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Author Topic: Cartiform cartilage graft for chondromalacia patella  (Read 20122 times)

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Offline canyonking

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Cartiform cartilage graft for chondromalacia patella
« on: April 11, 2014, 08:36:59 PM »
Background: 40 year old male, weekend warrior athlete. Crossfit, mtn biking, volleyball, weights, climbing, canyoneering, etc.

Lateral release left knee 08
Scope debridement left knee 11. Plan was to have microfracture but woke up to find that they decided it was too damaged to be of any good.

Scope with debridement right knee Dec 13
Cartiform cartilage graft right knee March 14

Ive been very physically active my whole life with no major injuries. Knee pain started creeping in my left knee in 07 and the lateral release helped me get quite a few more good years out of it. Right knee pain came on much more quickly (possibly from overcompensating). Had it scoped. Both knees have the exact same problem: osteochondral defects in both patellas but the rest of the knee is healthy. I had made the decision to get an arthrosurface partial knee replacement in the left knee by an OS who specializes in joint resurfacing in Park City. He suggested that even though the left knee looked worse, the right knee bothered me more and he had a biological solution: cartiform

Cartiform is a cartilage graft from a cadaver that is microfractured, sewn, and glued into place. It is made by a company called Osiris. It has only been out 6 months and I will have been his 6th patient. It sounds like it is similar to Denovo.

I had the surgery on the 19th in Park City and he said it went well. I'll include pictures for those that are fascinated by the stuff they come up with like I am. But be warned - graphic images - do not view while eating cafeteria corn dogs. The problem started that night when I started taking a little pill called xarelto - a blood thinner. I guess he was worried about me getting a blood clot. I took my pills like a good boy but little did I know that it would cause excessive bleeding into my leg for the next 10 days. I was in a dark hole for that time. I haven't cried that much since watching E.T. in the 4th grade. After the nerve block wore off they had me on 2 10mg oxycodone every 4 hours and a 12 hr release oxycontin.

After trying to convince the medical team that something was wrong multiple times I decided to see another orthopedic surgeon closer to where I live. His eyes went wide when he saw the swelling. He told me he was going to drain it and I would get instant relief. I was so excited as I have had this done on the other leg years ago. I couldn't have been more disappointed if there were no presents for Christmas when he pulled and pulled but got nothing. He said it had thickened now and it was too late to drain it. He told me to stop the blood thinner immediately and suggested that I might have to go back into surgery to have the hematoma "scooped" out. He likened it to a placenta.

The OS in Park City did not want to open me back up and basically said I would have to tough it out as my body would try to re-absorb all that blood. So, that's where I'm at right now. I got immediate relief after quitting the blood thinner and have started to improve ever since. I'm off the oxycontin as of day 10 and have reduced the others. Problem is, all of this has put me behind schedule. They wanted me to start the cpm (continual passive motion - think medieval torture device) machine at 50 degrees flexion. Basically, you strap your leg in and it bends your leg for you. I'm supposed to use it about 6 hours a day. I started it at 35 a week or more behind schedule. It felt like my knee would just burst and innards would spray all over the wall. But I really am doing better. I got up to 75 last night and when I'll start to go to rehab 3 times a week here next week.
« Last Edit: April 12, 2014, 06:55:02 PM by canyonking »

Offline canyonking

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Re: Cartiform cartilage graft for chondromalacia patella
« Reply #1 on: April 12, 2014, 07:08:00 PM »
Started taking as much fish oil as possible yesterday. Have heard research of Dr's prescribing 10 to 15 grams a day (megadoses) to reduce inflammation in critical organs in patients. 14 huge pills equals about 4 grams. Also using some liquid I have mixed into a shake for dinner. I'm probably getting about 5 grams per day or so. I swear I've noticed a change in the size of the knee. It's still tight, but just smaller. Has anybody had experience with this?

Offline canyonking

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Re: Cartiform cartilage graft for chondromalacia patella
« Reply #2 on: April 12, 2014, 07:11:54 PM »
Here is a picture of the cartilage graft. It's a new one called cartiform. It's microfractured in, sewn in (they dissolve), and glued in. I'm hopeful but skeptical that it will actually GROW into functional cartilage. Sounds miraculous actually. Time will tell. I doubt I will ever actually see it rather feel that it is working.

