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Author Topic: Meniscus Transplant & MACI (w TruFit plugs)  (Read 4179 times)

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Offline mrpenguin

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Meniscus Transplant & MACI (w TruFit plugs)
« on: September 19, 2011, 12:26:10 PM »
Starting this new thread to write about my (hopefully) soon to happen Meniscus Transplant & MACI procedure.  Up to this point I have written about my condition under the thread of 'Micro fracture 11 months on, possible relapse? :-s '

A bit of history first:
Circa May 2003 I snapped my right ACL playing football. This was later reconstructed in August 2004.  In December 2004 I underwent a left knee lateral meniscectomy ('very feathered'), the damage to which 'may' have been caused by the imbalance/compensation of playing football from Feb to August 2004 with no right ACL.

Circa April 2009 I suffered some trauma to the lateral femoral articular cartilage playing football (unbeknown at the time) although there was the moment when my knee 'locked and clicked free' while running *ouch*.

After months of soldiering on and playing more football, it continued to became very sore and painful after football.  Physio didn't help and so my OS diagnosed either more meniscus damage or possible articular cartilage damage.  I underwent an arthroscopy in December 2009 during which the micro fracture (MFX) was performed.  The defect size at the time was around 1.5x2.5cm.  In September 2010 after a good rehab I returned to football.  The only issue I had was an occasional dull twinge on the MFX site when ‘cutting’ whilst playing football.

In November 2010 while walking across the landing at home I felt a sharp ‘sheering’ sensation on the MFX site as I planted my left foot down, leg straight.  I was not able to play any more football for about 6 – 8 weeks.  After revisiting the OS he performed an arthroscopy in Feb 2011 and advised that the MFX had began to break down (bits of debris were flushed out during the procedure).  He advised that the next options were to try a HEMI cap/TruFit plug and Menaflex implant.  I decided to leave it and see how I faired, not wanting to undergo more procedures.  After months of trying to get by, the knee became too sore and so I went back to request the next procedure to be carried out. 

My original OS was not certain that this would be best option so referred me to a knee specialist (Tim Spalding) who advised that the Menaflex implant would not be suitable given the condition of the articular cartilage surface and what parts of the lateral meniscus remained (the Menaflex would be shredded by the rough articular surfaces and the implant would not work as I not have a stable outer meniscal rim).  The recommended procedure to try to correct my problems is a Meniscus transplant along with a combination of MACI & Trufit plugs.

From my perspective I’m looking to continue to enjoy an active lifestyle (cycling, swimming, running etc) but no football.  This seems like the best option I have to achieve it so I have decided to go ahead and have the procedure(s) done.

Fingers crossed!

Offline mrpenguin

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Re: Meniscus Transplant & MACI (w TruFit plugs)
« Reply #1 on: September 19, 2011, 12:27:01 PM »
Update:

Booked in for 14/10/2011 for the biospy as the first part of the MACI.  From what I gather, the cells will then be kept in the freezer next to a bg of peas until the required parts (donor meniscus) come in. 

Once that is in, I will undergo the transplant and the MACI impant together.  Dependant on my luck, I could be waiting anywhere between 6 weeks to infinity and beyond.... having said that it appears about 6 months is standard for someone of my height and build (5ft 9.5in & 11st 4lbs).

I'm really excited about getting this sorted however on the flip side I'm also thinking about the poor donor... 


Offline mrpenguin

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Re: Meniscus Transplant & MACI (w TruFit plugs)
« Reply #2 on: October 17, 2011, 09:59:33 AM »
Update:

I had the left knee biopsy performed on the 14th, went well.  The knee is a little sore and stiff as exptected post op but walkinn about fine now.

When I saw Mr Spalding before the procedure he advised that a meniscus was available and post op he confirmed again - it looks like there is a real chance of having the meniscus transplant done in the next 6 - 8 weeks!

Feeling very excited and very nervous at the same time... waiting for a call/letter now from Tim's offices to advise on the situation.

Offline mrpenguin

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Re: Meniscus Transplant & MACI (w TruFit plugs)
« Reply #3 on: November 02, 2011, 11:03:06 AM »
Update:

Knee post biopsy healed really well.  After 1 week the stiches needed to come out as I was starting to heal over them! Can't beleive how good the knee feels at present, able to cycle without any pain at all on the biopsy site.

I have now been given a date of 16/12/2011 for the stage 2 of the MACI and the Meniscus Allograft transplant.  It's happening at the Nuffield hospital in Lemington.

From the details I've been given, looks like I'll be in for 2 nights post procedure and up to 6 weeks in crutches.

