MACI practicalities

[vickster]

Found this with some Googling, answers quite a lot of questions (not Stanmore but UK)

http://www.kneeclinic.info/download/CKC_GNHFT_ACI_RehabGuide_101106.pdf

HR asked for some details, might send to them as well (not many gory pictures  )

[vickster]

I had the scope yesterday but am not going to be having the second stage - the femur defect fibro is still of decent quality but more importantly, there is extensive softening of the cartilage on the tibia opposite - with kissing lesions, the OS thinks the chance of success are simply too low to put me through the op and rehab.  He performed chondroplasty and gave me a hyaluronic acid injection which he is confident should help.  He talked about an osteotomy being a future option to shift the weight from the affected lateral side to the medial side which is ok. in the short term I need to get over the scope (very sore and swollen today) and see if strengthening the muscles further with static cycling helps.  So I'll be getting an exercise bike for Christmas!  I see him again for follow up in 6 weeks so can discuss the options further.   So a somewhat unexpected outcome but a potential option for the future   3 weeks off work for me and then time to plan a spring holiday!

[Rennschnecke]

Hi Vickster,

Good to hear that your OS is trying to spare you the long rehab from MACI with low possibility of success.

I was in your position 2 years ago and had chondroplasty but I didn't have the hyaluranic acid injection.  I also had a hemarthrosis following the arthroscopy so recovery was complicated and didn't go too well.  As a result, I was put on the list for MACI for kissing lesions, but in the PFJ.  I'm guessing that kissing lesions at the condyles are subject to more stress as they are weight-bearing.

It's lucky ( ) that your lateral side is affected so that an osteotomy is an option.  I just hope that it isn't needed and that your cartilage holds up for a long while yet.

Take care over Christmas and enjoy the holiday!
 

[markld]

Vickster,

MACI can and has been used for kissing lesions. It sounds like your surgeon doesn't have much confidence. Here in the US Tom Minas performs ACI to kissing lesions quite often and has great success with it. It is a matter of finding a surgeon who has lots of experience.

[vickster]

Hi markld

I don't think confidence is his issue here, he has done 100s of MACI ops (including plenty on members of this forum), one of the leading OS's in the country doing cartilage repair.  I have a lateral femoral defect which is full of fibrocartilage (which developed after the initial trauma and is in decent condition according to the two OS who have scoped my knee), plus the extensive and diffuse grade 1-2 softening on the lateral tibia (no full thickness).All on WB surfaces unfortunately - I think that is the main contraindication here, not the fact the lesions are kissing

I also have grade III damage on the lateral facet of the patella.  It does seem to make sense that there is some malalignment (the OS did recognise a slight genu valgus / knock knee on initial exam) and that maybe an osteotomy is the way to go.  I am hoping the tidy up and Durolane injection helps.  I will be glad to be rid of the scope stitches tomorrow too! 

I see the OS at the end of Jan, so can talk next steps then.  I am inclined to leave anything until at least October as I want to spend the summer cycling on the bike I bought for myself today    This will also build up the leg muscles which should also benefit the knee obviously 

[Rennschnecke]

Hi Mark

I think Vickster may be correct in her assessment of risk.  The guidelines here embargo MACI for kissing lesions although I was granted an op for kissing lesions after my OS consulted with international colleagues.  However, mine were in the PFJ which are non-weightbearing when static.  Even so, I am regarded as well beyond operational guidelines for the UK surgeons, but I guess it can be justified in the name of research.

I have researched this op and believe that kissing lesions that are treated are more likely to be in the PFJ – open to learning otherwise.  If the lesions are the result of malalignment then this needs to be sorted out otherwise the defects may occur again.  If the malalignment can be corrected by an osteotomy then there may be no need for a MACI as the forces through the joint will be changed.  I guess the conservative approach would be to go for the osteotomy and see what the result is.  If a MACI is still needed then it could be reviewed then in the light of further knowledge.

I have to say, if she can get relief without MACI I'm all for it!

[KartBoy]

Vickster

Your in good hands at Stanmore/ Bushey and if they don't think its worth going forward then I too would be inclined to accept it. I think its worth rembering that MACI/ ACI is still really experimental surgery and although many of us (me included) have benefitted there is still much to be learned and they don't know enough yet to be able to fix all knee cartilage failures, its is good to hear though that there are still options going forward and I wish you all the best for the new year.

Regards

Andrew