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Author Topic: My MACI experience  (Read 3275 times)

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Offline zarf1

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My MACI experience
« on: December 10, 2012, 02:36:45 PM »
I had a MACI operation on a 2 defect on patella femoral groove in July last year. Unfortunately, the operation was not a success with the graft detaching at the first MRI at 3 months. I am posting here in hoping that others may benefit from my experience. Please bear in mind that my operation was not a success - it's important to way up the evidence and come to your own decisions.

Prior to the MACI I was doing really well. Walking and riding with no pain at all. I was very fit and a competitive mountain bike rider. I had the operation as 2 years prior following a locking episode that occurred following a fall in a volleyball game an MRI had revealed a hole in the cartilage in this area. I recovered from this episode in 3 days. However, as I was having minor pain in the area I saw a Ortho surgeon. He recommended MACI and said I should have the operation within 2 years (prior to turning 40) to have the best chance of success. I turned 40 in March and decided to have the operation. Even though I had normal tracking in the knee the surgeon recommended a lateral release (not exactly sure why - I think there was some minor abnormality that he felt may be impacting tracking).

The operation did not seem to go well. My knee just did not feel right after the operation and I had a massive fluid filled haemotoma in the post-operative period. The rehab was helll and pain stakingly slow. I was restricted as there was a clicking and crepitus in my knee that I did not have before the operation. I worked hard on rehabilitation and stayed within my restictions wearing the knee brace. I have young children so this period of restriction was extremely difficult. I returned to work after 3 weeks as I felt I had to (I have a busy mgmt position) I think this was way too soon.

As mentioned the graft was not present at the first MRI at 3 months. The surgeon said this was due to the inward pronation of my knees and that he believed it would have occurred early in the operation. He advised me to return in 12 months.  I am quite frustrated that these issues were not identified prior to the operation as possible issues for me. I have had significant difficulties since the operation. The crepitus and clicking form the post op peridod remains. Whislt the MRI indicates that my knee is much the same post as pre-op I have significantly more pain. it feels like razor blades in the region of the graft. I did not have this prior to the operation. The pain has gotten worse over the last 6 months (still no major changes on MRI to explain this). I have stuck with the rehabilitation and gradually returned to more activity, including non-competitive riding - though I am finding even this increasingly challenging.

My advice if considering this operation;

- Approach it as an absolute last resort. if your knee pain is manageable and not limiting get some physiotherapy advice and focus on strength training. The operation will set your strength back totally. There is research that strength throughout the ROM is limited at 5 years psot MACI. I have great difficulty standing when kneeling on one leg since the operation. 
- Do not believe a surgeon who claims 90-100% success rate without scrutiny. Obtain copies of the results/research papers and question what they tell you. The success rate seems to be more around the 60% mark from the papers I have since read. I have read no research papers that go into any detail regarding the impact of the operation if it fails. I certainly lost good function and for 6 months had extremely limited function. I have significant pain that continues since the operation.
- Request a pre-operative assessment. I did a pre-operative assessment for research purposes post-operatively as it was not provided pre-op. This revealed very high function/low pain and should have probably resulted in advice not to have the operation.
- If you have young kids my advice would be to think carefully as to whether you can cope with the demands of family life and the severe limitations of this operation in the recovery period.

I hope this is helpful and I wish anyone reading this with similar issues the best of luck.