Offline canyonking

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Re: Cartiform cartilage graft for chondromalacia patella
« Reply #3 on: April 15, 2014, 08:39:34 PM »
April 13 15 Day 26-28. Benchmarks: Have been using only one crutch for the last 2 days. Started taking at least 5 grams of fish oil per day (4 pills 4 times a day + liquid in shakes). Ron at rehab said there was significant decrease in swelling in just 5 days. 1 & centimeters less diameter around the knee- said it was significant Im convinced its the fish oil hes skeptical. Still cannot sleep more than 4 hours in the night. One night I slept well I took one of my remaining 3 (now 2) 12 hour release oxycontin plus alterill natural sleeping aid plus 10 mg oxycodone plus halfway through the night ambien. Almost a full month now without a good nights sleep. Its really taking its toll. Benchmark: Rarely use the Breg polar ice care anymore. Only at night and even then only for a few hours its too uncomfortable to sleep with anymore. Down to using one icepack intermittently on the knee throughout the day. Benchmark: walked with no crutch and no brace today in the kitchen not bad either.


Offline canyonking

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Re: Cartiform cartilage graft for chondromalacia patella
« Reply #4 on: April 28, 2014, 05:56:10 PM »
5 & weeks benchmarks: Saturday slept through the night! Ony took 10 mg oxycodone and 1 full ambien and slept almost 9 hours. Have quit using the brace (am supposed to use it until Wednesday) and quit using crutches as well. Doing a lot more now. Pulled weeds on Sunday. Started the rowing machine on Saturday rowed 1,000 M in 5 minutes it hurt and was whimpering. Very next day got after it on the rower and pulled 1,000 M in 4:20. Walking much better now. Still limping but it wont be long now. Still bleeding from incision. Still wearing the compression sock. Pain is much better now. Use IB in the morning then 5 mg oxycodone around 3:00 then another 10 to go to bed. Total = 15 to 20 per 24 hrs. Can brake with the R foot but still trade off (lazy or comfort?)

Offline diggz1

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Re: Cartiform cartilage graft for chondromalacia patella
« Reply #5 on: June 02, 2014, 01:59:07 AM »
Canyon King, just curious how your recovery is going as I have grade IV chondro in my right knee after 2 surgeries as well as chondro in my left knee as well as a bone spur and patellafemoral arthritis from overcompensating for so many years and may be interested in this procedure in the future. 
2009--Torn R acl, mcl, medial & lateral meniscus
June 2009-R knee Double partial meniscectomy
July 2012-R knee ACL recon. hamstring graft
Aug2013-R knee Grade IV Chondromalacia
L knee pain 3+ yrs

Offline FlyingKnuckle

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Re: Cartiform cartilage graft for chondromalacia patella
« Reply #6 on: June 02, 2014, 05:08:03 AM »
canyon king,

WOW what an oversight on the blood thinner that is scary. Your story makes my ACLr look like a walk in the park. Hope your doing better now that is some frightening stuff. Fish oil is awesome. I used it religiously after my surgery and it really helped with joint pain and kept my back from hurting while laying down so much. I don't take nearly as much as you but I take double the recommended dose. Keep at it.

FlyingKnuckle

Offline canyonking

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Re: Cartiform cartilage graft for chondromalacia patella
« Reply #7 on: June 05, 2014, 05:26:05 AM »
Well I'm at week 11 today. The knee still looks huge (like a softball). The scar has finally quit weeping - only a week ago it was still oozing sanguinous fluid. The function continues to improve. It survived a weekend in Vegas with lots of walking and lots of dancing. I would go back to the room with it so tight though there would be swelling down to the ankle. I was just at rehab and my therapist thinks it's getting better. Riding a stationary bike is no problem and they even had me doing quarter squats on a bosu ball. I also use their pilates machine and use an ergonomic rower at the gym as well as kettlebell swings. I did 30 reps of stepping up and down an 8 inch riser. The patella pain seems to be gone. I'm hoping that means the graft "took". I have an appt. with my surgeon at the end of June. I'll post when I find out what he says. I just started riding my real bike today as well on the local bike paths (paved). So I feel like it's coming along but its still numb on the outside and huge like I said. I've also ordered some tumeric and joint vibrance to help with the inflamation. I think in another month or so I should be able to advocate for this surgery much more (hopefully).
« Last Edit: March 10, 2016, 12:52:32 AM by canyonking »

Offline pilsoo5861

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Re: Cartiform cartilage graft for chondromalacia patella
« Reply #8 on: July 15, 2014, 10:18:31 PM »
I would like to see your latest update.

