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Author Topic: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel  (Read 8664 times)

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Offline djb123

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Hi Everyone,

Thanks in advance for any help you can provide.  I have a 7mm by 7mm area of missing cartilage in my left knee.  I had an orthoscopic procedure in January to clean it up and take pictures, and now it is time for step 2.  My knee has been consistently swelling up since October 2012, and I cannot do stairs or any form of exercise other than swimming.  I am 37 with 2 small boys and would very much like to run around with them again.  My Orthopedic doctor has recommended these procedures as the next step, and stresses that they each have pros/cons and are not mutually exclusive.  That said, I am looking to do as little surgery as possible and the least amount of rehab/recovery the better.

Here are the options he suggested:

Microfracture (drilling bone to have bone marrow scar tissue fill in whole).  Pros: cheaper and faster recovery.  Cons: not real hyaline cartilage, so could be a 10 year band-aid.

OATS: (transplanting cartilage from non-weight bearing areas to plug hole, fill in with microfracture).  Pros: one procedure, less costly (easier HMO approval).  Cons: disputes online if 7mm is too big for OATS, could be weakening knee in other areas.

Carticel: (extracting cartilage cells, culturing them at Genzyme, transplanting them back in).  Pros: highest success rate if it works/takes.  Cons: most expensive, recovery time of 12 to 18 months, very complicated and things could go wrong (membrane not adheres to bone, cells grow too little or too much, movement displaces them before they set).

Thanks to this forum I have learned about DeNovo NT, and am looking into that, although I do not know if my insurance will cover it.  It sounds great though.

The plans the doctor suggests are:

Microfracture while extracting cartilage for a Carticel procedure.  If Microfracture does not work than we have a plan B ready to go.  He says removing the scar tissue would be easy and not impact Carticel.  I am skeptical my insurance would pay for both procedures, waiting for answer from them.

- OR -

OATS procedure.


What do you think?  Any suggestions or advice?  I would really appreciate the help.

Thank you so much.

David

Offline papasmurf1978

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Re: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel
« Reply #1 on: July 29, 2014, 12:51:17 AM »
Hi David,

Sorry about your knee problems. you are definitelly in good forum.

i have couple of articles for you to read as they are latest in cartilage regeneration. they are in clinical trials i believe but am sure in couple of years or sooner they might be available to everyone:
http://www.israel21c.org/health/good-news-for-knees/
http://www.amedrix.de/index.php?option=com_content&view=article&id=23&Itemid=130&lang=en

I have chondtomalacia patella since feb of this year and my defect is 6mm by 4mm and my knee hurts on occasions so im also looking in getting it fixed. Let me know what you think about the articles.

Cheers,

mariusz
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline vickster

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Re: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel
« Reply #2 on: July 29, 2014, 09:35:46 AM »
Where is your knee is the defect?  Is it a result of a specific trauma or wear and tear?  How old are you?  Is your meniscus intact, the bones aligned correctly?

This link is quite useful to explain the different procedures (there are variations nowadays)

http://www.kneeclinic.info/problems_articular_cartilage.php

Lots of other links embedded to read as well including Carticel rehab etc

Ultimately, you should go with the one that your surgeon thinks has the best chance of lasting success given your lifestyle and activity level.  If on a weightbearing, any repair will be more vulnerable and on the patella, the shearing forces reduce the success rates

There are plenty of US based posters on here who have had these types of surgeries funded, albeit with a bit of a fight often

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 djb123

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Re: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel
« Reply #3 on: July 29, 2014, 04:22:01 PM »
Thank you for replying.

Carti-heal looks great, as does Denovo NT, my only concern is that they are not FDA approved yet, and therefore most likely not covered by my health insurance.  I am reaching out to them to see what they say, but realize it is a long shot at this point.  Is it worth waiting for?  I would like to try to get back to a normal range of motion as soon as possible, but it is hard knowing better options might be coming soon.

Regarding exactly where my knee damage is, I will have to find that out.  Medical terminology is not my strength.  I am 37, so young enough to qualify for these procedures and not in consideration for a partial knee replacement (thankfully).

My primary care physician diagnosed me with Osteoarthritis as the fluid from my knee consistently shows ~2700 white blood cells, well below the 5,000 to 10,000 "normal" range.  Both he and the orthopedic doctor believe the osteoarthritis is a result of a traumatic injury, since the cartilage damage is limited to just one area and everything else in the knee seems fine.  But of course this diagnosis complicates things, and the chicken/egg debate of what caused what is not conclusive.

Both doctors think cartilage replacement surgery is my best way forward, and have encouraged me to take that route.  I am trying do decide which of the available options would be the best.  My biggest concerns are:

HMO approval, recovery time/effort, likelihood of success, and longevity of results.

It seems hard to find objective information on these procedures as a lot of material is biased by those with an interest in one procedure versus another.

What are your feelings on Microfracture?  Good first try or skip it?

Which do you think is better, OATS or Carticel/ACI?

I am still able to walk on my gigantic swollen knee, so maybe it is not in a weight bearing area?  Would that impact my decision?

Thanks so much.