I guess this is question for the hospital but will they put me in/supply me with a knee brace?  If not I've been looking at some to potentially buy.  I also need to ensure I've done all the Xmas shopping early and wrapped all the gifts too!


Offline RichardUK

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Re: Meniscus Transplant & MACI (w TruFit plugs)
« Reply #4 on: December 07, 2011, 06:06:42 PM »
Just seen your post, when scanning through the site haviing not visited for a long time.  I'm not an expert but I have had experience of both MACI and tru-fit plugs in the UK. 

I see there is no mention of Tru-fit plugs in your last post.  That's good - as my advice is to avoid them if at all possible!  MACI is the lower risk/safer option.  However, the trufit plugs are drilled into the bone.  My tru-fit plugs failed and I was left with holes in my knee bone which had to be grafted with a follow-up repair operation combined with a MACI.  My knee was better before the original operation and I am regretting that the surgeon ever fitted tru-fit plugs.

I am sure your operation will be a success, with a combined MACI and Meniscus transplant.  Avoid any plugs though in my opinion from personal experience if you can...
Age 49
2001 - Right Knee - ACI Complete Trochlear and 1.5cm Medial Femoral Condyle
1997 - Right Knee - Debridement of MFC
1982 - Right Knee - Trimming of articular cartilage on MFC

Offline mrpenguin

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Re: Meniscus Transplant & MACI (w TruFit plugs)
« Reply #5 on: December 08, 2011, 01:08:24 PM »
Hi RichardUK, thanks for the post.  Sorry to hear ther plugs didn't work out for you.  I think that the resurfacing to be done will be a combo of the MACI and plugs - this maybe becasue of the size of the defect which was last measured about 2cm x 3cm.

I week tomorrow and I'm off to Leamington Spa for an overnight stay then checking in at the Nuffield Hospital 7am the next day.  Its a bit of a trek from where I live in Hertfordshire so not looking forward hence the stay overnight before hand.

Does anyone know if I'll be having an epidural?

Offline RichardUK

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Re: Meniscus Transplant & MACI (w TruFit plugs)
« Reply #6 on: December 19, 2011, 11:15:56 PM »
Hope your operation has gone well, and wishing you a speedy and good recovery!
Age 49
2001 - Right Knee - ACI Complete Trochlear and 1.5cm Medial Femoral Condyle
1997 - Right Knee - Debridement of MFC
1982 - Right Knee - Trimming of articular cartilage on MFC

Offline mrpenguin

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Re: Meniscus Transplant & MACI (w TruFit plugs)
« Reply #7 on: December 21, 2011, 03:24:08 PM »
Thanks RichardUk, I had the op on Friday 16th as scheduled and discharged on Sunday morning.  The surgeon/consultant sais he was really please with the fit and coverage of the menisus and also that the MACI looked good too - no signs of true fit plugs in the post op notes.

I was in some reall pain and discomfort post op but the meds helped me through, I have my frist physio appointment this Friday with my first clinic follow up appointment mid January.

At the moment my leg is in a brace, locked in full extension with only touch weight bearing allowed.  Bending to 30 degrees flexion will be allowed from Friday.

Due to have my clips/staples removed around boxing day.

So far so good but a long long road to recovery :-)

Offline lannarth999

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Re: Meniscus Transplant & MACI (w TruFit plugs)
« Reply #8 on: January 07, 2012, 10:14:22 PM »
hello mrpenguin
i'm probably starting along a similiar road, you must be 2/3 weeks into recovery, i'm sure its to early to say, but how is it going?
best of luck

Offline mrpenguin

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Re: Meniscus Transplant & MACI (w TruFit plugs)
« Reply #9 on: January 08, 2012, 07:41:09 PM »
Hey lannarth999,

It's now 3 weeks and 2 days since the op.  There were a few things that have casued me problems but nothing too major:

1. The brace made it awkward to do even the simplest of things like sitting on the loo to putting socks, underwear etc on.  I would advise the practice before hand if you can (and get a foot  stool for the toilet!) lol.

2. Pain management was a big thing for me.  It was much more painful than expected and it wasn't until about 2 weeks that I could move about without causing pain when standing up or sitting down.

3. My knee didn't swell to much to start with so my range of motion has been good.  I have been able to get to 90 degrees flexion while resting just before the 3 weeks marker and about 80 degrees doing very low friction heel slides.  I would urge anyone having this type of procedure to get their core muscles and also thigh/hip flexors etc in real good condition before the op.