Offline canyonking

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Re: Cartiform cartilage graft for chondromalacia patella
« Reply #9 on: July 24, 2014, 05:45:24 PM »
So I met with the surgeon about a week ago and he told me I was clear to jumprope, run, do partial un-weighted squats and get back on the trail for mtn. biking. Thinking I should start slow I planned to do a half-ride this last weekend but instead went to Cedar city for two days of riding back to back - the knee felt fantastic. Virtually no pain. The other knee hurt a lot more than normal instead ( I think it's a focus in priority of pain). Next day was fine as well, no pain, no nothing. 4 months and I'm really thrilled with it. The doc has ordered an MRI for it (I think he wants to see his handiwork). I told him I wanted to have the same thing done on the left knee within a year and he said fine. I tried to run a 1/4 mile and it definitely hurt then. Both knees - it was too painful and uncomfortable. So running's out for the time being. Jumping hurts as well. But again, it's hard to tell because the left hurts so much, but there was pain in the right during that. It's hard to pinpoint if it's soft - tissue pain which should go away or if it's joint pain. Other than those two things everything else feels great. I did 75 burpees in the gym with no pain! Stairs I can do just fine and even take two at a time with the right leg although I do that infrequently. It's still quite swollen and possibly permanently stained purple (looks like a bruise) he explained that it was staining from the iron in the blood from when I had the hematoma. He also said that it can actually take up to 2 years for the graft to reach full maturity. If it only gets better that's just a bonus as I'm very happy with it right now. I probably won't post again unless I hit a major milestone or anybody has any questions. Thanks.

Offline pilsoo5861

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Re: Cartiform cartilage graft for chondromalacia patella
« Reply #10 on: July 26, 2014, 10:11:43 PM »
thank you so much for your great posting, wish you will be fully recovered soon.

Offline willrunagain

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Re: Cartiform cartilage graft for chondromalacia patella
« Reply #11 on: April 06, 2015, 03:32:35 AM »
Hi Canyonking,

I would love to hear about any progress since your last update. I am trying to push for this surgery as I also have a patellar defect

Offline canyonking

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Re: Cartiform cartilage graft for chondromalacia patella
« Reply #12 on: April 14, 2015, 09:55:14 PM »
Overall, I've been very happy with having had this procedure. I'm actually saving up my sick time to have my other knee done this coming December. One hiccup has been that this past december, I went hiking and did quite a large jump from one boulder to another. When landing, I heard a click in my knee. I didn't have pain but the click persisted with every step. It's now been almost 3 months and that click is still there. I went to see the doc for a year follow up. The MRI he ordered a few months after my surgery revealed a "de-lamination". Where a part of the cartilage graft is lifting up. He said the graft hadn't failed, but that he wants to scope it to clip the lifted part off. He likened it to a hangnail and said that left untreated, it could tear farther and make it worse. I still have no pain in the knee and am looking at when to schedule the scope. Trouble is, my insurance resets in August. He doesn't advise that I wait that long, but money-wise, it makes a lot more sense. So I've kind of been taking it easy as far as sports goes. I still mtn bike a couple times a week (pretty hard) and the knee just feels so good. He also thinks there could be some overgrowth of cartilage in there that he would shave down during the scope so that is the next move.

Offline willrunagain

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Re: Cartiform cartilage graft for chondromalacia patella
« Reply #13 on: April 16, 2015, 02:53:01 PM »
Sorry to hear about the delamination of the graft.  Hopefully the scope can settle that problem for you.  It sounds like everything else is going very well for you with the mountain biking and all. Congrats on that! Before your setback in December, were you able to do any impact sports without pain?

Offline canyonking

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Re: Cartiform cartilage graft for chondromalacia patella
« Reply #14 on: April 22, 2015, 05:30:12 PM »
I didn't really play any impact sports, but I was playing pickleball. In the gym I was back to doing burpees, rowing, power cleans, etc. I even did a very low amount of air squats - all without pain. To be more specific, the pain under my patella was gone, there was and is still pain in the soft tissue (patellar tendon, etc.) that I think is a result of the trauma from the surgery. It has gone down quite a bit and I suspect over time it will go away all together.