do as you are. Iíll be travelling to do this operation, so ACI/MACI will be very difficult, especially considering that I will be in a foreign country. Cartifill would be great as it is a one stop go, but it just seems to me to be a great way to create a good microfracture clot. Iím very excited to know that Dr. Shetty is planning to inject stem cells into the gel eventually. I feel so confident about this idea that I wouldnít mind being one of the first to try it. Do you have any idea when he will be starting this procedure? Maybe itís worth waiting for.

Iím considering Chondron in India, which is produced by the same Korean company as Cartifill. However, it is an A.C.I. type procedure involving two operations. Itís not that much cheaper than going to the U.K., and Iíd have to stay in India for the summer break.

Iím also considering the Regenexx procedure, but Dr. Centeno told me there is no way to tell what will happen in any individual patient with a small chondral defect. I have written them back to get more information before I fill in any forms and send off MRIs etc. Lastly, Iím looking at Xcell-Center in Germany, although Iím wondering if Regenexx and Xcell-Center type procedures might be better for general arthritis cases as opposed to people with focal lesions. I will have to decide in the coming weeks as my summer break is coming up in a month from now.

Don't take too long to treat the problems, Lottie.

Offline WestPoint

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 0
Re: Cartifill vs. A.C.I.
« Reply #14 on: June 08, 2010, 04:30:29 PM »
Since you are having patella problems, I thought I'd post this, assuming that you haven't seen it yet:

http://www.regenexx.com/2009/05/364/
















support