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Author Topic: Cartilage repair: how sturdy is the graft?  (Read 620 times)

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Offline margret

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Cartilage repair: how sturdy is the graft?
« on: February 22, 2013, 11:33:28 PM »
I'm 16 days out from a DeNovo graft on my patella. (Similar to the final stage of an ACI.) I'm afraid that any move I make could damage the graft. Otherwise, why would there be such restrictions on bending and weight bearing? Can someone help me understand whether the graft is really as delicate as I think?

Offline Vickster

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Re: Cartilage repair: how sturdy is the graft?
« Reply #1 on: February 23, 2013, 10:55:42 AM »
This is for ACI not de Novo but will give you an idea

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

"consistency of your “new” cartilage is:
•after 1 week like WATER
•after 3 months like YOGHURT
•after 6 months like DOUGH
•after 9 months like CHEESE
•and after 12 months like RUBBER"

So yes, the graft is liquid at 16 days - and the back of the patella is even more in need of protection early on due to the shearing forces during bending

Best thing to do is to talk to your doctor.  However, if he told you to be braced, non weight bearing and be very careful as the graft is very delicate, I would listen to him :)
« Last Edit: February 23, 2013, 11:22:31 AM by Vickster »
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 gh05

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Re: Cartilage repair: how sturdy is the graft?
« Reply #2 on: February 23, 2013, 04:08:44 PM »
This is for ACI not de Novo but will give you an idea

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

"consistency of your “new” cartilage is:
•after 1 week like WATER
•after 3 months like YOGHURT
•after 6 months like DOUGH
•after 9 months like CHEESE
•and after 12 months like RUBBER"

So yes, the graft is liquid at 16 days - and the back of the patella is even more in need of protection early on due to the shearing forces during bending

Best thing to do is to talk to your doctor.  However, if he told you to be braced, non weight bearing and be very careful as the graft is very delicate, I would listen to him :)

wow...no wonder it is not commonly recommended. 

12 months is a long time without normal movement!  Good luck OP

Offline Vickster

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Re: Cartilage repair: how sturdy is the graft?
« Reply #3 on: February 23, 2013, 04:17:08 PM »
There are several large centres in the UK that are doing a lot of MACI (obviously this is relative to other procedures like scopes,  ACLrs and replacements).  However, private insurance companies are unwilling to cover the very high cost (£12-15k + all the physio).  NICE is not convinced, but the procedure is done at some hospitals on the NHS in the correct indications.  It is a very painful op (indeed 2 ops, arthroscopy and then an open arthrotomy) and post op (I was told this by a surgeon so I am sure it is the case).   

I was told 1 year to feel as pre-op and 2 years to start seeing benefit - impact stuff is not normally allowed for 18 months.  Cycling and swimming at around 6 I think (but probably depends on defect location and size).  Also, the documented long term success rates aren't fantastic, especially for the patella (about 50% and 70% for the femur / tibia).  If you have kissing defects or more generalised damage and/or non stable margins around the defect, you can pretty much forget getting it done, except in certain salvage circumstances.

There was a big multi centre trial ongoing but that has now stopped recruiting I believe.  Presumably, they are collating the data now.
« Last Edit: February 23, 2013, 04:29:50 PM by Vickster »
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 margret

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Re: Cartilage repair: how sturdy is the graft?
« Reply #4 on: March 13, 2013, 08:54:27 PM »
Thanks for the input...DeNovo seems different because it's placed in a "fibrin glue" instead of covered by a patch. My physician's assistant (my only contact with my surgeon's office between visits) says emphatically that I WILL NOT damage the graft, short of taking a fall, so I'm trying to believe her.















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