David

Offline papasmurf1978

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Re: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel
« Reply #4 on: July 29, 2014, 05:23:27 PM »
Hi David,

did you have MRI done on the knee to receive a conclusion that you have osteoarthritis? Is the part of cartilage missing behind the patella or on another joint? A swollen knee could be a sign of osteoarthritis. Does your knee crack or pop when you walk up or down stairs?

In regards to the new treatments, I called Cartiheal in Israel yesterday and was told that the doctors are in europe now overseeing clinical trials. One of them will get back to me as I would like to know if their product would be good for me, I have chondromalacia patella and in the studies published, I saw that patellar cartilage defects were excluded from the trials. SO I'm crossing my fingers that this procedure will be good for me.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline papasmurf1978

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Re: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel
« Reply #5 on: July 29, 2014, 05:29:58 PM »
If I were you, I would get MRI does asap if not done yet. Then you can start from there seeking best solution. I'm in Canada and here too procedures of such will take long time to get approved. If Cartiheal treats my condition, I will fly out to Poland where I was born to have it done. Currently they are doing the Chondrofiller procedure in Poland (Europe actually) but I don't think that the ultimate result is hyaline cartilage but rather hyaline-like one. So I'm hoping Cartilheal (claiming to produce true hyaline cartilage) will be offered in Poland soon. Why Poland cause treatment are inexpensive, I have family where I can stay so cost is way low for me.

By the way, Chondrofiller procedure is used for treatment of patella cartilage defects (I confirmed with european doctor) but the procedure involves opening the knee rather than arthroscopy. Hmmm..... Don't know if I feel confortable with that, but then again, whatever can cure my condition...

Yes, there are good options coming our way David, if we can patiently wait for the best one which hopefully will come soon, I'm up for that. My PT put me on exercise regime which includes front squats. Wow, I though squats were bad for knees especially for chondromalacia patella. So far it's going good.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline papasmurf1978

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Re: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel
« Reply #6 on: July 29, 2014, 05:33:03 PM »
And I would stay away from microfracture as it's short result and:

Risks for microfracture surgery are:

Cartilage breakdown over time. The new cartilage made by microfracture surgery is not as strong as the body’s original cartilage. It can break down more easily.
Increase stiffness of the knee.

Taken from http://www.nlm.nih.gov/medlineplus/ency/article/007255.htm
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline djb123

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Re: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel
« Reply #7 on: July 29, 2014, 07:23:27 PM »
Thanks.

I am also looking into Denovo NT:
http://www.zimmer.com/en-US/hcp/common/product/denovo-nt-natural-tissue.jspx?cate=knee

What are your thoughts on that as compared to the other options?

What do you think of OATS? 

I have had 3 MRIs done on the knee, and the only damage they see is the 7mm x 7mm missing cartilage.  I forget where exactly.  I want to say it starts with Femural, but I will have to look it up later.

Offline papasmurf1978

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Re: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel
« Reply #8 on: July 29, 2014, 07:43:08 PM »
Let us know where  the damage is. I will check out the product you mentioned and get back to you.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline vickster

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Re: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel
« Reply #9 on: July 29, 2014, 11:00:10 PM »
Femoral condyle? The knobbly bit at the bottom of the thigh bone?
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 papasmurf1978

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Re: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel
« Reply #10 on: July 30, 2014, 12:23:52 PM »
Hi David,

Denovo NT sounds interesting but I can't put my finger on it if it produces true hyaline cartilage of hyaline-like which might not be as strong.

Check out this relevant post:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=50741.0
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline vickster

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Re: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel
« Reply #11 on: July 30, 2014, 02:36:10 PM »
There are a number of de novo posts and diaries, although I think quite a few are on the patella with an osteotomy rather than the condyle

I am not sure the type of cartilage really matters as long as there is a positive outcome, it is durable and the patient is satisfied.  However, any open surgery requiring an athrotomy rather than arthroscopic is likely to have a longer rehab, higher risk of scar tissue and so on.  You need to be clear as to what you want from the surgery in terms of outcomes and discuss with your surgeon.  It is important to remember that in almost every case a surgeried knee will never be the same as what you had before the damage occurred. Moreover pain and function may well be far worse than before the the surgery for quite a long time after the operation, which can be physically and mentally draining.  For example, when I was considering aci, the surgeon told me I would need a year to get back to pre op function and 2 years to see benefit (in the end it was decided it would probably not work so wasn't done and here I am nearly 4 years on managing with injections every 12-18 months)
« Last Edit: July 30, 2014, 02:41:07 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 papasmurf1978

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Re: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel
« Reply #12 on: July 30, 2014, 04:12:13 PM »
Hi Vickster,

correct me if I'm wrong but I think any knee surgery involving patella cartilage repair requires open knee surgery instead of arthroscopy correct?
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline vickster

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Re: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel
« Reply #13 on: July 30, 2014, 04:33:07 PM »
I don't think microfracture or chondroplasty no, done arthroscopically.  I had my grade 3 kneecap tidied via scope
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 papasmurf1978

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Re: Missing Cartilage Surgeries: Microfracture vs OATS vs Carticel
« Reply #14 on: July 30, 2014, 04:35:14 PM »
what do you think about Chondrofiller or Denovo for patella cartilage treatment? Orthroscopically or open knee surgery?
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps















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