4. One of the incisions made was just below the knee at the top of the shin bone (horizontally) and the top strap of the knee brace was constantly placing preassure on it causing it to weep alot.  I'm going to mention this to the surgeon when I see him tomorrow as the would is healing but unlike the other two incisions it opened a bit (the other twp are completely healed nicely).

I do a feel a slight click or catching sensation behind my knee cap when doing heel sllides, but not every thie so I'll raise this with the surgeon too. 

The most frustrating thing for me though it the crutches.  They are driving me mad! cant wait to be off them but this is a rehab process that is deliberatleuy slow so will just have to grin and bear it!

You mentioned that you are possibly heading down this road - what is the situation with yourself?

All the best, Mr P

Offline lannarth999

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Re: Meniscus Transplant & MACI (w TruFit plugs)
« Reply #10 on: January 08, 2012, 07:59:12 PM »
Hello Mr P
Glad all is sounding well. Hope the pains are starting to decrease and the mental boredom of recovery is managable.
I'm trying to see in the inevitable future, i've had the usual partial med meniscus removal, need another on the same, so in short his days are numbered. More worringly i have over the three years since op developed new types of deeper, more diffuse and episodic pains in and around the knee, which rest does not help. I have periods of 6mth of pain each year and know that this is degenerative ie articular cartilage wear.
So in sort i think i would like to go down the maci route but have meniscal issues to sort out as well.

Offline mrpenguin

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Re: Meniscus Transplant & MACI (w TruFit plugs)
« Reply #11 on: February 27, 2012, 08:42:37 AM »
Update:

Well its been 10 weeks since the procdures and so far all is going well and according to plan.

I had to start a new job after 4 weeks and getting to work on crutches was not the best experience, bus, train & tube involved!

I am pleased to say that I was able to start weight bearing after 6 weeks as planned and come off the crutches by 7/8 weeks.

My physio now includes the following:
Low resistance exercixse bike.
Heel slides on friction free surface
Straight leg rasies with 2.5 lb weight
mini squat - not even a quarter of the way down, just enough to engage to muscle
A bit of balance and proprioception.

It is a very long rehab protocol and the deliberate intention is to hold me back as much as possible so that I am not tempted to push things or do too much.  At time is feels like no progress is being made but patience is the key.

I have had an 8 week follow up with the surgeon which went well, I mentioned a clicking sensation I was feeling but this is something that was said would subside (hopefully) and so far it seems to have done so...

Next review/progress update is 6 months (June).  In the meatime I am in the hands of the physio (who is awesome) and so there isn't too much to post on progress really.  Next physio appt is in 3 or 4 weeks.

Will next post around then, please shout if you want to know any thing.

Mr P

Offline James13

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Re: Meniscus Transplant & MACI (w TruFit plugs)
« Reply #12 on: January 10, 2013, 06:08:43 PM »
Hi Mr P,

Its been a long time since your last post, and so I was wondering how you are getting on? I have been given the option of having a MACI procedure to sort out a femoral chondral defect i have from osteochondritis which has stopped me running and cycling. It is a very difficult decision as I am told there is a slight chance the op could make the knee worse!

I was really wondering how you have got on and what level of sport you have been able to get back to? I havent been able to speak to many people who have had a MACI procedure and so any feedback you can give would be greatly appreciated!

Many thanks,
J

Offline mrpenguin

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Re: Meniscus Transplant & MACI (w TruFit plugs)
« Reply #13 on: January 14, 2013, 01:14:45 PM »
Hi J,

Just looking back over the post and it has been a long while!

I'm due to undergo a procedure on the left knee soon to check out what has been described as a ganglion cyst - although I think this is due to the meniscus and not the MACI.

In terms of the MACI, I'm told it looks to be healing well from the last MRI - The only activity I've returned to so far is cycling.  I'm being very cautious in my rehab and so once this latest procedure if completed, hopefully successfully.  I'll be able to advise you what I'm told I can do and what I end up actually doing.

Best

Mr P

Offline mauro23

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Re: Meniscus Transplant & MACI (w TruFit plugs)
« Reply #14 on: August 14, 2014, 11:48:51 PM »
Hello Mr P,
You haven't posted for a long time and I was wondering how you are getting on? was your outcome a success? did it fail? what is your activity level these days?  hopefully it is good news.

Im booked for the maci biopsy 05/09, and will then get an actifit implant as well as the maci patch in 6-8 weeks time...

An update on your situation would be great. Many thanks.

Best,
M
Left knee lateral partial menisoctomy dec.2010, developed chondral defect 2 yrs later and had Microfracture in Oct.2012....   Symptoms persisted and got OATS procedure done in the same defect on Oct.2014















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